BACKGROUND: Clomiphene citrate is used as the first line drug for anovulatory infertility treatment. When a woman fails to ovulate using clomiphene at maximum dose, letrozole is used as a second line drug.

OBJECTIVE: To determine association between a patient's age and body mass index (BMI) and their response to clomiphene citrate or letrozole in the treatment of anovulation-related infertility.

MATERIALS AND METHODS: The authors reviewed 147 patient records from January 2011 to August 2016 and investigated the age, BMI and response of patients when given clomiphene or letrozole for ovulation induction.

RESULTS: Ninety-nine (99) patients received clomiphene citrate while the other 118 patients received letrozole. Those who responded positively to clomiphene were at least 35 years old (72.2%) or had above normal BMI (61.5%). Patients who responded positively to letrozole were at least 35 years old (95%) and were categorized with above normal BMI (82.9%). The authors found that patients who are older than 35 years of age are more likely to respond to letrozole compared to younger patients.

CONCLUSION: This study found no significant association between BMI and response to either Letrozole or Clomiphene. Patients who are more than 35 years old are more likely to respond to letrozole, compared to younger patients. 

Human ; Clomiphene ; Body Mass Index

BACKGOUND: Polycystic ovary syndrome (PCOS) is usually present with reproductive dysfunction. Ovarian function of women with polycystic ovary syndrome might be disturbed, with resultant abnormal folliculogenesis and steroidogenesis. Although it is difficult to define the exact pathogenesis of anovulation, multiple other possible abnormalities have been postulated as contributory factors in the reproductive failure.

OBJECTIVE: The study aimed to determine the association of polycystic ovary syndrome with immune reproductive disorder.

MATERIALS AND METHODS: The study was carried out in a private institution from October 2017 to November 2017. A total of 192 patients were included in the study with ages ranging from 19-40 years old. Review of clinical charts and laboratory results were the primary mode of data gathering. The primary outcome of the study was the presence of immune reproductive disorders among women with and without polycystic ovary syndrome. The Rotterdam criteria were used for the diagnosis of polycystic ovary syndrome and positive results of immunoassays for the five categories were used for the basis for diagnosis of the immune reproductive disorder.

RESULTS: A total of 102 patients were included in the first group and 90 were included in the second group. Out of 102 in Group A, 66 (64.71%) tested positive for immune reproductive disorder. On the other hand, out of 90 patients in Group B, 59 (65.56%) tested positive for immune reproductive disorder. The computed relative risk is almost 1, which means that there is no difference in the risk of having immune reproductive disorder for patients with or without polycystic ovary syndrome.

CONCLUSION: Current evidence does not support a central role of autoimmunity in the pathogenesis of PCOS.

Human ; Female ; Polycystic Ovary Syndrome

Malignant ovarian germ cell tumors are rare ovarian malignancies accounting for 3 to 5% of all ovarian malignancies. They are mostly seen in adolescents and young women and are usually unilateral making fertility preservation imperative. Raised alpha-feto protein level is the hallmark of this tumor. Presented is a case of a premenarcheal 13 year old female diagnosed with yolk sac tumor and who underwent fertility-sparing surgery and adjuvant platinum-based chemotherapy post-operatively, with good outcome. In young patients, conservative surgery with adjuvant chemotherapy has made the preservation of fertility possible, even in patients with advanced disease. The increase in cure rates has shifted the focus of recent studies to the long term menstrual, reproductive, and gynecologic outcomes in these patients. 

Human ; Female ; Adolescent (a Person 13-18 Years Of Age)

Unilateral cervicovaginal agenesis in a didelphic uterus is an extremely rare congenital anomaly. Women born with this anomaly present with menarche associated with progressive dysmenorrhea and symptoms of worsening endometriosis. Presented here is a case of a 12 year old nulligravid who presented with progressive cyclic abdominal pain. Physical examination revealed a tender large right adnexal mass and presence of a vaginal canal and cervix tilted to the left. Sonography showed the presence of uterine didelphys, right hematosalpinx and hematocolpos. Preoperative impression was outflow tract obstruction probably due to Herlyn Werner-Wunderlich syndrome. However, intraoperatively, it was discovered this was a case of uterine didelphys with outflow tract obstruction of the right hemiuterus due to unilateral cervicovaginal agenesis and ipsilateral renal agenesis.

Human ; Female ; Congenital Abnormalities ; Genitalia, Female ; Gynecology ; Philippines ; Case Reports

Ovarian cancer is the second most common gynecologic cancer worldwide and the six most common cancer among females. Germ cell tumorbs are the most common ovarian neoplasm in the first two decades of life constituting approximately two-thirds of all ovarian tumors. Malignant germ cell tumors constitute one-third of germ cell origin tutors and two-thirds of all ovarian malignancy in this age-group. This paper presents a case of a 19 year-old nulligravid who presented at the emergency room with abdominal pain, and was intraoperatively diagnosed with yolk sac tutor of the right ovary, stage 1A mature cystic teratoma of the left ovary. She subsequently underwent unilateral salpingooophorectomy and contralateral oophorocystectomy, left. Patient is advised chemotherapy postoperatively, with Bleomycin, Etoposide and Paclitaxel. This paper discusses the incidence, risk factors, prognosis and management of yolk of sac tutor in a young nulligravid.

Human ; Female ; Adult (a Person 19-44 Years Of Age) ; Yolk Sac Tumor

Primary ovarian ectopic pregnancy, is one of the rarest forms of ectopic pregnancy. Ovarian ectopic pregnancy may occur with or without the essence of any of the classical risk factors or signs and symptoms. The diagnosis is made often at surgery and required histologic confirmation. This is a case of a primary ovarian pregnancy in a 36-year old elderly primigravida who presented with abdominal pain and subsequently underwent ovarian wedge resection. Diagnosis of ovarian pregnancy was later confirmed using the Spiegelberg criteria. This paper presents a review of literature regarding ovarian pregnancy's clinical presentation, risk factors, and the possibility of a conservative management.

Human ; Female ; Adult (a Person 19-44 Years Of Age) ; Primary Ovarian Pregnancy

A nine-year old myxedematous girl with short stature, isosexual pseudoprecocious puberty and bilateral multicystic ovaries underwent pelvic laparotomy due to an acute abdomen because of adnexal torsion. She also delayed bone, age, severe hypothyroidism, hyperprolactinemia, hyperestrogenism and pituitary adenoma. All of these findings led to the diagnosis of Van Wyk Grumback Syndrome, which is a rare condition characterized by long standing untreated hypothyoidism, pseudoprecocious puberty and nulticystic ovaries. Adminsitration of levothyroxine efected gradual regression and reversal of symptoms. This case highlight the significance of recognizing the clinical features of this syndrome in order to medically treat the child and thus, prevent its undesirable effects in the physial andmental growth an dpossible surgical cimplications that ay affect her future reproductive capacity.

Human ; Female ; Pre-adolescent (a Child 6-12 Years Of Age) ; Syndrome

Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is characterized by failure of embryologic growth of the mullerian ducts resulting to agenesis or hypoplasia of the uterus and upper part of the vagina while both ovaries and fallopian tubes are normal. Various associated malformation with MRKH syndrome are noted in literature, with a renal system anomaly as the most common. However, adnexal tumors in MRKH syndome are rare. To date there have been no reported cases of fallopian tube tumors in patients diagnosed with MRKH. This paper presents a case of an 18 year old nulligravida who presented with primary amenorrhea secondary to MRKH sydnrome, with an associated Papiliary Serous Cystadenofibroma of the right fallopian tube Management of the case as well as review of related literature are presented. 

Cystadenofibroma

The use of hormonal contraceptives in a breastfeeding patient has been questioned by breastfeeding advocates. Their fear was that hormonal contraceptives will affect the milk production of the patient. This review of literature showed that progestins do not affect breastmilk supply whether it is the progestin only pill (POP), depot medroxyprogesterone acetate, levonorgestrel-containing intrauterine system (LNG-IUS) or the etonogestrel implant (ENG). The timing of administration of the progesterone derivative contraceptive method also does not affect milk production, whether immediately postpartum (within 48 hrs after delivery) or delayed (4 - 6 weeks postpartum). With this in mind, clinicians may safely advise these to breastfeeding patients to prevent unplanned pregnancies.

Human ; Female

Background: The recurrence of endometriosis after fertility sparing surgery poses a challenge to clinicians. Presently, no treatment option is curative and available medication only changes the hormonal milieu to suppress or delay disease recurrence.
Objective: The aim of this review was to present current literature on recurrent endometriosis including dilemmas in definition, risk factors for recurrence and medical options for the prevention of recurrent endometriosis after surgery.
Methods: A review of literature was done using PubMed, EMBASE and HERDIN, with the following keywords: endometriosis, endometrioma, endometriosis-associated pelvic pain, recurrence of endometriosis. The authors identified reviews, trials and guidelines. The population was limited to reproductive-aged women suspected of having endometriosis.
Results and Discussion: The recurrence rate of endometriosis after conservative surgery ranges from 7.1-56%. The incidence varies according to the criteria used to define recurrence: relapse of pain, physical examination findings, presence of endometrioma on imaging studies, increase in serum CA-125, and intraoperative findings during repeat surgery. The risk factors for disease recurrence include: young age, high body mass index, large endometriomas at diagnosis, severe pre-operative pain, intraoperative findings of extensive adhesions, and positive surgical margins. The identification of patients at high risk for recurrence will enable clinicians to give appropriate post-surgical therapy to prevent recurrence. The choice of pharmacologic agent after conservative surgery includes: combined hormonal contraceptive pills, progestogens, and GnRH agonist. Although no major difference was seen in the effect of available drugs used to relieve endometriosis- associated pain and prevent disease recurrence, differences exist in safety, tolerability and costs.
Conclusion: There is an urgent need to standardize the definition of recurrent endometriosis. Patients should be counselled on the need for long term medical management to delay disease recurrence. A step-wise approach and algorithm in the medical management for the prevention of endometriosis recurrence are proposed.

Human ; Female ; Recurrent Endometriosis