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

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

A 4-year old female was admitted to the hospital for evaluation of an abdominal mass. Early appearance of secondary isosexual characteristics such as breast enlargement, axillary and pubic hair, and vaginal bleeding were noted. Pertinent laboratory examination results included a very much elevated serum estradiol, low LH and FSH titers and a negative 24-hour urine hCG. With an identifiable focus in the pelvis that would consolidate the clinical presentation and laboratory findings, our pre-operative diagnosis was: Pseudoprecocious puberty secondary to a functioning ovarian newgrowth probably granulosa cell tumor. The final histopathologic diagnosis unexpectedly was mixed germ cell tumor predominantly yolk sac (endodermal sinus tumor) with areas of dysgerminoma. This is the first locally documented case of ovarian endodermal sinus tumor with the symptomatology of precocity.
X

OBJECTIVE: This study aimed to determine the factors that result in stress for Filipino women with infertility. It sought to gain knowledge about the potentially serious implications of infertility on their psychological and emotional health to aid in formulation of a more structured program of counseling.

MATERIALS AND METHODS: This is a prospective descriptive study utilizing a validated Fertility Problem Inventory (FPI) tool translated in Filipino. The study population consisted of 35 women aged 21-40 years who consulted at the infertility clinic of a tertiary hospital with at least 12 months of unsuccessful attempts at conceiving.

RESULTS: The mean global stress score was 163.03 (+SD 14.13.). Age, number of infertile years, educational attainment, occupation, cause of infertility, and number of years trying to conceive did not significantly contribute to the global stress. Infertility related stress involving social concerns and need for parenthood were significantly greater than the others. Patients with less educational attainment had higher infertility related stress when it comes to sexual concerns. Patients with shorter duration of infertility had more stress related to attitude towards having a childfree lifestyle. Patients with longer duration of infertility had greater stress with the need for parenthood.

CONCLUSION: Filipino female patients were found to have elevated global stress scores using FPI. FPI is a useful tool in identifying patients with infertility related stress and facilitation of subsequent referral to Psychiatry. It should be part of the initial evaluation of infertility patients. It identifies specific concerns that are useful in counseling.

Human ; Female ; Adult (a Person 19-44 Years Of Age) ; Infertility ; Psychology ; Health ; Female ; Patients ; Hospitals

Disorders of sex development (DSD) refer to an extensive range of conditions wherein the chromosomal, gonadal or phenotypic sex is incongruous. Presented is a case of ambiguous genitalia in a 3 year old child reared as female since birth and subsequently assigned a male gender after being diagnosed with 46,XY DSD. Management ideally involves a multidisciplinary approach to address the myriad of issues in the care of a child with DSD and to address significant concerns including: gender assignment and gender identity; timing of medical and surgical interventions and equally important, psychosocial and psychosexual development. Current recommendations revolve around patient-centered care which advocates respect for the autonomy and personhood of the patient by postponing the making of crucial decisions, whenever possible, until the child is capable of participating in the decision-making process.

Human ; Female ; Disorders Of Sex Development ; ; Genitalia ; ; Gender Identity ; ; Child ; Disorder Of Sex Development, 46,xy ; Patient-centered Care

A 20 year old nulligravid, presented with primary amenorrhea, short stature, multiple exostoses and delayed mental development. She complained of cyclic pelvic pain. Her karyotyping showed 46, X.t(X;8)(q24;q22). Pelvic ultrasound done on her showed a diagonal vaginal septum, hematosalpinx and hematotrachelocolpos. On exploratory laparotomy, she also had a unicornuate uterus with hematometra and a non-communicating, non-functioning right rudimentary horn. Hysterectomy was done on this patient.

In a review of available literature, this may not be the first case reported to describe occurrence of congenital reproductive tract anomalies in combination with gonadal dysgenesis. However, this is a case with a rare combination of congenital anomalies. Its possible pathogenesis, treatment and implications on the patient's reproductive future are discussed.

Human ; Female ; Adult (a Person 19-44 Years Of Age) ; Turner Syndrome ; Uterus

A 20 year old nulligravid, presented with primary amenorrhea, short stature, multiple exostoses and delayed mental development. She complained of cyclic pelvic pain. Her karyotyping showed 46,X,t(X;8)(q24;q22). Pelvic ultrasound done on her showed a diagonal vaginal septum, hematosalpinx and hematotrachelocolpos. On exploratory laparotomy, she also had a unicornuate uterus with hematometra and a non-communicating, non-functioning right rudimentary horn. Hysterectomy was done on this patient. In a review of available literature, this may not be the first case reported to describe occurrence of congenital reproductive tract anomalies in combination with gonadal dysgenesis. However, this is a case with a rare combination of congenital anomalies. Its possible pathogenesis, treatment and implications on the patient's reproductive future are discussed.

Human ; Female ; Young Adult: 19-24 Yrs Old ; Turner Syndrome

OBJECTIVE

This study aimed to determine the factors that result in stress for Filipino women with infertility. It sought to gain knowledge about the potentially serious implications of infertility on their psychological and emotional health to aid formulation of a more structured program of counseling.

MATERIALS AND METHODS

This is a prospective descriptive study utilizing a validated Fertility Problem Inventory (FPI) tool translated in Filipino. The study population consisted of 35 women aged 21-40 years who consulted at the infertility clinic of a tertiary hospital with at least 12 months of unsuccessful attempts at conceiving.

RESULTS

The main global stress score was 163.03 (+SD 14.13). Age, number of infertile years, educational attainment, occupation, cause of  infertility, and number of years trying to conceive did not significantly contribute to the global stress. Infertility related stress involving social concerns and need for parenthood were significantly greater than the others. Patients with less educational attainment had higher infertility related stress when it comes to sexual concerns. Patients with shorter duration of infertility had more stress related to attitude towards having a  childfree lifestyle. Patients with longer duration of infertility had greater stress with the need for parenthood.

CONCLUSION

Filipino female patients were found to have elevated global stress scores using FPI. FPI is a useful tool in identifying patients with infertility related stress and facilitation of subsequent referral to Psychiatry. It should be part of the initial evaluation of infertility patients. It identifies specific concerns that are useful in counseling.

Human ; Female ; Infertility

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