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Objective: To study the pregnancy rate after ulipristal acetate (UPA) therapy for fibroids., Design: Retrospective analysis of a series of 52 patients prospectively included in the PGL4001 (ulipristal acetate) Efficacy Assessment in Reduction of Symptoms Due to Uterine Leiomyomata (PEARL) II and III trials., Setting: Academic hospital., Patient(s): Among the 52 patients, 21 wished to conceive upon treatment completion., Intervention(s): None., Main Outcome Measure(s): Pregnancy rate and live birth rate., Result(s): Twenty-one patients attempted to get pregnant, among whom 15 (71%) succeeded, totaling 18 pregnancies. Among these 18 pregnancies, 12 resulted in the birth of 13 healthy babies and 6 ended in early miscarriage. No regrowth of fibroids was observed during pregnancy., Conclusion(s): We report the first series of pregnancies achieved after UPA treatment. Our data confirm a sustained long-term effect after UPA therapy., (Copyright © 2014 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To assess follicular development after long-term xenotransplantation and exogenous stimulation of cryopreserved prepubertal ovarian tissue., Design: Pilot study., Setting: Gynecology research unit in a university hospital., Patient(s): Cryopreserved ovarian fragments were obtained from five prepubertal patients aged 7.2-12.2 years., Intervention(s): Xenografting of frozen-thawed prepubertal ovarian fragments to SCID mice for 5 months and exogenous stimulation., Main Outcome Measure(s): Follicular density, morphology, proliferation, development., Result(s): Follicular density varied between 1.05 and 47.89 follicles/mm(2) in frozen-thawed ovarian tissue and 0.48 and 32.74 follicles/mm(2) in grafted prepubertal ovarian tissue. Growing follicles at the last stage of follicular development were observed at significantly higher proportions after grafting. No statistical difference was evidenced in the number of primordial follicles, representing the largest proportion of the follicle pool (99.51% before grafting and 92.46% after grafting). Ki67 and antimüllerian hormone expression were observed in these growing follicles., Conclusion(s): This is the first description of transplantation of human cryopreserved prepubertal ovarian tissue to mice, demonstrating that a very high number of follicles survive after transplantation and a large pool of primordial follicles remains dormant. Growing follicles were observed, proving the responsiveness of prepubertal ovarian tissue to gonadotropins., (Copyright © 2013 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

To define the role of surgery in the treatment of endometriomas, we review the literature available via PubMed and cross-reference the published data. We analyze the arguments in favor of and against surgical treatment of endometriomas and compare surgical techniques. Pain relief and pregnancy rates of more than 50% after surgery are the most important arguments in favor of surgery. Histologic and biologic markers of ovarian reserve show a risk of decreased ovarian reserve that should be taken into consideration, especially in cases of repeated surgery. Considerable surgical expertise is required, and the lack of comparative studies yields no conclusions on the best surgical technique. Despite the risk of decreased ovarian reserve due to the surgical procedure, surgery has an important role in the treatment of ovarian endometriomas, and more studies are required to define the most appropriate surgical technique., (Copyright © 2012 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To report the restoration of ovarian function and pregnancy in a woman after bilateral oophorectomy for benign disease after autotransplantation of cryopreserved ovarian cortex., Design: Case report., Setting: Gynecology research unit in a university hospital., Patient(s): A 28-year-old woman who underwent bilateral adnexectomy for ovarian abscesses at the age of 18 years., Intervention(s): We performed ovarian cortex autotransplantation to a peritoneal pocket in the broad ligament., Main Outcome Measure(s): Restoration of ovarian activity and pregnancy., Result(s): Restoration of ovarian function began at 20 weeks and was achieved 24 weeks after transplantation. After the fifth stimulation attempt, two mature oocytes were obtained and microinjected. One embryo (seven cells) was obtained and transferred, leading to a normal pregnancy. The patient delivered a healthy baby boy weighing 2,370 g at 38 weeks of gestation., Conclusion(s): Ovarian cortex cryopreservation can be performed at the time of surgery for benign diseases when fertility is impaired. We report the first pregnancy to occur after ovarian tissue cryopreservation for benign ovarian pathology after bilateral oophorectomy., (Copyright © 2012 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To report the restoration of ovarian function in a woman with Turner syndrome by allografting ovarian cortex from her monozygotic twin., Design: Case report., Setting: Gynecology research unit in a university hospital., Patient(s): A 37-year-old woman with Turner syndrome who had suffered premature ovarian failure (POF) at the age of 15., Intervention(s): In this woman, we performed ovarian cortex transplantation. The donor was her monozygotic twin who had not experienced POF and who had had two normal deliveries., Main Outcome Measure(s): Restoration of ovarian activity and pregnancy., Result(s): Restoration of ovarian function was achieved 3 months after transplantation. After 7 months of regular cycles, spontaneous pregnancy occurred. The patient delivered a healthy baby girl weighing 2,850 g at 38 weeks of gestation., Conclusion(s): Girls with Turner syndrome suffer accelerated loss of ovarian follicles and only 2%-5% experience spontaneous menses with the potential to achieve pregnancy without medical intervention. This manuscript reports the first live birth after allografting between monozygotic twins with 45,XO/46,XX mosaicism and discordant growth pattern and ovarian function., (Copyright © 2011 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To evaluate which factors determine premature ovarian failure after bone marrow transplantation (BMT) during childhood and adolescence., Design: Cross-sectional study., Setting: Academic teaching hospital., Patient(s): Thirty-five women with previous allogeneic (n = 19) or autologous (n = 16) BMT for benign (n = 12) or malignant disease (n = 23). Mean age at BMT was 9.8 ± 5.2 years. Eighteen patients had received total body irradiation (TBI). Twenty-three (66%) were premenarchal at the time of BMT., Intervention(s): Evaluation of ovarian function., Main Outcome Measure(s): Retrospective analysis of gynecologic history and hormone measurements (FSH, E(2), and antimüllerian hormone [AMH]) in relation to initial pathology, treatment protocols, age, and menarchal status at the time of BMT and time elapsed since BMT., Result(s): Clinical evidence of persistent ovarian function after BMT was found in 46% of patients (16/35), but low AMH concentrations (<1.2 μg/L) were observed in 85% of patients, including a large subset (2/3) of clinically eugonadal subjects. Age ≤10 years at the time of BMT and absence of TBI were significantly and independently associated with higher rates of clinically proven persistent ovarian function at the time of evaluation., Conclusion(s): After BMT, ovarian function is impaired in the majority of women, even without clinical signs of premature ovarian failure. This impairment is mostly related to older age at the time of treatment and conditioning treatment with TBI., (Copyright © 2011 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To report a live birth after orthotopic transplantation of cryopreserved ovarian tissue., Design: Case report., Setting: Department of Gynecology, Cliniques Universitaires Saint-Luc, Brussels., Patient(s): Woman with metastatic cancer who had her ovarian tissue cryopreserved in 2001 before undergoing chemotherapy and hematopoietic stem cell transplantation, resulting in premature ovarian failure., Intervention(s): Orthotopic reimplantation of ovarian cortex performed 7 years after cryopreservation., Main Outcome Measure(s): Restoration of ovarian activity., Result(s): Restoration of ovarian activity was observed 3.5 months after reimplantantation, and ongoing pregnancy was diagnosed 9 months after grafting. The patient delivered a healthy baby weighing 2.830 kg., Conclusion(s): Our patient represents the thirteenth live birth to occur after orthotopic reimplantation of cryopreserved tissue, but the first in a woman treated for metastatic disease., (Copyright © 2011 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To evaluate the safety of conservative management of early cervical cancer., Design: Case report and analysis of literature guidelines., Setting: Academic teaching hospital., Patient(s): A 35-year-old, nulliparous woman treated by simple trachelectomy and pelvic lymphadenectomy for a well-differentiated, 12-mm squamous cell carcinoma infiltrating to a depth of 3 mm (stage Ib1) without lymphovascular space involvement., Intervention(s): Follow-up., Main Outcome Measures(s): Recurrence and disease evolution., Result(s): Sixteen months after surgery, at 32 weeks' gestation, a local recurrence of 5 cm in diameter was diagnosed, associated with pelvic and interaortocaval lymph node involvement. Despite extensive radiotherapy, chemotherapy, and radical surgery, disease progression could not be halted., Conclusion(s): We report a case of early-stage cervical cancer, conservatively treated by simple trachelectomy and lymphadenectomy, that recurred although none of the known risk factors for recurrence were initially present, and despite the fact that literature guidelines were followed., (Copyright © 2011 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To describe and evaluate a new technique of laparoscopic treatment of endometriomas that combines excisional and ablative surgery., Design: Descriptive and prospective study., Setting: Gynecology research unit in a university hospital., Patient(s): Fifty-two women under 35 years of age presenting for infertility and/or pelvic pain with endometriomas larger than 3 cm were included in the study. None had undergone any surgery for endometriosis., Intervention(s): A large part of the endometrioma wall was first excised according to the cystectomy technique. After this first step, CO(2) laser was used to vaporize the remaining 10%-20% of the endometrioma wall close to the hilus., Main Outcome Measure(s): The feasibility of this new technique was assessed. Ovarian volume and antral follicle count (AFC) were compared between operated ovaries and nonoperated ovaries of patients with endometriosis and controls (women with male factor infertility)., Result(s): The combined technique was possible in all cases. The volume of the ovary after the combined technique was similar to that of the contralateral normal ovary, as well as to that observed in infertile women without endometriosis presenting for male factor infertility. The AFC on day 2-5 showed the same number of antral follicles in all subgroups. Histopathology of the excised part of the endometrioma revealed the presence of follicles in only one case (2%). The pregnancy rate was 41% at a mean follow-up of 8.3 months. Recurrence of a small endometrioma was observed in only one case (2%)., Conclusion(s): The combined technique (stripping and ablation) has proved not to be deleterious to the ovary., (Copyright (c) 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To report a case of uterine fistula arising after laparoscopic myomectomy after a uterine artery embolization., Design: Case report., Setting: A university hospital center., Patient(s): A 38-year-old woman with a uteroperitoneal fistula after laparoscopic myomectomy after a uterine artery embolization., Intervention(s): Laparoscopic excision of the fistula and repair of the myometrial defect with laparoscopic suture., Main Outcome Measure(s): Not applicable., Result(s): Complete correction of the myometrial defect was observed after laparoscopic surgery., Conclusion(s): Uterine artery embolization before myomectomy may interfere with myometrial cicatrization and thus alter the repair.

Objective: To propose a new laparoscopic technique for repair of scar dehiscence after cesarean section., Design: The dehiscent scars were evaluated by ultrasound, hysterography, hysteroscopy, and magnetic resonance imaging. The results were correlated with those after laparoscopic repair., Setting: University hospital., Patient(s): Three patients underwent cesarean section and presented with symptomatic dehiscence at the level of the incision., Intervention(s): Laparoscopic repair of the dehiscence, including excision of the fibrotic tissue and laparoscopic closure of the anterior uterine wall., Main Outcome Measure(s): Evaluation by ultrasound and magnetic resonance imaging of the sagittal depth of the scar and the thickness of the residual myometrium covering the dehiscence., Result(s): The defect was completely corrected by laparoscopic repair in all cases., Conclusion(s): Evaluation of uterine scar dehiscence after cesarean section can be performed by ultrasound and magnetic resonance imaging, and laparoscopic surgical repair may be performed with good postoperative anatomic outcomes.

Objective: To describe the technique of laparoscopic ovariectomy with a view to cryopreservation of a whole ovary with its vascular pedicle., Design: Descriptive study., Setting: Gynecology research unit in a department of gynecology in a university hospital., Patient(s): Women with indications for chemotherapy or radiotherapy who are at high risk of premature ovarian failure., Intervention(s): Laparoscopic ovariectomy for whole ovary cryopreservation in nine patients., Main Outcome Measure(s): Feasibility of laparoscopic ovariectomy for whole ovary cryopreservation and later autotransplantation without delaying chemotherapy., Result(s): The whole ovary was successfully removed by laparoscopy and cryopreserved by arterial catheterization in all nine patients., Conclusion(s): Ovariectomy with a view to whole ovary cryopreservation for future transplantation may be performed by laparoscopy. Great care must be taken to remove the ovary, together with a large part (> or =5 cm) of the infundibulopelvic ligament, allowing dissection of the ovarian vessels, perfusion with a cryoprotective medium, and cryopreservation for subsequent autografting of the whole ovary. The period of ischemia between ligation of the ovarian pedicle and ovarian cryopreservation must be as short as possible.

Five years after laparoscopic subtotal hysterectomy and morcellation, pelvic magnetic resonance imaging demonstrated the presence of an irregular and heterogeneous pelvic mass measuring 40 x 40 x 30 mm. Histologic examination confirmed smooth muscle hyperplasia infiltrated by numerous endometrial glands (adenomyosis).

Objective: To report two cases of orthotopic transplantation of fresh ovarian tissue., Setting: Academic hospital., Patient(s): Two patients with severe endometriosis, who underwent left oophorectomy for recurrent endometriosis., Intervention(s): Ovarian cortex was reimplanted in the heterolateral orthotopic site., Result(s): Biopsies of the grafted tissue were taken 3 months after reimplantation. Viable primordial follicles were found. The presence of a neovascular capillary network was demonstrated., Conclusion(s): Reimplantation of fresh ovarian cortex allows the survival of primordial follicles and may represent an alternative method for the preservation of ovarian cortex when oophorectomy is mandatory.

We describe an unusual case of ascites caused by the rupture of a large endometrioma.

Taking a relevant history that includes pelvic inflammatory disease or exposure to sexually transmitted diseases is not obsolete.

Magnetic resonance imaging and laparoscopy demonstrated the presence of a myoma in a woman with Rokitansky syndrome.

Objective: To evaluate whether an alternative treatment to radical hysterectomy exists for young women with endometrial adenocarcinoma., Design: A review of the literature (70 articles) plus personal results., Setting: University hospital., Patient(s): Women with atypical endometrial hyperplasia or adenocarcinoma., Main Outcome Measure(s): The recurrence rate and the pregnancy rate after conservative therapy., Conclusion(s): Conservative treatment of well-differentiated stage I endometrial adenocarcinoma can be considered in young patients, with close surveillance to diagnose any possible recurrence.

Objective: To compare the use of a new antiestrogen fulvestrant with goserelin in reducing uterine fibroid growth before hysterectomy., Design: An international, multicenter, randomized, placebo-controlled study., Setting: Departments of obstetrics and gynecology., Patient(s): Premenopausal women (n = 307) diagnosed with uterine fibroids requiring hysterectomy., Intervention(s): Over a 12-week period, patients received fulvestrant (50 mg, 125 mg, or 250 mg) as an i.m. injection, goserelin (3.6 mg) as a s.c. injection, or an injection-matched placebo once every 4 weeks. Patients underwent a hysterectomy at week 13., Main Outcome Measures: Efficacy endpoints included changes in fibroid growth, endometrial thickness, and uterine volume. The excretion of urinary markers of bone resorption was also examined., Result(s): Goserelin significantly reduced fibroid growth and endometrial thickness compared with placebos. Fulvestrant did not significantly alter fibroid volume or endometrial thickness or change endpoints such as endometrial histology or vaginal bleeding. Fulvestrant was associated with fewer postmenopause-related adverse events than goserelin. Goserelin, but not fulvestrant, significantly increased markers of bone resorption., Conclusion(s): At doses equivalent to those used for the treatment of breast cancer in postmenopausal women, fulvestrant did not significantly inhibit fibroid growth and, of particular note, did not lead to bone resorption.

Objective: To assess the safety of fertility-sparing treatment and the remaining chance of childbearing after surgery., Design: Retrospective clinical study., Design: Gynecology department of a university teaching hospital., Patient(s): Seventy-five women underwent surgical management in our institution between 1986 and 2001 for borderline tumors of the ovary., Intervention(s): Fifty-nine patients were treated by radical, fertility-compromising surgery. The remaining 16 patients underwent conservative surgery, preserving the uterus and at least some functional ovarian tissue. Seven unilateral adnexectomies, one simple cystectomy, and two adnexectomies associated with contralateral cystectomy were performed., Main Outcome Measure(s): Recurrence, survival, and pregnancy rates., Result(s): The observed recurrence rates after radical and conservative surgery were 0.0% and 18.7%, respectively. No disease-related deaths occurred in any group; there is no significant difference in survival rates. We can report 12 pregnancies in 7 of 11 women who underwent fertility-sparing management and who wished to become pregnant., Conclusion(s): In certain circumstances, conservative management offers a safe solution for borderline tumors of the ovary. Recurrence is noted significantly more often after this type of treatment, but all cases of recurrent disease can be detected with close follow-up and can be treated accordingly. No significant change in survival rates was found. Moreover, the pregnancy rate in women desiring pregnancy, those treated conservatively, was as high as 63.6%.