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Ovulatory disorders are common causes of amenorrhea, abnormal uterine bleeding and infertility and are frequent manifestations of polycystic ovary syndrome (PCOS). There are many potential causes and contributors to ovulatory dysfunction that challenge clinicians, trainees, educators, and those who perform basic, translational, clinical and epidemiological research. Similarly, therapeutic approaches to ovulatory dysfunction potentially involve a spectrum of lifestyle, psychological, medical and procedural interventions. Collaborative research, effective education and consistent clinical care remain challenged by the absence of a consensus comprehensive system for classification of these disorders. The existing and complex system, attributed to the World Health Organization (WHO), was developed more than three decades ago and did not consider more than 30 years of research into these disorders in addition to technical advances in imaging and endocrinology. This article describes the development of a new classification of ovulatory disorders performed under the aegis of the International Federation of Gynecology and Obstetrics (FIGO) and conducted using a rigorously applied Delphi process. The stakeholder organizations and individuals who participated in this process comprised specialty journals, experts at large, national, specialty obstetrical and gynecological societies, and informed lay representatives. After two face-to-face meetings and five Delphi rounds, the result is a three-level multi-tiered system. The system is applied after a preliminary assessment identifies the presence of an ovulatory disorder. The primary level of the system is based on an anatomic model (Hypothalamus, Pituitary, Ovary) that is completed with a separate category for PCOS. This core component of the system is easily remembered using the acronym HyPO-P. Each anatomic category is stratified in the second layer of the system to provide granularity for investigators, clinicians and trainees using the 'GAIN-FIT-PIE' mnemonic (Genetic, Autoimmune, Iatrogenic, Neoplasm; Functional, Infectious and Inflammatory, Trauma and Vascular; Physiological, Idiopathic, Endocrine). The tertiary level allows for specific diagnostic entities. It is anticipated that, if widely adopted, this system will facilitate education, clinical care and the design and interpretation of research in a fashion that better informs progress in this field. Integral to the deployment of this system is a periodic process of reevaluation and appropriate revision, reflecting an improved understanding of this collection of disorders.

Since the advent of assisted reproductive technology (ART) using laparoscopy for egg collection, significant clinical and technological evolution has paved the way for simpler and safer techniques of egg recovery. Although transvaginal ultrasound-guided oocyte retrieval is the mainstay of modern ART practice, the use of laparoscopy in select indications continues to be relevant and often imperative. An extensive literature search was accomplished using Cochrane, Embase, and Medline searches and relevant literature was reviewed. The surgical technique of laparoscopic oocyte retrieval has evolved through the years in the hands of different groups of clinicians across the world and the authors have discussed their own experience. Although surgical safety checks and complications have improved, laparoscopy nevertheless is more cumbersome when compared to the vaginal procedure. However, the role of laparoscopic egg retrieval in modern practice is invaluable in certain cases, including in prepubertal and adolescent girls diagnosed with cancer requiring fertility preservation, in women with Mullerian agenesis with malpositioned ovaries, in those with cervical cancer with a risk of dissemination, and occasionally in those who need concomitant laparoscopy for diagnosis of pelvic pathology. The authors' experience in laparoscopic oocyte retrieval in a tertiary hospital in the UK showed good results but had several drawbacks. Although there is a paucity of studies stating the extent of use or incidence of laparoscopic oocyte retrieval in any ART program, this technique should be considered as an effective and safe alternative to difficult transvaginal recovery and may enable patients with specific clinical backgrounds to achieve pregnancy. [ABSTRACT FROM AUTHOR]

A case of reconstruction after penile skin avulsion is described in an eight-year-old boy. Penile coverage was gained by use of the avulsed skin flap itself, without a graft or local tissue flap. The procedure avoids any valuable time delay; thus, enhancing the chances to obtain adequate flap viability, avoids patient discomfort caused by perineal expansion, gives a satisfactory cosmetic appearance, and taking into account his age, avoids future psychosomatic and psychosexual problems.

The use of gonadotropin-releasing hormone (GnRH) antagonist protocols in assisted conception is a major advance in modern reproductive medicine practice. Specifically, the application of GnRH agonist (GnRHa) as the final trigger for oocyte maturation in cycles where GnRH antagonist has been used is associated with a significant reduction in the risk of developing one of the most serious iatrogenic complications of assisted conception, ovarian hyperstimulation syndrome. GnRHa trigger has been shown to be as effective as human chorionic gonadotropin trigger with respect to oocyte yield and maturity in both autologous and donor cycles in multiple studies. This trigger, however, results in poor corpus luteum development and consequently luteal phase dysfunction and impaired endometrial receptivity. In this review, we address the indications, contraindications, outcomes, and practical considerations when using the GnRHa trigger. [ABSTRACT FROM AUTHOR]