Dr Alpha Gebeh

With advances in assisted reproductive technology (ART), the role of reproductive surgery as the primary treatment of infertility has been questioned. Tubo-peritoneal factor infertility is common, and accounts for 30¿40% of female infertility. The pathology of tubal disease ranges from peritubal adhesions, proximal and/or distal tubal blockage, hydrosalpinx to previous sterilization. In tubo-peritoneal factor infertility, reproductive surgery remains an important option and is complementary to ART. It should be considered as the first-line treatment if a good result is expected, when the pathology is treatable or if left untreated would adversely affect the results of ART. The success of reproductive surgery depends on careful patient selection using proper investigative tools, performed in units with expertise following microsurgical principles.

With the advances in assisted reproductive technology (ART), the role of reproductive surgery as the primary treatment of infertility has been questioned. Tubo-peritoneal factor infertility is common, and accounts for 30¿40% of female infertility. The pathology of tubal disease ranges from peritubal adhesions, proximal and/or distal tubal blockage, hydrosalpinx to previous sterilisation. In tubo-peritoneal factor infertility, reproductive surgery remains an important option and is complementary to ART. It should be considered as the first-line treatment if a good result is expected, when the pathology is amendable or if left untreated will adversely affect the results of ART. The success of reproductive surgery depends on careful patient selection using proper investigative tools, performed in units with expertise following microsurgical principles.

Anovulatory infertility is one of the commonest causes of infertility and can be caused by problems related to the ovary (normogonadotropic and hypergonadotropic hypogonadism) or the pituitary and hypothalamus (hypogonadotropic hypogonadism). Consequently induction of ovulation will depend on the cause of infertility. For those with normogonadotropic hypogonadism, ovulation can be induced using antioestrogens such as clomifene citrate and tamoxifen or aromatase inhibitors such as letrozole. Second line treatments include metformin, gonadotropins and laparoscopic ovarian drilling. Those with hypogonadotropic hypogonadism will require gonadotropins or GnRH analogues. The following review outlines the different approaches to ovulation induction with a focus on commonly encountered clinical scenarios.

A 31-year-old woman presented with a 7-week history of irregular vaginal bleeding without abdominal pain. She had been using the intrauterine contraceptive device (IUD) for the last 3 years. A pregnancy test was positive and subsequent serum beta human chorionic gonadotropin (ß-HCG) was 4992 mIU/mL. A transvaginal ultrasound scan demonstrated an empty uterus with an associated adnexal mass but no free fluid. A right primary ovarian ectopic pregnancy was diagnosed a laparoscopy. This was managed laparoscopically using monopolar diathermy hook with conservation of the ovary and minimal blood loss. Ovarian pregnancy is rare, especially in women without the classical risk factors for tubal pregnancy, and efforts should be made to exclude ectopic pregnancy in the absence of abdominal pain in a woman of reproductive age presenting with prolonged and irregular vaginal bleeding. Methods to conserve the ovary are also encouraged in cases of ovarian pregnancy. © 2013 by the authors; licensee MDPI, Basel, Switzerland.

Ectopic pregnancy is common and is still associated with significant morbidity and mortality, despite advances in diagnosis and treatment. Most of the consequences are related to either late or missed diagnosis. Despite these consequences, a reliable biomarker is yet to be developed. Although the classical risk factors include pelvic inflammatory disease, smoking, tubal surgery, previous ectopic pregnancy and tubal disease, a significant number of ectopic pregnancies occur in women without risk factors. This article aims to elaborate on the understanding of the molecular biology of ectopic pregnancy by discussing the role of interleukins, mucins, activins, VEGF, prokineticins, integrins, inducible nitric oxide synthase, cysteine-rich secretory protein 3 and endocannabinoids in the pathophysiology of tubal pregnancy. Such an understanding of the molecular/biological basis and etiopathogenesis may ultimately lead to the development of a reliable biomarker for diagnosis. © 2010 Expert Reviews Ltd.

Abstract: There is an increasing recognition that the endocannabinoid system is the crucial cytokine-hormone system regulating early human pregnancy. The synchronous development of the fertilized embryo and the endometrium to ensure timely implantation has been shown to be one of the pivotal steps to successful implantation. This development is thought to be regulated by a finely balanced relationship between various components of the endocannabinoid system in the endometrium, the embryo and the Fallopian tube. In addition, this system has also been shown to be involved in the regulation of the development and maturation of the gametes prior to fertilization. In this review, we will examine the evidence from animal and human studies to support the role of the endocannabinoid system in gametogenesis, fertilization, implantation, early pregnancy maintenance, and in immunomodulation of pregnancy. We will discuss the role of the cannabinoid receptors and the enzymes involved in the synthesis and degradation of the key endocannabinoid ligands (e.g., anandamide and 2-arachinoylglycerol) in early reproduction. © 2010 by the authors.