大橋 麻衣

Progestin-primed ovarian stimulation法(以下PPOS法)は近年急速に広まりつつある調節卵巣刺激法であるが,臨床成績に関するデータが少なく刺激法として確立されていない。今回,2021年4月から2023年3月に当院で採卵した患者のうち,MPAを用いたPPOS法116例とGnRH antagonist法(以下antagonist法)108例の臨床成績を比較検討した。平均年齢はPPOS法で36.9±4.3歳,antagonist法で37.8±4.3歳,平均AMH値はPPOS法で3.3±3.8ng/mL,antagonist法で3.2±2.8ng/mLであった。採卵数,獲得胚盤胞数は,両群で差を認めなかったが,獲得良好胚盤胞数は,PPOS法で1.2±1.9個,antagonist法で0.7±1.1個とPPOS法で有意に多かった(p=0.02)。採卵後初回胚移植での臨床的妊娠率は,PPOS法で40.7%(37/91),antagonist法で26.1%(23/88)とPPOS法で有意に高かった(p=0.04)。AMH値で層化した解析では,獲得良好胚盤胞数は低・中反応群では有意差はなかったが,高反応群ではPPOS法で有意に多かった。本研究では,PPOS法はantagonist法と比較し獲得良好胚盤胞数が多く妊娠成績が良好であった。(著者抄録)

Assisted reproductive technology (ART) requires transvaginal oocyte retrieval (TVOR), and ovarian bleeding after TVOR rarely occurs. We present a case of a 37-year-old woman (0-gravida) who was diagnosed with possible hemorrhagic telangiectasia (HHT) and had a history of three laparotomies for ovarian bleeding and an inclusion cyst adjacent to the right ovary after the third operation. HHT is a hereditary disease characterized by spontaneous hemorrhage of some organs, such as the nose, brain, lungs, gastrointestinal tract, and liver. She desired ART after fertility treatment and then had abdominal pain with ovarian swelling five days after TVOR. Moreover, both the right ovary and inclusion cyst were gradually swollen with hematoma. Finally, abdominal pain and the hemoglobin level deteriorated, necessitating an emergency surgery on the eighth day. We notify reproductive physicians that patients with HHT may readily develop ovarian bleeding with or without inclusion cysts after TVOR, although inclusion cysts may also be associated with late-onset bleeding.

Retained products of conception(RPOC)は,流産や分娩後に絨毛,胎盤組織が子宮内に残存する状態を指し,癒着胎盤と関連している。ARTは癒着胎盤のリスク因子の1つだが,ARTによる妊娠において,その分娩後に形成されたRPOCの臨床的特徴は十分に分かっていない。今回,2006年1月～2021年6月の間に,当院において分娩後に形成されたRPOCをARTで妊娠した群(ART妊娠:21症例)とART以外で妊娠した群(非ART妊娠:38症例)とに分け,後方視的に比較検討した。帝王切開既往,分娩週数,胎盤用手剥離,分娩時出血量,輸血は,ART妊娠と非ART妊娠で有意差を認めなかったが,RPOC消失までの期間はART妊娠で有意に長かった(P=0.015)。ART妊娠で形成されるRPOCは非ART妊娠のそれとは自然史が異なる可能性があり,さらなる検討を要する。(著者抄録)

Caudal regression syndrome (CRS) is rare congenital malformation, which is characterized by abnormal development of the lower end of the spine and complicated with neurodevelopmental disorders of vesico-rectal functions and the lower extremities. We report the case of a woman with CRS who became pregnant and gave birth following continent bladder reconstruction (CBR) for intractable urinary incontinence. A 25-year-old primigravida woman with CRS became pregnant naturally and was referred to our department. She had undergone CBR in our institute at 14 years old. Emergency cesarean section (CS) was performed at 30 + 5 weeks of gestation due to severe preeclampsia. This is the first report of a woman with CRS who became pregnant and gave birth following CBR. A multidisciplinary team is needed to manage pregnant women with CRS following CBR. Collaboration with a urologist is especially important for managing pregnancy and performing CS. The CBR is performed for the purpose of improving quality of life by gaining urinary continence and may increase sexual behavior in women with CRS, and so obstetricians may encounter pregnancies more frequently in the future.