Objective: To evaluate the uterine scar and endometrial viability after laparoscopic myomectomy by two-dimensional (2D) ultrasound (US). To examine reproductive performance after surgery. Study Design: We performed a prospective, single-case, nonrandomized study in patients at the Dubai London Hospital: 107 patients with symptomatic fibroids who underwent laparoscopic myomectomy between January 2012 and May 2013. Methods: A total of 107 who underwent lap myomectomy were identified. An inclusion/exclusion criteria applied of which - 76 fulfilled the same. Their endometrial lining and uterine scar evaluated with the 2D US. Doppler study of the uterine artery and endometrial region performed alongside. The reproductive performance of these patients was then followed up over a 2 year period. Outcome: The endometrial sparing technique seems to be fertility sparing without the use of traction and minimal coagulation intraoperatively. The myometrial scar and endometrial lining can be followed up with 2D US, and the multiple suturing technique helps in improving scar integrity and ensures the absence of hematomas while preserving the endometrial thickness. The low resistance index (RI) of the ipsilateral uterine artery in a fibroid uterus shows an increase after surgery and goes back to normal between day 30-day 60. The subendometrial region had some increase but could not be quantified adequately due to lack of a method for the same. The RI of the uterine artery and the measurement of subendometrial color voxels still can be used as a measure of fertility prognosis and uterine receptivity after myomectomy. Limitations: This is a cohort investigation on a limited number of patients and does not compare the different number/size of myoma prior to removal in the US follow-up. Endometrial Doppler studies cannot be used as a prognostic tool of endometrial viability especially due to the lack of an accepted standard criteria to evaluate and measure the subendometrial perfusion.

Segmentation of the assisted reproductive technology (ART) treatment not only assists patients with conception through the in vitro process but also, as in our case, with the motivation to manage a severe uterine prolapse. The patient was previously unsuccessful in the management of her severe uterine prolapse with a vaginal pessary and in conception with traditional in vitro fertilization treatment. Using segmented treatment pessary accustomization formed part of her treatment schedule and, therefore, added to the motivation to take control of her prolapse management. In addition, her prolapse management received clinical support for the duration of treatment. This is the first report on the successful use of segmented ART treatment and pessary support in a case of severe uterine prolapse. The segmented treatment schedule allowed the patient to progress from consultation to pregnancy test within a 3-month period.

A 41.9-year-old patient, G 10101, was referred for fertility preservation 2 weeks before chemotherapy, due to metastatic liver malignancy. Her past history was positive for laparoscopic sigmoidectomy, 5 years ago due to stage I colon carcinoma. She has undergone a normal vaginal delivery in her previous marriage, 15 years ago and a septic abortion, 2 days after amniocentesis, a year ago, in her current marriage. Despite high follicle stimulating hormone (FSH), she started ovarian stimulation with high dose recombinant gonadotropins and gonadotrophin-releasing hormone antagonist, on the 6^th day of her cycle, in the presence of two antral follicles. By mistake, she injected 650 µg of human chorionic gonadotropin (hCG), in addition to 450 units FSH/luteinizing hormone (Pergoveris, Merck Serono) on the 1^st day of stimulation. The controlled ovarian stimulation continued and on the 18^th cycle day, 650 µg of hCG was administered and 35.5 h afterward, two metaphase II ova were retrieved by vaginal follicular aspiration. The ova have undergone intracytoplasmic sperm injection and fertilization was documented after 20 h, and two embryos were cryopreserved on the 2^nd day. This unusual case suggests that premature exposure to supraphysiological concentrations of hCG and progesterone, may not interfere with normal folliculogenesis, oocyte maturation, and in vitro fertilization.

A viable human blastocyst must demonstrate the capacity to expand in vitro and hatch out from its protective zona pellucida after transfer, in order to implant into the endometrial lining. Some blastocysts, however, experience hatching difficulties and remain enclosed within their zonae, preventing implantation after transfer to the uterus. Successful pregnancies have been reported by transferring embryos that have been treated to partially remove the zonae by chemical intervention (e.g. pronase or acid Tyrode's) or mechanical intervention (e.g. by laser or use of assisted hatching pipettes). Complete zonae removal has also been reported prior to embryo transfer. This is a report of a case where expanded blastocysts naturally hatched in vitro and completely escaped from their zonae on day 5 of preimplantation development. The careful transfer of these fully expanded hatched blastocysts on the same day resulted in a successful clinical pregnancy.