論文ID: JNMS.2023_90-202
A 29-year-old nulliparous woman was diagnosed with ovotesticular disorder of sex development (DSD) based on postoperative histopathological findings after undergoing unilateral gonadectomy at the age of 6 years; later (age of 8 years), she had also undergone vulvoplasty and vaginoplasty. Her karyotype was 46, XX. She had dyspareunia because of a narrow vagina, but had a normal uterus and left gonad.Spontaneous ovulation was confirmed, but sexual intercourse was impossible because of dyspareunia despite performing vaginal self-dilatation using a vaginal dilator. Artificial insemination was initiated; however, five cycles failed to yield a viable pregnancy. We decided to perform in vitro fertilization (IVF), which resulted in conception. To reduce her distress during IVF because of insufficient lumen expansion following vaginoplasty, we administered adequate intravenous anesthesia before oocyte collection. The patient delivered a healthy male infant weighing 2,558 g at 37 weeks of gestation via cesarean section, which was performed because of gestational hypertension. This is the eighth report of a viable neonate born from a patient with ovotesticular DSD following gonadectomy and the first such pregnancy achieved by IVF. Therefore, IVF seems to be an effective option for infertile patients with ovotesticular DSD. Additionally, self-management of the plastic vagina is important during the peri- and postoperative periods of early vaginoplasty to prevent dyspareunia.
