The purpose of sperm cryopreservation in cancer patients is to preserve fertility and improve quality of life. We report our experience with sperm cryopreservation from 2001. During the study period (Jan 2001-Feb 2018), a total of 369 patients underwent private sperm banking at our hospital. We analyzed the type of cancer, timing of sperm cryopreservation, sperm quality, and clinical outcomes of assisted reproductive technology. Among all patients, there were 217 testicular tumor patients (58.8%) and 89 hematological malignancy patients (24.1%). Chemotherapy was administered to almost 54% of non-urological patients, but to only 7.1% of urological patients. All patients with previous chemotherapy had below-normal sperm concentration and motility. Forty-one patients utilized their specimens for reproductive purposes. Intracytoplasmic sperm injection using frozen sperm was performed in 40 cases, of which 29 resulted in successful birth. The fertilization rate of this procedure was 79.4%, and the clinical pregnancy rate per embryo transfer was 47.6%. This analysis indicates that sperm cryopreservation is an effective method of fertility preservation. It is important to inform young cancer patients of sperm cryopreservation options promptly after diagnosis. To improve awareness toward oncofertility, we must understand and inform patients of the significance of fertility preservation using sperm cryopreservation. [Adv Obstet Gynecol, 71(1) : 1-8, 2019 (H31.2)]

Complete hydatidiform mole coexisting with a live twin fetus (CHMCF) is very rare, occurring in 1/20,000 to 1/100,000 pregnancies. We report three cases of CHMCF diagnosed at 12-14 weeks of gestation. Two of the three pregnancies were conceived after administration of an ovulation inducer. Maternal complications included severe hyperemesis gravidarum (n = 1) and genital bleeding (n = 2). Pregnancies were terminated at 14 and 15 weeks in two women at their request. One woman was diagnosed with a clinical invasive mole 20 days after the termination and received methotrexate/etoposide/actinomycin-D therapy. The other woman intended to continue the pregnancy, but the pregnancy was terminated at 21 weeks of gestation due to lung metastasis. After methotrexate treatment, her serum human chorionic gonadotropin (hCG) levels rapidly decreased and the lung metastasis disappeared. The overall rate of gestational trophoblastic neoplasia (GTN) is 67%. In our presented cases of CHMCF, the incidence of GTN was considerably high. Even if the pregnancy is terminated in the first trimester, strict monitoring for GTN is crucial. [Adv Obstet Gynecol, 71(1) : 9-16, 2019 (H31.2)]

A benign mature cystic teratoma is the most frequently encountered ovarian neoplasm, accounting for about 20% of all ovarian neoplasia cases and more than 50% in adolescent patients. Tumors developing in the bilateral ovaries have been found in 10% of reported cases, with the existence of two in an ovary occasionally noted, whereas multiple tumors in the bilateral ovaries of an adolescent are rarely encountered.

A 16-year-old female was referred to our hospital because of multiple intraabdominal masses detected by computed tomography in an examination performed because of a febrile episode. We conducted magnetic resonance imaging, which showed multiple cystic teratomas in the intraabdominal cavity, with the possibility that some were teratomatosis peritonei. Laparoscopy findings demonstrated that all were derived from the bilateral ovaries and negative for teratomatosis peritonei. A bilateral ovarian cystectomy under a laparotomy approach was performed. Her menstrual cycle, which had been irregular prior to the operation, became regular thereafter, with no reappearance of an ovarian tumor up to 18 months after the procedure. [Adv Obstet Gynecol, 71(1) : 17-21, 2019 (H31.2)]

Hepatocellular adenoma (HCA), a rare benign liver tumor, occurs particularly in women taking low-dose estrogen progestin (LEP). We report one case of hepatocyte nuclear factor 1α-inactivated (H)-HCA associated with LEP use. A 29-year-old woman was referred to our hospital for examination of abnormal cervical cytology. Histological diagnosis on conization was adenocarcinoma in situ. Computed tomography revealed a 4.6 cm liver tumor in segment 4. We suspected H-HCA as she had been taking LEP for four years, and magnetic resonance imaging showed that the tumor was hypointense on opposed phase compared with in-phase T1W images. One year after the discontinuation of LEP, the size of the tumor did not change, and she was planning to conceive. Therefore, she underwent laparoscopic partial hepatectomy of segment 4. The tumor was composed of hepatocytes without nuclear atypia, and immunohistochemically showed an absence of liver fatty acid binding protein in the tumor, but presence in the background. These findings were consistent with those of H-HCA. Three months after resection, she had a pregnancy that reached term, and she delivered without any complications. Thus, while prescribing long-term LEP, HCA should be considered. [Adv Obstet Gynecol, 71(1) : 22-29, 2019 (H31.2)]

We present three cases of ovarian-hyperstimulation-syndrome (OHSS)-associated polycystic ovary syndrome (PCOS) with different pregnancy outcomes. Case1 : A 35-year-old woman was treated with controlled ovarian stimulation (COS) and hCG for assisted reproductive technology therapy. After freezing all embryos, she was suffer from severe OHSS. Despite intravenous fluid therapy or cabergoline administration, her ascites increased ; thus, cell-free and concentrated ascites reinfusion therapy was initiated. Case2 : A 27-year-old woman was treated with COS and hCG, and had intrauterine insemination with additional hCG as luteal support. At three weeks’ gestation, she was suffer from moderate OHSS and treated with intravenous fluid therapy or cabergoline administration. Her symptoms improved despite the increasing hCG levels, but her pregnancy ended in miscarriage. Case3 : A 30-year-old woman was treated with clomiphene citrate and hMG, and got pregnant. At four weeks’ gestation, she was suffer from severe OHSS. Ultrasonography revealed enlarged ovaries and increased ascites. Abdominal paracentesis with intravenous fluid therapy or cabergoline administration improved her condition, resulting in an uncomplicated vaginal delivery. Although hCG is assumed to be a key molecule for inducing OHSS, hCG levels are not necessarily correlated with OHSS severity. Clinicians should be aware that OHSS may occur in patients with PCOS after ovarian stimulation even if hCG levels are low. [Adv Obstet Gynecol, 71(1) : 30-36, 2019 (H31.2)]

Laparoscopic surgery is now often performed to treat benign ovarian tumors during pregnancy. However, there have so far been few studies on the use of laparoscopic surgery in the treatment of borderline ovarian tumors (BOT) during pregnancy, and this practice remains controversial. We report two cases in which laparoscopic surgery was performed to treat the BOTs in pregnant women. [Case 1] A 26-year-old (gravida 0) woman was suspected bilateral BOTs. At 14 weeks of gestation, laparoscopic left salpingo-oophorectomy, right ovarian cystectomy and omentectomy were performed. The operation was performed with a small amount of blood loss and the patient was discharged on the 4^th day after surgery without any adverse effects. A pathological examination revealed bilateral ovarian tumors (serous borderline tumor, stage IB). Thereafter, the patient’s pregnancy progressed normally and she delivered a healthy male baby at 40 weeks of gestation. The patient has currently been followed for 18 months since the initial surgery and there have been no signs of recurrence. [Case 2] A 30-year-old (gravida 0) woman was suspected bilateral BOTs. At 15 weeks of gestation, laparoscopic right salpingo-oophorectomy, right and omentectomy were performed. The operation was performed with a small amount of blood loss and she was discharged on the 4^th day after surgery without any adverse effects. A pathological examination revealed a right ovarian tumor (seromucinous borderline tumor, stageIA). Thereafter the patient’s pregnancy progressed normally and a normal infant was delivered by cesarean section (due to obstetric reasons) at 40 weeks of gestation. The patient has currently been followed for 30 months since the initial surgery and there have been no signs of recurrence. [Adv Obstet Gynecol, 71(1) : 37-44, 2019 (H31.2)]

Anti-N-methyl-d-aspartate (NMDA) receptor encephalitis is non-herpetic limbic encephalitis occurring primarily in young women. Here we report the case of anti-NMDA receptor encephalitis associated with a mature cystic ovarian teratoma, which was difficult to treatment. The patient was a 14-year-old female who developed encephalitis after the onset of symptoms of common cold. MRI showed right tubo-ovarian cyst. She was positive for anti-NMDA receptor antibody, and laparoscopic right tubo-ovarian cystectomy was performed. There were no histopathological findings of teratoma in the excised specimen. Her consciousness disorder did not improve, and her condition was resistant to treatment. Pelvic MRI performed four months after the initial surgery revealed a mass suspected to be a mature cystic teratoma in the left ovary, which was not observed on MRI performed before the initial surgery. Subsequently, laparoscopic left salpingo-oophorectomy was performed, and the pathological diagnosis was a mature cystic teratoma. Postoperatively, her consciousness level gradually improved, and she was discharged on postoperative day 37. She has been under outpatient observation since discharge, and no recurrence of encephalitis has been noted. Anti-NMDA receptor encephalitis can be associated with a small-sized teratoma; therefore, detailed image inspection should be frequently repeated if the patient’s condition does not improve after treatment. [Adv Obstet Gynecol, 71(1) : 45-50, 2019 (H31.2)]