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Key content Congenital anomalies of the genital tract are uncommon. Embryological knowledge is essential in diagnosis and management. Mayer–Rokitansky–Kuster–Hauser (MRKH) syndrome is best managed in tertiary centres by a multidisciplinary team. The more complex the obstructive disorder, the more specialist care is required. Ultrasound imaging is usually all that is required. Learning objectives To understand the relationship between embryology and congenital abnormalities. To gain ability to recognise those problems that need specialist care. To understand the need for a holistic approach to care in MRKH syndrome. Ethical issues Is failure to provide a multidisciplinary holistic approach acceptable medical care?

Thirty-three patients with unexplained infertility underwent a total of 42 programmed superovulation cycles in a gamete intrafallopian transfer (GIFT) programme. The date of oocyte retrieval was decided in advance and the cycle preceding oocyte collection was modified with norethisterone from mid-cycle until 14 days before the scheduled laparoscopy. This was followed by a fixed schedule superovulation regimen. Serum oestradiol, progesterone and luteinizing hormone were monitored and the data analysed retrospectively. A single ultrasound scan was performed on the day of laparoscopy to exclude ovulation. Thirty-eight GIFT procedures were performed, resulting in 11 (29%) clinical pregnancies of which four twin and four singleton pregnancies are continuing. There was a significant correlation between the oestradiol response pattern and the maturity of oocytes retrieved, the fertilization rate of supernumerary oocytes and the pregnancy rate. Programmed cycles may be conveniently combined with GIFT, and basic endocrinological monitoring can be used to identify cycles with a poor prognosis before laparoscopy.