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Diseases in end stage typically occur with hypothalamic-pituitary-ovarian axis disorders, with consequent anovulation and infertility. The solid organ transplantation increased survival of patients with end-stage organs disease and the vast majority of women improve their reproductive capacity after transplantation. Although adoption can always be a possibility, the transplanted infertile woman has the right to self-reproductive determination using assisted reproductive techniques. While it is known that pregnancies in transplantedwomen are at high risk, there is no evidence of differences in pregnancy outcome in pregnant transplanted subject to technical, compared with spontaneous pregnancies. The use of assisted reproductive techniques in transplanted women is a medical, ethical and psychosocial challenge, whose approach must be multidisciplinary, to ensure reproductive success without compromising the function of the transplanted organ or maternal health, allowing the birth of a healthy child. The literature remains scarce. Three clinical cases are presented.

Objective: To test the hypothesis that women with polycystic ovary syndrome (PCOS) are distinguishable from those with 21-hydroxylase-deficient nonclassic adrenal hyperplasia on the basis of having polycystic ovaries and metabolic dysfunction., Design: Prospective observational., Setting: Tertiary care center., Patient(s): Fifty-two lean and 54 obese women with PCOS according to the 1990 National Institutes of Health criteria, 23 women with nonclassic adrenal hyperplasia, and 27 controls., Intervention(s): History and physical examination, blood sampling, ovarian sonography, oral glucose tolerance, and acute adrenocorticotropin stimulation testing., Main Outcome Measure(s): The frequency of clinical, biochemical, and metabolic features., Result(s): Women with PCOS had a higher frequency of oligomenorrhea or amenorrhea than those with nonclassic adrenal hyperplasia. Mean androstenedione and DHEAS levels were highest in nonclassic adrenal hyperplasia. The degree of metabolic dysfunction was greatest in obese women with PCOS; women with nonclassic adrenal hyperplasia and lean women with PCOS did not differ in degree of metabolic dysfunction. Women with nonclassic adrenal hyperplasia had a lower prevalence of polycystic ovaries than those with PCOS. The proportion of patients with an LH/FSH ratio >2 was greater in women with PCOS, compared with those with nonclassic adrenal hyperplasia. Basal 17-hydroxyprogesterone levels >2 ng/mL were found in 87%, 25%, 20%, and 7% of women with nonclassic adrenal hyperplasia, lean women with PCOS, obese women with PCOS, and controls, respectively., Conclusion(s): Nonclassic adrenal hyperplasia should be excluded in all women presenting with hirsutism, with use of a basal follicular phase 17-hydroxyprogesterone level, regardless of the presence of polycystic ovaries or metabolic dysfunction; however, women with nonclassic adrenal hyperplasia have a higher prevalence of normal ovulation and lower likelihood of having an LH/FSH ratio >2 or polycystic ovaries., (Copyright 2010 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To compare serum levels of vascular endothelial growth factor (VEGF), tumor necrosis factor-alpha (TNF-alpha), and C-reactive protein (CRP) throughout the menstrual cycle in women with and without endometriosis and to quantify the association between these serum markers., Methods: Twenty five endometriosis patients (ASRM stage III-IV) and 13 controls were followed through one menstrual cycle. VEGF, TNF-alpha and CRP concentrations were measured with enzyme-linked immunosorbent assay in each of the four cycle phases (early and late proliferative and early and late secretory). Non-parametric methods and Pearson's correlation coefficients were used for statistical analysis., Results: Increased serum levels of VEGF in secretory phases and of TNF-alpha in all cycle phases were observed. A positive correlation between CRP and VEGF was found in endometriosis patients but not in controls., Conclusions: Our results suggest that excessive systemic angiogenic activity is a feature of patients with endometriosis.

Objective: To use power Doppler ultrasound to assess the effect of endometriosis on intraendometrial and subendometrial blood flow during the menstrual cycle., Design: An observational prospective study., Setting: Academic teaching hospital., Patient(s): Thirty patients with histologically confirmed ovarian endometrioma and 15 control women., Intervention(s): Power Doppler ultrasound examination during the menstrual cycle., Main Outcome Measure(s): Intraendometrial and subendometrial color signals assessed by power Doppler ultrasound., Result(s): A statistically significant higher proportion of endometrioma patients presented simultaneous intraendometrial and subendometrial color signals in the late secretory cycle phase compared with controls (40.0% vs. 6.7%)., Conclusion(s): The higher endometrial perfusion in patients with ovarian endometrioma that is observed in the late secretory phase of the cycle, close to menstrual shedding, favors the hypothesis that women with endometriosis might have higher endometrial vascular activity, thus facilitating the implantation process of endometrial cells outside the uterus.