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Impact of Ovarian Endometrioma and Surgery on Reproductive Outcomes: A Single-Center Spanish Cohort Study. Biomedicines 2023; 11:biomedicines11030844. [PMID: 36979823 PMCID: PMC10045802 DOI: 10.3390/biomedicines11030844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 03/07/2023] [Accepted: 03/08/2023] [Indexed: 03/12/2023] Open
Abstract
Anti-Müllerian hormone (AMH) and antral follicular count (AFC) decrease in women with ovarian endometrioma (OMA) and in vitro fertilization (IVF). In addition, these parameters drop even further when women with OMA undergo surgery. In this study, the primary aim was to compare the reproductive variables in IVF-treated women with and without endometriosis. The secondary aim was to explore if the reproductive variables were modified by endometrioma surgery. In this retrospective study, 244 women undergoing IVF were enrolled at the Hospital Universitario La Paz (Madrid, Spain). Women were categorized as OMA not surgically treated (OMA; n = 124), OMA with surgery (OMA + S; n = 55), and women with infertility issues not related to OMA (control; n = 65). Demographic and clinical variables, including age, body mass index (BMI), and reproductive (AMH, AFC, number of extracted oocytes, and transferred embryos) and obstetrical data (biochemical pregnancy and fetal heart rate at 6 weeks) were collected. Adjusted logistic regression models were built to evaluate reproductive and pregnancy outcomes. The models showed that women with OMA (with and without surgery) had significantly decreased levels of AMH and AFC and numbers of cycles and C + D embryos. Women with OMA + S had similar rates of pregnancy to women in the control group. However, women with OMA had lower biochemical pregnancy than controls (aOR = 0.08 [0.01; 0.50]; p-value = 0.025). OMA surgery seems to improve pregnancy outcomes, at least until 6 weeks of gestation. However, it is important to counsel the patients about surgery expectations due to the fact that endometrioma itself reduces the quality of oocytes.
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Non-invasive diagnosis of endometriosis: Immunologic and genetic markers. Clin Chim Acta 2023; 538:70-86. [PMID: 36375526 DOI: 10.1016/j.cca.2022.11.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 11/07/2022] [Accepted: 11/07/2022] [Indexed: 11/13/2022]
Abstract
Endometriosis, a benign gynecologic and chronic inflammatory disease, is defined by the presence of endometrial tissue outside the uterus characterized mainly by pelvic pain and infertility. Because endometriosis affects approximately 10% of females, it represents a significant socioeconomic burden worldwide having tremendous impact on daily quality of life. Accurate and prompt diagnosis is crucial for the management of this debilitating disorder. Unfortunately, diagnosis is typically delayed to lack of specific symptoms and readily accessible biomarkers. Although histopathologic examination remains the current gold standard, this approach is highly invasive and not applicable for early screening. Recent work has focused on the identification of reliable biomarkers including immunologic, ie, immune cells, antibodies and cytokines, as well as genetic and biochemical markers, ie, microRNAs, lncRNAs, circulating and mitochondrial nucleic acids, along with some hormones, glycoproteins and signaling molecules. Confirmatory research studies are, however, needed to more fully establish these markers in the diagnosis, progression and staging of these endometrial lesions.
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Tian Z, Wang Y, Zhao Y, Chang XH, Zhu HL. Serum and peritoneal fluid leptin levels in endometriosis: a systematic review and meta-analysis. Gynecol Endocrinol 2021; 37:689-693. [PMID: 33355014 DOI: 10.1080/09513590.2020.1862789] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
The role of leptin in the development of endometriosis has been investigated previously. However, researches on the change of leptin levels in endometriosis remains controversial. So, we aimed to clarify changes of leptin levels in patients with endometriosis and their association with the progression of endometriosis. We searched PubMed, Embase, Web of Science, and The Cochrane Library to identify relevant studies published before May 25, 2020. The detected levels of leptin in patients with endometriosis versus controls were evaluated in this meta-analysis. Eighteen studies met our inclusion criteria, five studies detected serum, nine detected peritoneal fluid and another four detected both serum and peritoneal fluid leptin levels. The overall results showed that peritoneal fluid leptin levels in patients with endometriosis was significantly higher than that in the control group, but the serum and corrected peritoneal fluid leptin levels were comparable in both groups. Subgroup analysis failed to eliminate the high degree of heterogeneity included in the studies and showed that peritoneal fluid leptin levels were significantly elevated in both early and advanced endometriosis. In conclusion, peritoneal fluid rather than serum leptin levels was elevated in patients with endometriosis, which did not seem to be related to the severity of endometriosis, but was related to body mass index.
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Affiliation(s)
- Zhao Tian
- Department of Obstetrics and Gynecology, People's Hospital, Peking University, Beijing, China
| | - Yue Wang
- Department of Obstetrics and Gynecology, People's Hospital, Peking University, Beijing, China
| | - Yan Zhao
- Department of Obstetrics and Gynecology, People's Hospital, Peking University, Beijing, China
| | - Xiao-Hong Chang
- Department of Obstetrics and Gynecology, People's Hospital, Peking University, Beijing, China
| | - Hong-Lan Zhu
- Department of Obstetrics and Gynecology, People's Hospital, Peking University, Beijing, China
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Kalaitzopoulos DR, Lempesis IG, Samartzis N, Kolovos G, Dedes I, Daniilidis A, Nirgianakis K, Leeners B, Goulis DG, Samartzis EP. Leptin concentrations in endometriosis: A systematic review and meta-analysis. J Reprod Immunol 2021; 146:103338. [PMID: 34126469 DOI: 10.1016/j.jri.2021.103338] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 04/21/2021] [Accepted: 05/25/2021] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Endometriosis is an inflammatory condition, affecting mainly women of reproductive age. Leptin is a regulator of food intake and energy expenditure, posing pleiotropic actions, and regulating immunity and fertility. The aim of this study was to systematically review the literature regarding leptin concentrations in biological fluids and tissues of women with endometriosis, and to investigate and propose a possible role of leptin in the pathophysiology of endometriosis. MATERIALS AND METHODS A systematic search of the literature was conducted in two electronic databases (MEDLINE, COCHRANE) and grey literature for original research articles on humans, published in any language. RESULTS Twenty-nine studies with 1291 women with endometriosis and 1664 controls were included in the systematic review. Peritoneal fluid and follicular fluid leptin concentrations were higher in endometriosis compared with control group [mean difference (MD) 7.10, 95 % confidence interval (CI) 4.76 to 9.44 ng/mL, 18 studies), (MD 1.35, 95 % CI 0.54-2.17 ng/ml, 2 studies) respectively. No differences were evident in serum (MD 0.92, 95 % CI -0.84 to 2.68 ng/mL, 12 studies) or plasma (MD -0.95, 95 % CI -4.63 to 2.72 ng/mL, 3 studies) between the groups. No meta-analysis was conducted for ovarian tissue leptin (2 studies). CONCLUSIONS This meta-analysis provided evidence for increased leptin concentrations in both peritoneal fluid and follicular fluid of women with endometriosis compared with control; these differences were not present in the serum or plasma. The above results support a potential pathophysiologic role for leptin in the local microenvironment while declines its use as a blood diagnostic marker. Furthermore, we propose a possible role of leptin in the pathophysiology of endometriosis.
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Affiliation(s)
| | - Ioannis G Lempesis
- Institute of Metabolism and Systems Research (IMSR), College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK; Centre for Endocrinology, Diabetes and Metabolism (CEDAM), Birmingham Health Partners, Birmingham, UK; Department of Human Biology, School of Nutrition and Translational Research in Metabolism (NUTRIM), Maastricht University, Maastricht, the Netherlands
| | - Nicolas Samartzis
- Department of Gynecology and Obstetrics, Cantonal Hospital Schaffhausen, Geissbergstrasse 81, 8208, Schaffhausen, Switzerland
| | - Georgios Kolovos
- Department of Gynecology and Obstetrics, Cantonal Hospital Schaffhausen, Geissbergstrasse 81, 8208, Schaffhausen, Switzerland
| | - Ioannis Dedes
- Department of Gynecology, University Hospital Zurich, Frauenklinikstr. 10, CH 8091 Zurich, Switzerland
| | - Angelos Daniilidis
- 2nd University Department of Obstetrics and Gynecology, Hippokratio General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Konstantinos Nirgianakis
- Department of Obstetrics and Gynaecology, University Hospital of Bern, Inselspital, Friedbühlstrasse 19, 3010, Bern, Switzerland
| | - Brigitte Leeners
- Division of Reproductive Endocrinology, University Hospital Zurich, Frauenklinikstr. 10, CH 8091 Zurich, Switzerland
| | - Dimitrios G Goulis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Manzoor I, Bacha R, Gilani SA. Sonographic association of polycystic ovaries with intraovarian arterial pulsatility and resistive index. Gynecol Endocrinol 2019; 35:851-853. [PMID: 31062996 DOI: 10.1080/09513590.2019.1612357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
The aim of the research is to know the sonographic association of polycystic ovaries with intraovarian arterial pulsatility index (PI) and resistive index (RI).We observed the PI and resistive index (RI) of 50 polycystic ovarian syndrome (PCOS) and 50 normal individuals. Polycystic ovary was seen with gray scale transabdominal and endo-vaginal sonography and labeled according to the developed sonographic criteria. The results were correlated and cross tabulated with independent sample t-test to determine the existing relationship among them. According to the results, PI and RI of the intraovarian artery were seen to decreases during PCOS as compared with the PI and RI of normal group women at the follicular phase. In case of polycystic ovary, the stroma undergoes hyperstimulation as a result of vascular remodeling and hypervascularity. It is concluded that Doppler analysis is very helpful in the diagnosis of PCOS and to give detailed information about the pathophysiology of the hemodynamics of diseased ovary.
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Affiliation(s)
| | - Raham Bacha
- Department (UIRSMIT) FAHS, University of Lahore, Lahore, Pakistan
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Nickkho-Amiry M, Savant R, Majumder K, Edi-O'sagie E, Akhtar M. The effect of surgical management of endometrioma on the IVF/ICSI outcomes when compared with no treatment? A systematic review and meta-analysis. Arch Gynecol Obstet 2018; 297:1043-1057. [PMID: 29344847 PMCID: PMC5849664 DOI: 10.1007/s00404-017-4640-1] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 12/22/2017] [Indexed: 01/13/2023]
Abstract
Objective To assess the impact of surgical management of endometrioma on the outcome of assisted reproduction treatment (ART). Design A systematic review and meta-analysis. Setting Department of reproductive medicine at teaching university hospital, UK. Patients Subfertile women with endometrioma undergoing ART. Interventions Surgical removal of endometrioma or expectant management. Main outcome measures Clinical pregnancy rate, pregnancy rate, live birth rate, number of oocytes retrieved and number of embryos available and ovarian response to gonadotrophins. Results An extensive search of electronic databases for articles published from inception to September 2016 yielded 11 eligible studies for meta-analysis. Meta-analysis was conducted comparing surgery versus no treatment of endometrioma. There were no significant differences in pregnancy rate per cycle, clinical pregnancy rate and live birth rate between women who underwent surgery for endometrioma and those who did not. Conclusion Current evidence suggests that women with endometriosis-related infertility have similar cycle outcomes to other patients going through ART. It is pertinent for clinicians to assess the risks of surgical intervention on ovarian reserve prior to initiating therapy.
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Affiliation(s)
- M Nickkho-Amiry
- University Hospital of South Manchester, Southmoor Rd, Wythenshawe, Manchester, M23 9LT, UK.
| | - R Savant
- Central Manchester Foundation Trust, Manchester, UK
| | - K Majumder
- Central Manchester Foundation Trust, Manchester, UK
| | | | - M Akhtar
- Central Manchester Foundation Trust, Manchester, UK
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El-Mazny A, Kamel A, Ramadan W, Gad-Allah S, Abdelaziz S, Hussein AM. Effect of ovarian endometrioma on uterine and ovarian blood flow in infertile women. Int J Womens Health 2016; 8:677-682. [PMID: 27932897 PMCID: PMC5135397 DOI: 10.2147/ijwh.s124229] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Angiogenesis has been found to be among the most important factors in the pathogenesis of endometriosis. The formation of new blood vessels is critical for the survival of newly implanted endometriotic foci. The use of 3-D power Doppler allows for the demonstration of the dynamic vascular changes that occur during the process of in vitro fertilization (IVF). We aimed to evaluate the effect of ovarian endometrioma on uterine and ovarian blood flow in infertile women. Materials and methods In a case–control study at a university teaching hospital, 138 women with unilateral ovarian endometrioma scheduled for IVF were compared to 138 women with male-factor or unexplained infertility. In the mid-luteal (peri-implantation) phase of the cycle, endometrial thickness, uterine and ovarian artery pulsatility index and resistance index, endometrial and ovarian volume, 3-D power Doppler vascularization index (VI), flow index (FI), and vascularization FI (VFI) values were measured in both groups. Results There were no significant differences (P>0.05) in endometrial thickness, uterine ovarian artery pulsatility index and resistance index, endometrial and ovarian volume, or VI, FI, and VFI between the two groups. Furthermore, the endometrial and ovarian Doppler indices were not influenced by endometrioma size. No significant differences were observed in the ovarian Doppler indices between endometrioma-containing ovaries and contralateral ovaries. Conclusion Ovarian endometrioma is not associated with impaired endometrial and ovarian blood flows in infertile women scheduled for IVF, and it is not likely to affect endometrial receptivity or ovarian function through a vascular mechanism.
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Affiliation(s)
- Akmal El-Mazny
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed Kamel
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Wafaa Ramadan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Sherine Gad-Allah
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Suzy Abdelaziz
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt
| | - Ahmed M Hussein
- Department of Obstetrics and Gynecology, Faculty of Medicine, Cairo University, Cairo, Egypt
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Xing W, Lin H, Wu Z, Li Y, Zhang Q. EFFECT OF PELVIC ENDOMETRIOSIS, ENDOMETRIOMAS AND RECURRENT ENDOMETRIOMAS ON IVF-ET/ICSI OUTCOMES. Mater Sociomed 2016; 28:91-4. [PMID: 27147911 PMCID: PMC4851495 DOI: 10.5455/msm.2016.28.91-94] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 03/12/2016] [Indexed: 11/13/2022] Open
Abstract
Introduction: Endometriosis, the most common gynecological disorder, is a challenging disease observed in 20% - 40% of subfertile women. Material and Methods: 380 women were divided into four groups. Group A consisted of 176 women with pelvic endometriosis. Group B consisted of 125 women who had previously undergone a laparoscopic endometrioma cystectomy. Group C consisted of 38 women with recurrent endometriomas without aspiration before IVF-ET/ICSI. Group D consisted of 41 women with recurrent endometriomas undergone aspiration before IVF-ET/ICSI. Results: Baseline FSH level (8.61 ± 3.42 mIU/mL) and total dose of Gn (2337.15 ± 853.00 IU) in Group A were the lowest (p < 0.05). The number of retrieved oocytes in Group B (7.98 ± 5.05) was significantly fewer than those in Group A and D (p < 0.05). The numbers of MII oocytes in Groups A, C and D were significantly larger than that in Group B. The number of retrieved oocytes, high-quality embryos, implantation and pregnancy rates were similar in Groups C and D. Conclusions: Pelvic endometriosis had a less adverse effect on ovarian reserve than endometrioma. No advantage was found in transvaginal aspiration for recurrent endometriomas before IVF-ET/ICSI.
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Affiliation(s)
- Weijie Xing
- Center for Reproductive Medicine, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Haiyan Lin
- Center for Reproductive Medicine, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Zexuan Wu
- Center for Reproductive Medicine, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yu Li
- Center for Reproductive Medicine, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Qingxue Zhang
- Center for Reproductive Medicine, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
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Hamdan M, Dunselman G, Li T, Cheong Y. The impact of endometrioma on IVF/ICSI outcomes: a systematic review and meta-analysis. Hum Reprod Update 2015; 21:809-825. [DOI: 10.1093/humupd/dmv035] [Citation(s) in RCA: 198] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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10
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Wu MH, Hsiao KY, Tsai SJ. Endometriosis and possible inflammation markers. Gynecol Minim Invasive Ther 2015. [DOI: 10.1016/j.gmit.2015.05.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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11
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Velazquez MA. Impact of maternal malnutrition during the periconceptional period on mammalian preimplantation embryo development. Domest Anim Endocrinol 2015; 51:27-45. [PMID: 25498236 DOI: 10.1016/j.domaniend.2014.10.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 10/27/2014] [Accepted: 10/28/2014] [Indexed: 02/07/2023]
Abstract
During episodes of undernutrition and overnutrition the mammalian preimplantation embryo undergoes molecular and metabolic adaptations to cope with nutrient deficits or excesses. Maternal adaptations also take place to keep a nutritional microenvironment favorable for oocyte development and embryo formation. This maternal-embryo communication takes place via several nutritional mediators. Although adaptive responses to malnutrition by both the mother and the embryo may ensure blastocyst formation, the resultant quality of the embryo can be compromised, leading to early pregnancy failure. Still, studies have shown that, although early embryonic mortality can be induced during malnutrition, the preimplantation embryo possesses an enormous plasticity that allows it to implant and achieve a full-term pregnancy under nutritional stress, even in extreme cases of malnutrition. This developmental strategy, however, may come with a price, as shown by the adverse developmental programming induced by even subtle nutritional challenges exerted exclusively during folliculogenesis and the preimplantation period, resulting in offspring with a higher risk of developing deleterious phenotypes in adulthood. Overall, current evidence indicates that malnutrition during the periconceptional period can induce cellular and molecular alterations in preimplantation embryos with repercussions for fertility and postnatal health.
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Affiliation(s)
- M A Velazquez
- Centre for Biological Sciences, University of Southampton, Southampton General Hospital, Southampton, UK.
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12
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Laparoscopic excision of ovarian endometrioma does not exert a qualitative effect on ovarian function: insights from in vitro fertilization and single embryo transfer cycles. J Assist Reprod Genet 2015; 32:685-9. [PMID: 25758989 DOI: 10.1007/s10815-015-0457-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 03/02/2015] [Indexed: 10/23/2022] Open
Abstract
PURPOSE To evaluate whether laparoscopic excision of endometrioma exerts a qualitative effect on ovarian function. METHODS A retrospective analysis of oocytes retrieved in 25 cycles of 21 patients undergoing IVF treatment with controlled ovarian stimulation. The number of oocytes recovered from ovaries with a history of excision of endometrioma (E-Ov) were compared to those from contra-lateral healthy ovaries (H-Ov) as for the analysis of a quantitative effect of surgery. As for the analysis of a qualitative effect, 55 oocytes from E-Ov were compared to 128 oocytes from H-Ov in terms of normal fertilization rate and the rate of top-quality embryos per normally fertilized eggs. Furthermore, 10 embryos derived from oocytes recovered from E-Ov were compared to 24 embryos derived from oocytes from H-Ov in terms of clinical and on-going pregnancy rates per embryos in 34 single embryo transfer cycles. RESULTS Mean number of oocytes recovered from E-Ov was significantly smaller than that from H-Ov (2.2 ± 2.0 vs. 5.1 ± 3.3, P = 0.009). There was no difference between oocytes from E-Ov and H-Ov as for normal fertilization rate (63.6% vs. 69.5%, P = 0.43) and the rate of top-quality embryos (40.0% vs. 49.0%, P = 0.34). Clinical and on-going pregnancy rates per embryos were also similar in embryos derived from oocytes recovered from E-Ov and H-Ov (40.0% vs. 25.0%, P = 0.39 and 20.0% vs. 20.8%, P = 0.96). CONCLUSIONS The quality of oocytes recovered from the ovary with a history of laparoscopic excision of endometrioma is not inferior to the quality of oocytes from contra-lateral healthy ovary.
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Velázquez MA. [Impact of maternal overnutrition on the periconceptional period]. ACTA ACUST UNITED AC 2015; 62:246-53. [PMID: 25733194 DOI: 10.1016/j.endonu.2015.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 01/13/2015] [Accepted: 01/16/2015] [Indexed: 10/23/2022]
Abstract
Overnutrition may lead to obesity. Maternal obesity may affect fertility not only via anovulation, but also through direct effects on oocytes and preimplantation embryos, indicating that the periconceptional period is sensitive to conditions of overnutrition. The periconceptional period includes from folliculogenesis to implantation. Animal model studies suggest that oocytes derived from obese females usually have a small size and mitochondrial abnormalities. These disruptions are probably induced by changes in the components of the ovarian follicular fluid. Experimental evidence also suggests that obesity may affect the microenvironment in oviducts and uterus, resulting in development of preimplantation embryos with reduced cell numbers and up-regulation of proinflammatory genes. However, further research is needed for in-depth characterization of the effects of maternal obesity during the periconceptional period.
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Affiliation(s)
- Miguel Abraham Velázquez
- Centre for Biological Sciences, University of Southampton, Southampton General Hospital , Southampton, Reino Unido.
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14
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Relationship between urinary 6-sulfatoxymelatonin excretion and cancer antigen 125 in women with endometriosis. Gynecol Minim Invasive Ther 2014. [DOI: 10.1016/j.gmit.2014.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Huang TS, Chen YJ, Chou TY, Chen CY, Li HY, Huang BS, Tsai HW, Lan HY, Chang CH, Twu NF, Yen MS, Wang PH, Chao KC, Lee CC, Yang MH. Oestrogen-induced angiogenesis promotes adenomyosis by activating the Slug-VEGF axis in endometrial epithelial cells. J Cell Mol Med 2014; 18:1358-71. [PMID: 24758741 PMCID: PMC4124020 DOI: 10.1111/jcmm.12300] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Accepted: 03/18/2014] [Indexed: 01/22/2023] Open
Abstract
Adenomyosis is an oestrogen-dependent disease characterized by the invasion of endometrial epithelial cells into the myometrium of uterus, and angiogenesis is thought to be required for the implantation of endometrial glandular tissues during the adenomyotic pathogenesis. In this study, we demonstrate that compared with eutopic endometria, adenomyotic lesions exhibited increased vascularity as detected by sonography. Microscopically, the lesions also exhibited an oestrogen-associated elevation of microvascular density and VEGF expression in endometrial epithelial cells. We previously reported that oestrogen-induced Slug expression was critical for endometrial epithelial–mesenchymal transition and development of adenomyosis. Our present studies demonstrated that estradiol (E2) elicited a Slug-VEGF axis in endometrial epithelial cells, and also induced pro-angiogenic activity in vascular endothelial cells. The antagonizing agents against E2 or VEGF suppressed endothelial cells migration and tubal formation. Animal experiments furthermore confirmed that blockage of E2 or VEGF was efficient to attenuate the implantation of adenomyotic lesions. These results highlight the importance of oestrogen-induced angiogenesis in adenomyosis development and provide a potential strategy for treating adenomyosis through intercepting the E2-Slug-VEGF pathway.
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Affiliation(s)
- Tze-Sing Huang
- National Institute of Cancer Research, National Health Research Institutes, Miaoli, Taiwan
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Diagnosis of solid breast tumors using vessel analysis in three-dimensional power Doppler ultrasound images. J Digit Imaging 2014; 26:731-9. [PMID: 23296913 DOI: 10.1007/s10278-012-9556-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
This study aims to evaluate whether the distribution of vessels inside and adjacent to tumor region at three-dimensional (3-D) power Doppler ultrasonography (US) can be used for the differentiation of benign and malignant breast tumors. 3-D power Doppler US images of 113 solid breast masses (60 benign and 53 malignant) were used in this study. Blood vessels within and adjacent to tumor were estimated individually in 3-D power Doppler US images for differential diagnosis. Six features including volume of vessels, vascularity index, volume of tumor, vascularity index in tumor, vascularity index in normal tissue, and vascularity index in surrounding region of tumor within 2 cm were evaluated. Neural network was then used to classify tumors by using these vascular features. The receiver operating characteristic (ROC) curve analysis and Student's t test were used to estimate the performance. All the six proposed vascular features are statistically significant (p < 0.001) for classifying the breast tumors as benign or malignant. The A Z (area under ROC curve) values for the classification result were 0.9138. Accuracy, sensitivity, specificity, positive predictive value, and negative predictive value of the diagnosis performance based on all six proposed features were 82.30 (93/113), 86.79 (46/53), 78.33 (47/60), 77.97 (46/59), and 87.04 % (47/54), respectively. The p value of A Z values between the proposed method and conventional vascularity index method using z test was 0.04.
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Ovarian damage after laparoscopic endometrioma excision might be related to the size of cyst. Fertil Steril 2013; 100:464-9. [DOI: 10.1016/j.fertnstert.2013.03.033] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Revised: 03/19/2013] [Accepted: 03/21/2013] [Indexed: 11/17/2022]
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Wu MH, Cheng YC, Chang CH, Ko HC, Chang FM. Three-dimensional Ultrasound in Evaluation of the Ovary. J Med Ultrasound 2012. [DOI: 10.1016/j.jmu.2012.07.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Surgical treatment of ovarian endometriomas: state of the art? Fertil Steril 2012; 98:556-63. [DOI: 10.1016/j.fertnstert.2012.06.023] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Revised: 06/15/2012] [Accepted: 06/15/2012] [Indexed: 11/23/2022]
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Chen ML, Lee KC, Yang CT, Hung KH, Wu MH. Simultaneous laparoscopy for endometriotic women undergoing in vitro fertilization. Taiwan J Obstet Gynecol 2012; 51:66-70. [DOI: 10.1016/j.tjog.2012.01.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2011] [Indexed: 11/24/2022] Open
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May K, Conduit-Hulbert S, Villar J, Kirtley S, Kennedy S, Becker C. Peripheral biomarkers of endometriosis: a systematic review. Hum Reprod Update 2010; 16:651-74. [PMID: 20462942 PMCID: PMC2953938 DOI: 10.1093/humupd/dmq009] [Citation(s) in RCA: 260] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2008] [Revised: 01/27/2010] [Accepted: 04/06/2010] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Endometriosis is estimated to affect 1 in 10 women during the reproductive years. There is often delay in making the diagnosis, mainly due to the non-specific nature of the associated symptoms and the need to verify the disease surgically. A biomarker that is simple to measure could help clinicians to diagnose (or at least exclude) endometriosis; it might also allow the effects of treatment to be monitored. If effective, such a marker or panel of markers could prevent unnecessary diagnostic procedures and/or recognize treatment failure at an early stage. METHODS We used QUADAS (Quality Assessment of Diagnostic Accuracy Studies) criteria to perform a systematic review of the literature over the last 25 years to assess critically the clinical value of all proposed biomarkers for endometriosis in serum, plasma and urine. RESULTS We identified over 100 putative biomarkers in publications that met the selection criteria. We were unable to identify a single biomarker or panel of biomarkers that have unequivocally been shown to be clinically useful. CONCLUSIONS Peripheral biomarkers show promise as diagnostic aids, but further research is necessary before they can be recommended in routine clinical care. Panels of markers may allow increased sensitivity and specificity of any diagnostic test.
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Affiliation(s)
- K.E. May
- Nuffield Department of Obstetrics & Gynaecology, University of Oxford, Women's Centre, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - S.A. Conduit-Hulbert
- Nuffield Department of Obstetrics & Gynaecology, University of Oxford, Women's Centre, John Radcliffe Hospital, Oxford OX3 9DU, UK
- Drexel University College of Medicine, Philadelphia, PA, USA
| | - J. Villar
- Nuffield Department of Obstetrics & Gynaecology, University of Oxford, Women's Centre, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - S. Kirtley
- Nuffield Department of Obstetrics & Gynaecology, University of Oxford, Women's Centre, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - S.H. Kennedy
- Nuffield Department of Obstetrics & Gynaecology, University of Oxford, Women's Centre, John Radcliffe Hospital, Oxford OX3 9DU, UK
| | - C.M. Becker
- Nuffield Department of Obstetrics & Gynaecology, University of Oxford, Women's Centre, John Radcliffe Hospital, Oxford OX3 9DU, UK
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Short-term feed restriction decreases the systemic and intrafollicular concentrations of leptin and increases the vascularity of the preovulatory follicle in mares. Theriogenology 2010; 73:1202-9. [DOI: 10.1016/j.theriogenology.2009.11.032] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2009] [Revised: 11/15/2009] [Accepted: 11/16/2009] [Indexed: 11/22/2022]
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Shimizu Y, Takashima A, Takahashi K, Kita N, Fujiwara M, Murakami T. Long-term outcome, including pregnancy rate, recurrence rate and ovarian reserve, after laparoscopic laser ablation surgery in infertile women with endometrioma. J Obstet Gynaecol Res 2010; 36:115-8. [DOI: 10.1111/j.1447-0756.2009.01119.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Panchal S, Nagori CB. Pre-hCG 3D and 3D power Doppler assessment of the follicle for improving pregnancy rates in intrauterine insemination cycles. J Hum Reprod Sci 2009; 2:62-7. [PMID: 19881150 PMCID: PMC2800929 DOI: 10.4103/0974-1208.57224] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The assessment of follicular maturity at the time of human chorionic gonadotropin (hCG) is one of the key factors for the success of all assisted reproductive techniques. AIM To assess follicles by three dimensional (3D) and 3D power Doppler (PD) before giving hCG to improve pregnancy rates in intrauterine insemination (IUI) cycles. DESIGN Prospective randomized study. MATERIALS AND METHODS Ultrasound for pre-hCG follicular assessment was performed over a period of 10 months for all 1000 cycles of IUI. Follicular assessment was performed using a transvaginal multifrequency volume probe. Follicles considered mature by 2D US and color Doppler were assessed by 3D and 3D PD. These values were independently evaluated for the conception and the non-conception groups. RESULTS Conception rates were 32.3 and 27% respectively and individually when the perifollicular resistance index was < 0.50 and the peak systolic velocity was > 11 cm/s 10-12 h before hCG. Conception rates of 32% were achieved with a follicular volume between 3 and 7 cc. The conception rate was 32.3% in the cumulus group. A perifollicular vascularity index of between six and 20 gave conception rates of 35% and perifollicular flow index of 27-43 gave conception rates of 33%. CONCLUSIONS 3D ultrasound is much more accurate for volume assessment of the follicle. Presence of cumulus increases the surety of the presence of a mature ovum in the follicle. 3D and 3D PD when used with 2D US and color Doppler for pre-hCG follicular assessment would definitely improve pregnancy rates in IUI cycles.
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Affiliation(s)
- Sonal Panchal
- Department of Ultrasound, Dr. Nagori's Institute for Infertility and IVF, Ahmedabad, India
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Tsoumpou I, Kyrgiou M, Gelbaya TA, Nardo LG. The effect of surgical treatment for endometrioma on in vitro fertilization outcomes: a systematic review and meta-analysis. Fertil Steril 2009; 92:75-87. [DOI: 10.1016/j.fertnstert.2008.05.049] [Citation(s) in RCA: 85] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2008] [Revised: 05/07/2008] [Accepted: 05/15/2008] [Indexed: 10/21/2022]
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Garcia-Velasco JA, Somigliana E. Management of endometriomas in women requiring IVF: to touch or not to touch. Hum Reprod 2008; 24:496-501. [DOI: 10.1093/humrep/den398] [Citation(s) in RCA: 198] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Wu MH, Pan HA, Chang FM. Three-dimensional and Power Doppler Ultrasonography in Infertility and Reproductive Endocrinology. Taiwan J Obstet Gynecol 2007; 46:209-14. [DOI: 10.1016/s1028-4559(08)60022-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Timor-Tritsch IE, Monteagudo A. Three and four-dimensional ultrasound in obstetrics and gynecology. Curr Opin Obstet Gynecol 2007; 19:157-75. [PMID: 17353685 DOI: 10.1097/gco.0b013e328099b067] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Developments in ultrasound in general, but even more so in three-dimensional ultrasound, parallel the growth in computing power and speed of computer technology. It is not surprising, therefore, that three-dimensional ultrasound technology is constantly evolving at a fast pace. The purpose of this article is to provide enhanced diagnostic capabilities for the obstetrical and gynecologic provider. RECENT FINDINGS The most recent advances in three-dimensional ultrasound have to do with two main features. First, an increasingly fast acquisition speed, enabling quick sequences of fast moving organs such as the heart to be captured. Second, the increasing number of different display modalities, making understanding and analysis of normal anatomy and pathology easier for clinicians. SUMMARY This article highlights a selected number of clinical situations in which three-dimensional ultrasound meaningfully enhances the contribution of this fast evolving diagnostic imaging tool.
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Affiliation(s)
- Ilan E Timor-Tritsch
- Department of Obstetrics and Gynecology, New York University School of Medicine, New York 10016, USA.
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Esinler I, Bozdag G, Aybar F, Bayar U, Yarali H. Outcome of in vitro fertilization/intracytoplasmic sperm injection after laparoscopic cystectomy for endometriomas. Fertil Steril 2006; 85:1730-5. [PMID: 16690058 DOI: 10.1016/j.fertnstert.2005.10.076] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2005] [Revised: 10/31/2005] [Accepted: 10/31/2005] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To assess the impact of prior unilateral or bilateral endometrioma cystectomy on controlled ovarian hyperstimulation (COH) and intracytoplasmic sperm injection (ICSI) outcome. DESIGN Retrospective case-control study. SETTING Department of Obstetrics and Gynecology, School of Medicine, Hacettepe University, Ankara, Turkey. PATIENT(S) Fifty-seven consecutive infertile patients were enrolled who had previously undergone unilateral (n = 34) or bilateral (n = 23) laparoscopic cystectomy for endometriomas more than 3 cm in diameter and underwent ICSI. The control group consisted of 99 patients with tubal factor infertility. INTERVENTION(S) Controlled ovarian hyperstimulation and ICSI. MAIN OUTCOME MEASURE(S) Cycle cancellation rate, number of oocytes, fertilization rate, embryo quality, clinical pregnancy rate (PR), and implantation rate. RESULT(S) The mean number of oocytes, metaphase II oocytes, and two-pronucleated oocytes were significantly lower in the bilateral cystectomy group compared to the unilateral cystectomy and control groups. However, all other parameters, including fertilization rate, the mean number of embryos transferred, the mean number of grade 1 embryos transferred, the clinical PR per embryo transfer, and implantation rate, were comparable among the three groups. Within the unilateral cystectomy group, the mean number of oocyte retrieved from the operated site was significantly less than in the contralateral nonoperated site. CONCLUSION(S) Laparoscopic endometrioma cystectomy does reduce the ovarian reserve. However, diminished ovarian reserve does not translate into impaired pregnancy outcome.
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Affiliation(s)
- Ibrahim Esinler
- Department of Obstetrics and Gynecology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Mercé LT, Bau S, Barco MJ, Troyano J, Gay R, Sotos F, Villa A. Assessment of the ovarian volume, number and volume of follicles and ovarian vascularity by three-dimensional ultrasonography and power Doppler angiography on the HCG day to predict the outcome in IVF/ICSI cycles. Hum Reprod 2006; 21:1218-26. [PMID: 16410330 DOI: 10.1093/humrep/dei471] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE The aim of this prospective study was to investigate whether ovarian blood flow is related to embryological parameters and whether it could be a predictor of outcomes of IVF/ICSI. METHODS Eighty infertile women underwent ovarian stimulation with gonadotrophins after a long protocol with GnRH agonists. The ovarian volume (OV), number of follicles (NF) and follicular volume (FV) of all follicles >10 mm and vascularization index (VI), flow index (FI) and vascularization-flow index (VFI) were obtained by three-dimensional (3D) ultrasonography and power Doppler angiography (PDA) on the day of HCG administration. These parameters were tested for their relation with IVF laboratory parameters. RESULTS The OV, FV, VI, FI and VFI were significantly greater in the pregnant group. The NF and FV were the only independent predictors of the number of oocytes retrieved, mature and fertilized, and the number of embryos developed and their cumulative embryo score. Nevertheless, the number of grade 1 embryos depends on the NF and the VI. The ovarian FI and the number of transferred grade 1 embryos can predict gestation in 76% of IVF patients. A low FI and non-grade 1 embryo transferred are also associated with an increased pregnancy loss. CONCLUSION 3D ultrasonography and PDA allow for an easier ovarian assessment in IVF cycles. The predictive value of IVF outcome suggests a high clinical usefulness of this new technique.
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Affiliation(s)
- Luis T Mercé
- Assisted Reproduction Unit, International Ruber Hospital, Madrid, Spain.
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Candiani M, Barbieri M, Bottani B, Bertulessi C, Vignali M, Agnoli B, Somigliana E, Busacca M. Ovarian recovery after laparoscopic enucleation of ovarian cysts: Insights from echographic short-term postsurgical follow-up. J Minim Invasive Gynecol 2005; 12:409-14. [PMID: 16213426 DOI: 10.1016/j.jmig.2005.06.006] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2004] [Revised: 03/28/2005] [Accepted: 03/28/2005] [Indexed: 11/28/2022]
Abstract
STUDY OBJECTIVE To evaluate damage to ovarian reserve following laparoscopic cystectomy of benign ovarian cysts. DESIGN Prospective study (Canadian Task Force classification II-3). SETTING Tertiary gynecologic endoscopic unit at a university-affiliated hospital. PATIENTS Thirty-one patients who underwent excision of monolateral (n=25) or bilateral (n=6) benign ovarian cysts. INTERVENTIONS Serial transvaginal ultrasound examinations during the first and third postsurgical menstrual cycles. The following ovarian echographic variables were evaluated: antral follicle count, ovarian volume, stromal blood flow, and side of ovulation. Two types of statistical analysis were performed: a paired analysis comparing operated and intact ovaries of the same patient and a prospective analysis comparing ecographic characteristics of the operated gonad at first and second evaluation. MEASUREMENTS AND MAIN RESULTS Antral follicle count and stromal blood flow were not significantly affected by surgery. While ovarian volume was similar in the operated and in the contralateral intact gonad at the first ultrasound evaluation, the volume of the operated ovary was significantly reduced at the second assessment. The median (interquartile range) of the percentage of this reduction was 33% (18%-81%). This progressive reduction was confirmed by prospectively analyzing the operated ovaries. An increased probability of ovulation in the intact gonad was observed at both assessments. CONCLUSION Laparoscopic excision of ovarian cysts is associated with damage to ovarian reserve, at least immediately after surgery. This effect does not appear to be consequent to an injury to ovarian vascularization.
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Affiliation(s)
- Massimo Candiani
- Department of Obstetrics, Gynecology and Neonatology, Policlinico, L. Mangiagalli Hospital, and Università Degli Studi di Milano, Milan, Italy
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Borini A, Tallarini A, Sciajno R, Maccolini A. Colour power Doppler in infertility and ART. ACTA ACUST UNITED AC 2004. [DOI: 10.1016/j.rigp.2004.04.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Wu MH, Huang MF, Tsai SJ, Pan HA, Cheng YC, Lin YS. Effects of Laparoscopic Ovarian Drilling on Young Adult Women with Polycystic Ovarian Syndrome. ACTA ACUST UNITED AC 2004; 11:184-90. [PMID: 15200772 DOI: 10.1016/s1074-3804(05)60196-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
STUDY OBJECTIVE To assess changes in serum hormone levels and ovarian stromal blood flow after laparoscopic ovarian drilling (LOD) in young adult women with polycystic ovary syndrome (PCOS). DESIGN Prospective, nonrandomized study (Canadian Task Force classification II-1). SETTING Tertiary care, major teaching hospitals. PATIENTS Anovulatory young women with PCOS who were resistant to clomiphene citrate. INTERVENTION Laparoscopic ovarian drilling. MEASUREMENTS AND MAIN RESULTS To evaluate the endocrinological effects of LOD, serum leptin, insulin-like growth factor-1, estrone (E1), and estradiol were measured before and after ovarian drilling in the early follicular phase. Three-dimensional transabdominal power Doppler examinations were performed to determine the effects of LOD. Serum leptin was correlated with body mass index (BMI) before LOD. Levels of BMI, fasting blood sugar, and leptin were higher and LH, LH/FSH, and the sugar/insulin ratio were lower in the obese group. There were significant decreases in the free androgen index, and total testosterone, luteinizing hormone (LH), and LH/follicle-stimulating hormone (FSH) levels, and a significant increase in sex hormonebinding globulin (SHBG) concentration in the 3 months after the operation. The vascularization index and vascularization flow index of the intraovarian stroma significantly decreased after treatment. Reversed correlations between leptin and LH, LH/FSH, E1, thyroid-stimulating hormone, and SHBG were noted 3 months after the operation compared with levels obtained before the operation. CONCLUSIONS Treatment of young adult women with PCOS using LOD did not influence leptin levels but changed the ovarian stromal blood flow dynamics during short-term follow-up. The surgical procedure may be beneficial both to endocrine profiles and to intraovarian stromal flow in patients with PCOS.
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Affiliation(s)
- Meng-Hsing Wu
- Department of Obstetrics and Gynecology and Institute of Clinical Medicine, Chi-Mei Foundation Medical Center, Tainan, Taiwan
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Chang CH, Yu CH, Ko HC, Chang FM, Chen HY. Prenatal assessment of normal fetal humerus volume by three-dimensional ultrasound. ULTRASOUND IN MEDICINE & BIOLOGY 2003; 29:1675-1680. [PMID: 14698333 DOI: 10.1016/j.ultrasmedbio.2003.08.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Because fetal humerus dysplasia is associated with a variety of congenital syndromes, prenatal assessment of the fetal humerus growth is very important. The fetal humerus volume is one of the indexes in evaluating the humerus growth, but it has never been studied by 3-D ultrasound (US) in utero. To establish a normal reference chart of the fetal humerus volume for clinical use, we undertook a prospective and cross-sectional study using 3-D US to assess the fetal humerus volume in normal pregnancy. A total of 216 singleton fetuses that ranged between 20 and 40 weeks of gestation and fit the criteria of normal pregnancies were included in this study. Our results showed that the fetal humerus volume is highly correlated with the gestational age (GA). Using GA as the independent variable and the humerus volume as the dependent variable, the best-fit regression equation was humerus volume (mL) = 0.0044GA(2) - 0.0841GA + 0.6874 (r = 0.97, n = 216, p < 0.0001). For clinical use, a chart of normal growth centiles of the fetal humerus volume was then established based on this equation. In addition, the common indexes of fetal biometry, such as biparietal diameter, occipitofrontal diameter, head circumference, abdominal circumference, femur length and estimated fetal weight, were all highly correlated with the humerus volume (all p < 0.0001). In conclusion, our data of the fetal humerus volume assessed by 3-D US can serve as a useful reference in evaluating the fetal humerus growth during normal gestation.
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Affiliation(s)
- Chiung-Hsin Chang
- Department of Obstetrics and Gynecology, National Cheng Kung University Medical College, Tainan, Taiwan.
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Chang CH, Yu CH, Ko HC, Chen CL, Chang FM. Three-dimensional power Doppler ultrasound for the assessment of the fetal brain blood flow in normal gestation. ULTRASOUND IN MEDICINE & BIOLOGY 2003; 29:1273-1279. [PMID: 14553804 DOI: 10.1016/s0301-5629(03)00982-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Early identification of the abnormal fetal brain vascularization and blood flow is very important, because the deficient perfusion of the fetal brain may be related to a poor prognosis of the central nervous system (CNS) development. To assess the fetal brain vascularization and the blood flow in normal gestation, we measured the fetal brain vascularization and the brain blood flow in normal fetuses using three-dimensional (3-D) power Doppler ultrasound (US) and the quantitative 3-D power Doppler histogram analysis. This study was undertaken by a prospective and cross-sectional design. In total, 155 normal singletons with gestational age (GA) between 21 and 40 weeks were included. The 3-D power Doppler US and the quantitative 3-D histogram analyses were used to assess the fetal brain vascular indexes, i.e., vascularization index (VI), flow index (FI) and vascularization-flow index (VFI), in each case. Our results revealed that all the fetal brain VI, FI and VFI increased significantly with GA (all p<0.001). In addition, the fetal brain VI, FI and VFI were all significantly correlated with the common fetal growth indices, such as biparietal diameter, occipitofrontal diameter, head circumference, abdominal circumference, femur length and estimated fetal weight. Our study indicates that fetal brain vascularization and blood flow increase significantly with the advancement of GA as well as the fetal common growth indices during normal gestation. We believe our data may serve as a reference for further studies of the fetal brain blood flow in abnormal conditions.
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Affiliation(s)
- Chiung-Hsin Chang
- Department of Obstetrics and Gynecology, National Cheng Kung University Medical College, Tainan, Taiwan
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Chang CH, Yu CH, Ko HC, Chen WC, Chang FM. Quantitative three-dimensional power Doppler sonography for assessment of the fetal renal blood flow in normal gestation. ULTRASOUND IN MEDICINE & BIOLOGY 2003; 29:929-933. [PMID: 12878237 DOI: 10.1016/s0301-5629(03)00886-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
Renal blood flow is very important to fetal hemodynamics. To assess the development of fetal renal vascularization and blood flow in normal gestation, we measured the fetal renal vascularization and blood flow in healthy fetuses using three-dimensional (3-D) power Doppler sonography and quantitative 3-D power Doppler histogram analysis. This study was undertaken with a prospective, cross-sectional design. In total, 106 healthy singletons with gestational ages between 20 and 40 weeks were included. The 3-D power Doppler sonography and quantitative histogram analyses were used to assess the fetal renal vascularization index (VI), flow index (FI) and vascularization-flow index (VFI) in each case. Our results showed that all the VI, FI and VFI increased significantly with gestational age (GA). Using GA as the independent variable, the linear regression equations for fetal renal VI, FI and VFI were VI = 0.214 x GA - 3.5289 (r = 0.84, n = 106, p < 0.0001); FI = 0.3326 x GA + 35.224 (r = 0.33, n = 106, p < 0.001); and VFI = 0.1047 x GA - 1.8064 (r = 0.82, n = 106, p < 0.0001). Our study indicates that normal fetal renal vasculature and blood flow increase with the advancement of gestational age. In addition to our previous study for fetal renal volume using 3-D sonography, our data in this series may serve as a reference for further studies of fetal renal blood flow in abnormal conditions.
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Affiliation(s)
- Chiung-Hsin Chang
- Department of Obstetrics and Gynecology, National Cheng Kung University Medical College, Tainan, Taiwan
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Pan HA, Wu MH, Cheng YC, Wu LH, Chang FM. Quantification of ovarian Doppler signal in hyperresponders during in vitro fertilization treatment using three-dimensional power Doppler ultrasonography. ULTRASOUND IN MEDICINE & BIOLOGY 2003; 29:921-927. [PMID: 12878236 DOI: 10.1016/s0301-5629(03)00901-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
To test the hypothesis that the increased ovarian sensitivity to gonadotropins observed in women embarking on an in vitro fertilization (IVF) treatment may be due to changes in ovarian stromal blood flow, we undertook this prospective comparative clinical study using three-dimensional (3-D) power Doppler ultrasound (US). The 3-D power Doppler ultrasonographic indexes were used to quantify ovarian stromal blood flow and vascularization in hyperresponders. A total of 58 patients undergoing an IVF cycle were recruited and divided into two groups, a hyperresponder group (n = 23) (peak estradiol > 3000 pg/mL or >/= 15 oocytes retrieved) and normal responders (n = 35), based on their response to a standard down-regulation protocol for controlled ovarian stimulation. During ovarian stimulation, on the day of human chorionic gonadotropin (HCG) administration, patients underwent hormonal (serum E2), ovarian volume and 3-D power Doppler (ovarian stroma flow) evaluation. The serum estradiol levels on the day of HCG administration, the number of oocytes retrieved and the ovarian volume were significantly higher in the hyperresponders than in the normal groups. The vascularization flow index (VFI), flow index (FI), and vascularization index (VI), were significantly higher (p < 0.05) in the hyperresponders (1.18 +/- 0.60, 50.23 +/- 2.81 and 2.27 +/- 1.08, respectively), compared to the women with a normal response (0.63 +/- 0.61, 43.19 +/- 7.81 and 1.25 +/- 1.18, respectively). Our study may help to explain the excessive response during gonadotropin administration in the hyperresponsive women.
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Affiliation(s)
- Hsien-An Pan
- Department of Obstetrics and Gynecology, Hospital, National Cheng Kung University, Tainan, Taiwan
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