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Nguyen E, Strug M, Gardner A, Burney R, Campbell S, Aghajanova L. Initial fertility evaluation with saline sonography vs. hysterosalpingography: it is debate-tubal. Fertil Steril 2024; 121:922-930. [PMID: 38703168 DOI: 10.1016/j.fertnstert.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 04/02/2024] [Indexed: 05/06/2024]
Affiliation(s)
- Edward Nguyen
- Division Reproductive Endocrinology and Infertility, Stanford University School of Medicine, Sunnyvale, California
| | - Michael Strug
- Division Reproductive Endocrinology and Infertility, Stanford University School of Medicine, Sunnyvale, California
| | - Austin Gardner
- Division Reproductive Endocrinology and Infertility, University of Alabama at Birmingham, Birmingham, Alabama
| | - Richard Burney
- Division Reproductive Endocrinology and Infertility, University of Alabama at Birmingham, Birmingham, Alabama
| | - Sukhkamal Campbell
- Division Reproductive Endocrinology and Infertility, University of Alabama at Birmingham, Birmingham, Alabama
| | - Lusine Aghajanova
- Division Reproductive Endocrinology and Infertility, Stanford University School of Medicine, Sunnyvale, California
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2
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Sonigo C, Robin G, Boitrelle F, Fraison E, Sermondade N, Mathieu d'Argent E, Bouet PE, Dupont C, Creux H, Peigné M, Pirrello O, Trombert S, Lecorche E, Dion L, Rocher L, Arama E, Bernard V, Monnet M, Miquel L, Birsal E, Haïm-Boukobza S, Plotton I, Ravel C, Grzegorczyk-Martin V, Huyghe É, Dupuis HGA, Lefebvre T, Leperlier F, Bardet L, Lalami I, Robin C, Simon V, Dijols L, Riss J, Koch A, Bailly C, Rio C, Lebret M, Jegaden M, Fernandez H, Pouly JL, Torre A, Belaisch-Allart J, Antoine JM, Courbiere B. [First-line management of infertile couple. Guidelines for clinical practice of the French College of Obstetricians and Gynecologists 2022]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2024; 52:305-335. [PMID: 38311310 DOI: 10.1016/j.gofs.2024.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 01/25/2024] [Indexed: 02/10/2024]
Abstract
OBJECTIVE To update the 2010 CNGOF clinical practice guidelines for the first-line management of infertile couples. MATERIALS AND METHODS Five major themes (first-line assessment of the infertile woman, first-line assessment of the infertile man, prevention of exposure to environmental factors, initial management using ovulation induction regimens, first-line reproductive surgery) were identified, enabling 28 questions to be formulated using the Patients, Intervention, Comparison, Outcome (PICO) format. Each question was addressed by a working group that had carried out a systematic review of the literature since 2010, and followed the Grading of Recommendations Assessment, Development and Evaluation (GRADE®) methodology to assess the quality of the scientific data on which the recommendations were based. These recommendations were then validated during a national review by 40 national experts. RESULTS The fertility work-up is recommended to be prescribed according to the woman's age: after one year of infertility before the age of 35 and after 6months after the age of 35. A couple's initial infertility work-up includes a single 3D ultrasound scan with antral follicle count, assessment of tubal permeability by hysterography or HyFOSy, anti-Mullerian hormone assay prior to assisted reproduction, and vaginal swabbing for vaginosis. If the 3D ultrasound is normal, hysterosonography and diagnostic hysteroscopy are not recommended as first-line procedures. Chlamydia trachomatis serology does not have the necessary performance to predict tubal patency. Post-coital testing is no longer recommended. In men, spermogram, spermocytogram and spermoculture are recommended as first-line tests. If the spermogram is normal, it is not recommended to check the spermogram. If the spermogram is abnormal, an examination by an andrologist, an ultrasound scan of the testicles and hormonal test are recommended. Based on the data in the literature, we are unable to recommend a BMI threshold for women that would contraindicate medical management of infertility. A well-balanced Mediterranean-style diet, physical activity and the cessation of smoking and cannabis are recommended for infertile couples. For fertility concern, it is recommended to limit alcohol consumption to less than 5 glasses a week. If the infertility work-up reveals no abnormalities, ovulation induction is not recommended for normo-ovulatory women. If intrauterine insemination is indicated based on an abnormal infertility work-up, gonadotropin stimulation and ovulation monitoring are recommended to avoid multiple pregnancies. If the infertility work-up reveals no abnormality, laparoscopy is probably recommended before the age of 30 to increase natural pregnancy rates. In the case of hydrosalpinx, surgical management is recommended prior to ART, with either salpingotomy or salpingectomy depending on the tubal score. It is recommended to operate on polyps>10mm, myomas 0, 1, 2 and synechiae prior to ART. The data in the literature do not allow us to systematically recommend asymptomatic uterine septa and isthmoceles as first-line surgery. CONCLUSION Based on strong agreement between experts, we have been able to formulate updated recommendations in 28 areas concerning the initial management of infertile couples.
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Affiliation(s)
- Charlotte Sonigo
- Service de médecine de la reproduction et préservation de la fertilité, hôpital Antoine-Béclère, 157, rue de la Porte-Trivaux, 92140 Clamart, France; Faculté de médecine, université Paris-Sud Saclay, 63, rue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France
| | - Geoffroy Robin
- Service d'assistance médicale à la procréation et préservation de la fertilité, CHU de Lille, Lille, France
| | - Florence Boitrelle
- Service de biologie de la reproduction, préservation de fertilité, CECOS, CHI de Poissy, Poissy, France; INRAe, ENVA, BREED, UVSQ, université Paris Saclay, Jouy-en Josas, France
| | - Eloïse Fraison
- Département médecine de la reproduction, CHU Lyon, hôpital Femme-Mère-Enfant, 59, boulevard Pinel, 69500 Bron, France
| | - Nathalie Sermondade
- Service de biologie de la reproduction CECOS, hôpital Tenon, AP-HP, Sorbonne université, 75020 Paris, France; Inserm US938, centre de recherche Saint-Antoine, Sorbonne université, 75012 Paris, France
| | - Emmanuelle Mathieu d'Argent
- Service de gynécologie-obstétrique et médecine de la reproduction, Dmu Origyne, hôpital Tenon, GHU Sorbonne université, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - Pierre-Emmanuel Bouet
- Service de gynécologie-obstétrique, centre hospitalier universitaire d'Angers, 4, rue Larrey, 49000 Angers, France
| | - Charlotte Dupont
- Service de biologie de la reproduction - CECOS, hôpital Tenon, AP-HP, Sorbonne université, 75012 Paris, France
| | - Hélène Creux
- Centre AMP, polyclinique Saint-Roch, 550, avenue du Colonel-André-Pavelet, 34070 Montpellier cedex, France
| | - Maeliss Peigné
- Service de médecine de la reproduction et préservation de la fertilité, hôpital Jean-Verdier-Béclère, avenue du 14-Juillet, Bondy, France
| | - Olivier Pirrello
- Service d'aide médicale à la procréation, centre médicochirurgical obstétrique (CMCO), CHU de Strasbourg, 19, rue Louis-Pasteur, 67303 Schiltigheim, France
| | - Sabine Trombert
- Laboratoire Cerba, 6-11, rue de l'Équerre, 95310 Saint-Ouen L'Aumône, France
| | - Emmanuel Lecorche
- Laboratoire Cerba, 6-11, rue de l'Équerre, 95310 Saint-Ouen L'Aumône, France
| | - Ludivine Dion
- Département de gynécologie-obstétrique et reproduction humaine - CECOS, hôpital Sud, CHU de Rennes, 16, boulevard de Bulgarie, 35000 Rennes, France
| | - Laurence Rocher
- Service de radiologie diagnostique et interventionnelle, site Bicêtre, hôpitaux Paris Sud, 94270 Le Kremlin-Bicêtre, France; Université Paris Sud, 63, rue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France; Service hospitalier Frédéric-Joliot, imagerie par résonance magnétique médicale et multimodalités, CNRS UMR8081, université Paris Sud, 4, place du Gal-Leclerc, 91401 Orsay cedex, France
| | - Emmanuel Arama
- Service de radiologie diagnostique et interventionnelle, site Bicêtre, hôpitaux Paris Sud, 94270 Le Kremlin-Bicêtre, France; Université Paris Sud, 63, rue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France; Service hospitalier Frédéric-Joliot, imagerie par résonance magnétique médicale et multimodalités, CNRS UMR8081, université Paris Sud, 4, place du Gal-Leclerc, 91401 Orsay cedex, France
| | - Valérie Bernard
- Service de chirurgie gynécologique, gynécologie médicale et médecine de la reproduction, centre Aliénor d'Aquitaine, CHU Pellegrin, Bordeaux, France
| | - Margaux Monnet
- Département de gynécologie médicale, maternité régionale de Nancy, hôpitaux universitaires de Nancy, Nancy, France
| | - Laura Miquel
- Service d'assistance médicale à la procréation, pôle Femmes-Parents-Enfants, hôpital de la Conception, AP-HM, 147, boulevard Baille, 13005 Marseille, France
| | - Eva Birsal
- Service d'assistance médicale à la procréation, pôle Femmes-Parents-Enfants, hôpital de la Conception, AP-HM, 147, boulevard Baille, 13005 Marseille, France
| | | | - Ingrid Plotton
- Service d'hormonologie, endocrinologie moléculaire et maladies rares, CPBE, groupement hospitalier Lyon-Est, Lyon-Bron, France; Université Claude-Bernard, Lyon 1, Lyon, France; Unité Inserm 1208, Lyon, France
| | - Célia Ravel
- Département de gynécologie-obstétrique et reproduction humaine - CECOS, hôpital Sud, CHU de Rennes, 16, boulevard de Bulgarie, 35000 Rennes, France
| | - Véronika Grzegorczyk-Martin
- Centre d'assistance médicale à la procréation et de préservation de la fertilité, clinique Mathilde, 76100 Rouen, France
| | - Éric Huyghe
- Département d'urologie, hôpital de Rangueil, CHU de Toulouse, Toulouse, France; Service de médecine de la reproduction, hôpital Paule-de-Viguier, CHU de Toulouse, Toulouse, France; Inserm 1203, UMR DEFE, université de Toulouse, université de Montpellier, Montpellier, France
| | - Hugo G A Dupuis
- Service d'urologie et d'andrologie, CHU - hôpitaux de Rouen, CHU Charles-Nicolle, 76031 Rouen, France
| | - Tiphaine Lefebvre
- Service de médecine et biologie de la reproduction - gynécologie médicale, centre hospitalier universitaire de Nantes, 38, boulevard Jean-Monnet, 44093 Nantes, France
| | - Florence Leperlier
- Service de médecine et biologie de la reproduction - gynécologie médicale, centre hospitalier universitaire de Nantes, 38, boulevard Jean-Monnet, 44093 Nantes, France
| | - Léna Bardet
- Service de gynécologie-obstétrique et médecine de la reproduction, Dmu Origyne, hôpital Tenon, GHU Sorbonne université, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - Imane Lalami
- Service de gynécologie-obstétrique et de médecine de la reproduction, grand hôpital de l'Est Francilien - site de Meaux, 6-8, rue Saint-Fiacre, 77100 Meaux, France
| | - Camille Robin
- Service d'assistance médicale à la procréation et préservation de la fertilité, CHU de Lille, Lille, France
| | - Virginie Simon
- Unité fonctionnelle de gynécologie endocrinienne, service de gynécologie médicale, orthogénie et sexologie, hôpital Jeanne-de-Flandre, CHU de Lille, avenue Eugène-Avinée, 59037 Lille cedex, France
| | - Laura Dijols
- Service de médecine de la reproduction et préservation de la fertilité, hôpital Bretonneau, CHU de Tours, Tours, France
| | - Justine Riss
- Service d'aide médicale à la procréation, centre médicochirurgical obstétrique (CMCO), CHU de Strasbourg, 19, rue Louis-Pasteur, 67303 Schiltigheim, France
| | - Antoine Koch
- Service d'aide médicale à la procréation, centre médicochirurgical obstétrique (CMCO), CHU de Strasbourg, 19, rue Louis-Pasteur, 67303 Schiltigheim, France
| | - Clément Bailly
- Service de biologie de la reproduction CECOS, hôpital Tenon, AP-HP, Sorbonne université, 75020 Paris, France; Inserm US938, centre de recherche Saint-Antoine, Sorbonne université, 75012 Paris, France
| | - Constance Rio
- Service de gynécologie-obstétrique, centre hospitalier universitaire d'Angers, 4, rue Larrey, 49000 Angers, France
| | - Marine Lebret
- Service de gynécologie-obstétrique, CHU Charles-Nicolle, 37, boulevard Gambetta, 76000 Rouen, France
| | - Margaux Jegaden
- Faculté de médecine, université Paris-Sud Saclay, 63, rue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France; Département de chirurgie gynécologique et obstétrique, hôpital Bicêtre, GHU-Sud, AP-HP, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - Hervé Fernandez
- Faculté de médecine, université Paris-Sud Saclay, 63, rue Gabriel-Péri, 94270 Le Kremlin-Bicêtre, France; Département de chirurgie gynécologique et obstétrique, hôpital Bicêtre, GHU-Sud, AP-HP, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - Jean-Luc Pouly
- Service de gynécologie chirurgicale, CHU Estaing, 1, place Lucie-et-Raymond-Aubrac, 63003 Clermont-Ferrand, France
| | - Antoine Torre
- Centre d'assistance médicale à la procréation clinicobiologique, centre hospitalier Sud Francilien Corbeil-Essonnes, 40, avenue Serge-Dassault, 91106 Corbeil-Essonnes, France
| | - Joëlle Belaisch-Allart
- Service de médecine de la reproduction, pôle Femme-Enfant, Centre hospitalier des 4 villes, rue Charles-Lauer, 92210 Saint-Cloud, France
| | - Jean-Marie Antoine
- Service de gynécologie-obstétrique et médecine de la reproduction, Dmu Origyne, hôpital Tenon, GHU Sorbonne université, AP-HP, 4, rue de la Chine, 75020 Paris, France
| | - Blandine Courbiere
- Service d'assistance médicale à la procréation, pôle Femmes-Parents-Enfants, hôpital de la Conception, AP-HM, 147, boulevard Baille, 13005 Marseille, France; IMBE, CNRS, IRD, Aix-Marseille université, Avignon université, Marseille, France.
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Reitz L, Balaya V, Pache B, Feki A, Le Conte G, Benammar A, Ayoubi JM. Ovarian Follicular Response Is Altered by Salpingectomy in Assisted Reproductive Technology: A Pre- and Postoperative Case-Control Study. J Clin Med 2023; 12:4942. [PMID: 37568343 PMCID: PMC10419397 DOI: 10.3390/jcm12154942] [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: 05/22/2023] [Revised: 07/20/2023] [Accepted: 07/20/2023] [Indexed: 08/13/2023] Open
Abstract
Objectives: The goal of this study was to assess the effect of unilateral salpingectomy on the number of mature follicles in the ipsilateral ovary during an assisted reproductive technology (ART) stimulation cycle, as compared to the contralateral ovary. Methods: This was a retrospective, single-center, case-control cohort study conducted from 2017 to 2022. Patients from 18 to 43 years old who underwent at least one ART cycle before and after a unilateral salpingectomy were included. The number of recruited follicles, including mature (≥16 mm) and intermediate follicles (13-15.5 mm), on the salpingectomy side (case) were compared to those present on the contralateral ovary (control) during an ART attempt. To take into account the inter-ovarian variability, the comparison was performed on two ART cycles, performed before then after the salpingectomy. Results: Overall, 24 patients were included in our study. While the number of mature follicles was similar in both ovaries before surgery, the mean number of mature follicles was significantly reduced after salpingectomy in the operated side, as compared to the control side, being, respectively 3.00 vs. 5.08 (p = 0.048). There was no significant difference between the intermediate and total recruited follicles. Conclusions: Our study suggests that salpingectomy may impact the follicle recruitment on the ipsilateral side by altering the vascularization during mesosalpinx coagulation. Gynecologists should be mindful of this concept and accurately set surgical indications. Beyond the indication, this emphasizes the critical role of having infertility surgeons sensitive to fertility preservation for optimal management of ART patients. Further studies with larger patient populations are required to confirm these results.
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Affiliation(s)
- Laurianne Reitz
- Obstetrics and Gynecology Department, Foch Hospital, 92150 Suresnes, France; (G.L.C.); (A.B.); (J.-M.A.)
- Gynecology and Obstetrics Unit, University Hospital of Reunion Island, BP 350, 97448 Saint Pierre Cedex, France
- Department of Obstetrics and Gynecology, Félix Guyon Hospital, CHU Nord of La Réunion, 97400 Saint-Denis, France;
| | - Vincent Balaya
- Department of Obstetrics and Gynecology, Félix Guyon Hospital, CHU Nord of La Réunion, 97400 Saint-Denis, France;
| | - Basile Pache
- Obstetrics and Gynecology Department, Fribourg Cantonal Hospital, 1708 Fribourg, Switzerland; (B.P.); (A.F.)
- Faculty of Medicine, University of Fribourg, 1700 Fribourg, Switzerland
| | - Anis Feki
- Obstetrics and Gynecology Department, Fribourg Cantonal Hospital, 1708 Fribourg, Switzerland; (B.P.); (A.F.)
- Faculty of Medicine, University of Fribourg, 1700 Fribourg, Switzerland
| | - Grégoire Le Conte
- Obstetrics and Gynecology Department, Foch Hospital, 92150 Suresnes, France; (G.L.C.); (A.B.); (J.-M.A.)
| | - Achraf Benammar
- Obstetrics and Gynecology Department, Foch Hospital, 92150 Suresnes, France; (G.L.C.); (A.B.); (J.-M.A.)
| | - Jean-Marc Ayoubi
- Obstetrics and Gynecology Department, Foch Hospital, 92150 Suresnes, France; (G.L.C.); (A.B.); (J.-M.A.)
- Medical School, University of Versailles Saint-Quentin, 78000 Versailles, France
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4
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El-Kharoubi AF. Tubal Pathologies and Fertility Outcomes: A Review. Cureus 2023; 15:e38881. [PMID: 37197301 PMCID: PMC10184952 DOI: 10.7759/cureus.38881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/11/2023] [Indexed: 05/19/2023] Open
Abstract
Anomalies of the fallopian tubes represent one of the most significant elements that might contribute to reproductive issues. They can be inherited or acquired; they are among the most important problems of the profession. Although there is much discussion regarding which therapies for each tubal disease are the most effective and result in the best long-term reproductive outcomes. During the evaluation of an infertile couple, certain anomalies of the fallopian tubes are frequently discovered. These abnormalities were thought, for a long time, to not have an influence on fertility; however, in recent years, researchers have discovered that they seem to play a crucial role in fertility problems. Couples in industrialized countries are postponing childbearing, which raises the risk of women developing tubal diseases before they are ready to become pregnant. These disorders may have a negative impact on a woman's ability to get pregnant. The goals of this study are to conduct research to gain a deeper understanding of the recent advancements that have been made in the field of tubal diseases and to carry out an evaluation of the medical conducts that have the best fertility outcomes. We searched both Medline and PubMed, paying special attention to the most relevant articles that have been added to either database over the course of the last six years.
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Delgado-Morell A, Nieto-Tous M, Andrada-Ripollés C, Pascual MÁ, Ajossa S, Guerriero S, Alcázar JL. Transvaginal Ultrasound Accuracy in the Hydrosalpinx Diagnosis: A Systematic Review and Meta-Analysis. Diagnostics (Basel) 2023; 13:diagnostics13050948. [PMID: 36900092 PMCID: PMC10000875 DOI: 10.3390/diagnostics13050948] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 02/28/2023] [Accepted: 03/01/2023] [Indexed: 03/06/2023] Open
Abstract
Hydrosalpinx is a condition with a crucial prognostic role in reproduction, and its diagnosis by a non-invasive technique such as ultrasound is key in achieving an adequate reproductive assessment while avoiding unnecessary laparoscopies. The aim of the present systematic review and meta-analysis is to synthetize and report the current evidence on transvaginal sonography (TVS) accuracy to diagnose hydrosalpinx. Articles on the topic published between January 1990 and December 2022 were searched in five electronic databases. Data from the six selected studies, comprising 4144 adnexal masses in 3974 women, 118 of which were hydrosalpinxes, were analyzed as follows: overall, TVS had a pooled estimated sensitivity for hydrosalpinx of 84% (95% confidence interval (CI) = 76-89%), specificity of 99% (95% CI = 98-100%), positive likelihood ratio of 80.7 (95% CI = 33.7-193.0), and negative likelihood ratio of 0.16 (95% CI = 0.11-0.25) and DOR of 496 (95% CI = 178-1381). The mean prevalence of hydrosalpinx was 4%. The quality of the studies and their risk of bias were assessed using QUADAS-2, evidencing an overall acceptable quality of the selected articles. We concluded that TVS has a good specificity and sensitivity for diagnosing hydrosalpinx.
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Affiliation(s)
- Aina Delgado-Morell
- Department of Obstetrics and Gynecology, Hospital de la Santa Creu i Sant Pau, 08025 Barcelona, Spain
- Institute of Biomedical Research Sant Pau (IIB SANT PAU), 08041 Barcelona, Spain
| | - Mar Nieto-Tous
- Department of Obstetrics and Gynecology, Hospital Universitari i Politècnic La Fe, 46026 València, Spain
| | - Cristina Andrada-Ripollés
- Department of Obstetrics and Gynecology, Hospital General Universitari de Castelló, 12004 Castelló, Spain
| | - Maria Ángela Pascual
- Department of Obstetrics, Gynecology and Reproduction, Hospital Universitari Dexeus, 08028 Barcelona, Spain
| | - Silvia Ajossa
- Centro Integrato di Procreazione Medicalmente Assistita (PMA) e Diagnostica Ostetrico-Ginecologica, Azienda Ospedaliero Universitaria-Policlinico Duilio Casula, 09042 Monserrato, Italy
- Department of Obstetrics and Gynecology, Università degli Studi di Cagliari, 09043 Monserrato, Italy
| | - Stefano Guerriero
- Centro Integrato di Procreazione Medicalmente Assistita (PMA) e Diagnostica Ostetrico-Ginecologica, Azienda Ospedaliero Universitaria-Policlinico Duilio Casula, 09042 Monserrato, Italy
- Department of Obstetrics and Gynecology, Università degli Studi di Cagliari, 09043 Monserrato, Italy
| | - Juan Luis Alcázar
- Department of Obstetrics and Gynecology, School of Medicine, Universidad de Navarra, 31009 Pamplona, Spain
- Correspondence: ; Tel.: +34-948-29-62-34
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Petrozza JC, Fitz V, Bhagavath B, Carugno J, Kwal J, Mikhail E, Nash M, Barakzai SK, Roque DR, Bregar AJ, Findley J, Neblett M, Flyckt R, Khan Z, Lindheim SR. Surgical approach to 4 different reproductive pathologies by 3 different gynecologic subspecialties: more similarities or differences? Fertil Steril 2023; 119:377-389. [PMID: 36574916 DOI: 10.1016/j.fertnstert.2022.12.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 12/19/2022] [Indexed: 12/25/2022]
Affiliation(s)
- John C Petrozza
- Division of Reproductive Medicine and IVF, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Victoria Fitz
- Division of Reproductive Medicine and IVF, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Bala Bhagavath
- Department of Obstetrics and Gynecology, University of Wisconsin, Madison, Wisconsin
| | - Jose Carugno
- Obstetrics, Gynecology and Reproductive Sciences Department, Minimally Invasive Gynecology Unit, University of Miami, Miller School of Medicine, Miami, Florida
| | - Jaclyn Kwal
- Obstetrics, Gynecology and Reproductive Sciences Department, Minimally Invasive Gynecology Unit, University of Miami, Miller School of Medicine, Miami, Florida
| | - Emad Mikhail
- Division of Gynecologic Subspecialties, Department of Obstetrics and Gynecology, University of South Florida Health Morsani College of Medicine, Tampa, Florida
| | - Moawad Nash
- Division of Minimally Invasive Gynecologic Surgery, Department of Obstetrics & Gynecology, University of Florida College of Medicine, Gainesville, Florida
| | - Syem K Barakzai
- Division of Gynecologic Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Dario R Roque
- Division of Gynecologic Oncology, Feinberg School of Medicine, Northwestern University
| | - Amy J Bregar
- Division of Gynecologic Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Joseph Findley
- Department of Obstetrics and Gynecology, University Hospitals of Cleveland, Beachwood, Ohio
| | - Michael Neblett
- Division of Reproductive Endocrinology and Infertility, Mayo Clinic, Rochester, Minnesota
| | - Rebecca Flyckt
- Department of Obstetrics and Gynecology, University Hospitals of Cleveland, Beachwood, Ohio
| | - Zaraq Khan
- Division of Reproductive Endocrinology and Infertility, Mayo Clinic, Rochester, Minnesota
| | - Steven R Lindheim
- Department of Obstetrics and Gynecology, Boonshoft School of Medicine, Wright State University, Dayton, Ohio; Department of Obstetrics and Gynecology, University of Central Florida, Orlando, Florida; Center for Reproductive Medicine Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, People's Republic of China.
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7
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Souza MDCBD, Silva LABD, Sequeira FF, Azevedo Antunes RD, Souza MMD. The management of infertility for primary care physicians. Women Health 2023; 63:194-203. [PMID: 36696953 DOI: 10.1080/03630242.2023.2165599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
To conduct this review of primary care, we looked for related papers in PubMed from the last 15 years. WHO's initial concept of Health defined a condition of physical, mental, and social well-being, nowadays extended to quality of life. Infertility or not being able to form a family fits perfectly into the definition. Primary care is responsible for mandatory discussions about fertility as part of a broader aspect regarding reproductive health issues. Having children is a decision taken by heterosexual couples, same sex couples, or single individuals. Understanding factors associated with infertility help guiding propedeutic. Although woman's age is one of the main factors to influence treatment success rates, multifactorial male factor may contribute to 50 percent. Infertility consultations should include partners, alleviating the accompanying stress and anxiety. Anamnesis must focus on duration of infertility, primary or secondary, sexual activity, and lifestyle habits such as smoking, alcohol consumption, diet, physical activity, use of licit and/or illicit drugs, and occupational risks. Previous treatments should be accessed. Management of infertility by primary care is mandatory, and patients requiring specialized treatments must not have their journey protracted. Strategies and couple-based interventions are essential to continuity of care and close follow-up should follow these patients.
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Affiliation(s)
- Maria do Carmo Borges de Souza
- Centro de Reproducao Humana, Fertipraxis, Rio de Janeiro, Brazil.,UFRJ - Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | | | - Roberto de Azevedo Antunes
- Centro de Reproducao Humana, Fertipraxis, Rio de Janeiro, Brazil.,UFRJ - Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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YÜCEL ÇİÇEK ÖS, DOĞER E, KARAN AM, ZEYNALLI M. The Diagnostic Value of Laparoscopy for the Evaluation of Patent but Abnormal Tubes on Hysterosalpingography. KOCAELI ÜNIVERSITESI SAĞLIK BILIMLERI DERGISI 2023. [DOI: 10.30934/kusbed.1138375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Objective: The diagnostic value of hysterosalpingography (HSG) findings suggestive of subtle tubal pathologies is controversial. The gold standard method to evaluate the fallopian tubes is laparoscopy. The aim of this study is to explore the laparoscopic findings of patients with abnormal findings but patent tubes detected on HSG.
Methods: The study population included infertile women undergoing laparoscopy for further evaluation of abnormal tuba-related findings on HSG. The HSG views were evaluated for the presence of tubal patency and the convoluted tubes, loculation of the dye in the peritubal area, tubal ectasia, and fimbrial phimosis. The type and frequency of pelvic pathologies detected on laparoscopic examination and the predictive value of patent but abnormal fallopian tube finding on HSG were analyzed.
Results: A total of 73 laparoscopy cases were eligible. Of these, 18 (25%) had normal laparoscopic findings. In 75% of the cases, there was at least one pelvic pathology detected during laparoscopy. The most common pelvic pathology detected was tubal adhesions. Tubal adhesions were detected in 21 cases (29%). Fimbrial phimosis was detected in 11 cases (13%). Paratubal cysts were detected in 7 cases (10%).
Conclusion: While evaluating a HSG, focusing only on tubal patency may result in the failure of detecting subtle tubal pathologies. Clinicians should be familiar with abnormal HSG findings suggestive of tubal abnormalities. Careful examination of the HSG views regarding other tubal pathologies is warranted as these subtle conditions may impair fertility and laparoscopic correction of these pathologies has a positive impact on fertility.
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Yilei H, Shuo Y, Caihong M, Yan Y, Xueling S, Jiajia Z, Ping L, Rong L, Jie Q. The influence of timing of oocytes retrieval and embryo transfer on the IVF-ET outcomes in patients having bilateral salpingectomy due to bilateral hydrosalpinx. Front Surg 2023; 9:1076889. [PMID: 36684225 PMCID: PMC9849570 DOI: 10.3389/fsurg.2022.1076889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2022] [Accepted: 11/28/2022] [Indexed: 01/06/2023] Open
Abstract
Objective The objective of the study was to investigate whether the sequence of oocyte retrieval and salpingectomy for hydrosalpinx affects pregnancy outcomes of in vitro fertilization and embryo transfer (IVF-ET) patients. Study Design There were 1,610 bilateral hydrosalpinx patients who underwent laparoscopy salpingectomy and IVF-ET/intracytoplasmic sperm injection (ICSI) from January 2009 to December 2018. They were divided into two groups: oocyte retrieval first group: 235 accepted oocyte retrieval before salpingectomy; operation first group: 1,375 accepted oocyte retrieval after salpingectomy. The basic information and pregnancy outcomes of the two groups were compared. The pregnancy outcomes and influencing factors were analyzed among patients at different starting times of frozen-thawed embryo transfer (FET) or oocyte retrieval after the salpingectomy. Results Patients in the oocyte retrieval first group had higher levels of basal follicle stimulating hormone and lower anti-Mullerian hormone levels (P < 0.05). There were no cases of pelvic infection or oocyte and embryo contamination after oocyte retrieval in the oocyte retrieval first group. In the frozen cycle, the clinical pregnancy and miscarriage rates of the oocyte retrieval first group were lower than those in the operation first group (P < 0.05), while the live birth rate was not significantly different (P > 0.05). The live birth rates of patients ≥35 years old in the operation first group and the oocyte retrieval first group were not significantly different (29.3% vs. 23.3%, P = 0.240). After adjusting for age and antral follicle count (AFC), oocyte retrieval 4-6 and 7-12 months after the operation had higher accumulated pregnancy rates [OR 1.439 (1.045-1.982), P = 0.026; OR 1.509 (1.055-2.158), P = 0.024] and higher accumulated live birth rates [OR 1.419 (1.018-1.977), P = 0.039; OR 1.544 (1.068-2.230), P = 0.021]. No significant difference was observed in the pregnancy outcomes of frozen embryo transfer at different times after salpingectomy (P > 0.05). Conclusion No contamination of the embryo or infection was observed in patients who underwent oocyte retrieval before the operation. The interval between the operation and frozen embryo transfer did not affect the pregnancy outcomes. After adjusting for age and AFC, patients who underwent oocyte retrieval 4-6 and 7-12 months after the operation had higher accumulated pregnancy rates and live birth rates.
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Affiliation(s)
- He Yilei
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China,National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China,Key Laboratory of Assisted Reproduction, Ministry of Education, Peking University, Beijing, China,Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China
| | - Yang Shuo
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China,National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China,Key Laboratory of Assisted Reproduction, Ministry of Education, Peking University, Beijing, China,Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China,Correspondence: Yang Shuo
| | - Ma Caihong
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China,National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China,Key Laboratory of Assisted Reproduction, Ministry of Education, Peking University, Beijing, China,Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China
| | - Yang Yan
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China,National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China,Key Laboratory of Assisted Reproduction, Ministry of Education, Peking University, Beijing, China,Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China
| | - Song Xueling
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China,National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China,Key Laboratory of Assisted Reproduction, Ministry of Education, Peking University, Beijing, China,Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China
| | - Zhang Jiajia
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China,National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China,Key Laboratory of Assisted Reproduction, Ministry of Education, Peking University, Beijing, China,Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China
| | - Liu Ping
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China,National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China,Key Laboratory of Assisted Reproduction, Ministry of Education, Peking University, Beijing, China,Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China
| | - Li Rong
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China,National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China,Key Laboratory of Assisted Reproduction, Ministry of Education, Peking University, Beijing, China,Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China
| | - Qiao Jie
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China,National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital, Beijing, China,Key Laboratory of Assisted Reproduction, Ministry of Education, Peking University, Beijing, China,Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology, Beijing, China
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Devine K, Dolitsky S, Ludwin I, Ludwin A. Modern assessment of the uterine cavity and fallopian tubes in the era of high-efficacy assisted reproductive technology. Fertil Steril 2022; 118:19-28. [PMID: 35725118 DOI: 10.1016/j.fertnstert.2022.05.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 05/12/2022] [Accepted: 05/12/2022] [Indexed: 11/28/2022]
Abstract
The high efficacy of modern assisted reproductive technology (ART) and increase in the number of noninfertile patients who are using ART for family building in the United States call into question the relevance of the standard, one-size-fits-all infertility evaluation. Here, we explore whether all patients presenting for ART need uterine cavity and tubal assessment and what tests are most appropriate, efficient, and cost-effective in current times.
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Affiliation(s)
- Kate Devine
- Division of Reproductive Endocrinology and Infertility, Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver NICHD, National Institutes of Health, Bethesda, Maryland; Shady Grove Fertility, Washington, D.C..
| | - Shelley Dolitsky
- Division of Reproductive Endocrinology and Infertility, Program in Reproductive and Adult Endocrinology, Eunice Kennedy Shriver NICHD, National Institutes of Health, Bethesda, Maryland
| | - Inga Ludwin
- Department of Gynecology and Oncology, Jagiellonian University, Krakow, Poland; Ludwin & Ludwin Gynecology, Private Medical Center, Krakow, Poland
| | - Artur Ludwin
- Department of Gynecology and Oncology, Jagiellonian University, Krakow, Poland; Ludwin & Ludwin Gynecology, Private Medical Center, Krakow, Poland
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Toth B, Feil K, Zippl AL, Vomstein K, Strowitzki T. Bedeutung der Fertilitätschirurgie bei Kinderwunsch. GYNAKOLOGISCHE ENDOKRINOLOGIE 2021. [DOI: 10.1007/s10304-021-00379-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
ZusammenfassungDie Bedeutung der Fertilitätschirurgie bei Kinderwunsch kann vielfach aufgrund fehlender eigener Erfahrung während der Facharztweiterbildung nicht erfasst werden, da nur an wenigen Zentren eine spezifische operative Ausbildung erfolgt. Neben der Abklärung anatomischer Fehlbildungen mittels Hysteroskopie bzw. Laparoskopie gehört die operative Myom- und Endometriosebehandlung zu den Standardverfahren der Fertilitätschirurgie. Hier ist die Erfahrung der Reproduktionsmediziner gefragt, damit unter maximaler Schonung der Ovarreserve ein bestmöglichstes Ergebnis hinsichtlich Endometriosesanierung bzw. Myomenukleation erreicht wird. Die Abklärung der Tubendurchgängigkeit mit Chromopertubation ist nach wie vor Goldstandard, auch wenn im ambulanten Sektor vorwiegend nichtoperative Verfahren zum Einsatz kommen. Die diagnostische und gegebenenfalls operative Hysteroskopie dient der Beurteilung des Endometriums und erlaubt den Ausschluss von Entzündungsprozessen oder dem Vorliegen von Polypen.
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