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Zhang L, Li H, Wu Z, Han L, Zhang J. Associations between cytokines and the risk of female and male infertility: A two-sample Mendelian randomization analysis. J Reprod Immunol 2024; 163:104238. [PMID: 38479056 DOI: 10.1016/j.jri.2024.104238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 03/07/2024] [Indexed: 06/03/2024]
Abstract
PURPOSE Observational studies have linked cytokines to the occurrence of female and male infertility. However, it is not clear how biomarkers of inflammation are causally related to infertility. To explore whether genetic variants in circulating cytokines are associated with the pathogenesis of infertility, we performed two-sample Mendelian randomization (MR) analysis. METHODS A total of 31,112 individuals of European ancestry were included in a genome-wide association study (GWAS) of 47 circulating cytokines as instrumental variables (IVs). Outcome data were female infertility, including four different subtypes, and male infertility, from the FinnGen consortium. Five MR methods, including inverse-variance weighted (IVW), MR-Egger, simple mode, weighted median, and weighted mode were employed to examine the genetic association between cytokines and the risk of female infertility and male infertility. The false discovery rate (FDR) was controlled using the Benjamini-Hochberg method. RESULTS After FDR correction, cis-protein quantitative trait locus (cis-pQTL) instruments showed that the cytokines GROa and MCSF were positively associated with female infertility. In analyses of subtypes of female infertility, eotaxin and sICAM were inversely associated with ovulation-related infertility; MCP3 alone was positively associated with uterus-related infertility; GROa and MCSF were positively correlated with infertility of cervical, vaginal, and other or unspecified origin; and MIP1a was negatively correlated with tubal origin infertility. The cytokines HGF, IL-2ra, and RANTES were positively correlated with male infertility. Similar findings were obtained in sensitivity analyses. There was no evidence of pleiotropy or heterogeneity in the results. CONCLUSION These findings contribute to current understanding of the role of cytokine biomarkers in the etiology of female and male infertility. Furthermore clinical experimental validation is required to evaluate the potential of these cytokines as biomarkers.
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Affiliation(s)
- Lei Zhang
- The First Clinical College, Shandong University of Traditional Chinese medicine, Jinan, China
| | - Honglin Li
- The First Clinical College, Shandong University of Traditional Chinese medicine, Jinan, China
| | - Zhijuan Wu
- The First Clinical College, Shandong University of Traditional Chinese medicine, Jinan, China
| | - Letian Han
- Reproductive and Genetic Center of Integrated Traditional and Western Medicine, Hospital Affiliated to Shandong University of Traditional Chinese Medicine, Jinan, China; Shandong Qidu Pharmaceutical Co. Ltd., Shandong Provincial Key Laboratory of Neuroprotective Drugs, Zibo, China
| | - Jianwei Zhang
- The First Clinical College, Shandong University of Traditional Chinese medicine, Jinan, China; Reproductive and Genetic Center of Integrated Traditional and Western Medicine, Hospital Affiliated to Shandong University of Traditional Chinese Medicine, Jinan, China.
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Fatima W, Akhtar AM, Hanif A, Gilani A, Farooq SMY. Comparison of Baseline Characteristics, Sociodemographics, and Gynecological Risk Factors Associated with Secondary Infertility of Females in Pakistan. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2024; 5:340-345. [PMID: 38655147 PMCID: PMC11035849 DOI: 10.1089/whr.2023.0145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/12/2024] [Indexed: 04/26/2024]
Abstract
Introduction Secondary infertility is characterized by the inability to conceive for a period of 1 year, after having previously conceived at least once. Objectives To explore the risk factors of secondary infertility and compare sociodemographics and anthropometric variables of each studied group. Methods Study was conducted at University Institute of Public Health, Faculty of Allied Health Sciences, The University of Lahore, collecting data from Gilani Ultrasound Center in 18 months after approval of synopsis. Total 690 females (345 cases and 345 controls) were enrolled. Participants were included in case group if they were 20-45 years of age, having any parity, and confirmed diagnosis of secondary infertility. Results The mean age of cases and controls was 33.08 ± 4.17 years and 31.37 ± 4.36 years, respectively. The mean body mass index (BMI) in cases was 27.61 ± 4.27 kg/m2, and in controls the mean BMI was 25.52 ± 4.30 kg/m2. There was not a significant difference among religion that shows no association (p = 0.73) with secondary infertility as profession has association with it (p = 0.01). History of polycystic ovary syndrome, pelvic inflammatory disease, endometriosis, uterine fibroids, menorrhagia, intermenstrual bleeding, and history of abortion are associated with secondary infertility. Conclusions While several sociodemographic features and medical disorders have been associated to secondary infertility, it is vital to stress that not all of these factors are controllable by medical therapy. Factors like age and certain medical issues may be unaffected by intervention. However, for controllable variables like BMI and certain medical diseases, focused therapies and lifestyle changes may reduce the chance of subsequent infertility.
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Affiliation(s)
- Wafa Fatima
- Faculty of Allied Health Sciences, University Institute of Public Health, The University of Lahore, Lahore, Pakistan
| | - Abdul Majeed Akhtar
- Faculty of Allied Health Sciences, University Institute of Public Health, The University of Lahore, Lahore, Pakistan
| | - Asif Hanif
- Faculty of Allied Health Sciences, University Institute of Public Health, The University of Lahore, Lahore, Pakistan
| | - Aima Gilani
- Trauma and Orthopedic Surgery, Salford Royal NHS Foundation Trust Hospital, Manchester, United Kingdom
| | - Syed Muhammad Yousaf Farooq
- Faculty of Allied Health Sciences, University Institute of Radiological Sciences and Medical Imaging Technology, The University of Lahore, Lahore, Pakistan
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Hardel AS, Flye Sainte Marie H, Lorrain S, Iacobelli S, Lazaro G, Boukerrou M, Tran PL. [Pregnancy after intrauterine insemination following hysterosalpingo-foam-sonography or hysterosalpingography]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2024:S2468-7189(24)00093-X. [PMID: 38547932 DOI: 10.1016/j.gofs.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 03/09/2024] [Accepted: 03/18/2024] [Indexed: 04/14/2024]
Abstract
OBJECTIVE To compare clinical pregnancy rates following intrauterine insemination performed after hysterosalpingography (HSG) or hysterosalpingo-foam-sonography (HyFoSy). MATERIAL AND METHODS This is a retrospective study including 242 intrauterine insemination (IUI) performed between 2015 and 2020 at the fertility center of the Reunion Island. Among these inseminations, 121 with previous HSG and 121 with previous HyFoSy were matched. The main outcome of interest was clinical pregnancy rate. Secondary outcomes were birth rate and time to pregnancy after tubal patency test. RESULTS The pregnancy rate after insemination was 9.9% for the HSG group and 11.6% for the HyFoSy group, with no statistically significant difference between the groups (P=0.66). The live birth rate was similar in the two groups (7.4% for HSG and 10.7% for HyFoSy; P=0.37). Over half (57.1%) of the pregnancies occurred within 6 months after HyFoSy, whereas only 8.3% after HSG. CONCLUSION IUI results are not influenced by HyFoSy compared to HSG with regard to the pregnancy rates. Use of HyFoSy in infertility assessment allows global evaluation and more rapid adapted management. This approach could optimize management of patients undergoing IUI.
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Affiliation(s)
- Anne-Sophie Hardel
- Service de gynécologie-obstétrique, centre hospitalier universitaire Sud-Réunion, BP 350, 97448 Saint-Pierre cedex, Réunion
| | - Hélène Flye Sainte Marie
- Service de gynécologie-obstétrique, centre hospitalier universitaire Sud-Réunion, BP 350, 97448 Saint-Pierre cedex, Réunion
| | - Simon Lorrain
- Centre d'études périnatales de l'Océan Indien (UR 7388), université de la Réunion, Saint-Pierre, Réunion
| | - Silvia Iacobelli
- Centre d'études périnatales de l'Océan Indien (UR 7388), université de la Réunion, Saint-Pierre, Réunion; Réanimation néonatale et pédiatrique, néonatologie, centre hospitalier universitaire Sud Réunion, Saint-Pierre cedex, Réunion
| | - Glorianne Lazaro
- Empartners, 760 Newtown Yardely Rd Suite 112, Newtown, PA, 18940, États-Unis
| | - Malik Boukerrou
- Service de gynécologie-obstétrique, centre hospitalier universitaire Sud-Réunion, BP 350, 97448 Saint-Pierre cedex, Réunion; Centre d'études périnatales de l'Océan Indien (UR 7388), université de la Réunion, Saint-Pierre, Réunion; Université de la Réunion, UFR santé, 40, avenue de Soweto, Terre Sainte, BP 373, 97455 Saint-Pierre cedex, Réunion
| | - Phuong Lien Tran
- Service de gynécologie-obstétrique, centre hospitalier universitaire Sud-Réunion, BP 350, 97448 Saint-Pierre cedex, Réunion; Université de la Réunion, UFR santé, 40, avenue de Soweto, Terre Sainte, BP 373, 97455 Saint-Pierre cedex, Réunion; Inserm, CIC 1410, Reunion University Hospital, 97448 Saint-Pierre, Réunion.
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Fatima W, Akhtar AM, Hanif A, Gilani A, Farooq SMY. Predicted risk factors associated with secondary infertility in women: univariate and multivariate logistic regression analyses. Front Med (Lausanne) 2024; 10:1327568. [PMID: 38590911 PMCID: PMC11000415 DOI: 10.3389/fmed.2023.1327568] [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: 10/27/2023] [Accepted: 12/06/2023] [Indexed: 04/10/2024] Open
Abstract
Introduction Infertile women are those who regularly engage in unprotected intercourse for a period of at least 1 year and are unable to become clinically pregnant. Primary infertility means the inability of couples to conceive, without any previous successful pregnancies. Secondary Infertility refers to the inability to get pregnant for 12 months, after having a previous pregnancy for one time at least. The objectives of the current study were to analyze risk factors for secondary infertility and compare the predictive accuracy of artificial neural network (ANN) and multiple logistic regression models. Methods The study was conducted at The University Institute of Public Health collecting data from Gilani Ultrasound Center 18 months after approval of synopsis. A total of 690 women (345 cases and 345 controls) were selected. The women selected for the case group had to be 20-45 years of age, had any parity, and had a confirmed diagnosis of secondary infertility. Results Multiple logistic regression (MLR) and ANN were used. The chance of secondary infertility was 2.91 times higher in women living in a joint family [odds ratio (OR) = 2.91; 95% confidence interval (CI) (1.91, 4.44)] and was also 2.35 times higher for those women who had relationship difficulties with their husband [OR = 2.35; 95% CI (1.18, 4.70)]. Marriage at an earlier age was associated with secondary infertility with β being negative and OR being < 1 [OR = 0.94; 95% CI (0.88, 0.99)]. For the logistic regression model, the area under the receiver operative characteristic curve (ROC) was 0.852 and the artificial neural network was 0.87, which was better than logistic regression. Discussion Identified risk factors of secondary infertility are mostly modifiable and can be prevented by managing these risk factors.
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Affiliation(s)
- Wafa Fatima
- Faculty of Allied Health Sciences, University Institute of Public Health, The University of Lahore, Lahore, Pakistan
| | - Abdul Majeed Akhtar
- Faculty of Allied Health Sciences, University Institute of Public Health, The University of Lahore, Lahore, Pakistan
| | - Asif Hanif
- Faculty of Allied Health Sciences, University Institute of Public Health, The University of Lahore, Lahore, Pakistan
| | - Aima Gilani
- Trauma and Orthopedic Surgery, Salford Royal NHS Foundation Trust Hospital, Manchester, United Kingdom
| | - Syed Muhammad Yousaf Farooq
- Faculty of Allied Health Sciences, University Institute of Radiological Sciences and Medical Imaging Technology, The University of Lahore, Lahore, Pakistan
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Mody P, Salazar G, Kohi MP. Recanalization of Proximal Fallopian Tube Obstruction in the Treatment of Infertility. Semin Intervent Radiol 2023; 40:379-383. [PMID: 37575349 PMCID: PMC10415059 DOI: 10.1055/s-0043-1771042] [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: 08/15/2023]
Abstract
Infertility affects approximately 15% of patients worldwide, with up to 40% of cases attributed to tubal disease, and up to 25% of those being proximal fallopian tube obstruction (FTO). Evaluation of tubal patency can be performed via laparoscopic chromopertubation, hysterosalpingography, or hysterosalpingo-contrast-sonography (HyCoSy). In patients with proximal tubal obstruction, fallopian tube recanalization (FTR) can result in up to 100% technical success rate with pregnancy rates of 12.8 to 51%. More pregnancies occur when oil-soluble contrast media are used versus water-soluble contrast media. Complications of FTR are rare and include tubal perforation, ectopic pregnancy, and pelvic infection. Reocclusion of fallopian tubes may occur in 20 to 50% of patients; however, FTR may be repeated in these cases. Overall, FTR is underutilized in the treatment of infertility secondary to proximal FTO and it can obviate costly and time-consuming assistive reproductive techniques such as in vitro fertilization in some patients, as well as decreasing physical and emotional stress.
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Affiliation(s)
- Priya Mody
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Gloria Salazar
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Maureen P. Kohi
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Maidarti M, Anggraheny BAR, Umarghanies SS, Garinasih PD, Harzif AK, Simatupang ONN. Severe chronic pelvic pain due to cystic degeneration of subserosal uterine fibroid with type 2 diabetes and obesity: Serial case report. Int J Surg Case Rep 2023; 104:107934. [PMID: 36801770 PMCID: PMC9957740 DOI: 10.1016/j.ijscr.2023.107934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 01/19/2023] [Accepted: 02/15/2023] [Indexed: 02/19/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Uterine fibroids, benign tumors of the myometrium, can cause pelvic pain. Obesity and diabetes mellitus can increase the risk of developing fibroid. We present two cases of uterine fibroid, diabetes mellitus, and obesity with moderate-to-severe chronic pain. CASE PRESENTATION The first case is a 37-year-old woman with pelvic pain and a subserosal uterine fibroid, primary infertility, grade 2 obesity, and diabetes mellitus. Pathologic examination revealed smooth muscle cells with degeneration sites. The second case is a 35-year-old nulliparous woman with abdominal enlargement, lower abdominal pain, diabetes mellitus, and morbid obesity. Ultrasonography showed a large uterus with a hyperechoic mass and cystic degeneration. Histopathological examination revealed leiomyoma. CLINICAL DISCUSSION Our patient's chronic pelvic pain may be caused by its large size. Excess adipose tissue in obesity may result in the formation of estrone, causing the proliferation of fibroids. A subserous fibroid is less likely to cause infertility; thus, a myomectomy was performed to relieve pain. Obesity and diabetes could interfere with patients' periods. Higher levels of insulin and fat tissue induce androgen production. Increased estrogen levels lead to alteration of gonadotropin production, menstrual abnormalities, and ovulatory dysfunction. CONCLUSION Cystic degeneration of the subserous uterine fibroid could induce pain though it rarely affects fertility. A myomectomy was conducted to relieve pain. Comorbid diseases such as diabetes mellitus and obesity can lead to cystic degeneration of the uterine fibroid.
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Affiliation(s)
- Mila Maidarti
- Reproductive Immunoendocrinology Division, Department of Obstetrics and Gynecology, Faculty of Medicine Universitas Indonesia - Dr. Cipto Mangunkusumo General Hospital, Jakarta 10430, Indonesia; Yasmin IVF Clinic, Dr. Cipto Mangunkusumo General Hospital, Jakarta 10430, Indonesia; Human Reproduction, Infertility and Family Planning Cluster, Indonesia Reproductive Medicine Research and Training Center, Indonesia Medical Education and Research Institute (IMERI), Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia.
| | - Beta Andewi Resti Anggraheny
- Reproductive Immunoendocrinology Division, Department of Obstetrics and Gynecology, Faculty of Medicine Universitas Indonesia - Dr. Cipto Mangunkusumo General Hospital, Jakarta 10430, Indonesia; Human Reproduction, Infertility and Family Planning Cluster, Indonesia Reproductive Medicine Research and Training Center, Indonesia Medical Education and Research Institute (IMERI), Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia
| | - Sarah Safira Umarghanies
- Reproductive Immunoendocrinology Division, Department of Obstetrics and Gynecology, Faculty of Medicine Universitas Indonesia - Dr. Cipto Mangunkusumo General Hospital, Jakarta 10430, Indonesia; Yasmin IVF Clinic, Dr. Cipto Mangunkusumo General Hospital, Jakarta 10430, Indonesia; Human Reproduction, Infertility and Family Planning Cluster, Indonesia Reproductive Medicine Research and Training Center, Indonesia Medical Education and Research Institute (IMERI), Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia
| | - Prini Diandara Garinasih
- Reproductive Immunoendocrinology Division, Department of Obstetrics and Gynecology, Faculty of Medicine Universitas Indonesia - Dr. Cipto Mangunkusumo General Hospital, Jakarta 10430, Indonesia; Human Reproduction, Infertility and Family Planning Cluster, Indonesia Reproductive Medicine Research and Training Center, Indonesia Medical Education and Research Institute (IMERI), Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia
| | - Achmad Kemal Harzif
- Reproductive Immunoendocrinology Division, Department of Obstetrics and Gynecology, Faculty of Medicine Universitas Indonesia - Dr. Cipto Mangunkusumo General Hospital, Jakarta 10430, Indonesia; Yasmin IVF Clinic, Dr. Cipto Mangunkusumo General Hospital, Jakarta 10430, Indonesia; Human Reproduction, Infertility and Family Planning Cluster, Indonesia Reproductive Medicine Research and Training Center, Indonesia Medical Education and Research Institute (IMERI), Faculty of Medicine, Universitas Indonesia, Jakarta 10430, Indonesia
| | - Octaviyana Nadia Nitasari Simatupang
- Reproductive Immunoendocrinology Division, Department of Obstetrics and Gynecology, Faculty of Medicine Universitas Indonesia - Dr. Cipto Mangunkusumo General Hospital, Jakarta 10430, Indonesia
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Muacevic A, Adler JR. A Review of Tubal Factors Affecting Fertility and its Management. Cureus 2022; 14:e30990. [PMID: 36475176 PMCID: PMC9717713 DOI: 10.7759/cureus.30990] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 11/01/2022] [Indexed: 01/25/2023] Open
Abstract
Infertility is a problem that affects both developed and developing countries today. Many couples choose to have financial stability before conception, irrespective of age. Tubal blockage accounts for 30%-40% of a woman's fertility. Congenital abnormalities, acute and persistent inflammatory diseases, endometriosis, and different pathologies are associated with infertility and cause partial or complete obstruction of the fallopian tubes. Approximately 30% of women experience infertility due to fallopian tube illness, with 10%-25% of these women experiencing proximal fallopian tube obstruction. The fallopian tube is an integral part of the union of sperm, and its normal function is a prerequisite for natural conception. Tubal obstruction is a common cause of infertility. These patients are keen to unblock their blocked fallopian tubes and restore reproductive function. Accurate diagnosis and optimal treatment options are essential for treating infertility.
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Su H, Sung YJ, Pai AHY, Kuo HH, Wang CJ, Yen CF. Restoring tubal patency with laparoscopic tubocornual anastomosis. Taiwan J Obstet Gynecol 2022; 61:858-862. [PMID: 36088056 DOI: 10.1016/j.tjog.2021.10.009] [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: 10/28/2021] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To assess the technical feasibility of laparoscopic tubocornual anastomosis (TCA) at restoring tubal patency in patients with proximal tubal occlusions. MATERIALS AND METHODS A retrospective analysis of fourteen females with identified proximal tubal occlusions seeking to restore their tubal patency in a university-affiliated tertiary hospital between 2011 and 2018. Tubal patency within one year after the surgery was evaluated. RESULTS The patients had a mean age of 34.0 ± 3.6 years old, median parity of 1 child, and mean BMI of 23.0 ± 5.2 kg/m2. Of the fourteen patients, two (14.3%) received bilateral TCA, eight (57.1%) received only unilateral TCA, and four (28.6%) received TCA on one side and tubal anastomosis on the other. The operative time was 126.4 ± 37.9min for unilateral procedure and 201.0 ± 1.4 min for bilateral anastomoses. Postoperative hysterosalpingogram (HSG) demonstrated a patency rate of 64.2% at the TCA sites. Two ectopic pregnancies were reported thereafter. CONCLUSION This preliminary series demonstrates that laparoscopic TCA is technically feasible and provides promising results for patients with proximal tubal occlusions hoping to restore their tubal function in order to conceive naturally. A larger prospective series is mandatory to establish its significance and application in clinical practices. Notably, infertile patients without surgically correctable factors are not suitable for this procedure.
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Affiliation(s)
- Hsuan Su
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Kwei-Shan, Tao-Yuan, Taiwan
| | - Yen-Ju Sung
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Kwei-Shan, Tao-Yuan, Taiwan
| | - Angel Hsin-Yu Pai
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Kwei-Shan, Tao-Yuan, Taiwan
| | - Hsin-Hong Kuo
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Kwei-Shan, Tao-Yuan, Taiwan
| | - Chin-Jung Wang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Kwei-Shan, Tao-Yuan, Taiwan
| | - Chih-Feng Yen
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Kwei-Shan, Tao-Yuan, Taiwan.
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Dergacheva ТI, Starkova ЕV, Klimontov VV, Poveschenko ОV, Konenkov VI. Angioprotective and Follicle-Stimulating Effects of Administration of Bone Marrow Mesenchymal Stromal Cells in Chronic Inflammation of Internal Reproductive Organs. Bull Exp Biol Med 2022; 173:534-538. [DOI: 10.1007/s10517-022-05577-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Indexed: 11/30/2022]
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Zhu C, Yan L, He C, Wang Y, Wu J, Chen L, Zhang J. Incidence and risk factors of infertility among couples who desire a first and second child in Shanghai, China: a facility-based prospective cohort study. Reprod Health 2022; 19:155. [PMID: 35804377 PMCID: PMC9270756 DOI: 10.1186/s12978-022-01459-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 06/19/2022] [Indexed: 12/03/2022] Open
Abstract
Background With the implementation of the two-child policy in China, more couples have expressed the desire to have another child. We conducted this study to evaluate the incidence of infertility and risk factors in couples intending to have a first and second child. Methods From 2013 to 2017, a prospective cohort study was conducted at the pre-pregnancy center of the International Peace Maternal and Child Health Hospital. The participants were selected by screening and random sampling couples who came to the pre-pregnancy center. Data regarding patient sociodemographic characteristics, reproductive and gynecological history, male disease history, and laboratory and imaging examination results were collected. Couples were followed up every 3 months until pregnancy or for 12 months, whichever came first. Multi-factor logistic regression was used to analyze risk factors for infertility. Adjusted odds ratios (aORs) and corresponding 95% confidence intervals (CIs) were calculated and adjusted for potential confounding factors. Results The overall infertility incidence was 16.95% (369/2177). The infertility incidence of “first child intention” and “second child intention” was 19.30% (355/1839) and 4.14% (14/338), respectively. This study found great differences in both infertility rate (P < 0.001) and risk factors between the two groups. Risk factors for “first child intention” infertility included advanced age (> 35 years) (aOR = 1.70, 95% CI 1.27–2.28), abnormal body mass index (BMI) (aOR = 1.58, 95% CI 1.31–6.26), longer menstrual periods (aOR = 4.47, 95% CI 2.25–8.88), endometrial polyps (aOR = 2.52, 95% CI 1.28–4.97), polycystic ovarian syndrome (PCOS) (aOR = 6.72, 95% CI 1.79–7.39), salpingostomy (aOR = 3.44, 95% CI 1.68–7.07), and history of mycoplasma (aOR = 1.54, 95% CI 1.09–2.40). However, in the “second child intention” group, clinical risk factors slightly differed and included leiomyoma (aOR = 5.60, 95% CI 1.06–29.76), and higher age (> 40 years) (aOR = 7.36, 95% CI 1.01–53.84). Conclusion The overall infertility rate in Shanghai is similar to that of other large cities in China. Marriage at advanced ages has become increasingly common. As such, the government must consider subsidies to encourage childbirth at childbearing ages, which can improve fertility levels. Supplementary Information The online version contains supplementary material available at 10.1186/s12978-022-01459-x. Infertility is defined as pregnancy failure after at least 12 months of regular unprotected sexual intercourse. Few researchers have investigated the infertility rate in Shanghai in the past 15 years, and little attention has been paid to the infertility of couples hoping to have a second child. We conducted a prospective cohort study in Shanghai to evaluate infertility incidence and risk factors in couples intending to have a first or second child. The investigators administered a questionnaire survey to the participants and followed them for 1 year. Finally, 1839 couples intending to have a first child and 338 couples intending to have a second child were included in this study. The overall infertility incidence was 16.95% (369/2177). However, the infertility incidence of the “first child intention” and “second child intention” groups was 19.30% (355/1839) and 4.14% (14/338), respectively. Risk factors for “first child intention” infertility included advanced age (> 35 years), abnormal body mass index (BMI), longer menstrual periods, endometrial polyps, polycystic ovarian syndrome (PCOS), salpingostomy, and history of mycoplasma; in the “second child intention” group, clinical risk factors slightly differed and included leiomyoma and advanced age (> 40 years). Since studies have shown large differences in infertility risk factors between the two groups, early and targeted intervention for couples in different high-risk groups can help reduce infertility.
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Affiliation(s)
- Chenfeng Zhu
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.,Pre-Pregnancy center, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.,Shanghai Key Laboratory Embryo Original Diseases, Shanghai, China.,Shanghai Municipal Key Clinical Specialty, Shanghai, China
| | - Li Yan
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.,Shanghai Key Laboratory Embryo Original Diseases, Shanghai, China.,Shanghai Municipal Key Clinical Specialty, Shanghai, China
| | - Chuqing He
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.,Shanghai Key Laboratory Embryo Original Diseases, Shanghai, China.,Shanghai Municipal Key Clinical Specialty, Shanghai, China
| | - Yang Wang
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.,Shanghai Key Laboratory Embryo Original Diseases, Shanghai, China.,Shanghai Municipal Key Clinical Specialty, Shanghai, China
| | - Jiahao Wu
- Pre-Pregnancy center, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
| | - Luting Chen
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China. .,Shanghai Key Laboratory Embryo Original Diseases, Shanghai, China. .,Shanghai Municipal Key Clinical Specialty, Shanghai, China.
| | - Jian Zhang
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China. .,Shanghai Key Laboratory Embryo Original Diseases, Shanghai, China. .,Shanghai Municipal Key Clinical Specialty, Shanghai, China.
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Mina A, Boutzios G, Papoutsis I, Kaparos G, Christopoulos P, Kousta E, Mastrominas M, Athanaselis S, Mastorakos G. Bisphenol A correlates with fewer retrieved oocytes in women with tubal factor infertility. Hormones (Athens) 2022; 21:305-315. [PMID: 35524040 DOI: 10.1007/s42000-022-00370-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 04/12/2022] [Indexed: 11/04/2022]
Abstract
PURPOSE Serum and urinary bisphenol A (BPA) concentrations have been associated negatively with the number of retrieved oocytes after in vitro fertilization (IVF). The impact of BPA upon women with polycystic ovary syndrome (PCOS) and women with tubal factor infertility (TFI), following IVF, was investigated. To this purpose, associations among serum and urinary and follicular fluid (FF) BPA concentrations and the number of retrieved and fertilized oocytes and comparisons between pregnancy rates were evaluated. METHODS This was a cross-sectional study conducted at a university-affiliated assisted conception unit between January and November 2019, including 93 women of reproductive age (PCOS: 45; TFI: 48) following IVF. Unconjugated FF and serum BPA concentrations and total urinary BPA concentration were measured using a novel gas chromatography-mass spectrometry method. The number of retrieved and fertilized oocytes and pregnancy rate were documented and evaluated. RESULTS The number of oocytes retrieved from PCOS women was greater than that of 21 TFI women, independently of BMI. Lower FF BPA concentrations were found in all PCOS women and in overweight/obese PCOS compared to TFI women (0.50, 0.38, and 1.13 ng/mL, respectively). In TFI women, FF BPA concentrations correlated negatively with the number of retrieved oocytes. Serum and FF and urinary BPA concentrations did not significantly affect the number of fertilized oocytes and pregnancy rate in both groups. CONCLUSION FF BPA concentrations were lower in all PCOS women and in overweight/obese PCOS than in TFI women. In TFI women, FF BPA concentrations correlated negatively with retrieved oocytes. Confirmation of these findings might lead to moderation of use of BPA-containing products by women undergoing IVF.
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Affiliation(s)
- Areti Mina
- Endocrine Unit, Medical School, Aretaieion University Hospital, National and Kapodistrian University of Athens, 76 Vas. Sofias Str, PO Box 11528, Athens, Greece
- Department of Forensic Medicine and Toxicology, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Str, PO Box 11527, Athens, Greece
| | - Georgios Boutzios
- Endocrine Unit, Department of Pathophysiology, Medical School, Laiko University Hospital, National and Kapodistrian University of Athens, 75 Mikras Asias Str, PO Box 11527, Athens, Greece
| | - Ioannis Papoutsis
- Department of Forensic Medicine and Toxicology, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Str, PO Box 11527, Athens, Greece
| | - George Kaparos
- Hormonal and Biochemical Laboratory, Medical School, Aretaieion University Hospital, National and Kapodistrian University of Athens, 76 Vas. Sofias Str, PO Box 11528, Athens, Greece
| | - Panagiotis Christopoulos
- Endocrine Unit, Medical School, Aretaieion University Hospital, National and Kapodistrian University of Athens, 76 Vas. Sofias Str, PO Box 11528, Athens, Greece
| | - Eleni Kousta
- Endocrine Unit, Medical School, Aretaieion University Hospital, National and Kapodistrian University of Athens, 76 Vas. Sofias Str, PO Box 11528, Athens, Greece
| | - Minas Mastrominas
- Embryogenesis Assisted Conception Unit, Kifisias 49 Avenue, PO Box 15123, Athens, Greece
| | - Sotirios Athanaselis
- Department of Forensic Medicine and Toxicology, Medical School, National and Kapodistrian University of Athens, 75 Mikras Asias Str, PO Box 11527, Athens, Greece
| | - George Mastorakos
- Endocrine Unit, Medical School, Aretaieion University Hospital, National and Kapodistrian University of Athens, 76 Vas. Sofias Str, PO Box 11528, Athens, Greece.
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Prior salpingectomy impairs the retrieved oocyte number in in vitro fertilization cycles of women under 35 years old without optimal ovarian reserve. PLoS One 2022; 17:e0268021. [PMID: 35507603 PMCID: PMC9067640 DOI: 10.1371/journal.pone.0268021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 04/20/2022] [Indexed: 11/19/2022] Open
Abstract
Study objective The impairment of the ovarian response in in vitro fertilization (IVF) cycles after salpingectomy remains contentious. Therefore, we investigated whether a history of salpingectomy affects the number of oocytes retrieved in women undergoing IVF in comparison with the number in women without underlying tubal disease. Design Case–control study (Canadian Task Force Classification II-2). Setting A tertiary hospital–affiliated fertility center. Patients Fifty-four women aged <35 years with a history of salpingectomy and 59 age-matched women without tubal disease. Interventions Gonadotropin-releasing hormone antagonist protocol for controlled ovarian stimulation and transvaginal oocyte retrieval. Measurements and main results The antral follicle count (AFC), anti-Müllerian hormone (AMH) levels, and the number of retrieved oocytes were significantly lower in women with prior salpingectomy than in women without tubal disease. Day-3 follicle-stimulating hormone (FSH) levels, total gonadotropin dosage, and stimulation days did not significantly differ between the groups. The indications of salpingectomy (i.e., hydrosalpinx and ectopic pregnancy) did not differ significantly in terms of ovarian response or reserve among women with salpingectomy history. A history of salpingectomy and other factors related to ovarian response in IVF, such as age, AMH, AFC, day-3 FSH, and total gonadotropin dose, were significantly correlated with the number of oocytes retrieved by univariate regression analysis. In the multivariate-adjusted model after controlling all the above-mentioned variables, only AFC and AMH levels continued to exhibit significant associations with the number of retrieved oocytes. In a subgroup analysis, the negative impact of prior salpingectomy on the number of retrieved oocytes was especially significant in women with suboptimal ovarian reserves (defined as AMH < 4 ng/mL), regardless of the indication of salpingectomy or whether salpingectomy was bilateral or unilateral. Conclusion A negative effect on the number of retrieved oocytes in the subsequent IVF cycle after salpingectomy is more likely in women aged <35 years with suboptimal ovarian reserve. Nevertheless, postsurgical AMH and AFC levels still possess a more direct predictive value on ovarian response than the history of salpingectomy.
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Melcer Y, Shamir-Kaholi N, Vainer-Rotbart S, Pekar-Zlotin M, Youngster M, Gat I, Maymon R. Spontaneous pregnancy rates in infertile women after sequential hydrosonography and hysterosalpingo-foam sonography. Eur J Obstet Gynecol Reprod Biol 2022; 271:219-222. [PMID: 35231747 DOI: 10.1016/j.ejogrb.2022.02.025] [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: 12/19/2021] [Revised: 02/15/2022] [Accepted: 02/21/2022] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To determine the clinical pregnancy rate following sequential hydrosonography and hysterosalpingo-foam sonography (HyFoSy) in tubal patency assessment among women undergoing infertility work-up. STUDY DESIGN Prospective follow-up of women referred to our department between July 2019 and October 2020. Sequential hydrosonography and HyFoSy were carried out. RESULTS Out of 250 having the procedure, 100 women were excluded from study due to limited infertility, semen abnormal or not examined, evaluation for social egg freezing or they were single. Of the remaining 150 women, 48 (32%) conceived during a 10-24 months follow-up period: 17 (11%) conceived naturally and 7 (4.7%) by IUI. The mean time to conception was 5.5 ± 5.4 months and the pregnancy rate was 52% within 6 months. Among the spontaneous pregnancies 47% occurred within a month and 76% within 3 months. CONCLUSION Sequential hydrosonography and HyFoSy is a promising method for assessing the uterine cavity and tubal patency in women undergoing infertility workup. The findings suggest that the procedure may increase the chance of a spontaneous pregnancy following the procedure. Given the other known advantages of sequential hydrosonography and HyFoSy, this test is worth including in the initial workup for infertile patients.
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Affiliation(s)
- Yaakov Melcer
- Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center (formerly Assaf Harofeh Medical Center), Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Neta Shamir-Kaholi
- Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center (formerly Assaf Harofeh Medical Center), Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shirah Vainer-Rotbart
- Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center (formerly Assaf Harofeh Medical Center), Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Marina Pekar-Zlotin
- Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center (formerly Assaf Harofeh Medical Center), Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Youngster
- Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center (formerly Assaf Harofeh Medical Center), Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Itai Gat
- Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center (formerly Assaf Harofeh Medical Center), Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ron Maymon
- Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center (formerly Assaf Harofeh Medical Center), Affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Rashid D, Bardan R. Anti-mullerian Hormone Serum Level as a Predictor of Responsiveness to Clomiphene Citrate Therapy in Iraqi Women with PCOS. Open Access Maced J Med Sci 2022. [DOI: 10.3889/oamjms.2022.8691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Ovulation induction in polycystic ovarian syndrome is one of the most common interventions used in the treatment of infertility and prediction of the response is very important. Although the serum anti-mullerian hormone (AMH) concentrations are known to be a reliable predictor of ovarian response in in vitro fertilization, in women with polycystic ovary syndrome (PCOS) with a higher level of AMH ovulation induction by clomiphene citrate may be not enough to increase the level of follicle-stimulating hormone and reduce the intraovarain AMH to a level that compatible with the restoration of ovulation.
AIM: Our study aimed to identify those females who will respond to treatment and the starting dose of anti-mullerian hormone serum level as a predictor of responsiveness to clomiphene citrate therapy in Iraqi women with PCOS.
METHODS: 79 females with polycystic ovarian syndrome were included in the study. AMH serum concentrations were determined on the second or 3rd day of the early follicular phase of the menstrual cycle before initiating clomiphene citrate in the first treatment cycle.
RESULTS: The females were falling-out into two groups according to their response to treatment. The patient who ovulated had a significantly lower AMH level among responders 7.89 +−3.2 compared to non-responder 9.41 +−3.27. The women who responded at 50 mg dose had lower AMH 6.56 +−2.2 compared to women who responded at 100mg clomiphene citrate had AMH of 8.74 +−3 with optimum cutoff value for AMH is 6.25 to respond.
CONCLUSION: Serum AMH level measurement prior to treatment initiation in women with PCOS may be a useful method for predicting the outcome of clomiphene citrate treatment, and for each specific ethnic group, there is a cutoff value for AMH above which the response to clomiphene citrate is impaired.
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15
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Liu J, Kong H, Yu X, Zhou M, Liu X, Liu X, Zhang J, Liu Y, Wu S, Guan Y. The role of endometrial thickness in predicting ectopic pregnancy after in vitro fertilization and the establishment of a prediction model. Front Endocrinol (Lausanne) 2022; 13:895939. [PMID: 36157457 PMCID: PMC9493494 DOI: 10.3389/fendo.2022.895939] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 08/23/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To explore the risk factors of ectopic pregnancy after in vitro fertilization. METHODS This retrospective cohort study was conducted at the Reproductive Medical Center of the Third Affiliated Hospital of Zhengzhou University from January 2016 to April 2020. Univariate and multivariate analysis were used to analyze the related factors affecting the occurrence of ectopic pregnancy (EP) and to construct a nomographic prediction model for the incidence of ectopic pregnancy. RESULTS A total of 12,766 cycles of 10109 patients were included, comprising 214 cases of EP and 12,552 cases of intrauterine pregnancy (IUP). Multivariate logistic regression analysis showed that the tubal factor was associated with a 2-fold increased risk for EP (aOR = 2.72, 95% CI: 1.69-4.39, P < 0.0001). A stratified analysis showed that women with an endometrial thickness (EMT) between 7.6 to 12.1mm (aOR = 0.57, 95%CI: 0.36-0.90, P = 0.0153) and >12.1mm (aOR = 0.42, 95%CI: 0.24-0.74, P = 0.0026) had a significant reduction of the risk of EP compared to women with an EMT of <7.6mm. Compared to cleavage stage transfer, blastocyst transfer can reduce the risk of ectopic pregnancy (aOR = 0.36, 95%CI: 0.26-0.50, P < 0.0001). The saturation model (full mode) establishes a nomographic prediction model with an AUC = 0.68 and a sensitivity and specificity of 0.67and 0.64, respectively. The nomination model was internally verified by self-sampling method (bootstrap sampling resampling times = 500). The resulting AUC = 0.68 (sensitivity: 0.65; specificity: 0.65) showed that the model was relatively stable. CONCLUSIONS Our findings indicate that EMT is inversely proportional to the risk of EP. Embryo stage, number of embryos transferred were also significantly associated with EP rate. A simple nomogram for the predicting the risk of EP was established in order to reduce the occurrence of EP.
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Affiliation(s)
- Jing Liu
- Reproductive Medicine Center, Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Hongjiao Kong
- National Health Commission Key Laboratory of Birth Defects Prevention, Henan Institute of Reproduction Health Science and Technology, Zhengzhou, China
| | - Xiaona Yu
- Reproductive Medicine Center, Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Mengge Zhou
- Reproductive Medicine Center, Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xiaoyang Liu
- Reproductive Medicine Center, Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xinmi Liu
- Reproductive Medicine Center, Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Jianrui Zhang
- Reproductive Medicine Center, Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yanli Liu
- Reproductive Medicine Center, Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shanshan Wu
- Reproductive Medicine Center, Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yichun Guan
- Reproductive Medicine Center, Third Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- *Correspondence: Yichun Guan,
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16
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Qiang Y, Wu Y, Cai T. Clinical Significance of Increasing Pressure Curve's Slope When Injecting Ultrasound Contrast Agent During Evaluation of Fallopian Tubal Patency. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:2329-2338. [PMID: 33421176 DOI: 10.1002/jum.15616] [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: 06/28/2020] [Revised: 11/16/2020] [Accepted: 12/15/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To explore the association between Fallopian tubal patency and the slope of the increasing pressure curve for ultrasound contrast agent. MATERIALS AND METHODS A total of 136 patients underwent transvaginal 4-dimensional hysterosalpingo-contrast sonography (TVS 4D HyCoSy) between August 2015 and January 2016. We divided the patients into 3 groups according to different Fallopian tubal patency status: 71 patients (48.97%) in bilateral tubal patency group, 45 (31.03%) in unilateral tubal patency group, and 20 in bilateral tubal nonpatent group. The ultrasound contrast agent was injected and the pressure curve was recorded automatically in real time using a liquid-injecting machine that traces it as a pressure curve. The slopes of the different groups are compared through independent sample t test. RESULTS The slopes of the 3 groups were 1.242 ± 0.572, 1.472 ± 0.638, and 2.068 ± 1.236 kPa/s. A correlation was observed between the slope of the increasing pressure curve and tubal patency (R = 0.287, P < .05). The slopes differed significantly between the bilateral tubal patency group and bilateral tubal nonpatent group (P = .001) and between the unilateral tubal patency group and bilateral tubal nonpatent group (P = .012). However, the difference between the bilateral tubal patency and unilateral tubal patency groups was not significant (P = .266). CONCLUSION The increase of the injecting pressure curve's slope for contrast agent during 4D HyCoSy is associated with the nonpatent degree of the tube. This condition can be used as an objective index of tubal patency and can be a reference in diagnosis and treatment.
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Affiliation(s)
- Ye Qiang
- Department of Ultrasound, Affiliated Hospital of Nanjing University of Chinese Medicine, 155 Hanzhong Road, Qinhuai District, Nanjing 210029, Jiangsu Province, China
| | - Yiyun Wu
- Department of Ultrasound, Affiliated Hospital of Nanjing University of Chinese Medicine, 155 Hanzhong Road, Qinhuai District, Nanjing 210029, Jiangsu Province, China
| | - Ting Cai
- Department of Ultrasound, Affiliated Hospital of Nanjing University of Chinese Medicine, 155 Hanzhong Road, Qinhuai District, Nanjing 210029, Jiangsu Province, China
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17
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Anyalechi GE, Wiesenfeld HC, Kirkcaldy RD, Kissin DM, Haggerty CL, Hammond KR, Hook EW, Bernstein KT, Steinkampf MP, Geisler WM. Tubal Factor Infertility, In Vitro Fertilization, and Racial Disparities: A Retrospective Cohort in Two US Clinics. Sex Transm Dis 2021; 48:748-753. [PMID: 33833148 PMCID: PMC9012243 DOI: 10.1097/olq.0000000000001435] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Nearly 14% of US women report any lifetime infertility which is associated with health care costs and psychosocial consequences. Tubal factor infertility (TFI) often occurs as a result of sexually transmitted diseases and subsequent pelvic inflammatory disease. We sought to evaluate for and describe potential racial disparities in TFI and in vitro fertilization (IVF) prevalence. METHODS Records of women aged 19 to 42 years in our retrospective cohort from 2 US infertility clinics were reviewed. We calculated TFI prevalence, IVF initiation prevalence, and prevalence ratios (PRs), with 95% confidence intervals (CIs) for each estimate, overall and by race. RESULTS Among 660 infertile women, 110 (16.7%; 95% CI, 13.8-19.5%) had TFI which was higher in Black compared with White women (30.3% [33/109] vs 13.9% [68/489]; PR, 2.2 [95% CI, 1.5-3.1]). For women with TFI, IVF was offered to similar proportions of women by race (51.5% [17/33] vs 52.9% [36/68] for Black vs White women); however, fewer Black than White women with TFI started IVF (6.7% [1/15] vs 31.0% [9/29]; PR, 0.2 [95% CI, 0-1.0]), although the difference was not statistically different. CONCLUSIONS Tubal factor infertility prevalence was 2-fold higher among Black than White women seeking care for infertility. Among women with TFI, data suggested a lower likelihood of Black women starting IVF than White women. Improved sexually transmitted disease prevention and treatment might ameliorate disparities in TFI.
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Affiliation(s)
- Gloria E. Anyalechi
- Division of STD Prevention, Centers for Disease Control and
Prevention, Atlanta, GA
| | - Harold C. Wiesenfeld
- University of Pittsburgh School of Medicine and
Magee-Women’s Research Institute, Pittsburgh, PA
| | - Robert D. Kirkcaldy
- Division of STD Prevention, Centers for Disease Control and
Prevention, Atlanta, GA
| | - Dmitry M. Kissin
- Division of Reproductive Health, Centers for Disease
Control and Prevention, Atlanta, GA
| | - Catherine L. Haggerty
- Department of Epidemiology, University of Pittsburgh
Graduate School of Public Health, Pittsburgh, PA
- Magee-Womens Research Institute, Pittsburgh,
PA
| | | | - Edward W. Hook
- Department of Medicine, University of Alabama at
Birmingham, Birmingham, AL
| | - Kyle T. Bernstein
- Division of STD Prevention, Centers for Disease Control and
Prevention, Atlanta, GA
| | | | - William M. Geisler
- Department of Medicine, University of Alabama at
Birmingham, Birmingham, AL
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18
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Ramos J, Caligara C, Santamaría-López E, González-Ravina C, Prados N, Carranza F, Blasco V, Fernández-Sánchez M. Diagnostic Accuracy Study Comparing Hysterosalpingo-Foam Sonography and Hysterosalpingography for Fallopian Tube Patency Assessment. J Clin Med 2021; 10:jcm10184169. [PMID: 34575278 PMCID: PMC8466769 DOI: 10.3390/jcm10184169] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/03/2021] [Accepted: 09/10/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction: Simplified ultrasound-based infertility protocols that appear to provide enough information to plan effective management have been described. Thus, the objective of this study is to compare the diagnostic accuracy of the hysterosalpingo-foam sonography (HyFoSy) in tubal patency testing with the traditional hysterosalpngography (HSG) for establishing a new diagnostic strategy in infertility. Material and Methods: Prospective observational diagnostic accuracy was performed in a private fertility clinic in which 106 women undergoing a preconceptionally visit were recruited. All of them had low risk for tubal disease, had performed an HSG and were negative for Chlamydia trachomatis antibody. Main outcome measures were tubal patency and pain grade. Results: Evaluation of tubal patency by HyFoSy showed a total concordance with the results of the previous HSG in 72.6% (n = 77), and a total discordance for 4.7% (n = 6), with the inter-test agreement Kappa equal to 0.57, which means moderate concordance. Among the patients, 59.1% did not report pain during the procedure, while the remaining 48.1% indicated pain in different degrees; patients usually report less pain and only 6.6% described more pain with HyFoSy than with HSG (OR 6.57 (CI 95% 3.11–13.89)). Clinical outcomes after performing HyFoSy were not affected. Conclusions: HyFoSy is in concordance with HSG regarding tubal patency results and it is a less painful technique than HSG. HyFoSy is more economical and can be performed in an exam room only equipped with an ultrasound scanner. Based on these results, HyFoSy could be the first-choice diagnostic option to assess tubal patency in patients with low risk of tubal disease.
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Affiliation(s)
- Julia Ramos
- IVIRMA Sevilla, Avenida Américo Vespucio 19, ES-41092 Seville, Spain; (J.R.); (C.C.); (E.S.-L.); (N.P.); (F.C.); (V.B.); (M.F.-S.)
- Fundación IVI, Instituto de Investigación Sanitaria La Fe, ES-46026 Valencia, Spain
| | - Cinzia Caligara
- IVIRMA Sevilla, Avenida Américo Vespucio 19, ES-41092 Seville, Spain; (J.R.); (C.C.); (E.S.-L.); (N.P.); (F.C.); (V.B.); (M.F.-S.)
- Fundación IVI, Instituto de Investigación Sanitaria La Fe, ES-46026 Valencia, Spain
| | - Esther Santamaría-López
- IVIRMA Sevilla, Avenida Américo Vespucio 19, ES-41092 Seville, Spain; (J.R.); (C.C.); (E.S.-L.); (N.P.); (F.C.); (V.B.); (M.F.-S.)
- Fundación IVI, Instituto de Investigación Sanitaria La Fe, ES-46026 Valencia, Spain
| | - Cristina González-Ravina
- IVIRMA Sevilla, Avenida Américo Vespucio 19, ES-41092 Seville, Spain; (J.R.); (C.C.); (E.S.-L.); (N.P.); (F.C.); (V.B.); (M.F.-S.)
- Fundación IVI, Instituto de Investigación Sanitaria La Fe, ES-46026 Valencia, Spain
- Department of Molecular Biology and Biochemical Engineering, Universidad Pablo de Olavide, ES-41013 Seville, Spain
- Correspondence: ; Tel.: +34-954-286-274; Fax: +34-954-285-084
| | - Nicolás Prados
- IVIRMA Sevilla, Avenida Américo Vespucio 19, ES-41092 Seville, Spain; (J.R.); (C.C.); (E.S.-L.); (N.P.); (F.C.); (V.B.); (M.F.-S.)
- Fundación IVI, Instituto de Investigación Sanitaria La Fe, ES-46026 Valencia, Spain
- Department of Molecular Biology and Biochemical Engineering, Universidad Pablo de Olavide, ES-41013 Seville, Spain
| | - Francisco Carranza
- IVIRMA Sevilla, Avenida Américo Vespucio 19, ES-41092 Seville, Spain; (J.R.); (C.C.); (E.S.-L.); (N.P.); (F.C.); (V.B.); (M.F.-S.)
- Fundación IVI, Instituto de Investigación Sanitaria La Fe, ES-46026 Valencia, Spain
| | - Víctor Blasco
- IVIRMA Sevilla, Avenida Américo Vespucio 19, ES-41092 Seville, Spain; (J.R.); (C.C.); (E.S.-L.); (N.P.); (F.C.); (V.B.); (M.F.-S.)
- Fundación IVI, Instituto de Investigación Sanitaria La Fe, ES-46026 Valencia, Spain
| | - Manuel Fernández-Sánchez
- IVIRMA Sevilla, Avenida Américo Vespucio 19, ES-41092 Seville, Spain; (J.R.); (C.C.); (E.S.-L.); (N.P.); (F.C.); (V.B.); (M.F.-S.)
- Fundación IVI, Instituto de Investigación Sanitaria La Fe, ES-46026 Valencia, Spain
- Department of Molecular Biology and Biochemical Engineering, Universidad Pablo de Olavide, ES-41013 Seville, Spain
- Department of Surgery, Universidad de Sevilla, ES-41004 Seville, Spain
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Greydanus DE, Cabral MD, Patel DR. Pelvic inflammatory disease in the adolescent and young adult: An update. Dis Mon 2021; 68:101287. [PMID: 34521505 DOI: 10.1016/j.disamonth.2021.101287] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Pelvic inflammatory disease (PID) is an infection of the female upper genital tract that is typically polymicrobial with classic core involvement of Neisseria gonorrhoeae and/or Chlamydia trachomatis, though other endogenous flora from the vagino-cervical areas can be involved as well. It is often a sexually transmitted disease but other etiologic routes are also noted. A variety of risk factors have been identified including adolescence, young adulthood, adolescent cervical ectropion, multiple sexual partners, immature immune system, history of previous PID, risky contraceptive practices and others. An early diagnosis and prompt treatment are necessary to reduce risks of PID complications such as chronic pelvic pain, ectopic pregnancy and infertility. Current management principles of PID are also reviewed. It is important for clinicians to screen sexually active females for common sexually transmitted infections such as Chlamydia trachomatis and provide safer sex education to their adolescent and young adult patients. Clinicians should provide comprehensive management to persons with PID and utilize established guidelines such as those from the US Centers for Disease Control and Prevention (CDC).
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Affiliation(s)
- Donald E Greydanus
- Department of Pediatric and Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, 1000 Oakland Drive, Kalamazoo, Michigan, 49008, United States of America.
| | - Maria Demma Cabral
- Department of Pediatric and Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, 1000 Oakland Drive, Kalamazoo, Michigan, 49008, United States of America.
| | - Dilip R Patel
- Department of Pediatric and Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, 1000 Oakland Drive, Kalamazoo, Michigan, 49008, United States of America.
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Gu P, Yang X, Zhao X, Xu D. The value of transvaginal 4-dimensional hysterosalpingo-contrast sonography in predicting the necessity of assisted reproductive technology for women with tubal factor infertility. Quant Imaging Med Surg 2021; 11:3698-3714. [PMID: 34341743 DOI: 10.21037/qims-20-1193] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 03/20/2021] [Indexed: 12/13/2022]
Abstract
Background More than 50 million women suffer from infertility worldwide, among whom 30% have associated fallopian tube pathology. Fortunately, the diagnostic accuracy of tubal patency has been enhanced with the consistent development of ultrasound imaging technology, especially the invention of transvaginal 4-dimensional hysterosalpingo-contrast sonography (TV 4D HyCoSy). However, detailed imaging data for evaluating the tubal condition for spontaneous conception and assessing the necessity of assisted reproductive technology (ART) have yet to be amassed. Methods Patients with tubal factor infertility (TFI) who received TV 4D HyCoSy were recruited for this study. They were divided into two groups according to the method of conception: the natural pregnancy group (patients who naturally conceived within 3 months after TV 4D HyCoSy) and the assisted reproduction group (patients who failed to conceive naturally within the 3 months but successfully conceived through ART). Logistic regression analysis was performed to examine the data obtained from participants' medical history and TV 4D HyCoSy investigation. Results Of the initial 1,433 women, 348 were excluded due to exclusion criteria or lack of follow-up. A total of 1,085 TFI patients were finally included, with individuals in the natural pregnancy group accounting for 27.74% (n=301), and those in the ART group accounting for 37.33% (n=405). The age was younger and the duration of infertility was shorter in the group of women who conceive spontaneously after TV 4D HyCoSy (P<0.05). In terms of imaging data, their endometrial thickness was thinner, right fallopian tube wall was more intact, morphology of the right fallopian tube was smoother, and their ovarian motility (bilateral), fallopian tube visualization (bilateral) and overflow condition of the contrast agent from the fimbriae of fallopian tube (bilateral) were better. In addition, the resistance of the contrast agent injection was less likely to be persistent, reflux was less likely to happen and 0/1 dispersion of the contrast agent around the ovary (bilateral) were more likely to be annular (P<0.05). Conclusions The imaging data gathered from TV 4D HyCoSy in TFI patients were comprehensive, which suggested that TV 4D HyCoSy could have potential to be used to assess the necessity of post-HyCoSy ART intervention in patients with TFI. This could be of benefit in reducing the incidence of overtreatment and potential complications of ART.
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Affiliation(s)
- Pan Gu
- Department of Gynecology, Third Xiangya Hospital, Central South University, Changsha, China
| | - Xuan Yang
- Xiangya School of Medicine, Central South University, Changsha, China
| | - Xingping Zhao
- Department of Gynecology, Third Xiangya Hospital, Central South University, Changsha, China
| | - Dabao Xu
- Department of Gynecology, Third Xiangya Hospital, Central South University, Changsha, China
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Qu B, Xiong Y, Yu X, Ding J, Weng J, Yang X, Ma Y, Liu L, Yang J. Follicular Metabolites-Assisted Clinical Evaluation of IVF/ICSI Outcomes. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2021; 2021:9999659. [PMID: 34122613 PMCID: PMC8189786 DOI: 10.1155/2021/9999659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 04/15/2021] [Accepted: 04/20/2021] [Indexed: 11/17/2022]
Abstract
As infertility became a significant public health problem, assisted reproductive technologies (ARTs) were introduced. However, the fertilization rate of in vitro fertilization (IVF) per cycle varied, and patients needed to repeat IVF or change to intracytoplasmic sperm injection (ICSI). Here, 75 couples suffering from female fallopian tubal blockage (tubal group) and 42 spouses beset by male abnormal sperm status (dysspermia group) were recruited. We comprehensively explored the relationship among couples' clinical factors, follicular metabolites, and IVF/ICSI stepwise outcomes. IVF/ICSI outcomes were affected by follicular metabolites and physical status in both women and men, regardless of which side infertility came from. Particularly, in the tubal group, the energy supporting pathways-glycolysis and pyruvate metabolism-were most essential in follicles, and IVF/ICSI outcomes were also related to sperm parameters. However, in the dysspermia group, in addition to sperm conditions, oocyte quality acted as a compensation for poor sperm quality, for which aminoacyl-tRNA biosynthesis and the related supporting metabolism were critical in the follicular environment, and ultimately played a decisive role in IVF/ICSI outcomes. The respective logistic regression models in combination with selective male sperm parameters, estradiol (E2), follicular alanine, glutamine, glycoprotein, lipid, and acetic acid, were constructed to predict IVF or ICSI outcomes. No matter which sex infertility comes from, factors from both men and women should be considered. The current study provides a feasible option for pre-IVF evaluation, as well as guidance for follow-up clinical intervention to improve IVF/ICSI success rates.
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Affiliation(s)
- Bing Qu
- Reproductive Medicine Center, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Yunhe Xiong
- Urology Department, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Xiaofan Yu
- School of Pharmaceutical Sciences, Capital Medical University, Beijing, China
| | - Jinli Ding
- Reproductive Medicine Center, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
| | - Jing Weng
- School of Basic Medical Sciences, Capital Medical University, Beijing, China
| | - Xinghua Yang
- School of Public Health, Capital Medical University, Beijing, China
| | - Yanmin Ma
- Beijing Obsterics and Gynecology Hospital, Capital Medical University, Beijing, China
| | - Lingyan Liu
- School of Pharmaceutical Sciences, Capital Medical University, Beijing, China
| | - Jing Yang
- Reproductive Medicine Center, Renmin Hospital of Wuhan University, Wuhan, Hubei Province, China
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Coscia A, Bardanzellu F, Caboni E, Fanos V, Peroni DG. When a Neonate Is Born, So Is a Microbiota. Life (Basel) 2021; 11:life11020148. [PMID: 33669262 PMCID: PMC7920069 DOI: 10.3390/life11020148] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/09/2021] [Accepted: 02/11/2021] [Indexed: 02/06/2023] Open
Abstract
In recent years, the role of human microbiota as a short- and long-term health promoter and modulator has been affirmed and progressively strengthened. In the course of one’s life, each subject is colonized by a great number of bacteria, which constitute its specific and individual microbiota. Human bacterial colonization starts during fetal life, in opposition to the previous paradigm of the “sterile womb”. Placenta, amniotic fluid, cord blood and fetal tissues each have their own specific microbiota, influenced by maternal health and habits and having a decisive influence on pregnancy outcome and offspring outcome. The maternal microbiota, especially that colonizing the genital system, starts to influence the outcome of pregnancy already before conception, modulating fertility and the success rate of fertilization, even in the case of assisted reproduction techniques. During the perinatal period, neonatal microbiota seems influenced by delivery mode, drug administration and many other conditions. Special attention must be reserved for early neonatal nutrition, because breastfeeding allows the transmission of a specific and unique lactobiome able to modulate and positively affect the neonatal gut microbiota. Our narrative review aims to investigate the currently identified pre- and peri-natal factors influencing neonatal microbiota, before conception, during pregnancy, pre- and post-delivery, since the early microbiota influences the whole life of each subject.
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Affiliation(s)
- Alessandra Coscia
- Neonatology Unit, Department of Public Health and Pediatrics, Università degli Studi di Torino, 10124 Turin, Italy;
| | - Flaminia Bardanzellu
- Neonatal Intensive Care Unit, Department of Surgical Sciences, AOU and University of Cagliari, SS 554 km 4,500, 09042 Monserrato, Italy; (E.C.); (V.F.)
- Correspondence:
| | - Elisa Caboni
- Neonatal Intensive Care Unit, Department of Surgical Sciences, AOU and University of Cagliari, SS 554 km 4,500, 09042 Monserrato, Italy; (E.C.); (V.F.)
| | - Vassilios Fanos
- Neonatal Intensive Care Unit, Department of Surgical Sciences, AOU and University of Cagliari, SS 554 km 4,500, 09042 Monserrato, Italy; (E.C.); (V.F.)
| | - Diego Giampietro Peroni
- Clinical and Experimental Medicine Department, Section of Pediatrics, University of Pisa, Via Roma, 55, 56126 Pisa PI, Italy;
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Chinta P, Antonisamy N, Reddy N, Waanbah B, Samadhiya R, Aleyamma TK, Antonisamy B, Kamath M. Role of hysterosalpingography in diagnosing tubal blockage – A prospective diagnostic study. J Hum Reprod Sci 2021; 14:386-391. [PMID: 35197684 PMCID: PMC8812393 DOI: 10.4103/jhrs.jhrs_92_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 08/13/2021] [Accepted: 10/26/2021] [Indexed: 11/04/2022] Open
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Engels V, Medina M, Antolín E, Ros C, Amaro A, De-Guirior C, Manzour N, Sotillo L, De la Cuesta R, Rodríguez R, San-Frutos L, Peralta S, Martin-Martínez A, Alcázar JL. Feasibility, tolerability, and safety of hysterosalpingo-foam sonography (hyfosy). multicenter, prospective Spanish study. J Gynecol Obstet Hum Reprod 2020; 50:102004. [PMID: 33242678 DOI: 10.1016/j.jogoh.2020.102004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Revised: 11/14/2020] [Accepted: 11/19/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To determine the feasibility,tolerability, and safety of the ultrasound assessment of tubal patency using foam as contrast. METHODS This was a prospective multicenter study of 915 infertile nulliparous women scheduled for sonohysterosalpingography with foam instillation (HYFOSY) for tubal patency testing as a part of the fertility workup. Clinical and sonographic data were recorded into a web-shared database. Tubal patency, cervical catheterization, pain during the procedure and post-procedural complications were collected. Patients reported discomfort or pain experienced during the procedure with a visual analogue scale (VAS) score. RESULTS Nine hundred fifteen women were included in the final analysis. Median age was 34 (range, 21-45) years and median body mass index was 23 (range, 16-41) kg/m2. Of 839 women, only 8(0.95 %) cases were abandoned due to impossibility of introducing the intracervical catheter. Most of the cervical os were easily cannulated with either paediatric nasogastric probes or special catheter for intrauterine insemination / sonohysterosalpingography 688/914(75.3 %). With a median instillation of 4 mL (range 1-16) of foam, both tubes were identified in 649/875 (70.9 %) patients, while unilateral patency was observed in 190/875 (20.8 %). Only 36/875 (3.9 %) of the women had bilateral tubal obstruction. The median VAS score for perception of pain during HyFoSy examination was 2 (range 0-10), and only 17 (1.9 %) of women reported severe pain (VAS ≥ 7). Pain was unrelated to tubal patency or tubal blockage. Unexpectedly, difficult cervical catheterizations that needed tenaculum, were more likely associated with mild pain during procedure [nasogastric probe group 176/289 (70.9 %) vs. insemination catheter group 166/399 (41.6 %) vs. tenaculum group 190/218(87.2 %) p < 0.001]. Finally, among 915 patients, we only noticed 3 (0.32 %) complications of the technique: two vasovagal episodes and a mild urinary infection. CONCLUSION HYFOSY is a feasible, well-tolerated and safe technique for the evaluation of tubal patency in infertile women.
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Affiliation(s)
- V Engels
- Hospital Universitario Puerta de Hierro Majadahonda, Spain.
| | - M Medina
- Hospital Materno Infantil Las Palmas de Gran Canaria, Spain
| | - E Antolín
- Hospital Materno Infantil La Paz, Spain
| | - C Ros
- Hospital Clinic Barcelona, Spain
| | - A Amaro
- Hospital Materno Infantil Las Palmas de Gran Canaria, Spain
| | - C De-Guirior
- Hospital Materno Infantil La Paz, Spain; Hospital Clinic Barcelona, Spain
| | - N Manzour
- Clínica Universitaria De Navarra, Spain
| | - L Sotillo
- Hospital Materno Infantil La Paz, Spain
| | - R De la Cuesta
- Hospital Universitario Puerta de Hierro Majadahonda, Spain
| | | | - L San-Frutos
- Hospital Universitario Puerta de Hierro Majadahonda, Spain
| | - S Peralta
- Hospital Materno Infantil Las Palmas de Gran Canaria, Spain
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Fallopian tube endometriosis in women undergoing operative video laparoscopy and its clinical implications. Fertil Steril 2020; 114:1040-1048. [PMID: 32826047 DOI: 10.1016/j.fertnstert.2020.05.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 05/12/2020] [Accepted: 05/18/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To determine the incidence of fallopian tube endometriosis in patients undergoing laparoscopic surgery with a preoperative diagnosis of endometriosis, pelvic pain, infertility, or cystic adnexal mass. DESIGN Retrospective cross-sectional study. SETTING Gynecologic oncology and minimally invasive surgery practice. PATIENT(S) All patients who underwent surgery for endometriosis from July 2015 to June 2018 were included. Exclusion criteria were age ≥55 years, diagnosis of cancer, laparotomy, previous bilateral salpingectomy, and preoperative diagnosis other than endometriosis, pelvic pain, infertility, or cystic adnexal mass. INTERVENTION(S) Subjects were divided by those who did and those who did not have a salpingectomy at the time of surgery. MAIN OUTCOME MEASURE(S) Diagnosis of tubal endometriosis was based on macroscopic evidence of endometrial implants on the fallopian tube(s) noted within the operative report and microscopic evidence of endometriosis noted within the pathology report. RESULT(S) A total of 444 surgeries were performed and 185 met the study criteria. Among those, 153 (82.7%) had histologically diagnosed endometriosis within the abdominopelvic cavity. The incidence of tubal endometriosis was 11%-12% macroscopically and 42.5% microscopically after salpingectomy. Patients with tubal endometriosis were more likely to have severe disease. CONCLUSION(S) Among patients with endometriosis, the incidence of microscopic tubal endometriosis was significantly greater than that of macroscopic disease.
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Screening of Chlamydia trachomatis and Waddlia chondrophila Antibodies in Women with Tubal Factor Infertility. Microorganisms 2020; 8:microorganisms8060918. [PMID: 32560559 PMCID: PMC7355871 DOI: 10.3390/microorganisms8060918] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 06/08/2020] [Accepted: 06/12/2020] [Indexed: 11/29/2022] Open
Abstract
Waddlia chondrophila is an emerging intracellular pathogen belonging to the order of Chlamydiales, and was previously associated with adverse pregnancy outcomes, as well as tubal factor infertility (TFI). In this study, we investigate the link between both W. chondrophila and Chlamydia trachomatis IgG seropositivity and TFI. Antibodies against both bacteria were measured in 890 serum samples of women visiting a fertility clinic. After a hysterosalpingography and/or laparoscopy, they were classified as either TFI-negative (TFI−) or TFI-positive (TFI+). The total seroprevalence was 13.4% for C. trachomatis and 38.8% for W. chondrophila. C. trachomatis antibodies were present significantly more often in the TFI+ group than in the TFI− group, while for W. chondrophila no difference could be observed. In conclusion, our study confirms the association between C. trachomatis seropositivity and TFI, but no association was found between W. chondrophila seropositivity and TFI. The high percentage of W. chondrophila seropositivity in all women attending a fertility clinic does, however, demonstrate the need for further research on this Chlamydia-like bacterium and its possible role in infertility.
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27
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Liu C, Su K, Tian M, Ji H, Sun L, Li C, Zhou X. Effects of three abnormal conditions of fallopian tube on outcomes of the in vitro fertilization and embryo transfer technique. J Obstet Gynaecol Res 2020; 46:1412-1418. [PMID: 32500588 DOI: 10.1111/jog.14306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 04/09/2020] [Accepted: 04/30/2020] [Indexed: 01/15/2023]
Abstract
AIM The aim of this study was to demonstrate whether salpingitis affects the outcomes of in vitro fertilization and embryo transfer (IVF-ET). METHODS The retrospective study includes patients from 2013 to 2018 who received their first IVF-ET treatment during this period. On the basis of their tubal conditions, the patients were subgrouped as: hydrosalpinx (group A), salpingitis (group B), tubal occlusion (group C). It had a total of 726 cycles, of which 208 cycles were in group A, 201 cycles in group B and 317 cycles in group C. The outcomes of the IVF-ET treatment were compared amongst the three groups. RESULTS Group C had the highest number of retrieved oocytes as compared to the groups A and B, and the rate of the high-quality embryos at day 3 (66-68 h after insemination) was higher in the groups C and A compared to the group B. The blastocyst formation rate was significantly higher in group C compared to that of the group B. Group C had higher rates of implantation, clinical pregnancy and live birth compared to both groups A and B, while the birth weight of newborns did not differ amongst the three groups. CONCLUSION Salpingitis has adverse effects on the success rate of the IVF-ET treatment, exemplified by lower implantation, clinical pregnancy and live birth rates compared to tubal occlusion, it may be necessary to carry out appropriate management of salpingitis before IVF-ET treatment.
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Affiliation(s)
- Chengjun Liu
- College of Animal Sciences, Jilin University, Changchun, China
| | - Ketong Su
- Reproductive Medical Center, Zhanjiang Jiuhe Hospital, Zhanjiang, China
| | - Meng Tian
- College of Animal Sciences, Jilin University, Changchun, China
| | - Huili Ji
- Reproductive Medical Center, Zhanjiang Jiuhe Hospital, Zhanjiang, China
| | - Lina Sun
- Reproductive Medical Center, Department of Obstetrics and Gynecology, The Second Hospital of Jilin University, Changchun, China
| | - Chunjin Li
- College of Animal Sciences, Jilin University, Changchun, China
| | - Xu Zhou
- College of Animal Sciences, Jilin University, Changchun, China
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Merritt BA, Behr SC, Khati NJ. Imaging of Infertility, Part 1: Hysterosalpingograms to Magnetic Resonance Imaging. Radiol Clin North Am 2020; 58:215-225. [PMID: 32044003 DOI: 10.1016/j.rcl.2019.10.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Infertility, or subfertility, is the inability to achieve a clinical pregnancy after a 1-year period of regular unprotected sexual intercourse in women younger than 35 and after 6 months in women older than 35. Although initial assessment involves a multitude of factors, including a detailed medical history, physical examination, semen analysis, and hormonal evaluation, diagnostic imaging of the female partner often plays an important role in establishing the etiology for infertility. This article provides an overview of the multimodality imaging assessment of female infertility and details the developmental and acquired pelvic abnormalities in which diagnostic imaging aids in evaluation.
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Affiliation(s)
- Bryce A Merritt
- Diagnostic Radiology, UCSF Department of Radiology & Biomedical Imaging, 505 Parnassus Avenue, Moffitt, Suite 307H, San Francisco, CA 94143, USA
| | - Spencer C Behr
- UCSF Department of Radiology & Biomedical Imaging, 505 Parnassus Avenue, Moffitt, Suite 307H, San Francisco, CA 94143, USA
| | - Nadia J Khati
- Department of Radiology, Abdominal Imaging Section, The George Washington University Hospital, 900 23rd Street, Northwest, Washington, DC 20037, USA.
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Litzky JF, Marsit CJ. Epigenetically regulated imprinted gene expression associated with IVF and infertility: possible influence of prenatal stress and depression. J Assist Reprod Genet 2019; 36:1299-1313. [PMID: 31127477 PMCID: PMC6642239 DOI: 10.1007/s10815-019-01483-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 05/09/2019] [Indexed: 12/28/2022] Open
Abstract
PURPOSE Despite the growing body of research implying an impact of in vitro fertilization (IVF) on imprinted genes and epigenetics, few studies have examined the effects of underlying subfertility or prenatal stress on epigenetics, particularly in terms of their role in determining infant birthweights. Both subfertility and prenatal stressors have been found to impact epigenetics and may be confounding the effect of IVF on epigenetics and imprinted genes. Like IVF, both of these exposures-infertility and prenatal stressors-have been associated with lower infant birthweights. The placenta, and specifically epigenetically regulated placental imprinted genes, provides an ideal but understudied mechanism for evaluating the relationship between underlying genetics, environmental exposures, and birthweight. METHODS AND RESULTS In this review, we discuss the impacts of IVF and infertility on birthweight, epigenetic mechanisms and genomic imprinting, and the role of these mechanisms in the IVF population and discuss the role and importance of the placenta in infant development. We then highlight recent work on the relationships between infertility, IVF, and prenatal stressors in terms of placental imprinting. CONCLUSIONS In combination, the studies discussed, as well as two recent projects of our own on placental imprinted gene expression, suggest that lower birthweights in IVF infants are secondary to a combination of exposures including the infertility and prenatal stress that couples undergoing IVF are experiencing. The work highlighted herein emphasizes the need for appropriate control populations that take infertility into account and also for consideration of prenatal psychosocial stressors as confounders and causes of variation in IVF infant outcomes.
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Affiliation(s)
- Julia F Litzky
- Department of Epidemiology, Geisel School of Medicine at Dartmouth College, Hanover, NH, 03755, USA
| | - Carmen J Marsit
- Department of Environmental Health, Rollins School of Public Health, Emory University, 1518 Clifton Road, CNR 202, Atlanta, GA, 30322, USA.
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Yuan L, Jingying H, Xiujuan C, Chengying L, Xiaochen H, Xiumei X, Yulong Z, Zihua C. Predictive value of a modified classification of fallopian tube status on prognosis of tubal factor infertility after laparoscopic surgery. Medicine (Baltimore) 2019; 98:e14952. [PMID: 30921195 PMCID: PMC6455906 DOI: 10.1097/md.0000000000014952] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Built on 2 existing classification systems, this study was to develop a new classification system to better predict the pregnancy prognosis after laparoscopic surgery in patients with tubal factor infertility and accordingly propose a management strategy.We followed up 423 patients suffering from tubal factor infertility who had undergone hysteroscopic-laparoscopic surgery for 2 years without in vitro fertilization and embryo transfer (IVF/ET). Based on the operative reports, a new, modified classification of fallopian tube status (hereafter referred to as the modified classification) was developed with reference to the 2 existing classification systems (the r-AFS classification of pelvic adhesions and the scoring system of distal tubal obstruction). A score of 0 to 3 was assigned to each of the 4 factors (tubal wall consistency, hydrosalpinx, pelvic adhesions, and tubal patency) for each of the tubes with a total bilateral score of 0 to 24. The patients were classified for the abnormalities of the fallopian tubes into 3 groups: mild (<8), moderate (8-15) and severe (>15). By utilizing SPSS 20.0 Statistic Analysis Software, the data were analyzed with t test, Chi-Square test, ANOVA or ROC as appropriate.Each of the 4 factors of the modified classification was independently and closely associated with post-surgical prognosis (P < .05). There was a statistically significant difference in postoperative pregnancy prognosis among the 3 groups of patients (P < .05). Patients with a score of <8 (mild) had the highest intrauterine pregnancy rate, reaching 60.1%. In contrast, patients with a score of 8 to 15 (moderate) had a significant increase in ectopic pregnancy (21.5%), while patients with a score of >15 (severe) had a significantly increased infertility rate of 89.5%. When the pregnancy outcomes were divided into intrauterine pregnancy and other outcomes, the modified classification had the largest area under the ROC curve (0.569) (P < .05). With the optimum cutoff of 4.5, the sensitivity was 88.6%, specificity was 74.5% and accuracy was 63.1%.The modified classification of fallopian tube status is a simple and practical scoring system which can comprehensively and effectively evaluate the function of the fallopian tube and thus is more accurate than the other 2 systems in predicting the postoperative pregnancy outcomes.
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Affiliation(s)
- Lin Yuan
- Department of Obstetrics and Gynecology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian
| | - Huang Jingying
- Department of Obstetrics and Gynecology, First Hosipital of Quanzhou Affiliated to Fujian Medical University, Quanzhou, China
| | - Chen Xiujuan
- Department of Obstetrics and Gynecology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian
| | - Lian Chengying
- Department of Obstetrics and Gynecology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian
| | - Huang Xiaochen
- Department of Obstetrics and Gynecology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian
| | - Xiong Xiumei
- Department of Obstetrics and Gynecology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian
| | - Zhang Yulong
- Department of Obstetrics and Gynecology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian
| | - Chen Zihua
- Department of Obstetrics and Gynecology, Fujian Provincial Maternity and Children's Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian
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Castiglione Morelli MA, Iuliano A, Schettini SCA, Petruzzi D, Ferri A, Colucci P, Viggiani L, Cuviello F, Ostuni A. NMR metabolic profiling of follicular fluid for investigating the different causes of female infertility: a pilot study. Metabolomics 2019; 15:19. [PMID: 30830455 DOI: 10.1007/s11306-019-1481-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 01/21/2019] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Several metabolomics studies have correlated follicular fluid (FF) metabolite composition with oocyte competence to fertilization, embryo development and pregnancy but there is a scarcity of research examining the metabolic effects of various gynaecological diseases. OBJECTIVES In this study we aimed to analyze and correlate the metabolic profile of FF from women who were following in vitro fertilization (IVF) treatments with their different infertility pathologies. METHODS We selected 53 women undergoing IVF who were affected by: tubal diseases, unexplained infertility, endometriosis, polycystic ovary syndrome (PCOS). FF of the study participants was collected at the time of oocytes retrieval. Metabolomic analysis of FF was performed by nuclear magnetic resonance (NMR) spectroscopy. RESULTS FF presents some significant differences in various infertility pathologies. Although it was not possible to discriminate between FF of control participants and women with tubal diseases and unexplained infertility, comparison of FF metabolic profile from control women with patients with endometriosis and PCOS revealed significant differences in some metabolites that can be correlated to the causes of infertility. CONCLUSION NMR-based metabolic profiling may be successfully applied to find diagnostic biomarkers for PCOS and endometriosis and it might be also used to predict oocyte developmental potential and subsequent outcome.
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Affiliation(s)
| | - Assunta Iuliano
- Center for Reproductive Medicine of "San Carlo" Hospital, via Potito Petrone, 85100, Potenza, Italy
| | | | - Donatina Petruzzi
- Center for Reproductive Medicine of "San Carlo" Hospital, via Potito Petrone, 85100, Potenza, Italy
| | - Angela Ferri
- Center for Reproductive Medicine of "San Carlo" Hospital, via Potito Petrone, 85100, Potenza, Italy
| | - Paola Colucci
- Center for Reproductive Medicine of "San Carlo" Hospital, via Potito Petrone, 85100, Potenza, Italy
| | - Licia Viggiani
- Department of Sciences, University of Basilicata, viale Ateneo Lucano 10, 85100, Potenza, Italy
| | - Flavia Cuviello
- Department of Sciences, University of Basilicata, viale Ateneo Lucano 10, 85100, Potenza, Italy
| | - Angela Ostuni
- Department of Sciences, University of Basilicata, viale Ateneo Lucano 10, 85100, Potenza, Italy.
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Farquhar CM, Bhattacharya S, Repping S, Mastenbroek S, Kamath MS, Marjoribanks J, Boivin J. Female subfertility. Nat Rev Dis Primers 2019; 5:7. [PMID: 30679436 DOI: 10.1038/s41572-018-0058-8] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Subfertility is common and affects one in six couples, half of whom lack an explanation for their delay in conceiving. Developments in the diagnosis and treatment of subfertility over the past 50 years have been truly remarkable. Indeed, current generations of couples with subfertility are more fortunate than previous generations, as they have many more opportunities to become parents. The timely access to effective treatment for subfertility is important as many couples have a narrow window of opportunity before the age-related effects of subfertility limit the likelihood of success. Assisted reproduction can overcome the barriers to fertility caused by tubal disease and low sperm count, but little progress has been made in reducing the effect of increasing age on ovarian function. The next 5-10 years will likely see further increases in birth rates in women with subfertility, a greater awareness of lifestyle factors and a possible refinement of current assisted reproduction techniques and the development of new ones. Such progress will bring challenging questions regarding the potential benefits and harms of treatments involving germ cell manipulation, artificial gametes, genetic screening of embryos and gene editing of embryos. We hope to see a major increase in fertility awareness, access to safe and cost-effective fertility care in low-income countries and a reduction in the current disparity of access to fertility care.
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Affiliation(s)
- Cynthia M Farquhar
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand.
| | - Siladitya Bhattacharya
- College of Biomedical and Life Sciences, Cardiff University School of Medicine, Cardiff, UK
| | - Sjoerd Repping
- Amsterdam UMC, University of Amsterdam, Center for Reproductive Medicine, Amsterdam Reproduction & Development research institute, Amsterdam, Netherlands
| | - Sebastiaan Mastenbroek
- Amsterdam UMC, University of Amsterdam, Center for Reproductive Medicine, Amsterdam Reproduction & Development research institute, Amsterdam, Netherlands
| | - Mohan S Kamath
- Department of Reproductive Medicine, Christian Medical College, Vellore, India
| | - Jane Marjoribanks
- Department of Obstetrics and Gynaecology, University of Auckland, Auckland, New Zealand
| | - Jacky Boivin
- School of Psychology, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
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Shi W, Zhou H, Tian L, Zhao Z, Zhang W, Shi J. Cumulative Live Birth Rates of Good and Low Prognosis Patients According to POSEIDON Criteria: A Single Center Analysis of 18,455 Treatment Cycles. Front Endocrinol (Lausanne) 2019; 10:409. [PMID: 31293519 PMCID: PMC6606694 DOI: 10.3389/fendo.2019.00409] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 06/07/2019] [Indexed: 12/15/2022] Open
Abstract
Objective: To investigate the characteristics and outcomes of low prognosis patients defined by POSEIDON criteria undergoing IVF treatment. Design: Retrospective cohort analysis. Setting: An IVF clinic in a public hospital. Patients: 18,455 fresh aspirated IVF cycles with subsequently frozen embryo transfer from Jan 2014 to Jan 2017 in a single IVF clinic were included in the analysis. The low prognosis patients were categorized into 4 groups based on POSEIDON criteria: group 1: age < 35, antral follicle count (AFC) ≥ 5, number of oocytes retrieved ≤ 9 in the previous cycle; group 2: age ≥ 35, AFC≥5, number of oocytes retrieved ≤ 9 in the previous cycle; group 3: age < 35, AFC < 5; group 4: age ≥ 35, AFC < 5. The non-low prognosis patients: group 5: AFC ≥ 5, previous number of oocytes retrieved > 9 oocytes; group 6: AFC ≥ 5, no previous ovarian stimulation. Intervention(s): None. Main Outcome Measure: The primary outcome was cumulative live birth rate (CLBR). Result(s): Taking group 1 as reference, the CLBR from young women in group 3 (35.5%, OR 0.9, 95% CI 0.7-1.2) was slightly lower than that in group 1 (44.6%, p = 0.615). The CLBR in group 2 (24.5%, OR 0.6, 95% CI 0.4-0.8, p = 0.004) and group 4 (12.7%, OR 0.4, 95% CI 0.3-0.6, p < 0.001) was significant lower than that in group 1. In non-poor prognosis patients, the CLBR from young women in group 5 (53.5% OR 1.3 95% CI 0.9, 1.7, p = 0.111) was a slight higher than the reference group 1 while the highest CLBR was originated from the first IVF patients with good ovarian reserve in group 6 (66.9%, OR 2.0, 95% CI 1.6, 2.4). Conclusion(s): The CLBRs and implantation rates in the young women (group 3) with diminished ovarian reserve was similar in those young women (group 1), and was significantly higher than in advanced age women with a fair ovarian reserve (group 2). Though patients in group 2 had better ovarian reserve, more oocytes and more embryos, the pregnancy outcome was inferior to that of group 3 patients with poorer ovarian reserve, fewer oocytes and fewer embryos.
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Affiliation(s)
- Wenhao Shi
- The Assisted Reproduction Center, Northwest Women's and Children's Hospital, Xi'an, China
| | - Hanying Zhou
- The Assisted Reproduction Center, Northwest Women's and Children's Hospital, Xi'an, China
| | - Li Tian
- The Assisted Reproduction Center, Northwest Women's and Children's Hospital, Xi'an, China
| | - Zhenghao Zhao
- The Assisted Reproduction Center, Northwest Women's and Children's Hospital, Xi'an, China
| | - Wei Zhang
- Department of Respiratory Medicine, Shaanxi Provincial People's Hospital, Xi'an, China
- *Correspondence: Wei Zhang
| | - Juanzi Shi
- The Assisted Reproduction Center, Northwest Women's and Children's Hospital, Xi'an, China
- Juanzi Shi
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Bracewell-Milnes T, Saso S, Nikolaou D, Norman-Taylor J, Johnson M, Thum MY. Investigating the effect of an abnormal cervico-vaginal and endometrial microbiome on assisted reproductive technologies: A systematic review. Am J Reprod Immunol 2018; 80:e13037. [DOI: 10.1111/aji.13037] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Accepted: 07/25/2018] [Indexed: 12/26/2022] Open
Affiliation(s)
- Timothy Bracewell-Milnes
- Division of Surgery and Cancer; Institute of Developmental Reproductive & Developmental Biology; Imperial College London; London UK
| | - Srdjan Saso
- Division of Surgery and Cancer; Institute of Reproductive & Developmental Biology; Imperial College London; London UK
| | - Dimitrios Nikolaou
- Assisted Conception Unit; Chelsea and Westminster Hospital Campus; London UK
| | | | - Mark Johnson
- Division of Surgery and Cancer; Institute of Developmental Reproductive & Developmental Biology; Imperial College London; London UK
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Al-Jaroudi D, Aldughayyim AA, Alshamry WS, Alrashidi AS, Bahnassy AA. Hysterosalpingogram findings among subfertile women undergoing assisted reproductive technology. Int J Womens Health 2018; 10:431-436. [PMID: 30147380 PMCID: PMC6097507 DOI: 10.2147/ijwh.s156157] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
PURPOSE The objectives of our study included comparing reproductive histories and causes of infertility between patients with and without a hysterosalpingogram (HSG) investigation, and summarizing the prevalence and extent of tubal abnormalities among patients who underwent HSG. Outcomes following assisted reproductive technology (ART) were compared between HSG and non-HSG groups. MATERIALS AND METHODS A cross-sectional study was conducted to review the medical records of 200 Saudi women with subfertility. In addition to information on HSG, patient data extracted included age, body mass index (BMI), infertility duration, miscarriage experience, parity, cause of infertility, and history of previous surgery, ectopic pregnancy, endometriosis, tubal surgery, pelvic inflammatory disease (PID), in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), pregnancy, and live birth. RESULTS One hundred and ninety six (98.0%) patients had either IVF (n=18; 9.0%) or ICSI (n=178; 89.0%) performed; ICSI was performed in 157 (90%) and 21 (81%) patients. Of the 12 women with tubal factor who did not undergo HSG, 3 (25.0%) became pregnant after ART, 8 (66.7%) did not, and the status of 1 (8.3%) is yet unknown. CONCLUSIONS Our study aimed to contribute to resolving the debate regarding the continuing role of HSG in an environment where ART has become established as a successful approach to treat infertility. Most of the HSGs were done as per the attending physician's discretion, and not according to any specific policy.
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Affiliation(s)
- Dania Al-Jaroudi
- Reproductive Endocrine and Infertility Medicine Department, King Fahad Medical City, Riyadh, Saudi Arabia,
| | | | | | | | - Ahmed A Bahnassy
- Faculty of Medicine, King Fahad Medical City, Riyadh, Saudi Arabia
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Varga I, Kachlík D, Žišková M, Miko M. Lymphatic lacunae of the mucosal folds of human uterine tubes - A rediscovery of forgotten structures and their possible role in reproduction. Ann Anat 2018; 219:121-128. [PMID: 29990591 DOI: 10.1016/j.aanat.2018.06.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 06/04/2018] [Accepted: 06/21/2018] [Indexed: 11/29/2022]
Abstract
The mucosa of uterine tube forms multiple and branched longitudinal mucosal folds and takes part in many reproduction events, such as oocyte pick-up, gamete transport, sperm capacitation, fertilization, and early embryonic development. In the habilitation thesis of German physician Paul Kroemer (1904) was the first to describe the lymphatic lacunae inside the tubal folds (by injection of Indian ink), which the author named the öLymphbahnen" (ölymphatic channels"). Despite the fact that this first description has existed for 110 years, there is no mention of these lacunae in most of the current literature. In this article we present a rediscovery of completely overlooked morphological structures of uterine tubes - the lymphatic lacunae in their mucosal folds. The specimens from the uterine tubes were taken from 72 women (mean age 46.25 years) who underwent transabdominal or laparoscopic salpingectomy. The tissue samples from anatomically different parts of the uterine tubes were used for hematoxylin and eosin staining and for immunohistochemistry. Primary antibodies were used to label and detect podoplanin D2-40, a selective marker of lymphatic endothelia, CD34 antigen, and von Willebrand factor (Factor VIII). In the histological slides of the uterine tubes, there were noticeable slits or gaps within the loose connective tissue of the lamina propria of the mucosal folds. They were lined with one layer of squamous endothelial cells. These öempty spaces" were most prominent in the fimbriae, but were still well recognizable in mucosal folds of the ampulla. They always run through the central part of the fold. As a results of immunohistochemistry, we confirmed that in the centre of every mucosal fold, as well as in the fimbriae of the uterine tubes, dilated lymphatic spaces were situated and were lined with a simple layer of lymphatic endothelial cells (positive for podoplanin and CD34, and negative for Factor VIII). As there is no mention on them in the current Terminologia Histologica, we proposed the term ölymphatic lacunae of tubal mucosal folds and fimbriae" in English and ölacunae lymphaticae plicae mucosae et fimbriae" in Latin. According to our hypothesis, these lymphatic lacunae may be responsible for the thickening of the fimbriae during the oocyte pick-up and the maintenance of the tubal fluid.
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Affiliation(s)
- Ivan Varga
- Institute of Histology and Embryology, Faculty of Medicine, Comenius University in Bratislava, Sasinkova Street 4, 811 08 Bratislava, Slovakia.
| | - David Kachlík
- Department of Anatomy, Second Faculty of Medicine, Charles University, U nemocnice 3, 128 00 Prague, Czech Republic
| | - Marianna Žišková
- Institute of Histology and Embryology, Faculty of Medicine, Comenius University in Bratislava, Sasinkova Street 4, 811 08 Bratislava, Slovakia; Department of Gynaecology and Obstetrics, ForLife General Hospital,Mederská Street 39, 945 75 Komárno, Slovakia
| | - Michal Miko
- Institute of Histology and Embryology, Faculty of Medicine, Comenius University in Bratislava, Sasinkova Street 4, 811 08 Bratislava, Slovakia
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Promberger R, Simek IM, Nouri K, Obermaier K, Kurz C, Ott J. Accuracy of Tubal Patency Assessment in Diagnostic Hysteroscopy Compared with Laparoscopy in Infertile Women: A Retrospective Cohort Study. J Minim Invasive Gynecol 2017; 25:794-799. [PMID: 29221993 DOI: 10.1016/j.jmig.2017.11.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 11/21/2017] [Accepted: 11/29/2017] [Indexed: 11/17/2022]
Abstract
STUDY OBJECTIVE To evaluate whether the presence of a visualizable "flow" effect in the fallopian tube ostia in hysteroscopic routine evaluation is predictive of tube patency. DESIGN A retrospective cohort study (Canadian Task Force Classification II-2). SETTING Data from all patients who underwent surgery because of infertility at the study center between 2008 and 2016 were analyzed retrospectively. The main outcome parameter was fallopian tube patency as assessed by laparoscopic chromopertubation. The predictive parameters tested were the presence of hysteroscopic tube "flow," general patient characteristics, and intraoperative findings. PATIENTS Five hundred eleven infertile women who underwent combined hysteroscopy and laparoscopy were included. INTERVENTIONS All women underwent combined hysteroscopy and laparoscopy. Some had other interventions when necessary, but no additional interventions were taken because of this study. RESULTS In an analysis of 998 fallopian tubes, the hysteroscopic assessment of fallopian tube "flow" was highly accurate in predicting fallopian tube patency (p < .001), with a sensitivity of 86.4% (95% confidence interval [CI], 83.7-88.8) and a specificity of 77.6% (95% CI, 72.1-82.5). Risk factors for a false-negative hysteroscopy result were the presence of uterine myomas (odds ratio [OR] = 2.11; 95% CI, 1.10-4.05; p = .025), the presence of a hydrosalpinx on the analyzed side (OR = 2.50, 95% CI, 1.17-5.34; p = .019), and the presence of peritubal adhesions surrounding the analyzed tube (OR = 2.87; 95% CI, 1.21-6.76; p = .016). CONCLUSION A visualizable tube "flow" in hysteroscopy was accurate in the prediction of tubal patency, with a positive predictive value of about 91%. Knowledge about hysteroscopic fallopian tube "flow" can help to plan the future approach in an individual patient.
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Affiliation(s)
- Regina Promberger
- Department of Gynecological Endocrinology and Reproductive Medicine, Medical University of Vienna, Vienna, Austria; Department of Obstetrics and Gynecology, Saint John of God Hospital Eisenstadt, Burgenland, Austria
| | - Inga-Malin Simek
- Department of Gynecological Endocrinology and Reproductive Medicine, Medical University of Vienna, Vienna, Austria
| | - Kazem Nouri
- Department of Gynecological Endocrinology and Reproductive Medicine, Medical University of Vienna, Vienna, Austria
| | - Karin Obermaier
- Department of Gynecological Endocrinology and Reproductive Medicine, Medical University of Vienna, Vienna, Austria; Department of Neurology, Krankenhaus Mistelbach, Lower Austria, Austria
| | - Christine Kurz
- Department of Gynecological Endocrinology and Reproductive Medicine, Medical University of Vienna, Vienna, Austria
| | - Johannes Ott
- Department of Gynecological Endocrinology and Reproductive Medicine, Medical University of Vienna, Vienna, Austria.
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Li Z, Zhang Z, Ming WK, Chen X, Xiao XM. Tracing GFP-labeled WJMSCs in vivo using a chronic salpingitis model: an animal experiment. Stem Cell Res Ther 2017; 8:272. [PMID: 29191249 PMCID: PMC5709981 DOI: 10.1186/s13287-017-0714-z] [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] [Received: 08/03/2017] [Revised: 09/22/2017] [Accepted: 10/26/2017] [Indexed: 12/22/2022] Open
Abstract
Background The present study was conducted to evaluate the distribution of Wharton’s jelly-derived mesenchymal stem cells (WJMSCs) and their repairing function on the oviduct. Methods WJMSCs were transfected with the LV3-GFP-PURO lentivirus. Female New Zealand rabbits (n = 24) were divided randomly into control A and B groups and experimental C and D groups to establish inflammation models. Sterile saline solution or WJMSCs were injected into rabbits via ear veins and/or genital tract perfusion once weekly for 3 weeks. All rabbits were humanely sacrificed 1 week after the last perfusion to collect the oviduct, uterus, liver, and bladder for examination. Green fluorescent protein (GFP) and cytokeratin 7 (CK7) were imaged using a Leica Qwin Plus V3 fluorescence confocal microscope and analyzed as mean optical densities in an Image-Pro Plus analysis system. Results We found that lentivirus expressing the GFP gene produced an efficient transfection. The mean optical density values of GFP and CK7 in the oviducts were higher in the experimental D group than those in the control A and experimental C groups. No GFP fluorescence deposits occurred in the bladder of the control A group or experimental C group. Colocalization of CK7 and WJMSCs was observed in the oviducts in all groups. Conclusions WJMSCs exhibited homing characteristics and migrated to the injured oviduct to promote epithelial cell growth. Additionally, local treatment resulted in higher efficiency.
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Affiliation(s)
- Zhe Li
- The Department of Obstetrics and Gynecology, 1st Affiliated Hospital of Jinan University, Guangzhou, 510000, China
| | - Zhao Zhang
- The Department of Obstetrics and Gynecology, 1st Affiliated Hospital of Jinan University, Guangzhou, 510000, China.,The Department of Reproduction, Southern Medical University Affiliate Dongguan People's Hospital, Dongguan, China
| | - Wai-Kit Ming
- The Department of Obstetrics and Gynecology, 1st Affiliated Hospital of Jinan University, Guangzhou, 510000, China.,Harvard Medical School, Harvard University, Boston, MA, USA
| | - Xin Chen
- The Department of Obstetrics and Gynecology, 1st Affiliated Hospital of Jinan University, Guangzhou, 510000, China
| | - Xiao-Min Xiao
- The Department of Obstetrics and Gynecology, 1st Affiliated Hospital of Jinan University, Guangzhou, 510000, China.
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Li Z, Zhang Z, Chen X, Zhou J, Xiao XM. Treatment evaluation of Wharton's jelly-derived mesenchymal stem cells using a chronic salpingitis model: an animal experiment. Stem Cell Res Ther 2017; 8:232. [PMID: 29041961 PMCID: PMC5645885 DOI: 10.1186/s13287-017-0685-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 09/27/2017] [Accepted: 09/28/2017] [Indexed: 12/13/2022] Open
Abstract
Background The present study was conducted to evaluate new methods to repair the reproductive function of the oviduct, thereby allowing gametes to combine and grow in vivo under natural circumstances. Methods Sixty pathogen-free female New Zealand rabbits were divided into three groups: a wild-type group, an untreated control group, and a treatment group. Disposable sterile newborn sputum suction tubes were inserted into the urogenital tract to instill an Escherichia coli suspension into the uterine cavity to establish the chronic salpingitis model. Wharton’s jelly-derived mesenchymal stem cells (WJMSCs) or normal saline were used to treat this infection via different methods. The therapeutic effect was assessed by evaluating morphology, inflammatory factors, proteinology, and pregnancy outcomes. Results Oviducts of New Zealand rabbits in the untreated control group showed structural failure and abnormal supermicrostructure of epithelial cells. WJMSCs could partially repair the structure and supermicrostructure of the tubal epithelium. The concentration of tumor necrosis factor (TNF)-α in the untreated control group was significantly higher than that in the wild-type group (P = 0.015). The concentration of TNF-α in the local treatment group was significantly lower than that in the untreated control group (P = 0.011). The expression of oviductal glycoprotein (OVGP) and OVGP mRNA in the wild-type group was significantly higher than those in the untreated control group (P = 0.024 and P = 0.013, respectively). The litter size of the treatment group was 2 ± 2.39 kits, which was higher than that of the untreated control group (P = 0.035). Conclusion Chronic inflammation can destroy the structure of the oviduct and the supermicrostructure of epithelial cells as well as leading to infertility. WJMSC transplantation therapy in rabbits with chronic salpingitis partially restored fertility. WJMSCs also repaired the structure of the tubal epithelium subjected to chronic inflammation, decreased the level of inflammatory factors, and partially restored the secretion level of OVGP.
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Affiliation(s)
- Zhe Li
- The Department of Obstetrics and Gynecology at the 1st Affiliated Hospital of Jinan University, Guangzhou, 510000, China
| | - Zhao Zhang
- The Department of Obstetrics and Gynecology at the 1st Affiliated Hospital of Jinan University, Guangzhou, 510000, China.,The Department of Reproduction at the Southern Medical University Affiliate Dongguan People's Hospital, Dongguan, China
| | - Xin Chen
- The Department of Obstetrics and Gynecology at the 1st Affiliated Hospital of Jinan University, Guangzhou, 510000, China
| | - Juan Zhou
- The Department of Obstetrics and Gynecology at the 1st Affiliated Hospital of Jinan University, Guangzhou, 510000, China
| | - Xiao-Min Xiao
- The Department of Obstetrics and Gynecology at the 1st Affiliated Hospital of Jinan University, Guangzhou, 510000, China.
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Tanaka K, Chua J, Cincotta R, Ballard EL, Duncombe G. Hysterosalpingo-foam sonography (HyFoSy): Tolerability, safety and the occurrence of pregnancy post-procedure. Aust N Z J Obstet Gynaecol 2017; 58:114-118. [PMID: 28949014 DOI: 10.1111/ajo.12716] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 08/16/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Fallopian tube patency testing is an essential part of infertility evaluation. Hysterosalpingo-contrast sonography (HyCoSy) has been described as reliable, well tolerated and safe compared to other modalities such as laparoscopy and a dye test or hysterosalpingography. Limited availability of the previously used contrast has led to the introduction of a foam contrast agent as an alternative. AIMS To assess the tolerability, safety and occurrence of pregnancy post-procedure of hysterosalpingo-foam sonography (HyFoSy). MATERIALS AND METHODS A retrospective cohort study of women who had a HyFoSy at Queensland Ultrasound for Women from March 2013 to February 2015. A questionnaire was sent to their referring doctor to identify any complications or subsequent pregnancies with or without artificial reproductive technology (ART) within six months of the HyFoSy. RESULTS Of 200 women, four cases were abandoned due to difficulty introducing the intracervical catheter, severe discomfort or a vasovagal episode. Response from referring doctors for 155 women reported no post-procedural complication. One hundred and eleven women were followed up for at least six months. Twenty-four out of 59 women (40.7%) who had ART and 24 out of 52 women (46.2%) who did not have ART conceived. Fifty percent of women who were nulligravida at the time of investigation, found to have at least one patent fallopian tube, whose partner had a normal semen analysis, spontaneously conceived within the time of follow up. CONCLUSIONS HyFoSy is well tolerated and safe. A preponderance of pregnancies in the first month after HyFoSy suggests that a therapeutic effect may exist.
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Affiliation(s)
- Keisuke Tanaka
- Department of Obstetrics and Gynaecology, Gold Coast University Hospital, Southport, Australia
| | - Jackie Chua
- Queensland Ultrasound for Women, Spring Hill, Australia.,Department of Maternal Fetal Medicine, Mater Mother's Hospital, South Brisbane, Australia
| | - Robert Cincotta
- Queensland Ultrasound for Women, Spring Hill, Australia.,Department of Maternal Fetal Medicine, Mater Mother's Hospital, South Brisbane, Australia
| | - Emma L Ballard
- QIMR Berghofer Medical Research Institute, Herston, Australia
| | - Gregory Duncombe
- Queensland Ultrasound for Women, Spring Hill, Australia.,Centre for Advanced Prenatal Care, Royal Brisbane and Women's Hospital, Herston, Australia
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Abstract
We present an overview of the common types of tubal patency tests, with a focus on hysterosalpingo-foam sonography (HyFoSy). Current evidence suggests that HyFoSy is an accurate alternative to X-ray hysterosalpingography (HSG) for outpatient tubal evaluation in women who are at low risk for tubal disease. It may be superior to saline hysterosalpingo-contrast sonography (HyCoSy) in excluding tubal occlusion. A hyperechogenic medium may enhance contrast visualization and enable clearer delineation of tubal anatomy. This may enhance confidence in the diagnosis of tubal patency, reduce false occlusion results, and improve the diagnostic yield of the test. It would be reasonable to deduce that HyFoSy would have similar performance characteristics as HyCoSy with other positive contrast agents. The available evidence supports the accuracy of HyFoSy compared to other forms of tubal investigation. We suggest a decision-making pathway based on the most current professional recommendations and available evidence. However, in this article, we do not provide a definitive exposition of the methods used for investigating tubal patency. Rather, we explore the contexts in which the various investigations are most and least suitable, and identify their strengths and limitations. Finally, we also discuss challenges encountered when performing tubal contrast sonography in clinical practice, including the problem of false occlusion results.
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Affiliation(s)
- Hemashree Rajesh
- Centre of Assisted Reproduction, Department of Obstetrics and Gynecology, Singapore General Hospital, Singapore
| | - Serene Liqing Lim
- Centre of Assisted Reproduction, Department of Obstetrics and Gynecology, Singapore General Hospital, Singapore
| | - Su Ling Yu
- Centre of Assisted Reproduction, Department of Obstetrics and Gynecology, Singapore General Hospital, Singapore
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Haahr T, Jensen J, Thomsen L, Duus L, Rygaard K, Humaidan P. Abnormal vaginal microbiota may be associated with poor reproductive outcomes: a prospective study in IVF patients. Hum Reprod 2016; 31:795-803. [DOI: 10.1093/humrep/dew026] [Citation(s) in RCA: 110] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 02/01/2016] [Indexed: 01/25/2023] Open
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Panelli DM, Phillips CH, Brady PC. Incidence, diagnosis and management of tubal and nontubal ectopic pregnancies: a review. FERTILITY RESEARCH AND PRACTICE 2015; 1:15. [PMID: 28620520 PMCID: PMC5424401 DOI: 10.1186/s40738-015-0008-z] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Accepted: 09/29/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND Ectopic pregnancy is a potentially life-threatening condition occurring in 1-2 % of all pregnancies. The most common ectopic implantation site is the fallopian tube, though 10 % of ectopic pregnancies implant in the cervix, ovary, myometrium, interstitial portion of the fallopian tube, abdominal cavity or within a cesarean section scar. FINDINGS Diagnosis involves a combination of clinical symptoms, serology, and ultrasound. Medical management is a safe and effective option in most clinically stable patients. Patients who have failed medical management, are ineligible, or present with ruptured ectopic pregnancy or heterotopic pregnancy are most often managed with excision by laparoscopy or, less commonly, laparotomy. Management of nontubal ectopic pregnancies may involve medical or surgical treatment, or a combination, as dictated by ectopic pregnancy location and the patient's clinical stability. Following tubal ectopic pregnancy, the rate of subsequent intrauterine pregnancy is high and independent of treatment modality. CONCLUSION This review describes the incidence, risk factors, diagnosis, and management of tubal and non-tubal ectopic and heterotopic pregnancies, and reviews the existing data regarding recurrence and future fertility.
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Affiliation(s)
- Danielle M. Panelli
- Department of Obstcpetrics and Gynecology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02115 USA
| | - Catherine H. Phillips
- Department of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
| | - Paula C. Brady
- Department of Obstcpetrics and Gynecology, Brigham and Women’s Hospital, Harvard Medical School, 75 Francis St., Boston, MA 02115 USA
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Lopera J, Suri R, Kroma GM, Garza-Berlanga A, Thomas J. Role of Interventional Procedures in Obstetrics/Gynecology. Radiol Clin North Am 2013; 51:1049-66. [DOI: 10.1016/j.rcl.2013.07.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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