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Deng K, Zhang M, Kong WY, Liu W, Zhang YN, Yu Q, Wu GH, Yan L. Does a hyperechogenic endometrial mass in the uterus during controlled ovarian stimulation affect assisted reproductive technology cycle outcomes? Eur J Obstet Gynecol Reprod Biol 2020; 250:17-23. [PMID: 32375083 DOI: 10.1016/j.ejogrb.2020.04.041] [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: 02/03/2020] [Revised: 04/12/2020] [Accepted: 04/15/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Healthy embryos and endometrial receptivity are keys to the success of in-vitro fertilization and embryo transfer (IVF-ET). Abnormal transvaginal ultrasonography (TVU) findings in the endometrium are a concern during assisted reproductive technology (ART) treatments. Observation of a hyperechogenic endometrial mass (HEM) during controlled ovarian stimulation (COS) in an IVF or intracytoplasmic sperm injection (ICSI) cycle is a dilemma. Here we investigated whether an HEM would affect ART cycle outcomes. STUDY DESIGN We analyzed all data from patients who underwent IVF or ICSI treatment cycles from January 1, 2009 to December 31, 2016 at our institution. Patients diagnosed with an HEM were included. Each woman was matched with two control subjects of similar age (± 1 year), in terms of the number of cycles, type of infertility (primary or secondary), protocol used for COS, but with no HEM identified by TVU. Baseline characteristics, COS response, and pregnancy outcomes after ET were compared. RESULTS In all, 1088 patients were diagnosed with an HEM. Of these, 426 met the inclusion criteria and were matched with 852 controls. Baseline characteristics showed no significant differences between the groups. The peak endometrial thickness was significantly greater in the experimental group than in the control group (1.15 ± 0.18 cm vs. 1.08 ± 0.21 cm, p < 0.001). The live birth rates were 43.7% vs 46.2% in the experimental and control groups, respectively. There were no significant between-group differences in the rates of biochemical or clinical pregnancy or abortions at any stage. CONCLUSIONS Newly diagnosed HEMs < 18 mm in diameter monitored by TVU did not impair the outcomes of ART following COS in this study. If other conditions are suitable, completion of ART cycles should be the appropriate approach in such cases. KEY MESSAGE Newly diagnosed hyperechogenic endometrial masses measuring <18 mm in diameter monitored by TVU during COS did not adversely affect the outcomes of these IVF/ICSI-ET cycles.
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Affiliation(s)
- Ke Deng
- Reproductive Hospital Affiliated to Shandong University, Cheloo College of Medicine,Shandong University, Jinan 250012, PR China
| | - Mei Zhang
- Maternal and Child Health Hospital of Qufu, Qufu 273100, PR China
| | - Wei-Ya Kong
- Reproductive Hospital Affiliated to Shandong University, Cheloo College of Medicine,Shandong University, Jinan 250012, PR China
| | - Wei Liu
- Reproductive Hospital Affiliated to Shandong University, Cheloo College of Medicine,Shandong University, Jinan 250012, PR China
| | - Ya-Nan Zhang
- Reproductive Hospital Affiliated to Shandong University, Cheloo College of Medicine,Shandong University, Jinan 250012, PR China
| | - Qian Yu
- Reproductive Hospital Affiliated to Shandong University, Cheloo College of Medicine,Shandong University, Jinan 250012, PR China
| | - Gui-Hua Wu
- Center of Reproductive Medicine, Shandong Provincial Hospital, Cheloo College of Medicine, Shandong University, Jinan 250021, PR China.
| | - Lei Yan
- Reproductive Hospital Affiliated to Shandong University, Cheloo College of Medicine,Shandong University, Jinan 250012, PR China; Center of Reproductive Medicine, Shandong Provincial Hospital, Cheloo College of Medicine, Shandong University, Jinan 250021, PR China.
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Dibi RP, Zettler CG, Vanin CMDM, Ribeiro RVP, de Oliveira JM, Kremer TG, Borges J, Kato SK. Immunohistochemical assessment of symptomatic postmenopausal endometrial polyps in tamoxifen users and nonusers: a case control study. SAO PAULO MED J 2020; 138:64-68. [PMID: 32215462 PMCID: PMC9673849 DOI: 10.1590/1516-3180.2018.0346.r4.19112019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 11/19/2019] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Endometrial polyps are common in postmenopausal women, and the effect of tamoxifen use (a risk factor for endometrial polyps) on their pathogenesis is unclear. OBJECTIVES To evaluate the expression of hormone receptors and markers for proliferation/apoptosis (Ki-67 and Bcl-2) in endometrial polyps in postmenopausal users and nonusers of tamoxifen. DESIGN AND SETTING Cross-sectional analytical study in a tertiary-level academic hospital. METHODS 46 women (14 tamoxifen users and 32 nonusers) with postmenopausal bleeding underwent hysteroscopic resection of endometrial polyps. Polyp samples were immunohistochemically assessed for detection of Ki-67, Bcl-2 and estrogen and progesterone receptors. RESULTS Analysis on the glandular component of the polyps revealed progesterone receptor expression in the polyps of 96.9% of the nonusers of tamoxifen, and 92.3% of the tamoxifen users (P = 0.499). All polyps in nonusers and 92.3% of those in users were also positive for estrogen receptors (P = 0.295). Ki-67 was expressed in 75% of the polyps in the tamoxifen users and 82.8% of those in the nonusers. All endometrial polyps expressed Bcl-2. CONCLUSIONS The immunohistochemical analysis on endometrial polyps demonstrated that, although tamoxifen is considered to be a risk factor for endometrial polyps, there were no significant differences in the expression of hormone receptors between users and nonusers of tamoxifen. There were no between-group differences in Ki-67 and Bcl-2 expression, and all patients displayed inhibition of apoptosis by Bcl-2, thus supporting the theory that polyps develop due to inhibition of apoptosis, and not through cell proliferation.
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Affiliation(s)
- Raquel Papandreus Dibi
- MD, PhD. Professor, Department of Gynecology and Obstetrics, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA); and Professor, Gynecology and Obstetrics Service, Irmandade Santa Casa de Misericórdia de Porto Alegre (ISCMPA), Porto Alegre (RS), Brazil.
| | - Claudio Galleano Zettler
- MD, PhD. Pathologist, Pathology Service, Irmandade Santa Casa de Misericórdia de Porto Alegre (ISCMPA), Porto Alegre (RS), Brazil.
| | - Carla Maria de Martini Vanin
- MD, PhD. Professor, Department of Gynecology and Obstetrics, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA); and Professor, Gynecology and Obstetrics Service, Irmandade Santa Casa de Misericórdia de Porto Alegre (ISCMPA), Porto Alegre (RS), Brazil.
| | | | - Júlia Monteiro de Oliveira
- Undergraduate Medical Student, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre (RS), Brazil.
| | - Thaysa Guglieri Kremer
- Undergraduate Medical Student, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre (RS), Brazil.
| | - Josiane Borges
- MD. Pathologist, Pathology Service, Irmandade Santa Casa de Misericórdia de Porto Alegre (ISCMPA), Porto Alegre (RS), Brazil.
| | - Sérgio Kakuta Kato
- PhD. Epidemiologist, Postgraduate Program on Pathology, Universidade Federal de Ciências da Saúde de Porto Alegre (UFCSPA), Porto Alegre (RS), Brazil.
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Fenugreek seeds estrogenic activity in ovariectomized female rats. CURRENT ISSUES IN PHARMACY AND MEDICAL SCIENCES 2019. [DOI: 10.2478/cipms-2019-0026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Abstract
The estrogenic activities of fenugreek seeds (Trigonella foenum-graecum L.), widely used in traditional pharmacopoeia, are reflected in the uterus of ovariectomized female rats, with a slight increase in dry and wet weight, a thickening of the stroma and the uterine epithelium and the development of the endometrial glands. In the vagina, the estrogenic action is shown through an increase in the epidermal cell number and a tendency to keratinization, leading to vaginal opening.
Furthermore, this estrogenic potential of fenugreek seeds is confirmed by the over-expression of progesterone receptors in the uterine tissues supporting possible interactions between phytoestrogens and estrogen receptors.
Therefore, Fenugreek seeds may be capable of promoting the development of reproductive tissues of immature ovariectomized rats, and its estrogenic activity may take its action by holding phystoestrogens that interact with estrogen binding sites and activate the same estradiol-mediated cell signaling pathways.
Thus, our results give added scientific support to the popular use of Fenugreek seeds as an alternative for several health problems such as fertility and menopause related disorders.
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George A, Lefebvre-Lacoeuille C, Lacoeuille F, Fosse P, Bouchet F, Croue A, Hindre F, Descamps P, Couturier OF. Ciblage des tissus endométriaux par la 16α-[18F]fluoro-17β-œstradiol (PET-[18F]FES) : résultats préliminaires dans le diagnostic de l’endométriose. MEDECINE NUCLEAIRE-IMAGERIE FONCTIONNELLE ET METABOLIQUE 2014. [DOI: 10.1016/j.mednuc.2014.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Eddib A, Allaf B, Lee J, Yeh J. Risk for Advanced-Stage Endometrial Cancer in Surgical Specimens from Patients with Complex Endometrial Hyperplasia with Atypia. Gynecol Obstet Invest 2012; 73:38-42. [DOI: 10.1159/000329326] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2010] [Accepted: 05/03/2011] [Indexed: 11/19/2022]
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Body mass index is an independent risk factor for the development of endometrial polyps in patients undergoing in vitro fertilization. Fertil Steril 2009; 91:1056-60. [DOI: 10.1016/j.fertnstert.2008.01.002] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2007] [Revised: 01/02/2008] [Accepted: 01/02/2008] [Indexed: 11/18/2022]
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Belisário MSN, Vassallo J, Andrade LALA, Alvarenga M, Pinto GA, Monteiro IMU. The expression of the hormone receptors in the endometrium and endometrial polyps in postmenopausal women and its relationship to body mass index. Maturitas 2007; 53:114-8. [PMID: 15894442 DOI: 10.1016/j.maturitas.2005.03.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2005] [Revised: 03/03/2005] [Accepted: 03/11/2005] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate and compare the relationship of body mass index (BMI) and the immunoexpression of estrogen (ER) and progesterone receptors (PR) in endometrial polyps (EP) and endometrium, in gland and stromal cells of postmenopausal women. METHODS Thirty-five postmenopausal women with benign endometrial polyps, who had not been taking medication with hormonal effects for at least 6 months, were submitted to operative hysteroscopy. The presence of ER and PR were evaluated by immunohistochemical method using a semiquantitative analysis. RESULTS BMI was significantly higher among patients with lower expression of ER in the glands of endometrium (p=0.02). EP and adjacent endometrium showed significantly higher proportion of positive cells in the glands than in the stroma, for both ER (p=0.0015 and 0.0018, respectively) and PR (p=0.0176 and p<0.0001, respectively). Glands and stroma cells showed significantly higher proportion of positive cells in polyps than in the endometrium, for ER (p<0.0001 and p=0.0034, respectively). CONCLUSIONS The higher proportion of positive gland cells for ER in EP as compared to endometrium supports an implication of these receptors in the pathogenesis of polyps. Association of higher BMI with lower expression of ER in endometrial glands, but not in EP, may indicate that factors influencing ER expression do not affect EP, supporting an autonomous function of polyps.
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Affiliation(s)
- Miriam Siesler Nóbrega Belisário
- Department of Gynecology and Obstetrics, Faculty of Medical Sciences State University of Campinas (UNICAMP), Alexander Fleming, 101, Campinas, São Paulo CEP 13 083-970, Brazil
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Boutet G. [Levonorgestrel-releasing intrauterine device (Mirena) and breast cancer: what do we learn from literature for clinical practice?]. ACTA ACUST UNITED AC 2006; 34:1015-23. [PMID: 17092752 DOI: 10.1016/j.gyobfe.2006.09.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2006] [Accepted: 09/19/2006] [Indexed: 10/23/2022]
Abstract
Annual occurrence of breast cancer is constantly increasing in France. In 2000, the number of breast cancer cases for women of 30-49 years was estimated at 9,918, which represents 23.7% of all breast cancer cases diagnosed that year. The levonorgestrel-releasing intrauterine device (IUD LNG) is one of the most frequently used coils in France. Because contraception is an important matter for women whose ovarian function survived cancer treatments, the question of whether to use such device on a woman with breast cancer has become a frequent and controversial gynaecological issue. With the review of available literature as a basis, we have tried to answer the following questions. First, whether the use of IUD LNG increases the risk of breast cancer: there is at the moment no "A" level answer available. According to the only study published, which may be considered "C" level, there is no such increase. Second, whether the use of IUD LNG counterbalances the endometrial effects of Tamoxifene: based on a limited level of evidence via a single randomised controlled trial on a small number of patients for one year only, this device appears to be able to prevent benign endometrial modifications. However, there is no conclusive study regarding its effectiveness on the prevention of endometrium adenocarcinoma caused by Tamoxifene. In addition, there are numerous uncertainties as to whether levonorgestrel presence in the plasma would have a systemic prejudicial impact. Third, whether a woman with a personal antecedent of breast cancer can safely use DIU LNG: it is necessary to remove it promptly upon suspicion or diagnosis, to dissuade its use in case of current cancer, and, in the event of cancer remission for more than 5 years, to generally avoid this contraceptive method except on a case by case basis and with a regular medical follow-up. In the latter situation, the use of IUD LNG can be considered only after a multidisciplinary collective formal decision and after the woman gave her informed consent.
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Affiliation(s)
- G Boutet
- Cabinet de gynécologie, 28, rue de Norvège, 17000 La Rochelle, France.
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Sawathiparnich P, Osuwanaratana P, Santiprabhob J, Likitmaskul S. Tamoxifen improved final height prediction in a girl with McCune-Albright syndrome: patient report and literature review. J Pediatr Endocrinol Metab 2006; 19:81-6. [PMID: 16509532 DOI: 10.1515/jpem.2006.19.1.81] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
McCune-Albright syndrome (MAS) is characterized by gonadotropin-independent precocious puberty, café-au-lait spots on the skin and polyostotic fibrous dysplasia of bones. Treatment of precocious puberty (PP) in MAS should be considered in patients with poor predicted adult height (PAH). Treatment of gonadotropin-independent PP in MAS with ketoconazole, cyproterone acetate or testolactone, an aromatase inhibitor, does not appear to be always effective in slowing bon. maturation. We report here a Thai girl with MAS who received tamoxifen, one of the selective estrogen receptor modulators, for the management of advanced puberty and rapid bone maturation. Her pubertal progression, vaginal bleeding, growth rate and PAH improved during treatment with tamoxifen despite persistently elevated serum estradiol levels and an enlarged ovarian cyst.
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Affiliation(s)
- Pairunyar Sawathiparnich
- Division of Pediatric Endocrinology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
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