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Zheng X, Yu X, Xie X, Lyu G, Niu J, Li X, Chen H, Watrelot A, Guan J. The Clinical Significance of Subtle Distal Fallopian Tube Abnormalities: A Multicentre Prospective Observational Study. Facts Views Vis Obgyn 2024; 16:67-73. [PMID: 38551476 PMCID: PMC11198887 DOI: 10.52054/fvvo.16.1.007] [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: 06/27/2024] Open
Abstract
Background Subtle distal fallopian tube abnormalities are a group of diseases characterised by small variations in tubal anatomy. The clinical significance of these abnormalities need to be studied. Objectives The purpose of this multicentre prospective observational study was to investigate whether subtle distal fallopian tube abnormalities are related to infertility and endometriosis. Materials and Methods The investigation was carried out in five medical centres in China and France from February to July 2021 and included reproductive-age patients who underwent gynaecological laparoscopy. Subtle abnormalities included Hydatid of Morgagni (HM) , fimbrial agglutination, tubal diverticula, accessory ostium, fimbrial phimosis, and accessory fallopian tube. Results 642 patients were enrolled in the study and 257 (40.0%) were diagnosed with subtle tube abnormalities. Hydatid of Morgagni was the most common abnormality (22.7%; n=146), followed by fimbrial agglutination (19.8%; n=127), tubal diverticula (6.9%; n=44), accessory tube (2.0%; n=13), and tubal accessory ostium (1.9%; n=12). Fimbrial phimosis was the least common abnormality (0.3%; n=2). The prevalence of subtle fallopian tube abnormalities was significantly higher among infertile patients (188/375, 50.1%) than those without history of infertility (69/267, 25.8%, ᶍ2=38.332, P=0.000). 209 patients were diagnosed with endometriosis during surgery, and the prevalence of subtle abnormalities was significantly higher in the endometriosis group than in those without endometriosis (61.2%, [128/209] vs. 29.8% [129/433], ᶍ2=58.086, P=0.000). Conclusions Higher prevalence of subtle tubal abnormalities suggests that they may contribute to infertility. They are highly related to endometriosis and indicate fimbrial abnormalities of endometriosis. What is new? This is the largest multicentre study to investigate the subtle distal fallopian tube abnormalities in infertile women. Compared to previous studies, this study includes the main subtle distal abnormalities and the control group patients without a history of infertility.
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Zhang J, Wang J, Zhang J, Liu J, Xu Y, Zhu P, Dai L, Shu L, Liu J, Hou Z, Diao F, Liu J, Mao Y. Developing a Predictive Model for Minimal or Mild Endometriosis as a Clinical Screening Tool in Infertile Women: Uterosacral Tenderness as a Key Predictor. J Minim Invasive Gynecol 2024; 31:227-236. [PMID: 38147937 DOI: 10.1016/j.jmig.2023.12.008] [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: 08/23/2023] [Revised: 12/08/2023] [Accepted: 12/20/2023] [Indexed: 12/28/2023]
Abstract
STUDY OBJECTIVE To develop a noninvasive predictive model based on patients with infertility for identifying minimal or mild endometriosis. DESIGN A retrospective cohort study. SETTING This study was conducted at a tertiary referral center. PATIENTS A total of consecutive 1365 patients with infertility who underwent laparoscopy between January 2013 and August 2020 were divided into a training set (n = 910) for developing the predictive model and a validation set (n = 455) to confirm the model's prediction efficiency. The patients were randomly assigned in a 2:1 ratio. INTERVENTIONS Sensitivities, specificities, area under the curve, the Hosmer-Lemeshow goodness of fit test, Net Reclassification Improvement index, and Integrated Discrimination Improvement index were evaluated in the training set to select the optimum model. In the validation set, the model's discriminations, calibrations, and clinical use were tested for validation. MEASUREMENTS AND MAIN RESULTS In the training set, there were 587 patients with minimal or mild endometriosis and 323 patients without endometriosis. The combination of clinical parameters in the model was evaluated for both statistical and clinical significance. The best-performing model ultimately included body mass index, dysmenorrhea, dyspareunia, uterosacral tenderness, and serum cancer antigen 125 (CA-125). The nomogram based on this model demonstrated sensitivities of 87.7% and 93.3%, specificities of 68.6% and 66.4%, and area under the curve of 0.84 (95% confidence interval 0.81-0.87) and 0.85 (95% confidence interval 0.80-0.89) for the training and validation sets, respectively. Calibration curves and decision curve analyses also indicated that the model had good calibration and clinical value. Uterosacral tenderness emerged as the most valuable predictor. CONCLUSION This study successfully developed a predictive model with high accuracy in identifying infertile women with minimal or mild endometriosis based on clinical characteristics, signs, and cost-effective blood tests. This model would assist clinicians in screening infertile women for minimal or mild endometriosis, thereby facilitating early diagnosis and treatment.
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Affiliation(s)
- Jie Zhang
- State Key Laboratory of Reproductive Medicine, Clinical Center of Reproductive Medicine, The First Affiliated Hospital of Nanjing Medical University (Ms. Jie Zhang, Ms. Jingyi Zhang, Ms. Xu, Ms. Zhu, Mr. Dai, and Drs. Wang, Shu, Jinyong Liu, Hou, Diao, Jiayin Liu, and Mao)
| | - Jing Wang
- State Key Laboratory of Reproductive Medicine, Clinical Center of Reproductive Medicine, The First Affiliated Hospital of Nanjing Medical University (Ms. Jie Zhang, Ms. Jingyi Zhang, Ms. Xu, Ms. Zhu, Mr. Dai, and Drs. Wang, Shu, Jinyong Liu, Hou, Diao, Jiayin Liu, and Mao)
| | - Jingyi Zhang
- State Key Laboratory of Reproductive Medicine, Clinical Center of Reproductive Medicine, The First Affiliated Hospital of Nanjing Medical University (Ms. Jie Zhang, Ms. Jingyi Zhang, Ms. Xu, Ms. Zhu, Mr. Dai, and Drs. Wang, Shu, Jinyong Liu, Hou, Diao, Jiayin Liu, and Mao)
| | - Jin Liu
- Clinical Research Institute of the First Affiliated Hospital of Nanjing Medical University (Dr. Jin Liu), Nanjing, China
| | - Yanhong Xu
- State Key Laboratory of Reproductive Medicine, Clinical Center of Reproductive Medicine, The First Affiliated Hospital of Nanjing Medical University (Ms. Jie Zhang, Ms. Jingyi Zhang, Ms. Xu, Ms. Zhu, Mr. Dai, and Drs. Wang, Shu, Jinyong Liu, Hou, Diao, Jiayin Liu, and Mao)
| | - Peipei Zhu
- State Key Laboratory of Reproductive Medicine, Clinical Center of Reproductive Medicine, The First Affiliated Hospital of Nanjing Medical University (Ms. Jie Zhang, Ms. Jingyi Zhang, Ms. Xu, Ms. Zhu, Mr. Dai, and Drs. Wang, Shu, Jinyong Liu, Hou, Diao, Jiayin Liu, and Mao)
| | - Lei Dai
- State Key Laboratory of Reproductive Medicine, Clinical Center of Reproductive Medicine, The First Affiliated Hospital of Nanjing Medical University (Ms. Jie Zhang, Ms. Jingyi Zhang, Ms. Xu, Ms. Zhu, Mr. Dai, and Drs. Wang, Shu, Jinyong Liu, Hou, Diao, Jiayin Liu, and Mao)
| | - Li Shu
- State Key Laboratory of Reproductive Medicine, Clinical Center of Reproductive Medicine, The First Affiliated Hospital of Nanjing Medical University (Ms. Jie Zhang, Ms. Jingyi Zhang, Ms. Xu, Ms. Zhu, Mr. Dai, and Drs. Wang, Shu, Jinyong Liu, Hou, Diao, Jiayin Liu, and Mao)
| | - Jinyong Liu
- State Key Laboratory of Reproductive Medicine, Clinical Center of Reproductive Medicine, The First Affiliated Hospital of Nanjing Medical University (Ms. Jie Zhang, Ms. Jingyi Zhang, Ms. Xu, Ms. Zhu, Mr. Dai, and Drs. Wang, Shu, Jinyong Liu, Hou, Diao, Jiayin Liu, and Mao)
| | - Zhen Hou
- State Key Laboratory of Reproductive Medicine, Clinical Center of Reproductive Medicine, The First Affiliated Hospital of Nanjing Medical University (Ms. Jie Zhang, Ms. Jingyi Zhang, Ms. Xu, Ms. Zhu, Mr. Dai, and Drs. Wang, Shu, Jinyong Liu, Hou, Diao, Jiayin Liu, and Mao)
| | - Feiyang Diao
- State Key Laboratory of Reproductive Medicine, Clinical Center of Reproductive Medicine, The First Affiliated Hospital of Nanjing Medical University (Ms. Jie Zhang, Ms. Jingyi Zhang, Ms. Xu, Ms. Zhu, Mr. Dai, and Drs. Wang, Shu, Jinyong Liu, Hou, Diao, Jiayin Liu, and Mao)
| | - Jiayin Liu
- State Key Laboratory of Reproductive Medicine, Clinical Center of Reproductive Medicine, The First Affiliated Hospital of Nanjing Medical University (Ms. Jie Zhang, Ms. Jingyi Zhang, Ms. Xu, Ms. Zhu, Mr. Dai, and Drs. Wang, Shu, Jinyong Liu, Hou, Diao, Jiayin Liu, and Mao)
| | - Yundong Mao
- State Key Laboratory of Reproductive Medicine, Clinical Center of Reproductive Medicine, The First Affiliated Hospital of Nanjing Medical University (Ms. Jie Zhang, Ms. Jingyi Zhang, Ms. Xu, Ms. Zhu, Mr. Dai, and Drs. Wang, Shu, Jinyong Liu, Hou, Diao, Jiayin Liu, and Mao).
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Viganò P, Reschini M, Ciaffaglione M, Cucè V, Casalechi M, Benaglia L, Vercellini P, Somigliana E. Conventional IVF performs similarly in women with and without endometriosis. J Assist Reprod Genet 2023; 40:599-607. [PMID: 36637584 PMCID: PMC10033814 DOI: 10.1007/s10815-022-02700-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 12/17/2022] [Indexed: 01/14/2023] Open
Abstract
PURPOSE A reduced oocyte competence has been claimed as one of the factors underlying infertility in women with endometriosis. This idea has justified the hypothesis that intracytoplasmic sperm injection (ICSI), rather than conventional IVF (c-IVF), may overcome oocyte impairment and ensure better assisted reproduction technology (ART) outcomes; however, data from the literature are controversial. Thus, the aim of this study was to compare ART success rates following (c-IVF) between women with and without endometriosis in the presence of normozoospermic partners. METHODS This is a retrospective, matched case-control study of 314 patients who underwent c-IVF cycles between January 2014 and December 2020. Women with endometriosis were matched in a 1:1 ratio with patients undergoing ART for other indications, considering age (± 6 months), number of oocytes retrieved (± 1), and study period. The main outcome measures included total fertilization failure, fertilization rate, embryo quality, cumulative clinical pregnancy, and live birth rates. RESULTS The fertilization rate and the proportion of women with total fertilization failure did not differ between women with and without endometriosis. Similarly, all other embryological variables did not also differ, except for the number of top-quality cleavage stage embryos which was higher in the endometriosis group. Cumulative clinical pregnancy and live birth rates were similar between women with and without endometriosis. CONCLUSION A diagnosis of endometriosis does not negatively affect the performance of c-IVF; thus, c-IVF can be efficiently used in women affected, unless a male factor is also involved. This issue holds clinical relevance to help operators on their insemination technique decision-making.
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Affiliation(s)
- Paola Viganò
- Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 28, 20122, Milan, Italy.
| | - Marco Reschini
- Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 28, 20122, Milan, Italy
| | - Marta Ciaffaglione
- Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 28, 20122, Milan, Italy
| | - Veronica Cucè
- Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 28, 20122, Milan, Italy
| | - Maíra Casalechi
- Division of Human Reproduction, Hospital das Clínicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Laura Benaglia
- Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 28, 20122, Milan, Italy
| | - Paolo Vercellini
- Department of Clinical Sciences and Community Health, Università Degli Studi Di Milano, Milan, Italy
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Edgardo Somigliana
- Infertility Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via F. Sforza 28, 20122, Milan, Italy
- Department of Clinical Sciences and Community Health, Università Degli Studi Di Milano, Milan, Italy
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Csöbönyeiová M, Klein M, Feitscherová C, Pavlíková L, Kachlík D, Varga I. The Overview of Anatomical Variations and Congenital Anomalies of the Uterine Tubes and Their Impact on Fertility. Physiol Res 2022. [DOI: 10.33549/physiolres.935035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Anatomical variations and congenital anomalies of the uterine tubes (UTAVsCAs) are rare conditions, which are often undiagnosed, or accidentally diagnosed upon imaging, laparotomy, laparoscopy for unrelated condition, or during the Cesarean section. UTAVsCAs are often asymptomatic, but their clinical relevance lies in their possibly adverse impact on fertility. Since their rare occurrence, they are usually published as case reports. The most typically described are: agenesis of the uterine tubes (UTs), accessory UT (UT duplication), accessory UT ostium, and paratubal cysts (e.g. the hydatid cyst of Morgagni). UTAVsCAs are classified into an umbrella category of Müllerian duct anomalies (MDAs) which comprises anomalous development of all the organs developing from the paramesonephric (Müllerian) ducts, i.e., UTs, uterus and upper portion of the vagina. Interestingly, most of the classification systems of MDAs discuss solely the uterine and vaginal anomalies, while the UTs are often utterly ignored. This probably originates from the fact that UTs are no longer interesting for many clinicians as they think of UTs as superfluous organs whose function can be easily replaced in the in vitro fertilization (IVF) laboratory. Indeed, the modern reproductive medicine has been helping enormously with the conception of infertile couples. In many instances, the UTs are in fact successfully bypassed and a “test-tube” baby is born. Nevertheless, the UTs are still absolutely unique in providing suitable environment for fertilization and early embryo development - processes that hasn´t been still completely understood. This fact could partially explain why the success rate of IVF is “only” around 30-50 % depending on age. Therefore, the research of the UTAVsCAs is still clinically relevant in the context of reproductive medicine and should not be omitted from research endeavors.
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Affiliation(s)
| | | | | | | | | | - I Varga
- Institute of Histology and Embryology, Faculty of Medicine, Comenius University in Bratislava, Slovak Republic.
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