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Zhang H, Wu L, Liao T, Wang R, Zhu H, Lin L, Wang W, Huang W. Clinical utility of office hysteroscopy following failed in vitro fertilization-embryo transfer: A retrospective cohort study. Int J Gynaecol Obstet 2024. [PMID: 38578147 DOI: 10.1002/ijgo.15522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 03/01/2024] [Accepted: 03/24/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVE Despite its widespread use, in vitro fertilization (IVF) outcomes are challenged by implantation failure, largely due to factors such as embryo quality and endometrial receptivity. In this study, we investigated the clinical effect of office hysteroscopy (OH) on the subsequent frozen-thawed embryo transfer (FET) in infertile women who experienced a failed IVF-embryo transfer (IVF-ET) cycle. METHODS We included 577 infertile women who underwent OH because of a history of failed ET between October 2019 and September 2021. During OH, visible endometrial polyps (EPs) were diagnosed and removed by curette or biopsy forceps; chronic endometritis (CE) was diagnosed by histopathology and immunohistochemistry and treated with oral doxycycline (0.2 g/d) for 14 days. According to the hysteroscopic findings and endometrial pathology with immunohistochemistry, patients were divided into three groups: group A (n = 161) had CE with or without EPs, group B (n = 156) had EPs only, and group C (n = 260) had no CE or EPs. RESULTS In the following FET cycle, the implantation rates were 47%, 51%, and 45% (P = 0.411); the clinical pregnancy rates were 56%, 62%, and 55% (P = 0.436); the live birth rates were 45%, 51%, and 42% (P = 0.205); and the miscarriage rates were 18%, 16%, and 22% (P = 0.497) in groups A, B, and C, respectively. There were no significant differences among groups (P > 0.05). CONCLUSION OH is helpful for diagnosis and treatment of abnormal intrauterine environment in women with a failed IVF cycle and further improves their pregnancy outcome in the following FET.
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Affiliation(s)
- Hanyun Zhang
- Division of Reproductive Medicine, West China Second University Hospital of Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, Chengdu, China
- NHC Key Laboratory of Chronobiology of Sichuan University, Chengdu, China
| | - Lukanxuan Wu
- Division of Reproductive Medicine, West China Second University Hospital of Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, Chengdu, China
- NHC Key Laboratory of Chronobiology of Sichuan University, Chengdu, China
| | - Tianji Liao
- Division of Reproductive Medicine, West China Second University Hospital of Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, Chengdu, China
| | - Ruiying Wang
- Division of Reproductive Medicine, West China Second University Hospital of Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, Chengdu, China
- NHC Key Laboratory of Chronobiology of Sichuan University, Chengdu, China
| | - Huili Zhu
- Division of Reproductive Medicine, West China Second University Hospital of Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, Chengdu, China
| | - Lijun Lin
- Division of Reproductive Medicine, West China Second University Hospital of Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, Chengdu, China
| | - Wei Wang
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, Chengdu, China
- Department of Pathology, West China Second University Hospital of Sichuan University, Chengdu, China
| | - Wei Huang
- Division of Reproductive Medicine, West China Second University Hospital of Sichuan University, Chengdu, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, Chengdu, China
- NHC Key Laboratory of Chronobiology of Sichuan University, Chengdu, China
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Donnez J, Taylor HS, Marcellin L, Dolmans MM. Uterine fibroid-related infertility: mechanisms and management. Fertil Steril 2024:S0015-0282(24)00170-5. [PMID: 38453041 DOI: 10.1016/j.fertnstert.2024.02.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 02/29/2024] [Indexed: 03/09/2024]
Abstract
Fibroids are a common pathology and increasingly observed in women seeking medical treatment for infertility. The longer reproductive horizon because of improvements in medical care and current trend for women to postpone childbearing are making fibroid-related infertility increasingly common. This review aimed to critically analyze the association between uterine fibroids and infertility, mechanisms by which uterine fibroids may impair fertility, and management of myoma-related infertility. The association of fibroids with infertility is a source of controversy. As the focus of this review is infertility, it is crucial to analyze the mechanisms by which fertility may be impaired by the presence of fibroids. Current management strategies involve mainly surgical interventions, including myomectomy by hysteroscopy, laparotomy, or laparoscopy, and nonsurgical approaches, such as uterine artery embolization and focused ultrasound performed under radiologic or echographic guidance. The risks and benefits of each option should be discussed with patients, and several factors need to be considered, including the skills of surgeons and availability of different resources in various centers. Concerning the efficacy of oral gonadotropin-releasing hormone antagonists (i.e., elagolix, relugolix, and linzagolix), they were shown to have a rapid impact on heavy menstrual bleeding (HMB) in >70% of women. When used without add-back therapy, these drugs cause a significant reduction in fibroid volume, namely, approximately 50% from baseline to week 24. Further studies are required to determine the best protocol and optimal dosage if a reduction in myoma volume is the main goal, as in case of myoma-related infertility.
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Affiliation(s)
- Jacques Donnez
- Université Catholique de Louvain, Ottignies-Louvain-la-Neuve, Belgium; Society for Research into Infertility (SRI), Brussels, Belgium.
| | - Hugh S Taylor
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
| | - Louis Marcellin
- Département de Gynécologie Obstétrique II et Médecine de la Reproduction, Université Paris Cité, Assistance Publique-Hôpitaux de Paris (AP-HP), Centre Hospitalier Universitaire (CHU) Cochin, Hôpital Universitaire Paris Centre (HUPC), Paris, France
| | - Marie-Madeleine Dolmans
- Pôle de Recherche en Gynécologie, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain (UCL), Brussels, Belgium; Gynecology Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium
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Tian Y, Huang J, Wang CC, Lin H, Huang X, Zhao Y, Liu L, Zhang S. The impact of endometrial scratch performed in mid-luteal phase on the endometrium whole genome transcriptomic profiles in following menstrual cycle. HUM FERTIL 2023; 26:733-741. [PMID: 37029627 DOI: 10.1080/14647273.2023.2193909] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 01/21/2023] [Indexed: 04/09/2023]
Abstract
The value of endometrial scratch in women with recurrent embryo transfer has been controversial. Endometrial scratch is often performed in the mid-luteal phase of the cycle preceding embryo transfer but there is little scientific evidence if it affects the whole genome transcriptomic profile of peri-implantation endometrium in the following cycle. A prospective longitudinal cohort study was conducted in a university assisted reproductive unit. A total of eight women with recurrent implantation failure (RIF) were included. Each participant had endometrial biopsy twice, first biopsy on day LH + 7 in natural cycle and second on day LH + 7 of the following cycle. R package was used to identify differentially expressed genes between the sample and enriched gene ontology. However, the paired sample showed no significant difference, neither known endometrial receptive gene set nor other genes, before and after the endometrial scratch. It suggests that endometrial scratch performed during previous mid-luteal phase did not affect the transcriptomic profiles of endometrium on day LH + 7 in women with RIF.
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Affiliation(s)
- Yichao Tian
- Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jin Huang
- Department of Obstetrics & Gynecology, the Second Affiliated Hospital, the Chinese University of Hong Kong, Shenzhen, China
- Department of Obstetrics & Gynecology, the Chinese University of Hong Kong, Hong Kong SAR, China
| | - Chi-Chiu Wang
- Department of Obstetrics & Gynecology, the Chinese University of Hong Kong, Hong Kong SAR, China
- Li Ka Shing Institute of Health Sciences; School of Biomedical Sciences, Hong Kong-Sichuan University Joint Laboratory in Reproductive Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Huizhen Lin
- Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xiaona Huang
- Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Yue Zhao
- Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Liu Liu
- Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Songying Zhang
- Assisted Reproduction Unit, Department of Obstetrics and Gynecology, Key Laboratory of Reproductive Dysfunction Management of Zhejiang Province, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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Pounikar M, Shrivastava D, Sharma S, Tadghare J. Role of Hysteroscopy in Patients with Previous In Vitro Fertilization Failure: An Institutional Experience in Rural Population. J Obstet Gynaecol India 2023; 73:77-82. [PMID: 36879931 PMCID: PMC9984639 DOI: 10.1007/s13224-022-01729-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 10/30/2022] [Indexed: 12/13/2022] Open
Abstract
Objectives (1) To evaluate the use of hysteroscopy in the assessment of uterine pathologies, not evident on ultrasonography or hystero-salpingography in women with previous one or more IVF failures and (2) to determine whether correction of such pathologies during hysteroscopy improves clinical pregnancy rates in these women. Methods This is a prospective randomized study. The study population included were women with primary and secondary infertility registered at our center, fit into the inclusion and exclusion criteria of this study. The total 180 patients were included. Results Hysteroscopies were performed in 90 patients with at least one IVF cycle failure and another 90 patients taken as control with similar demographic parameters. The average duration of infertility between both the groups was not significant. Hysteroscopy was able to detect intrauterine pathologies in around 40% of the cases, which were treated in the same treatment phase. Early ultrasound findings with gestational sac and cardiac activity were found to be significant between two groups. Conclusion We noticed clinical improvement in IVF success rate after hysteroscopy. Hysteroscopy may be offered to the patients with previous one or more IVF failures, as clinically some of the previously undiagnosed pathologies could be detected and treated to achieve the positive outcomes.
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Affiliation(s)
- Minakshi Pounikar
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College and AVBRH Hospital, Sawangi, Wardha, India
| | - Deepti Shrivastava
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College and AVBRH Hospital, Sawangi, Wardha, India
| | - Sapna Sharma
- Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College and AVBRH Hospital, Sawangi, Wardha, India
| | - Jitendra Tadghare
- Department of Neurosurgery, Government Medical College and Super-Speciality Hospital, Nagpur, India
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Carrera M, Alonso L, Domínguez JA, Alcázar JL, Carugno J, Moratalla E, Pérez Milán F, Caballero M. Hysteroscopic metroplasty for the treatment of the dysmorphic uterus: A SWOT analysis. Front Surg 2023; 9:1097248. [PMID: 36776473 PMCID: PMC9909195 DOI: 10.3389/fsurg.2022.1097248] [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: 11/13/2022] [Accepted: 12/31/2022] [Indexed: 01/27/2023] Open
Abstract
Introduction Dysmorphic uterus or T-shaped uterus is an increasingly frequent diagnosis among the infertile population that has been associated to worse reproductive results. Hysteroscopic metroplasty is a safe and simple procedure that can improve the reproductive outcomes in this group of patients, although the benefits of this procedure remains controversial due to the lack of adequate scientific evidence. Objective To analyze the hysteroscopic metroplasty using the SWOT (Strengths, Weaknesses, Opportunities and Threats) methodology. Data sources An electronic search from inception each database up to December 2021 including the following databases was conducted: PubMed-MEDLINE, EMBASE, Web of Science, The Cochrane Library, and Google Scholar. Methods of study selection Studies reporting outcomes of patients undergoing hysteroscopic metroplasty were included. Tabulation Not applicable. Integration and Results Clinical evidence from the included studies suggests an improvement in reproductive results after performing hysteroscopic metroplasty especially in women with recurrent pregnancy loss and previous infertility, but all of them have relevant methodological limitations. For this reason, benefits, risks and alternatives of this intervention should be considered with caution. Conclusions Evidence from published data shows a probable association between dysmorphic uterus and poor reproductive outcomes. Hysteroscopic metroplasty in patients with dysmorphic uterus could improve pregnancy outcomes, but there is need of properly designed prospective controlled studies to determine the benefits of this technique.
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Affiliation(s)
- Maria Carrera
- Hospital Universitario Doce de Octubre, Madrid, Spain,Special Interest Group on Benign Reproductive Pathology of the Spanish Fertility Society, Spain,Correspondence: María Carrera
| | - Luis Alonso
- Special Interest Group on Benign Reproductive Pathology of the Spanish Fertility Society, Spain,Unidad de Cirugia Reproductiva, Centro Gutenberg, Málaga, Spain
| | - Jose Antonio Domínguez
- Special Interest Group on Benign Reproductive Pathology of the Spanish Fertility Society, Spain,IERA, Badajoz, Spain
| | - Juan Luis Alcázar
- Special Interest Group on Benign Reproductive Pathology of the Spanish Fertility Society, Spain,Clínica Universidad de Navarra, Pamplona, Spain
| | - Jose Carugno
- Obstetrics, Gynecology and Reproductive Sciences Department, Minimally Invasive Gynecology Division, University of Miami, Miller School of Medicine, Miami, FL, United States
| | - Enrique Moratalla
- Special Interest Group on Benign Reproductive Pathology of the Spanish Fertility Society, Spain,Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Federico Pérez Milán
- Special Interest Group on Benign Reproductive Pathology of the Spanish Fertility Society, Spain,Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Miguel Caballero
- Special Interest Group on Benign Reproductive Pathology of the Spanish Fertility Society, Spain,Hospital General Universitario Gregorio Marañón, Madrid, Spain
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Ma J, Gao W, Li D. Recurrent implantation failure: A comprehensive summary from etiology to treatment. Front Endocrinol (Lausanne) 2023; 13:1061766. [PMID: 36686483 PMCID: PMC9849692 DOI: 10.3389/fendo.2022.1061766] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 12/13/2022] [Indexed: 01/06/2023] Open
Abstract
Implantation is the first step in human reproduction. Successful implantation depends on the crosstalk between embryo and endometrium. Recurrent implantation failure (RIF) is a clinical phenomenon characterized by a lack of implantation after the transfer of several embryos and disturbs approximately 10% couples undergoing in vitro fertilization and embryo transfer. Despite increasing literature on RIF, there is still no widely accepted definition or standard protocol for the diagnosis and treatment of RIF. Progress in predicting and preventing RIF has been hampered by a lack of widely accepted definitions. Most couples with RIF can become pregnant after clinical intervention. The prognosis for couples with RIF is related to maternal age. RIF can be caused by immunology, thrombophilias, endometrial receptivity, microbiome, anatomical abnormalities, male factors, and embryo aneuploidy. It is important to determine the most possible etiologies, and individualized treatment aimed at the primary cause seems to be an effective method for increasing the implantation rate. Couples with RIF require psychological support and appropriate clinical intervention. Further studies are required to evaluate diagnostic method and he effectiveness of each therapy, and guide clinical treatment.
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Affiliation(s)
- Junying Ma
- Center of Reproductive Medicine, Shengjing Hospital of China Medical University, Shenyang, China
- Key Laboratory of Reproductive and Genetic Medicine, China Medical University, National Health Commission, Shenyang, China
- Shengjing Hospital of China Medical University, Key Laboratory of Reproductive Dysfunction Diseases and Fertility Remodeling of Liaoning Province, Shenyang, China
| | - Wenyan Gao
- Department of Obstetrics, the First Affiliated Hospital of China Medical University, Shenyang, China
| | - Da Li
- Center of Reproductive Medicine, Shengjing Hospital of China Medical University, Shenyang, China
- Key Laboratory of Reproductive and Genetic Medicine, China Medical University, National Health Commission, Shenyang, China
- Shengjing Hospital of China Medical University, Key Laboratory of Reproductive Dysfunction Diseases and Fertility Remodeling of Liaoning Province, Shenyang, China
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Lan J, Chen C, Chen L, Liu P. Intestinal Microflora Provides Biomarkers for Infertile Women with Endometrial Polyps. Biomarkers 2022; 27:579-586. [PMID: 35546106 DOI: 10.1080/1354750x.2022.2077445] [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: 11/02/2022]
Abstract
Endometrial polyps (EPs) are related to infertility; however, there are no biomarkers for identification. We evaluated changes in the intestinal microflora to identify microflora-based biomarkers that may be useful for detecting EPs. Intestinal specimens were prospectively collected from 100 women: 25 infertile women with EPs (InfEP + group), 25 infertile women without EPs (InfEP- group), and 50 healthy women (Fertile group). The microbiota composition was analyzed using 16S ribosomal RNA gene amplification and the intestinal expression of selected human genes using quantitative reverse transcription polymerase chain reaction. The InfEP + group had higher proportions of Prevotella, Streptococcus, Fusobacterium, Fenollaria, and Porphyromonas than the InfEP- and Fertile groups, while the Fertile group had higher proportions of Faecalibacterium, Bacteroides, and Blautia. We constructed a microbial dysbiosis index based on the intestinal microbiota at the genus level as a predictive model. The most accurate model to predict the presence of EPs was that including the Fertile and InfEP + groups (area under the curve: 0.89, 95% confidence interval: 0.79-0.96). The InfEP- and Fertile groups had significant differences in microflora composition compared with the InfEP + group. The intestinal microflora may be a useful biomarker for identifying EPs in infertile women.
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Affiliation(s)
- Jun Lan
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Dadao North Road, Baiyun District, Guangzhou City 510000, Guangdong Province, China.,Department of Obstetrics and Gynecology, Maternal and Child Health Hospital of Dong Guan, 99 Zhenxing Road, Dongguan City, Guangdong Province, Dongguan, 523000, China
| | - Chunlin Chen
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Dadao North Road, Baiyun District, Guangzhou City 510000, Guangdong Province, China
| | - Ling Chen
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Dadao North Road, Baiyun District, Guangzhou City 510000, Guangdong Province, China
| | - Ping Liu
- Department of Obstetrics and Gynecology, Nanfang Hospital, Southern Medical University, 1838 Guangzhou Dadao North Road, Baiyun District, Guangzhou City 510000, Guangdong Province, China
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Complex uterine cavity abnormalities increase the risk of miscarriage in in vitro fertilization/intracytoplasmic sperm injection in fresh cycle-assisted pregnancies. J Minim Invasive Gynecol 2022; 29:891-904. [DOI: 10.1016/j.jmig.2022.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 04/05/2022] [Accepted: 04/23/2022] [Indexed: 11/22/2022]
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Daniilidis A, Papandreou P, Grimbizis G. Uterine septum and reproductive outcome. From diagnosis to treatment. How, why, when? Facts Views Vis Obgyn 2022; 14:31-36. [DOI: 10.52054/fvvo.14.1.002] [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: Septate uterus is a benign congenital malformation and represents the most common uterine anomaly in women with poor reproductive outcome.
Objectives: To review the available scientific data concerning the biological context of the intrauterine septum and the association with poor reproductive outcome, the best methods for diagnosis and treatment.
Materials and methods: From July 2020 to October 2020, we searched for relevant free full text articles in PubMed, written in English, and published from the 1st of January 2000 to 31st of July 2020.
Main outcome measures: Association of the pathophysiology of septate uterus with poor reproductive outcome, evaluation of the different classification systems, the accuracy of diagnostic methods and the efficacy of the available treatment options.
Results: 259 articles were screened, and 22 articles were finally included in our study. Many theories regarding the pathophysiology of this congenital anomaly and its’ association with reproductive problems have been proposed along the recent decades. Combination of diagnostic methods should be used to avoid misclassification of this congenital anomaly.
Conclusions: Lack of uniformity in the different classification systems makes the diagnosis of septate uterus challenging as there is no universally accepted definition. Data regarding the reproductive outcome of women with septate uterus are still limited, thus recommendations regarding optimal treatment of these women are biased.
What is new? According to new insights regarding the pathophysiology of the uterine septum, differences in the underlying embryological defects are associated with changes in the histological composition and vascularisation of septa, as well as in clinical significance.
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Riemma G, Vitale SG, Manchanda R, Rathore A, Török P, De Angelis C, Urman B, Sareri MI, La Verde M, Carugno J, De Franciscis P, Tesarik J. The role of hysteroscopy in reproductive surgery: today and tomorrow. J Gynecol Obstet Hum Reprod 2022; 51:102350. [DOI: 10.1016/j.jogoh.2022.102350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 02/17/2022] [Accepted: 02/25/2022] [Indexed: 01/16/2023]
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Ghasemi M, Aleyasin A, Fatemi HM, Ghaemdoust F, Shahrakipour M. Uterine Cavity Irrigation With Office Hysteroscopy During Ovarian Stimulation for IVF: A Randomized Controlled Trial. Front Endocrinol (Lausanne) 2022; 13:778988. [PMID: 35222267 PMCID: PMC8864765 DOI: 10.3389/fendo.2022.778988] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 01/03/2022] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE This was a non-blinded randomized controlled study to evaluate whether endometrial irrigation via office hysteroscopy during the early follicular phase would lead to a higher level of live birth rates compared to no irrigation in the fresh embryo transfer cycle. METHOD The study was conducted in Tehran university of medical sciences from June 2015 to June 2016. women under the age of 40 with primary infertility without history of previous IVF/ICSI or hysteroscopic examination, were included. Controlled ovarian hyperstimulation was done. Hysteroscopy was performed in the early mid-follicular phase of a stimulation cycle (day 5-7) with a vaginoscopy approach and saline irrigation in hysteroscopy group. Embryo-transfer was done in the same cycle. RESULTS 228 patients completed their participation in the study. In the fresh cycle, clinical pregnancy rate was 46% in the hysteroscopy group and 40.43% in the control group. (p-value= 0.326, RR= 1.16 [95%CI: 0.862 to 1.56]). Live birth rate was 41.28% in the hysteroscopic group and 31.93% in the control group (p-value=0.143, RR= 1.293 [95%CI: 0.916 to 1.825]). For those patients having surplus cryopreserved embryos, after 2 months, a second embryo transfer was performed. The cumulative LBR was 44.05% in the hysteroscopic group and 32.25% in the control group (p-value=0.029, RR= 1.368 [95%CI: 1.031 to 1.815], RD= 11.9% [95%CI: 1.2% to 22.3%] and NNT= 8 [95%CI: 4 to 85]). CONCLUSION The current study clearly demonstrated a significantly higher cumulative live birth rate in the intervention group. CLINICAL TRIAL REGISTRATION [https://www.irct.ir/trial/19586], identifier IRCT2016011022795N2.
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Affiliation(s)
- Marzieh Ghasemi
- Pregnancy Health Research Center, Department of Obstetrics and Gynecology, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Ashraf Aleyasin
- Department of Infertility, Faculty of Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Human M. Fatemi
- In-Vitro-Fertilisation (IVF) Department, Assisted Reproductive Technology (ART) Fertility Clinics, Abu Dhabi, United Arab Emirates, Clinical Laboratory, Assisted Reproductive Technology (ART) Fertility Clinics, Abu Dhabi, United Arab Emirates
- *Correspondence: Human M. Fatemi,
| | - Faezeh Ghaemdoust
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahnaz Shahrakipour
- Department of Biostatistics, Zahedan University of Medical Sciences, Zahedan, Iran
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El estudio de receptividad endometrial ER®map mejora los resultados reproductivos tras fallos previos de implantación en ciclos de fecundación in vitro. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2021. [DOI: 10.1016/j.gine.2021.100688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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13
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DE Angelis MC, DI Spiezio Sardo A, Carugno J, Manzi A, Sorrentino F, Nappi L. Fertility outcomes after hysteroscopic removal of intrauterine leiomyomas and polyps. Minerva Obstet Gynecol 2021; 74:3-11. [PMID: 33876900 DOI: 10.23736/s2724-606x.21.04739-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Thanks to the progress of science, it is now understood that a successful implantation not only depends on the quality of the embryo, but also on having a receptive endometrium. During the years, several authors have reviewed the important role of the uterine factor, ranging from the congenital anomalies, such as uterine septa and subsepta, and acquired conditions such as endometrial polyps and submucous myomas. Currently, hysteroscopy has proved to be a powerful and accurate tool for visualizing the uterine cavity and treating intrauterine pathologies. EVIDENCE ACQUISITION This review of the literature aims to report the current available data on the effects of the two most common endouterine pathologies (i.e. endometrial polyps and submucous myomas) and the impact of hysteroscopic removal on fertility outcomes. EVIDENCE SYNTHESIS To date, the low number of randomized controlled trials available does not yet make it possible to give a definitive answer on what are the reproductive outcomes following treatment of endometrial polyps and leiomyomas. Nevertheless, existing evidence points to a benefit of removal of this two pathologies in infertile women, mostly when they have a history of recurrent pregnancy loss. CONCLUSIONS Further studies are needed to demonstrate that surgical treatments of endometrial polyps and myomas could improve not only the morphology but also the function of the uterine cavity before undergoing any assisted fertility treatment.
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Affiliation(s)
| | | | - Jose Carugno
- Obstetrics, Gynecology and Reproductive Sciences Department, University of Miami, Miami, FL, USA
| | - Alfonso Manzi
- Department of Neurologic, Reproductive, and Odontostomatologic Sciences, Federico II University, Naples, Italy
| | - Felice Sorrentino
- Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynecology, University of Foggia, Foggia, Italy
| | - Luigi Nappi
- Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynecology, University of Foggia, Foggia, Italy
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Mahdavinezhad F, Gharaei R, Farmani AR, Hashemi F, Kouhestani M, Amidi F. The Potential Relationship Between Different Human Female Reproductive Disorders and Sperm Quality in Female Genital Tract. Reprod Sci 2021; 29:695-710. [PMID: 33852138 DOI: 10.1007/s43032-021-00520-7] [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: 10/03/2020] [Accepted: 02/25/2021] [Indexed: 11/26/2022]
Abstract
Spermatozoa should travel throughout the female reproductive tract to reach its ultimate goal, fertilization of the oocyte. At the ejaculation moment, millions of sperm within a few milliliters of the ejaculate are deposited at the cranial segment of vagina and make their journey to the fertilization site. This is done by means of various factors, such as sperm motility, the uterine and fallopian tubes contractility, and the ciliary movement of the lining cells. During this migration, spermatozoa interact with the female microenvironment both physically and molecularly. In this regard, the quality of the environmental conditions may affect this interaction. Therefore, some alterations in women's genital tract microenvironment, such as conditions that occur in female reproductive disorders, may have detrimental effects on sperm reproductive function. In this review, human sperm migration through the female tract is described, and the potential effects of different reproductive disorders at reproductive organs, such as vagina, uterine cervix, uterus, fallopian tubes, and ovary on sperm survival and quality, are also argued. The understanding of those conditions that may impair sperm fertility in the female genital tract can provide a more accurate diagnosis of the causes of infertility in couples. This can ultimately lead to the discovery of effective treatment approaches.
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Affiliation(s)
- Forough Mahdavinezhad
- Department of Anatomy, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Roghaye Gharaei
- Department of Anatomy, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Reza Farmani
- Department of Tissue Engineering, Faculty of Advanced Technologies, Tehran University of Medical Sciences, Tehran, Iran
| | - Farideh Hashemi
- Department of Molecular Medicine, Faculty of Advanced Technologies in Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mahsa Kouhestani
- Department of Tissue Engineering, Faculty of Advanced Technologies, Tehran University of Medical Sciences, Tehran, Iran
| | - Fardin Amidi
- Department of Anatomy, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
- Department of Infertility, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
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Li M, Haixia Y, Kang M, An P, Wu X, Dang H, Xu X. The Arachidonic Acid Metabolism Mechanism Based on UPLC-MS/MS Metabolomics in Recurrent Spontaneous Abortion Rats. Front Endocrinol (Lausanne) 2021; 12:652807. [PMID: 33868179 PMCID: PMC8050334 DOI: 10.3389/fendo.2021.652807] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 03/08/2021] [Indexed: 11/25/2022] Open
Abstract
Recurrent spontaneous abortion (RSA) remains a critical and challenging problem in reproduction. To discover novel biomarkers for RSA, ultra performance liquid chromatography/tandem mass spectrometry (UPLC-MS/MS) metabolomics approach was applied to detect RSA serum metabolic profiles and explore its possible pathogenesis and mechanism. The abortion rat model was established, and a metabolomics analysis was performed to evaluate the differentially expressed metabolites between the control and model groups. Immunohistochemistry (IHC), qRT-PCR, and Western blot further examined the expression of Arachidonic acid metabolism-related genes in uterus tissues. To identify arachidonic acid metabolism-related changes in RSA, ELISA's potential mechanisms were further confirmed in serum. Ninety-one metabolites were significantly different between the two groups, as indicated by a VIP ≥1, fold change ≥1. The metabolic pathways involving arachidonic acid metabolism pathway (P = 0.00044) are related to RSA. Verification by experimental showed that compared with the control rats, the expression of the COX-1, COX-2, PTGFR, and TBXA2R genes associated with the arachidonic acid metabolism pathway has significantly increased the uterus and serum of RSA rats (P < 0.05). Regulation of the arachidonic acid metabolism pathway might serve as a promising therapeutic strategy for relieving RSA women's symptoms.
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Affiliation(s)
- Meihe Li
- Beijing Traditional Chinese Medicine Hospital Affiliated to Capital Medical University, Beijing, China
| | - Yang Haixia
- Department of Traditional Chinese Medicine, Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Minchao Kang
- Health Science Center of Xi’an Jiaotong University, Xi’an, China
| | - Peng An
- Department of Traditional Chinese Medicine, Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Xili Wu
- Department of Traditional Chinese Medicine, Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Huimin Dang
- Department of Traditional Chinese Medicine, Second Affiliated Hospital of Xi’an Jiaotong University, Xi’an, China
- *Correspondence: Huimin Dang, ; Xin Xu,
| | - Xin Xu
- Department of Gynaecology, Beijing Traditional Chinese Medicine Hospital Affiliated to Capital Medical University, Beijing, China
- *Correspondence: Huimin Dang, ; Xin Xu,
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16
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Stamenov GS, Vitale SG, Della Corte L, Vilos GA, Parvanov DA, Nikolova DN, Ganeva RR, Haimovich S. Hysteroscopy and female infertility: a fresh look to a busy corner. HUM FERTIL 2020; 25:430-446. [PMID: 33261529 DOI: 10.1080/14647273.2020.1851399] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Hysteroscopy has evolved from the traditional art of examining the uterine cavity for diagnostic purposes to an invaluable modality to concomitantly diagnose and (see and) treat a multitude of intrauterine pathologies, especially in the field and clinics specialising in female reproduction. This article reviews the literature on the most common cervical, endometrial, uterine and tubal pathologies such as chronic endometritis, endometrial polyps, adenomyosis, endometriosis, endometrial atrophy, adhesions, endometrial hyperplasia, cancer, and uterine malformations. The aim is to determine the efficiency of hysteroscopy compared with other available techniques as a diagnostic and treatment tool and its association with the success of in vitro fertilisation procedures. Although hysteroscopy requires an experienced operator for optimal results and is still an invasive procedure, it has the unique advantage of combining great diagnostic and treatment opportunities before and after ART procedures. In conclusion, hysteroscopy should be recommended as a first-line procedure in all cases with female infertility, and a special effort should be made for its implementation in the development of new high-tech procedures for identification and treatment infertility-associated conditions.
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Affiliation(s)
| | - Salvatore Giovanni Vitale
- Obstetrics and Gynecology Unit, Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Luigi Della Corte
- Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples "Federico II", Naples, Italy
| | - George Angelos Vilos
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Western University, London, Canada
| | | | | | | | - Sergio Haimovich
- Hillel Yaffe Medical Center/Technion - Israel Technology Institute, Hadera, Israel
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17
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Lier MCI, Özcan H, Schreurs AMF, van de Ven PM, Dreyer K, van der Houwen LEE, Johnson NP, Vandekerckhove F, Verhoeve HR, Kuchenbecker W, Mol BW, Lambalk CB, Mijatovic V. Uterine bathing with sonography gel prior to IVF/ICSI-treatment in patients with endometriosis, a multicentre randomised controlled trial. Hum Reprod Open 2020; 2020:hoaa054. [PMID: 33225080 PMCID: PMC7668398 DOI: 10.1093/hropen/hoaa054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 09/09/2020] [Indexed: 01/27/2023] Open
Abstract
STUDY QUESTION What is the effect of uterine bathing with sonography gel prior to IVF/ICSI-treatment on live birth rates after fresh embryo transfer in patients with endometriosis? SUMMARY ANSWER After formal interim analysis and premature ending of the trial, no significant difference between uterine bathing using a pharmacologically neutral sonography gel compared to a sham procedure on live birth rate after fresh embryo transfer in endometriosis patients (26.7% vs. 15.4%, relative risk (RR) 1.73, 95% confidence interval (CI) 0.81-3.72; P-value 0.147) could be found, although the trial was underpowered to draw definite conclusions. WHAT IS KNOWN ALREADY Impaired implantation receptivity contributes to reduced clinical pregnancy rates after IVF/ICSI-treatment in endometriosis patients. Previous studies have suggested a favourable effect of tubal flushing with Lipiodol® on natural conceptions. This benefit might also be explained by enhancing implantation through endometrial immunomodulation. Although recent studies showed no beneficial effect of endometrial scratching, the effect of mechanical stress by intrauterine infusion on the endometrium in endometriosis patients undergoing IVF/ICSI-treatment has not been investigated yet. STUDY DESIGN SIZE DURATION We performed a multicentre, patient-blinded, randomised controlled trial in which women were randomly allocated to either a Gel Infusion Sonography (GIS, intervention group) or a sham procedure (control group) prior to IVF/ICSI-treatment. Since recruitment was slow and completion of the study was considered unfeasible, the study was halted after inclusion of 112 of the planned 184 women. PARTICIPANTS/MATERIALS SETTING METHODS We included infertile women with surgically confirmed endometriosis ASRM stage I-IV undergoing IVF/ICSI-treatment. After informed consent, women were randomised to GIS with intrauterine instillation of ExEm-gel® or sonography with gel into the vagina (sham). This was performed in the cycle preceding the embryo transfer, on the day GnRH analogue treatment was started. The primary endpoint was live birth rate after fresh embryo transfer. Analysis was performed by both intention-to-treat and per-protocol. MAIN RESULTS AND THE ROLE OF CHANCE Between July 2014 to September 2018, we randomly allocated 112 women to GIS (n = 60) or sham procedure (n = 52). The live birth rate after fresh embryo transfer was 16/60 (26.7%) after GIS versus 8/52 (15.4%) after the sham (RR 1.73, 95% CI 0.81-3.72; P-value 0.147). Ongoing pregnancy rate was 16/60 (26.7%) after GIS versus 9/52 (17.3%) in the controls (RR 1.54, 95% CI 0.74-3.18). Miscarriage occurred in 1/60 (1.7%) after GIS versus 5/52 (9.6%) in the controls (RR 0.17, 95% CI 0.02-1.44) women. Uterine bathing resulted in a higher pain score compared with a sham procedure (visual analogue scale score 2.7 [1.3-3.5] vs. 1.0 [0.0-2.0], P < 0.001). There were two adverse events after GIS compared with none after sham procedures. LIMITATIONS REASONS FOR CAUTION The study was terminated prematurely due to slow recruitment and trial fatigue. Therefore, the trial is underpowered to draw definite conclusions regarding the effect of uterine bathing with sonography gel on live birth rate after fresh embryo transfer in endometriosis patients undergoing IVF/ICSI-treatment. WIDER IMPLICATIONS OF THE FINDINGS We could not demonstrate a favourable effect of uterine bathing procedures with sonography gel prior to IVF/ICSI-treatment in patients with endometriosis. STUDY FUNDING/COMPETING INTERESTS Investigator initiated study. IQ Medical Ventures provided the ExEm FOAM® kits free of charge, they were not involved in the study design, data management, statistical analyses and/or manuscript preparation, etc. C.B.L. reports receiving grants from Ferring, Merck and Guerbet, outside the submitted work. C.B.L. is Editor-in-Chief of Human Reproduction. V.M. reports grants and other from Guerbet, outside the submitted work. B.W.M. reports grants from NHMRC (GNT1176437), personal fees from ObsEva, Merck and Merck KGaA, Guerbet and iGenomix, outside the submitted work. N.P.J. reports research funding from Abb-Vie and Myovant Sciences and consultancy for Vifor Pharma, Guerbet, Myovant Sciences and Roche Diagnostics, outside the submitted work. K.D. reports personal fees from Guerbet, outside the submitted work. The other authors do not report any conflicts of interest. No financial support was provided. TRIAL REGISTRATION NUMBER NL4025 (NTR4198). TRIAL REGISTRATION DATE 7 October 2013. DATE OF FIRST PATIENT’S ENROLMENT 22 July 2014.
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Affiliation(s)
- M C I Lier
- Department of Reproductive Medicine, Academic Endometriosis Center, Amsterdam University Medical Center – Location VUmc, Amsterdam, the Netherlands
- Correspondence address. Department of Reproductive Medicine, Academic Endometriosis Center, Amsterdam University Medical Center – Location VUmc, De Boelelaan 1118, 1081 HZ, Amsterdam, the Netherlands. Tel: +31204445278; E-mail: https://orcid.org/0000-0002-9603-7718
| | - H Özcan
- Department of Reproductive Medicine, Academic Endometriosis Center, Amsterdam University Medical Center – Location VUmc, Amsterdam, the Netherlands
| | - A M F Schreurs
- Department of Reproductive Medicine, Academic Endometriosis Center, Amsterdam University Medical Center – Location VUmc, Amsterdam, the Netherlands
| | - P M van de Ven
- Department of Epidemiology & Biostatistics, Amsterdam University Medical Center – Location VUmc, Amsterdam, the Netherlands
| | - K Dreyer
- Department of Reproductive Medicine, Academic Endometriosis Center, Amsterdam University Medical Center – Location VUmc, Amsterdam, the Netherlands
| | - L E E van der Houwen
- Department of Reproductive Medicine, Academic Endometriosis Center, Amsterdam University Medical Center – Location VUmc, Amsterdam, the Netherlands
| | - N P Johnson
- Robinson Research Institute, University of Adelaide, North Adelaide, Australia
- Repromed Auckland and Auckland Gynaecology Group, Auckland, New Zealand
- The University of Auckland, Auckland, New Zealand
| | - F Vandekerckhove
- Department of Reproductive Medicine, Ghent University Hospital, Gent, Belgium
| | - H R Verhoeve
- Department of Reproductive Medicine, OLVG, Amsterdam, the Netherlands
| | - W Kuchenbecker
- Department of Reproductive Medicine, Isala, Zwolle, the Netherlands
| | - B W Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Australia
| | - C B Lambalk
- Department of Reproductive Medicine, Academic Endometriosis Center, Amsterdam University Medical Center – Location VUmc, Amsterdam, the Netherlands
| | - V Mijatovic
- Department of Reproductive Medicine, Academic Endometriosis Center, Amsterdam University Medical Center – Location VUmc, Amsterdam, the Netherlands
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Osaikhuwuomwan JA, Ikekwuibe I, Aziken ME. Experience with Hysteroscopy in a Private Specialist Hospital in Nigeria. Niger Med J 2020; 61:140-143. [PMID: 33100465 PMCID: PMC7547760 DOI: 10.4103/nmj.nmj_82_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 11/11/2019] [Accepted: 03/26/2020] [Indexed: 11/04/2022] Open
Abstract
Background Hysteroscopy is a standard method for the evaluation and treatment of various gynecological disorders. Its availability and accessibility are limited in our setting owing to resource constraints. Nevertheless, the utilization is on the increase mostly in private health institutions in Nigeria and as an adjunct in infertility management. Objectives The objective is to document the experience and outcome of hysteroscopy surgeries at a private specialist-assisted reproduction and endoscopy unit. Materials and Methods A retrospective review of all hysteroscopic procedures conducted at the unit was undertaken. Relevant sociodemographic and clinical information were extracted for analysis. In addition, outcomes of the procedure and outcome for those who eventually had in vitro fertilization (IVF) treatment were documented for analysis. Results A total of 106 patients had hysteroscopy over the study period. The age of patients ranged from 24 to 55 years. The most common indication for hysteroscopy was uterine synechiae (50%) others were preparatory for IVF (30.2%), uterine fibroid/polyp (10.4%), and abnormal uterine bleeding (9.4%), respectively. The major findings at hysteroscopy were intrauterine adhesions 68.9%. Therapeutic adhesiolysis was done using the scissors in most cases (83%) while two patients (1.9%) had adhesiolysis and resection of uterine polyp. A complication of noncardiogenic pulmonary edema was recorded from fluid overload. Overall most had return to normal menses (65.1%). Thirty-nine (38.8%) women had IVF treatment after hysteroscopy of which outcome was successful in 16 (41%) women. Conclusion The utilization of hysteroscopic surgeries in management of endometrial pathologies is increasing. It offers a safe and effective treatment and is a useful adjunct for improving IVF outcome especially for those with repeated failed treatment.
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Affiliation(s)
- James A Osaikhuwuomwan
- Graceland Medical Centre, Assisted Reproduction and Endoscopy Unit, Benin City, Nigeria.,Department of Obstetrics and Gynaecology, College of Medical Sciences, University of Benin, Benin City, Nigeria
| | - Israel Ikekwuibe
- Graceland Medical Centre, Assisted Reproduction and Endoscopy Unit, Benin City, Nigeria
| | - Michael E Aziken
- Graceland Medical Centre, Assisted Reproduction and Endoscopy Unit, Benin City, Nigeria.,Department of Obstetrics and Gynaecology, College of Medical Sciences, University of Benin, Benin City, Nigeria
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19
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Etiology and management of recurrent implantation failure: A focus on intra-uterine PBMC-therapy for RIF. J Reprod Immunol 2020; 139:103121. [DOI: 10.1016/j.jri.2020.103121] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Revised: 03/12/2020] [Accepted: 03/13/2020] [Indexed: 01/11/2023]
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Wang Y, Yang M, Huang X, Li X, Lin E, Feng Y. Prevention of Benign Endometrial Polyp Recurrence Using a Levonorgestrel-releasing Intrauterine System in Premenopausal Patients: A Retrospective Cohort Study. J Minim Invasive Gynecol 2020; 27:1281-1286. [PMID: 32446971 DOI: 10.1016/j.jmig.2019.11.023] [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: 08/20/2019] [Revised: 11/14/2019] [Accepted: 11/21/2019] [Indexed: 10/24/2022]
Abstract
STUDY OBJECTIVE To evaluate the levonorgestrel-releasing intrauterine system (LNG-IUS) to prevent the recurrence of endometrial polyps (EPs) after hysteroscopic polypectomies in premenopausal female patients. DESIGN A retrospective cohort study. SETTING A tertiary-care women's hospital. PATIENTS A total of 451 premenopausal female patients underwent hysteroscopic polypectomies between January 1, 2016, and December 31, 2017. INTERVENTIONS Treatment with LNG-IUS after hysteroscopic polypectomies. MEASUREMENTS AND MAIN RESULTS After the hysteroscopic polypectomies and placement of LNG-IUS, transvaginal ultrasounds were performed every 6 months to measure the recurrence of EPs. Overall, 5 (3.47%) of 144 patients in the LNG-IUS cohort and 49 (15.96%) of 307 patients in the control cohort experienced EP recurrence within the follow-up period of up to 3 years. The recurrence exhibited a strongly negative correlation when LNG-IUS was inserted (relative risk, 0.218; 95% confidence interval, 0.089-0.535; p <.05), but this did not significantly correlate with age, polyp size, number of polyps, previous history of polypectomy, and abnormal uterine bleeding. For the LNG-IUS and control cohorts, the recurrence in the first postoperative year was 1.39% and 6.19%, respectively, and 5.41% and 19.23% in the second postoperative year, respectively. CONCLUSION LNG-IUS reduces the recurrence of postoperative EPs in premenopausal patients.
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Affiliation(s)
- Yue Wang
- Department of Ambulatory Surgery, Women's Hospital, Zhejiang University School of Medicine (Dr. Wang)
| | - Min Yang
- Department of Reproductive Endocrinology, Zhejiang University School of Medicine (Dr. Yang)
| | - Xiufeng Huang
- Department of Gynecology, Zhejiang University School of Medicine (Dr. Huang)
| | - Xingmiao Li
- Department of Obstetrics, Zhejiang University School of Medicine (Dr. Li)
| | - Enze Lin
- Institute of Translational Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine (Dr. Feng and Mr. Lin); Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province (Dr. Feng and Mr. Lin), Hangzhou, Zhejiang, China
| | - Ye Feng
- Institute of Translational Medicine, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine (Dr. Feng and Mr. Lin); Key Laboratory of Microbial Technology and Bioinformatics of Zhejiang Province (Dr. Feng and Mr. Lin), Hangzhou, Zhejiang, China..
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Stepniewska AK, Verrazzo P, Savelli L, Trivella G, Signori C, Clarizia R, Guerriero M, Mollo A, De Placido G, Ceccaroni M. Comparison of Virtual Ultrasonographic Hysteroscopy with Conventional Hysteroscopy in the Workup of Patients Who Are Infertile. J Minim Invasive Gynecol 2020; 28:63-74. [PMID: 32197993 DOI: 10.1016/j.jmig.2020.03.003] [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: 08/08/2019] [Revised: 03/08/2020] [Accepted: 03/11/2020] [Indexed: 11/18/2022]
Abstract
STUDY OBJECTIVE To compare the tolerability and diagnostic accuracy of virtual ultrasonographic hysteroscopy (VUH) with that of conventional diagnostic outpatient hysteroscopy in the workup of patients who are infertile. DESIGN A single-center, retrospective cohort study. SETTING Department of Obstetrics and Gynecology, Gynecologic Oncology, and Minimally Invasive Pelvic Surgery Unit of Sacred Heart Hospital Don Calabria in Negrar, Italy. PATIENTS A total of 120 consecutive women who underwent hysterosalpingosonography and subsequent VUH and conventional hysteroscopy for infertility evaluation were included. The inclusion criterion was infertility for at least 1 year, with evaluation in the early or intermediate follicular phase of the menstrual cycle. INTERVENTIONS After the placement of an intracervical catheter, a Ringer Lactate solution was injected into the uterine cavity and fallopian tubes, and a 3D volume was obtained. The ultrasound volume acquired was successively elaborated offline, and a VUH was performed. Subsequently, a variable amount of air was introduced into the uterine cavity, and the patency of the salpinges was evaluated. MEASUREMENTS AND MAIN RESULTS The VUH findings were compared with those of conventional hysteroscopy performed in the subsequent month. For the detection of endometrial pathology in the overall pool, the sensitivity and specificity of VUH in comparison with conventional hysteroscopy were 100% (95% confidence interval [CI], 84.6%-100%) and 100% (95% CI, 96.3%-100%), respectively. For the detection of uterine cavity pathology and uterine malformations in the overall pool, the sensitivities of VUH were 80% (95% CI, 28.4%-99.5%) and 100% (95% CI, 75.3%-100%), respectively, with specificities of 100% (95% CI, 96.8%-100%) and 100% (95% CI, 96.6%-100%), respectively, when compared with conventional hysteroscopy. The positive predictive values for endometrial pathology, uterine cavity alterations, and uterine malformations were 100% (95% CI, 84.6%-100%), 100% (95% CI, 39.8%-100%), and 100% (95% CI, 75.3%-100%), respectively, with a receiver operating characteristic area of 100%, 90% (95% CI, 70%-100%), and 100%, respectively. There were no cases of severe vasovagal reactions or other complications. Most patients (67%, 81 of 120 women) described the examination as "less painful than expected," 25% (30 of 120 women) "just as expected," and only 7% (9 of 120 women) as "more painful than expected." CONCLUSION VUH was well tolerated and showed a high accuracy (100%) in the study of the uterine cavity when compared with conventional hysteroscopy.
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Affiliation(s)
- Anna Katarzyna Stepniewska
- Department of Obstetrics and Gynecology, Gynecologic Oncology, and Minimally Invasive Pelvic Surgery, International School of Surgical Anatomy, IRCCS Sacred Heart Hospital Don Calabria, Negrar, Verona (Drs. Stepniewska, Trivella, Signori, Clarizia, and Ceccaroni).
| | - Paolo Verrazzo
- University Department of Neuroscience, Reproductive Medicine, and Odontostomatology, University of Naples Federico II, Naples (Drs. Verrazzo, Mollo, and De Placido)
| | - Luca Savelli
- Department of Obstetrics and Gynecology (Dr. Savelli) University of Bologna, Bologna
| | - Giamberto Trivella
- Department of Obstetrics and Gynecology, Gynecologic Oncology, and Minimally Invasive Pelvic Surgery, International School of Surgical Anatomy, IRCCS Sacred Heart Hospital Don Calabria, Negrar, Verona (Drs. Stepniewska, Trivella, Signori, Clarizia, and Ceccaroni)
| | - Chiara Signori
- Department of Obstetrics and Gynecology, Gynecologic Oncology, and Minimally Invasive Pelvic Surgery, International School of Surgical Anatomy, IRCCS Sacred Heart Hospital Don Calabria, Negrar, Verona (Drs. Stepniewska, Trivella, Signori, Clarizia, and Ceccaroni)
| | - Roberto Clarizia
- Department of Obstetrics and Gynecology, Gynecologic Oncology, and Minimally Invasive Pelvic Surgery, International School of Surgical Anatomy, IRCCS Sacred Heart Hospital Don Calabria, Negrar, Verona (Drs. Stepniewska, Trivella, Signori, Clarizia, and Ceccaroni)
| | - Massimo Guerriero
- Department of Computer Science (Dr. Guerriero), University of Verona, Verona, Italy; Clinical Research Unit (Dr. Guerriero), IRCCS Sacred Heart Hospital Don Calabria, Negrar, Verona
| | - Antonio Mollo
- University Department of Neuroscience, Reproductive Medicine, and Odontostomatology, University of Naples Federico II, Naples (Drs. Verrazzo, Mollo, and De Placido)
| | - Giuseppe De Placido
- University Department of Neuroscience, Reproductive Medicine, and Odontostomatology, University of Naples Federico II, Naples (Drs. Verrazzo, Mollo, and De Placido)
| | - Marcello Ceccaroni
- Department of Obstetrics and Gynecology, Gynecologic Oncology, and Minimally Invasive Pelvic Surgery, International School of Surgical Anatomy, IRCCS Sacred Heart Hospital Don Calabria, Negrar, Verona (Drs. Stepniewska, Trivella, Signori, Clarizia, and Ceccaroni)
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Sar-Shalom Nahshon C, Sagi-Dain L, Wiener-Megnazi Z, Dirnfeld M. The impact of intentional endometrial injury on reproductive outcomes: a systematic review and meta-analysis. Hum Reprod Update 2020; 25:95-113. [PMID: 30388238 DOI: 10.1093/humupd/dmy034] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 10/11/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Endometrial injury is an intentional damage made to the endometrium, usually produced by a Pipelle catheter. Over the last two decades, endometrial injury has been studied to improve implantation rates and decrease the incidence of implantation failure in invitro fertilization (IVF) cycles. Recently, additional studies of endometrial injury, performed not only in patients with implantation failure but also in intrauterine insemination cycles, have been conducted, and the endometrial injury made by hysteroscopy has been researched. The evidence describing the impact of endometrial injury is controversial; therefore, we conducted a systematic review and meta-analysis to examine the issue. OBJECTIVE AND RATIONALE Our objective is to review the research that has been done until now and perform a meta-analysis regarding endometrial injury and its influence on implantation success and pregnancy rates in patients with at least one failed IVF cycle. In particular, we aim to study the efficacy of the procedure and look for confounding factors, such as maternal age, in assessing the efficacy of endometrial injury. SEARCH METHODS The systematic review of the literature was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) statement. Study protocol can be assessed at PROSPERO International prospective register of systematic reviews (registration number CRD42018092773). Searches were conducted by an experienced research librarian in the following databases: MEDLINE(R) using the OvidSP interface and PUBMED, Embase, Web of Science and Cochrane Library. This review considered for inclusion randomized-controlled trials examining the success of performing local endometrial injury on IVF outcomes in women with previous failed IVF cycles. OUTCOMES Ten studies, comprising a total of 1260 patients, were selected. Overall, when studying the effect of endometrial injury on clinical pregnancy rates (CPRs) and live birth rates (LBRs), higher rates were shown in the endometrial injury group. However, endometrial injury did not significantly improve CPRs and LBRs, when considering sub-group analyses of studies including patients with two or more failed IVF cycles, studies examining older patients or studies which did not include hysteroscopy. There was no significant difference found regarding multiple pregnancy rates, while a handful of studies showed an improvement in miscarriage rates. WIDER IMPLICATIONS Endometrial injury should be used restrictively and not routinely in clinics. Maternal age and number of previous failed treatment cycles may be contributing factors which can influence the results when studying the effect of endometrial local injury. It is possible that the relative contribution of endometrial receptivity to the chances of implantation decreases with any additional failed cycle. The optimal study to prove the efficacy of local endometrial injury on implantation and pregnancy rates, should be a random-controlled trial studying the effect of local endometrial injury in oocyte donation cycles, in recipients with repeated implantation failure. This kind of study will conclude whether local endometrial injury is an efficient procedure with minimum confounding factors, and may assist in defining the population, even outside of donation cycles, that will benefit from the procedure.
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Affiliation(s)
- Chen Sar-Shalom Nahshon
- Division of Reproductive Endocrinology-IVF, Department of Obstetrics and Gynecology, Carmel Medical Center, Bruce & Ruth Rappaport Faculty of Medicine, Technion Haifa, Israel
| | - Lena Sagi-Dain
- Division of Reproductive Endocrinology-IVF, Department of Obstetrics and Gynecology, Carmel Medical Center, Bruce & Ruth Rappaport Faculty of Medicine, Technion Haifa, Israel
| | - Zofnat Wiener-Megnazi
- Division of Reproductive Endocrinology-IVF, Department of Obstetrics and Gynecology, Carmel Medical Center, Bruce & Ruth Rappaport Faculty of Medicine, Technion Haifa, Israel
| | - Martha Dirnfeld
- Division of Reproductive Endocrinology-IVF, Department of Obstetrics and Gynecology, Carmel Medical Center, Bruce & Ruth Rappaport Faculty of Medicine, Technion Haifa, Israel
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Daniilidis A, Kalpatsanidis A, Kalkan U, Kasmas S, Pados G, Angioni S. Reproductive outcome after operative hysteroscopy for uterine septum: scissors or diathermy? ACTA ACUST UNITED AC 2020; 72:36-42. [DOI: 10.23736/s0026-4784.20.04444-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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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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Novel high-coverage targeted metabolomics method (SWATHtoMRM) for exploring follicular fluid metabolome alterations in women with recurrent spontaneous abortion undergoing in vitro fertilization. Sci Rep 2019; 9:10873. [PMID: 31350457 PMCID: PMC6659694 DOI: 10.1038/s41598-019-47370-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 07/16/2019] [Indexed: 12/31/2022] Open
Abstract
The complexity of follicular fluid metabolome presents a significant challenge for qualitative and quantitative metabolite profiling, and for discovering the comprehensive biomarkers. In order to address this challenge, a novel SWATHtoMRM metabolomics method was used for providing broad coverage and excellent quantitative capability to discover the human follicular fluid metabolites related to recurrent spontaneous abortion (RSA) after in vitro fertilization and embryo transfer, and to evaluate their relationship with pregnancy outcome. The follicular fluid samples from the spontaneous abortion group (n = 22) and the control group (n = 22) were analyzed using ultra-performance liquid chromatography high-resolution mass spectrometry. A novel, high-coverage, targeted metabolomics method (SWATH to MRM) and a targeted metabolomics method were used to find and validate the differential metabolites between the two groups. A total of 18 follicular fluid metabolites, including amino acids, cholesterol, vitamins, fatty acids, cholic acid, lysophosphatidylcholine and other metabolites, were identified. In the RSA group, 8 metabolites, namely dehydroepiandrosterone, lysoPC(16:0), lysoPC(18:2), lysoPC(18:1), lysoPC(18:0), lysoPC(20:5), lysoPC(20:4), and lysoPC(20:3), were up-regulated, and 10 metabolites, namely phenylalanine, linoleate, oleic acid, docosahexaenoic acid, lithocholic acid, 25-hydroxyvitamin D3, hydroxycholesterol, 13-hydroxy-alpha-tocopherol, leucine, and tryptophan, were down-regulated. These differential metabolites related to RSA may provide a possible diagnostic basis and therapeutic target for RSA, as well as a scientific basis for elucidating the mechanism of RSA.
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Ono S, Kuwabara Y, Matsuda S, Yonezawa M, Watanabe K, Akira S, Takeshita T. Is hysteroscopic metroplasty using the incision method for septate uterus a risk factor for adverse obstetric outcomes? J Obstet Gynaecol Res 2019; 45:634-639. [DOI: 10.1111/jog.13884] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 11/18/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Shuichi Ono
- Department of Obstetrics and Gynecology; Nippon Medical School Hospital; Tokyo Japan
| | - Yoshimitsu Kuwabara
- Department of Obstetrics and Gynecology; Nippon Medical School Hospital; Tokyo Japan
| | - Shigeru Matsuda
- Department of Obstetrics and Gynecology; Nippon Medical School Hospital; Tokyo Japan
| | - Mirei Yonezawa
- Department of Obstetrics and Gynecology; Nippon Medical School Hospital; Tokyo Japan
| | - Kenichiro Watanabe
- Department of Obstetrics and Gynecology; Nippon Medical School Hospital; Tokyo Japan
| | - Shigeo Akira
- Department of Obstetrics and Gynecology; Nippon Medical School Hospital; Tokyo Japan
| | - Toshiyuki Takeshita
- Department of Obstetrics and Gynecology; Nippon Medical School Hospital; Tokyo Japan
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Actual considerations concerning the contribution of histeroscopy to diagnosis and treatment of adenomyosis in infertile patients. GINECOLOGIA.RO 2019. [DOI: 10.26416/gine.25.3.2019.2496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Bosteels J, van Wessel S, Weyers S, Broekmans FJ, D'Hooghe TM, Bongers MY, Mol BWJ. Hysteroscopy for treating subfertility associated with suspected major uterine cavity abnormalities. Cochrane Database Syst Rev 2018; 12:CD009461. [PMID: 30521679 PMCID: PMC6517267 DOI: 10.1002/14651858.cd009461.pub4] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Observational studies suggest higher pregnancy rates after the hysteroscopic removal of endometrial polyps, submucous fibroids, uterine septum or intrauterine adhesions, which are present in 10% to 15% of women seeking treatment for subfertility. OBJECTIVES To assess the effects of the hysteroscopic removal of endometrial polyps, submucous fibroids, uterine septum or intrauterine adhesions suspected on ultrasound, hysterosalpingography, diagnostic hysteroscopy or any combination of these methods in women with otherwise unexplained subfertility or prior to intrauterine insemination (IUI), in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI). SEARCH METHODS We searched the following databases from their inception to 16 April 2018; The Cochrane Gynaecology and Fertility Group Specialised Register, the Cochrane Central Register of Studies Online, ; MEDLINE, Embase , CINAHL , and other electronic sources of trials including trial registers, sources of unpublished literature, and reference lists. We handsearched the American Society for Reproductive Medicine (ASRM) conference abstracts and proceedings (from 1 January 2014 to 12 May 2018) and we contacted experts in the field. SELECTION CRITERIA Randomised comparison between operative hysteroscopy versus control for unexplained subfertility associated with suspected major uterine cavity abnormalities.Randomised comparison between operative hysteroscopy versus control for suspected major uterine cavity abnormalities prior to medically assisted reproduction.Primary outcomes were live birth and hysteroscopy complications. Secondary outcomes were pregnancy and miscarriage. DATA COLLECTION AND ANALYSIS Two review authors independently assessed studies for inclusion and risk of bias, and extracted data. We contacted study authors for additional information. MAIN RESULTS Two studies met the inclusion criteria.1. Randomised comparison between operative hysteroscopy versus control for unexplained subfertility associated with suspected major uterine cavity abnormalities.In women with otherwise unexplained subfertility and submucous fibroids, we were uncertain whether hysteroscopic myomectomy improved the clinical pregnancy rate compared to expectant management (odds ratio (OR) 2.44, 95% confidence interval (CI) 0.97 to 6.17; P = 0.06, 94 women; very low-quality evidence). We are uncertain whether hysteroscopic myomectomy improves the miscarriage rate compared to expectant management (OR 1.54, 95% CI 0.47 to 5.00; P = 0.47, 94 women; very low-quality evidence). We found no data on live birth or hysteroscopy complication rates. We found no studies in women with endometrial polyps, intrauterine adhesions or uterine septum for this randomised comparison.2. Randomised comparison between operative hysteroscopy versus control for suspected major uterine cavity abnormalities prior to medically assisted reproduction.The hysteroscopic removal of polyps prior to IUI may have improved the clinical pregnancy rate compared to diagnostic hysteroscopy only: if 28% of women achieved a clinical pregnancy without polyp removal, the evidence suggested that 63% of women (95% CI 45% to 89%) achieved a clinical pregnancy after the hysteroscopic removal of the endometrial polyps (OR 4.41, 95% CI 2.45 to 7.96; P < 0.00001, 204 women; low-quality evidence). We found no data on live birth, hysteroscopy complication or miscarriage rates in women with endometrial polyps prior to IUI. We found no studies in women with submucous fibroids, intrauterine adhesions or uterine septum prior to IUI or in women with all types of suspected uterine cavity abnormalities prior to IVF/ICSI. AUTHORS' CONCLUSIONS Uncertainty remains concerning an important benefit with the hysteroscopic removal of submucous fibroids for improving the clinical pregnancy rates in women with otherwise unexplained subfertility. The available low-quality evidence suggests that the hysteroscopic removal of endometrial polyps suspected on ultrasound in women prior to IUI may improve the clinical pregnancy rate compared to simple diagnostic hysteroscopy. More research is needed to measure the effectiveness of the hysteroscopic treatment of suspected major uterine cavity abnormalities in women with unexplained subfertility or prior to IUI, IVF or ICSI.
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Affiliation(s)
- Jan Bosteels
- Cochrane BelgiumAcademic Centre for General PracticeKapucijnenvoer 33blok J bus 7001LeuvenBelgium3000
| | - Steffi van Wessel
- Ghent University HospitalWomen’s ClinicCorneel Heymanslaan 10GhentBelgium9000
| | - Steven Weyers
- University Hospital GhentObstetrics and GynaecologyDe Pintelaan 185GhentBelgium
| | - Frank J Broekmans
- University Medical CenterDepartment of Reproductive Medicine and GynecologyHeidelberglaan 100UtrechtNetherlands3584 CX
| | - Thomas M D'Hooghe
- University Hospital GasthuisbergLeuven University Fertility CentreHerestraat 49LeuvenBelgium3000
| | - M Y Bongers
- Máxima Medisch CentrumDepartment of Obstetrics and GynaecologyVeldhovenNetherlands
| | - Ben Willem J Mol
- Monash UniversityDepartment of Obstetrics and Gynaecology246 Clayton RoadClaytonVictoriaAustralia3168
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Coughlan C. What to do when good-quality embryos repeatedly fail to implant. Best Pract Res Clin Obstet Gynaecol 2018; 53:48-59. [DOI: 10.1016/j.bpobgyn.2018.07.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 07/12/2018] [Accepted: 07/17/2018] [Indexed: 12/22/2022]
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Ono S, Watanabe K, Yonezawa M, Ichikawa T, Kuwabara Y, Akira S, Takeshita T. Efficacy of Dienogest in Thinning the Endometrium Before Hysteroscopic Metroplasty and Analysis of Postoperative Reproductive Outcomes. J Gynecol Surg 2018. [DOI: 10.1089/gyn.2018.0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Shuichi Ono
- Department of Obstetrics and Gynecology, Nippon Medical School Hospital, Tokyo, Japan
| | - Kenichiro Watanabe
- Department of Obstetrics and Gynecology, Nippon Medical School Hospital, Tokyo, Japan
| | - Mirei Yonezawa
- Department of Obstetrics and Gynecology, Nippon Medical School Hospital, Tokyo, Japan
| | - Tomoko Ichikawa
- Department of Obstetrics and Gynecology, Nippon Medical School Hospital, Tokyo, Japan
| | - Yoshimitsu Kuwabara
- Department of Obstetrics and Gynecology, Nippon Medical School Hospital, Tokyo, Japan
| | - Shigeo Akira
- Department of Obstetrics and Gynecology, Nippon Medical School Hospital, Tokyo, Japan
| | - Toshiyuki Takeshita
- Department of Obstetrics and Gynecology, Nippon Medical School Hospital, Tokyo, Japan
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Li F, Wei S, Yang S, Liu Z, Nan F. Post hysteroscopic progesterone hormone therapy in the treatment of endometrial polyps. Pak J Med Sci 2018; 34:1267-1271. [PMID: 30344589 PMCID: PMC6191810 DOI: 10.12669/pjms.345.15330] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 09/04/2018] [Accepted: 09/06/2018] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVE To find out the clinical effects of post hysteroscopic progesterone hormone therapy in the treatment of endometrial polyps in terms of clinical outcome and the expression of endometrial Vascular Endothelial Growth Factor (VEGF). METHODS Ninety-eight patients who were confirmed as endometrial polyp in the hospital from April 2014 and December 2016 were selected and divided into treatment group and a control group using random number table, 49 in each group. Patients in both groups were given hysteroscopic operation. Patients in the treatment group were treated by progesterone hormone drugs after hysteroscopic operation, while patients in the control group were not given progesterone hormone. The changes of menstrual blood volume, menstrual cycle and expression of VEGF were compared between the two groups after treatment, and the recurrence condition, thickness of endometrium and hemoglobin were followed up one year after treatment. RESULTS The pictorial blood loss assessment chart (PBAC) scores of patients in the two groups had no significant difference before treatment (P>0.05); but the score of the treatment group was much lower than that of the control group. The improvement rate of menstrual cycle of the treatment group was much higher than that of the control group, and the difference had statistical significance (P<0.05). Compared to before treatment, the serum VEGF level of the patients in both groups had a remarkable decline in the 1st, 3rd and 6th month after treatment, and the difference had statistical significance (P<0.05). The difference of the serum VEGF level between the two groups in the 1st and 3rd month after treatment had no statistical significance (P>0.05). The serum VEGF level of the treatment group was notably lower than that of the control group six months after treatment, and the difference had statistical significance (P<0.05). The follow-up results demonstrated that the treatment group had smaller thickness of endometrium and higher level of hemoglobin compared to the control group, and the recurrence rate of the treatment group was lower than that of the control group (P<0.05). CONCLUSION Post hysteroscopic progesterone hormone therapy has favorable clinical effect in treating endometrial polyps as it can effectively prevent the recurrence of endometrial polyps, relieve the level of hemoglobin and reduce endometrial thickness.
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Affiliation(s)
- Fangfang Li
- Fangfang Li, Department of Obstetrics and Gynecology, Binzhou Medical University Hospital, Binzhou, 256603, China
| | - Shuangyan Wei
- Shuangyan Wei, Department of Obstetrics and Gynecology, Binzhou Medical University Hospital, Binzhou, 256603, China
| | - Shuye Yang
- Shuye Yang, Department of Orthopaedics, Binzhou Medical University Hospital, Binzhou, 256603, China
| | - Zhiqiang Liu
- Zhiqiang Liu, Department of Obstetrics and Gynecology, Binzhou Medical University Hospital, Binzhou, 256603, China
| | - Fangfang Nan
- Fangfang Nan, Department of Obstetrics and Gynecology, Binzhou Medical University Hospital, Binzhou, 256603, China
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Ali M, Al-Hendy A. Selective progesterone receptor modulators for fertility preservation in women with symptomatic uterine fibroids. Biol Reprod 2018; 97:337-352. [PMID: 29025038 PMCID: PMC5803778 DOI: 10.1093/biolre/iox094] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 08/23/2017] [Indexed: 12/15/2022] Open
Abstract
Uterine fibroids (UFs, AKA leiomyoma) are the most important benign neoplastic threat to women's health, with costs up to hundreds of billions of health care dollars worldwide. Uterine fibroids caused morbidities exert a tremendous health toll, impacting the quality of life of women of all ethnicities, especially women of color. Clinical presentations include heavy vaginal bleeding, pelvic pain, bulk symptoms, subfertility, and obstetric complications. Current management strategies heavily lean toward surgical procedures; nonetheless, the choice of treatment is generally subject to patient's age and her desire to preserve future fertility. Women with UF who desire to maintain future fertility potential face a dilemma because of the limited treatment choices that are currently available to help them achieve that goal. Recently, ulipristal acetate the first of the promising family of oral selective progesterone receptor modulators has been approved for UF treatment in Europe, Canada, and several other countries and is under review for possible approval in the USA. In this review article, we discuss recent advances in the management options against UF with a bend toward oral effective long-term treatment alternatives who are particularly suited for those seeking to preserve their future fertility potential. We also explore the transformative concept of primary and secondary UF prevention using these new anti-UF agents. We envision a remarkable shift in the management of UF in future years from surgical/invasive treatment to orally administrated options; clearly, this potential shift will require additional intense clinical research.
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Affiliation(s)
- Mohamed Ali
- Department of Obstetrics and Gynecology, Medical College of Georgia, Augusta University, Augusta, Georgia, USA.,Clinical Pharmacy department, Faculty of pharmacy, Ain Shams University, Cairo, Egypt
| | - Ayman Al-Hendy
- Department of Obstetrics and Gynecology, Medical College of Georgia, Augusta University, Augusta, Georgia, USA
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Wang Y, Sun Y, Di W, Kuang YP, Xu B. Association between induced abortion history and later in vitro fertilization outcomes. Int J Gynaecol Obstet 2018; 141:321-326. [PMID: 29508914 DOI: 10.1002/ijgo.12481] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 12/19/2017] [Accepted: 03/01/2018] [Indexed: 12/29/2022]
Affiliation(s)
- Yao Wang
- Department of Assisted Reproduction; Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine; Shanghai China
| | - Yun Sun
- Center for Reproductive Medicine; Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine; Shanghai China
- Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics; Renji Hospital; Shanghai Jiao Tong University School of Medicine; Shanghai China
| | - Wen Di
- Department of Gynecology and Obstetrics; Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine; Shanghai China
| | - Yan-ping Kuang
- Department of Assisted Reproduction; Shanghai Ninth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine; Shanghai China
| | - Bing Xu
- Center for Reproductive Medicine; Renji Hospital Affiliated to Shanghai Jiao Tong University School of Medicine; Shanghai China
- Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics; Renji Hospital; Shanghai Jiao Tong University School of Medicine; Shanghai China
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Gu F, Zhang H, Ruan S, Li J, Liu X, Xu Y, Zhou C. High number of endometrial polyps is a strong predictor of recurrence: findings of a prospective cohort study in reproductive-age women. Fertil Steril 2018. [DOI: 10.1016/j.fertnstert.2017.11.029] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Ono S, Yonezawa M, Watanabe K, Abe T, Mine K, Kuwabara Y, Akira S, Takeshita T. Retrospective cohort study of the risk factors for secondary infertility following hysteroscopic metroplasty of the uterine septum in women with recurrent pregnancy loss. Reprod Med Biol 2017; 17:77-81. [PMID: 29371825 PMCID: PMC5768972 DOI: 10.1002/rmb2.12072] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Accepted: 10/18/2017] [Indexed: 11/10/2022] Open
Abstract
Purpose A hysteroscopic metroplasty was performed for women with recurrent pregnancy loss owing to a uterine septum, following which some women became infertile. The aim of this study was to elucidate the risk factors of secondary infertility 1 year after hysteroscopic metroplasty for a uterine septum. Methods A retrospective, single-center, cohort study included women with a history of at least two miscarriages that had been attributed to a uterine septum who underwent a hysteroscopic metroplasty. The patients' background data were compared between the patients who conceived and those who remained infertile at 1 year postoperatively. The data were analyzed by using the Mann-Whitney U-test and multivariate analyses. Results The postoperative live birth rate was 83.9% (n = 26), with persistent infertility in five women at 1 year. When comparing the pregnancy group with the infertile group, the women in the postoperative infertility group were significantly older than those in the postoperative pregnancy group. The multivariate analysis showed that age was an independent risk factor for persistent infertility. Conclusion Age was identified as an independent risk factor for postoperative secondary infertility. Therefore, surgery as early as possible is recommended.
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Affiliation(s)
- Shuichi Ono
- Department of Obstetrics and Gynecology Nippon Medical School Tokyo Japan
| | - Mirei Yonezawa
- Department of Obstetrics and Gynecology Nippon Medical School Tokyo Japan
| | - Kenichiro Watanabe
- Department of Obstetrics and Gynecology Nippon Medical School Tokyo Japan
| | - Takashi Abe
- Department of Obstetrics and Gynecology Nippon Medical School Tokyo Japan
| | - Katsuya Mine
- Department of Obstetrics and Gynecology Nippon Medical School Tokyo Japan
| | | | - Shigeo Akira
- Department of Obstetrics and Gynecology Nippon Medical School Tokyo Japan
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A Review of the Molecular Basis for Reduced Endometrial Receptivity in Uterine Fibroids and Polyps. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2017. [DOI: 10.5301/jeppd.5000304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
The presence of fibroids and endometrial polyps is associated with reduced endometrial receptivity and subsequent fertility outcomes. The following review explores the molecular mechanisms behind reduced endometrial receptivity, with a focus upon homebox genes, basic transcription element binding proteins, transforming growth factor β-3, and bone morphogenetic protein 2. A better understanding of these processes is essential for future targeted therapy.
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The effect of frozen-thawed embryo transfer performed concurrently with hysteroscopy on the reproductive outcomes during assisted reproductive treatments. Sci Rep 2017; 7:11852. [PMID: 28928434 PMCID: PMC5605495 DOI: 10.1038/s41598-017-12068-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 08/31/2017] [Indexed: 11/08/2022] Open
Abstract
The uterine environment is vital to the successful conception; recently, hysteroscopy was used to remove uterine anomalies in patients undergoing assisted reproductive treatments in combination with a “freeze-all” strategy. However, the rapid recurrence of uterine anomalies impose a negative impact on pregnancy. A possible way to avoid this issue is to implement frozen-thawed embryo transfer (FET) as soon as possible. Thus, we sought to investigate the impact of performing FET concurrently with hysteroscopy in the same mense on the pregnancy outcome. Patients enrolled were divided into two groups: group 1 (n = 272, FET in this mense) and group 2 (n = 251, FET in the next mense). There were no differences in the clinical pregnancy rate (55.15% vs. 53.78%), implantation rate (39.32% vs. 37.2%), spontaneous miscarriage rate (10% vs. 8.89%), or live birth rate (45.96% vs. 45.02%) when comparing the two groups. Binary logistic regression indicated maternal age was negatively associated with the live birth rate, while FET following hysteroscopy in the same mense had no adverse effects on the live birth rate. Our data indicate performing FET concurrently with hysteroscopy in the same menstrual cycle does not impair the pregnancy outcomes, but additional studies with larger populations are needed to confirm these results.
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Removal of myomas in asymptomatic patients to improve fertility and/or reduce miscarriage rate: a guideline. Fertil Steril 2017; 108:416-425. [DOI: 10.1016/j.fertnstert.2017.06.034] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 06/29/2017] [Indexed: 11/22/2022]
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Armstrong SC, Showell M, Stewart EA, Rebar RW, Vanderpoel S, Farquhar CM. Baseline anatomical assessment of the uterus and ovaries in infertile women: a systematic review of the evidence on which assessment methods are the safest and most effective in terms of improving fertility outcomes. Hum Reprod Update 2017; 23:533-547. [DOI: 10.1093/humupd/dmx019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 07/02/2017] [Indexed: 11/14/2022] Open
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Tanos V, Berry KE, Seikkula J, Abi Raad E, Stavroulis A, Sleiman Z, Campo R, Gordts S. The management of polyps in female reproductive organs. Int J Surg 2017; 43:7-16. [DOI: 10.1016/j.ijsu.2017.05.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 05/02/2017] [Indexed: 02/07/2023]
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Evaluating the effect of cervical dilatation prior to operative hysteroscopy to the week of subsequent delivery. MIDDLE EAST FERTILITY SOCIETY JOURNAL 2017. [DOI: 10.1016/j.mefs.2016.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Park HJ, Kim YS, Yoon TK, Lee WS. Chronic endometritis and infertility. Clin Exp Reprod Med 2016; 43:185-192. [PMID: 28090456 PMCID: PMC5234283 DOI: 10.5653/cerm.2016.43.4.185] [Citation(s) in RCA: 80] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Revised: 06/09/2016] [Accepted: 06/30/2016] [Indexed: 11/22/2022] Open
Abstract
Chronic endometritis (CE) is a condition involving the breakdown of the peaceful co-existence between microorganisms and the host immune system in the endometrium. A majority of CE cases produce no noticeable signs or mild symptoms, and the prevalence rate of CE has been found to be approximately 10%. Gynecologists and pathologists often do not focus much clinical attention on CE due to the time-consuming microscopic examinations necessary to diagnose CE, its mild clinical manifestations, and the benign nature of the disease. However, the relationship between CE and infertility-related conditions such as repeated implantation failure and recurrent miscarriage has recently emerged as an area of inquiry. In this study, we reviewed the literature on the pathophysiology of CE and how it may be associated with infertility, as well as the literature regarding the diagnosis and treatment of CE. In addition, we discuss the value of hysteroscopic procedures in the diagnosis and treatment of CE.
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Affiliation(s)
- Hyun Jong Park
- Department of Obstetrics and Gynecology, Fertility Center of CHA Gumi Medical Center, CHA University, Gumi, Korea
| | - You Shin Kim
- Department of Obstetrics and Gynecology, Fertility Center of CHA Gangnam Medical Center, CHA University, Seoul, Korea
| | - Tae Ki Yoon
- Department of Obstetrics and Gynecology, Fertility Center of CHA Gangnam Medical Center, CHA University, Seoul, Korea
| | - Woo Sik Lee
- Department of Obstetrics and Gynecology, Fertility Center of CHA Gangnam Medical Center, CHA University, Seoul, Korea
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Davari-tanha F, Shahrokh Tehraninejad E, Ghazi M, Shahraki Z. The role of G-CSF in recurrent implantation failure: A randomized double blind placebo control trial. Int J Reprod Biomed 2016. [DOI: 10.29252/ijrm.14.12.737] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
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Donnez J, Dolmans MM. Uterine fibroid management: from the present to the future. Hum Reprod Update 2016; 22:665-686. [PMID: 27466209 PMCID: PMC5853598 DOI: 10.1093/humupd/dmw023] [Citation(s) in RCA: 350] [Impact Index Per Article: 43.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 05/12/2016] [Accepted: 05/27/2016] [Indexed: 12/24/2022] Open
Abstract
Uterine fibroids (also known as leiomyomas or myomas) are the most common form of benign uterine tumors. Clinical presentations include abnormal bleeding, pelvic masses, pelvic pain, infertility, bulk symptoms and obstetric complications.Almost a third of women with leiomyomas will request treatment due to symptoms. Current management strategies mainly involve surgical interventions, but the choice of treatment is guided by patient's age and desire to preserve fertility or avoid 'radical' surgery such as hysterectomy. The management of uterine fibroids also depends on the number, size and location of the fibroids. Other surgical and non-surgical approaches include myomectomy by hysteroscopy, myomectomy by laparotomy or laparoscopy, uterine artery embolization and interventions performed under radiologic or ultrasound guidance to induce thermal ablation of the uterine fibroids.There are only a few randomized trials comparing various therapies for fibroids. Further investigations are required as there is a lack of concrete evidence of effectiveness and areas of uncertainty surrounding correct management according to symptoms. The economic impact of uterine fibroid management is significant and it is imperative that new treatments be developed to provide alternatives to surgical intervention.There is growing evidence of the crucial role of progesterone pathways in the pathophysiology of uterine fibroids due to the use of selective progesterone receptor modulators (SPRMs) such as ulipristal acetate (UPA). The efficacy of long-term intermittent use of UPA was recently demonstrated by randomized controlled studies.The need for alternatives to surgical intervention is very real, especially for women seeking to preserve their fertility. These options now exist, with SPRMs which are proven to treat fibroid symptoms effectively. Gynecologists now have new tools in their armamentarium, opening up novel strategies for the management of uterine fibroids.
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Affiliation(s)
- Jacques Donnez
- Professor EM, Catholic University of Louvain, Director, Société de Recherche pour l'Infertilité (SRI), 143 Avenue Grandchamp, B-1150 Brussels, Belgium
| | - Marie-Madeleine Dolmans
- Gynecology Department, Cliniques Universitaires St-Luc, Avenue Hippocrate 10, 1200 Brussels, Belgium; Pôle de Gynécologie, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Avenue Mounier 52, bte B1.52.02, 1200 Brussels, Belgium
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Legro RS, Hurtado RM, Kilcoyne A, Roberts DJ. CASE RECORDS of the MASSACHUSETTS GENERAL HOSPITAL. Case 28-2016: A 31-Year-Old Woman with Infertility. N Engl J Med 2016; 375:1069-77. [PMID: 27626521 DOI: 10.1056/nejmcpc1609110] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Richard S Legro
- From the Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey (R.S.L.); and the Departments of Infectious Disease (R.M.H.), Radiology (A.K.), and Pathology (D.J.R.), Massachusetts General Hospital, and the Departments of Infectious Disease (R.M.H.), Radiology (A.K.), and Pathology (D.J.R.), Harvard Medical School - both in Boston
| | - Rocío M Hurtado
- From the Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey (R.S.L.); and the Departments of Infectious Disease (R.M.H.), Radiology (A.K.), and Pathology (D.J.R.), Massachusetts General Hospital, and the Departments of Infectious Disease (R.M.H.), Radiology (A.K.), and Pathology (D.J.R.), Harvard Medical School - both in Boston
| | - Aoife Kilcoyne
- From the Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey (R.S.L.); and the Departments of Infectious Disease (R.M.H.), Radiology (A.K.), and Pathology (D.J.R.), Massachusetts General Hospital, and the Departments of Infectious Disease (R.M.H.), Radiology (A.K.), and Pathology (D.J.R.), Harvard Medical School - both in Boston
| | - Drucilla J Roberts
- From the Department of Obstetrics and Gynecology, Penn State College of Medicine, Hershey (R.S.L.); and the Departments of Infectious Disease (R.M.H.), Radiology (A.K.), and Pathology (D.J.R.), Massachusetts General Hospital, and the Departments of Infectious Disease (R.M.H.), Radiology (A.K.), and Pathology (D.J.R.), Harvard Medical School - both in Boston
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Salehpour S, Zamaniyan M, Saharkhiz N, Zadeh modares S, Hosieni S, Seif S, Malih N, Rezapoor P, Sohrabi MR. Does intrauterine saline infusion by intrauterine insemination (IUI) catheter as endometrial injury during IVF cycles improve pregnancy outcomes among patients with recurrent implantation failure?: An RCT. Int J Reprod Biomed 2016. [DOI: 10.29252/ijrm.14.9.583] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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Zepiridis LI, Grimbizis GF, Tarlatzis BC. Infertility and uterine fibroids. Best Pract Res Clin Obstet Gynaecol 2016; 34:66-73. [DOI: 10.1016/j.bpobgyn.2015.12.001] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 12/15/2015] [Indexed: 10/22/2022]
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Surgical treatment: Myomectomy and hysterectomy; Endoscopy: A major advancement. Best Pract Res Clin Obstet Gynaecol 2016; 34:104-21. [DOI: 10.1016/j.bpobgyn.2015.11.021] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 11/26/2015] [Indexed: 12/12/2022]
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Smit JG, Kasius JC, Eijkemans MJC, Koks CAM, van Golde R, Nap AW, Scheffer GJ, Manger PAP, Hoek A, Schoot BC, van Heusden AM, Kuchenbecker WKH, Perquin DAM, Fleischer K, Kaaijk EM, Sluijmer A, Friederich J, Dykgraaf RHM, van Hooff M, Louwe LA, Kwee J, de Koning CH, Janssen ICAH, Mol F, Mol BWJ, Broekmans FJM, Torrance HL. Hysteroscopy before in-vitro fertilisation (inSIGHT): a multicentre, randomised controlled trial. Lancet 2016; 387:2622-2629. [PMID: 27132052 DOI: 10.1016/s0140-6736(16)00231-2] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Hysteroscopy is often done in infertile women starting in-vitro fertilisation (IVF) to improve their chance of having a baby. However, no data are available from randomised controlled trials to support this practice. We aimed to assess whether routine hysteroscopy before the first IVF treatment cycle increases the rate of livebirths. METHODS We did a pragmatic, multicentre, randomised controlled trial in seven university hospitals and 15 large general hospitals in the Netherlands. Women with a normal transvaginal ultrasound of the uterine cavity and no previous hysteroscopy who were scheduled for their first IVF treatment were randomly assigned (1:1) to either hysteroscopy with treatment of detected intracavitary abnormalities before starting IVF (hysteroscopy group) or immediate start of the IVF treatment (immediate IVF group). Randomisation was done with web-based concealed allocation and was stratified by centre with variable block sizes. Participants, doctors, and outcome assessors were not masked to the assigned group. The primary outcome was ongoing pregnancy (detection of a fetal heartbeat at >12 weeks of gestation) within 18 months of randomisation and resulting in livebirth. Analysis was by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT01242852. FINDINGS Between May 25, 2011, and Aug 27, 2013, we randomly assigned 750 women to receive either hysteroscopy (n=373) or immediate IVF (n=377). 209 (57%) of 369 women eligible for assessment in the hysteroscopy group and 200 (54%) of 373 in the immediate IVF group had a livebirth from a pregnancy during the trial period (relative risk 1·06, 95% CI 0·93-1·20; p=0·41). One (<1%) woman in the hysteroscopy group developed endometritis after hysteroscopy. INTERPRETATION Routine hysteroscopy does not improve livebirth rates in infertile women with a normal transvaginal ultrasound of the uterine cavity scheduled for a first IVF treatment. Women with a normal transvaginal ultrasound should not be offered routine hysteroscopy. FUNDING The Dutch Organisation for Health Research and Development (ZonMW).
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Affiliation(s)
- Janine G Smit
- Department of Reproductive Medicine and Gynaecology, University Medical Center Utrecht, Utrecht, Netherlands.
| | - Jenneke C Kasius
- Department of Reproductive Medicine and Gynaecology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Marinus J C Eijkemans
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | | | | | | | | | | | - Annemieke Hoek
- University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | | | | | | | | | | | | | | | | | | | | | - Leonie A Louwe
- Leids University Medical Center, University of Leiden, Leiden, Netherlands
| | - Janet Kwee
- Sint Lucas Andreas Hospital, Amsterdam, Netherlands
| | | | | | - Femke Mol
- Center for Reproductive Medicine, Academic Medical Center, Amsterdam, Netherlands
| | - Ben W J Mol
- The Robinson Institute, School of Paediatrics and Reproductive Health, Adelaide, SA, Australia; The South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | - Frank J M Broekmans
- Department of Reproductive Medicine and Gynaecology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Helen L Torrance
- Department of Reproductive Medicine and Gynaecology, University Medical Center Utrecht, Utrecht, Netherlands
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