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Bean EMR, Knez J, Thanatsis N, De Braud L, Taki F, Hirsch M, David A, Jurkovic D. Obstetric outcomes in women with pelvic endometriosis: a prospective cohort study. Fertil Steril 2024:S0015-0282(24)00511-9. [PMID: 38838806 DOI: 10.1016/j.fertnstert.2024.05.162] [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: 01/11/2024] [Revised: 05/27/2024] [Accepted: 05/28/2024] [Indexed: 06/07/2024]
Abstract
OBJECTIVE To determine whether obstetric outcomes differ between women with endometriosis and those without, where all women undergo first-trimester screening for endometriosis. DESIGN A prospective observational cohort study. SETTING The Early Pregnancy Unit at University College London Hospital, United Kingdom. PATIENTS Women with a live pregnancy progressing beyond 12 weeks' gestation and concurrent endometriosis (n = 110) or no endometriosis (n = 393). INTERVENTION All women underwent a pelvic ultrasound examination in early pregnancy to examine for the presence of endometriosis and uterine abnormalities. MAIN OUTCOME MEASURES The primary outcome of interest was preterm birth, defined as delivery before 37 completed weeks' gestation. Secondary outcomes included late miscarriage, antepartum hemorrhage, placental site disorders, gestational diabetes, hypertensive disorders of pregnancy, neonates small for gestational age, mode of delivery, intrapartum sepsis, postpartum hemorrhage, and admission to the neonatal unit. RESULTS Women with a diagnosis of endometriosis did not have statistically significantly higher odds of preterm delivery (adjusted odds ratio [aOR] 1.85 [95% confidence interval {CI} 0.50-6.90]), but they did have higher odds of postpartum hemorrhage during cesarean section (aOR 3.64 [95% CI 2.07-6.35]) and admission of their newborn infant to the neonatal unit (aOR 3.24 [95% CI 1.08-9.73]). Women with persistent or recurrent deep endometriosis after surgery also had higher odds of placental site disorders (aOR 8.65 [95% CI 1.17-63.71]) and intrapartum sepsis (aOR 3.47 [95% CI 1.02-11.75]). CONCLUSION We observed that women with endometriosis do not have higher odds of preterm delivery, irrespective of their disease subtype. However, they do have higher odds of postpartum hemorrhage during the cesarean section and newborn admission to the neonatal unit.
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Affiliation(s)
- Elisabeth M R Bean
- Elizabeth Garrett Anderson Institute for Women's Health, Faculty of Population Health Sciences, University College London (UCL), London, United Kingdom.
| | - Jure Knez
- Clinic for Gynecology, University Medical Centre Maribor, Maribor, Slovenia
| | - Nikolaos Thanatsis
- Elizabeth Garrett Anderson Institute for Women's Health, Faculty of Population Health Sciences, University College London (UCL), London, United Kingdom
| | - Lucrezia De Braud
- Elizabeth Garrett Anderson Institute for Women's Health, Faculty of Population Health Sciences, University College London (UCL), London, United Kingdom
| | - Fatima Taki
- Elizabeth Garrett Anderson Institute for Women's Health, Faculty of Population Health Sciences, University College London (UCL), London, United Kingdom
| | - Martin Hirsch
- Nuffield Department of Women's and Reproductive Health, Oxford Endometriosis CaRe Centre, University of Oxford, Oxford, United Kingdom
| | - Anna David
- Elizabeth Garrett Anderson Institute for Women's Health, Faculty of Population Health Sciences, University College London (UCL), London, United Kingdom
| | - Davor Jurkovic
- Elizabeth Garrett Anderson Institute for Women's Health, Faculty of Population Health Sciences, University College London (UCL), London, United Kingdom
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Shin JS, Kim S, Choi JY, Hong K, Shim S, Jung YW, Seong SJ, Jun HS, Kim ML. Pregnancy Outcomes and Obstetrical Complications of Twin Pregnancies with Endometriosis: A Single-Center Cohort Study. Yonsei Med J 2024; 65:356-362. [PMID: 38804030 PMCID: PMC11130589 DOI: 10.3349/ymj.2023.0099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 12/13/2023] [Accepted: 01/23/2024] [Indexed: 05/29/2024] Open
Abstract
PURPOSE There are many studies regarding the increased relationship between pregnancy outcomes of singleton with endometriosis. However, there was limited evidence of twin pregnancies with endometriosis. This study aimed to compare the pregnancy outcomes and complications in twin pregnancies with or without endometriosis in a single institution. MATERIALS AND METHODS From January 2011 to July 2022, a retrospective analysis of twin pregnancies was conducted. The endometriosis group included patient with histological or visual confirmation before pregnancy or during cesarean section. Pregnancy outcomes and complications were compared between the two groups. RESULTS Out of 1714 patients examined, 127 (7.4%) were included in the endometriosis group. Maternal body mass index (BMI) was lower in the endometriosis group (p<0.001). There were no significant differences in maternal age, mode of conception, chorionicity, and pregnancy outcomes, such as gestational age at delivery (p=0.835) and the preterm birth rate (p=0.579). The endometriosis group had a significantly higher rate of obstetrical complication: small for gestational age (SGA) <10% (p=0.029). However, after adjustment for BMI, the endometriosis group showed no statistical significance in obstetrical complications, including SGA (adjusted odds ratio, 1.568; 95% confidence interval, 0.984-2.499; p=0.059). CONCLUSION Twin pregnancies with endometriosis were not related to adverse effects on pregnancy outcomes and obstetrical complications. To confirm these outcomes, further large prospective studies are required.
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Affiliation(s)
- Joong Sik Shin
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul, Korea
| | - Sujin Kim
- Department of Obstetrics and Gynecology, Dong-A University Hospital, Dong-A University College of Medicine, Busan, Korea
| | - Jee Youn Choi
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul, Korea
| | - Kirim Hong
- Department of Obstetrics and Gynecology, CHA Ilsan Medical Center, CHA University, Goyang, Korea
| | - Sohyun Shim
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul, Korea
| | - Yong Wook Jung
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul, Korea
| | - Seok Ju Seong
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul, Korea
| | - Hye Sun Jun
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul, Korea
| | - Mi-La Kim
- Department of Obstetrics and Gynecology, CHA Gangnam Medical Center, CHA University, Seoul, Korea.
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3
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Urman B, Ata B, Gomel V. Reproductive surgery remains an essential element of reproductive medicine. Facts Views Vis Obgyn 2024; 16:145-162. [PMID: 38950529 DOI: 10.52054/fvvo.16.2.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/03/2024] Open
Abstract
Background Reproductive surgery has long been neglected and is perceived to be simple surgery that can be undertaken by all gynaecologists. However, given the ever-expanding knowledge in the field, reproductive surgery now comprises surgical interventions on female reproductive organs that need to be carefully planned and executed with consideration given to the individuals symptoms, function of the organ and fertility concerns. Objectives To discuss the different perspectives of reproductive surgeons and other gynaecological surgeons, e.g., gynaecological oncologists, and advanced minimally invasive surgeons, regarding diagnosis and management of pelvic pathology that affects reproductive potential. Furthermore, to highlight the gaps in knowledge and numerous controversies surrounding reproductive surgery, while summarising the current opinion on management. Materials and Methods Narrative review based on literature and the cumulative experience of the authors. Main outcome measures The paper does not address specific research questions. Conclusions Reproductive surgery encompasses all reproductive organs with the aim of alleviating symptoms whilst restoring and preserving function with careful consideration given to alternatives such as expectant management, medical treatments, and assisted reproductive techniques. It necessitates utmost technical expertise and sufficient knowledge of the female genital anatomy and physiology, together with a thorough understanding of and respect to of ovarian reserve, tubal function, and integrity of the uterine anatomy, as well as an up-to-date knowledge of alternatives, mainly assisted reproductive technology. What is new? A holistic approach to infertile women is only possible by focusing on the field of reproductive medicine and surgery, which is unattainable while practicing in multiple fields.
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Mathyk BA, Cetin E, Youssef Y, Imudia AN, Encalada Soto D, Mikhail E, Moawad G. Beyond the surface: Does stage I-II endometriosis impact fertility? Exploring the challenges of mild disease. Best Pract Res Clin Obstet Gynaecol 2024:102501. [PMID: 38760260 DOI: 10.1016/j.bpobgyn.2024.102501] [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: 03/05/2024] [Revised: 04/21/2024] [Accepted: 05/02/2024] [Indexed: 05/19/2024]
Abstract
Endometriosis is one of the most common gynecologic conditions that women face throughout their lives. Despite advances in technology, diagnosis and treatment of this relapsing and remitting condition is still challenging for many women. This review focuses on literature pertaining to minimal/mild (stage I/II) endometriosis and its impact on fertility. The effectiveness of medical interventions to improve infertility and obstetric outcomes in both natural and assisted reproductive technologies cycles remains debated. The recent ESHRE guidelines suggests that operative laparoscopy could be considered for rASRM stage I/II endometriosis as it improves ongoing pregnancy rates.
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Affiliation(s)
- Begum Aydogan Mathyk
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of South Florida Morsani College of Medicine, Tampa, FL, USA.
| | - Esra Cetin
- Department of Obstetrics and Gynecology, Hurley Medical Center, Michigan State University, 1 Hurley Plaza, Flint, MI, 48503, USA
| | - Youssef Youssef
- Division of Minimally Invasive Gynecology, Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY, 11220, USA
| | - Anthony N Imudia
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Diana Encalada Soto
- Division of Gynecologic Subspecialties, Department of Obstetrics and Gynecology, University of South Florida, Morsani College of Medicine, Tampa, FL, USA
| | - Emad Mikhail
- Division of Gynecologic Subspecialties, Department of Obstetrics and Gynecology, University of South Florida, Morsani College of Medicine, Tampa, FL, USA
| | - Gaby Moawad
- Department of Obstetrics and Gynecology, George Washington University, Washington, DC, 20037, USA; The Center for Endometriosis and Advanced Pelvic Surgery, Washington, DC, 22101, USA
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5
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Naem A, Krentel H, Moawad G, Naem J, Venezia R, Etrusco A, Terzic S, Laganà AS. Hormonal Therapies before in vitro fertilization in women with endometriosis: The Minotaur's Labyrinth and the Ariadne's Thread. Best Pract Res Clin Obstet Gynaecol 2024:102500. [PMID: 38772765 DOI: 10.1016/j.bpobgyn.2024.102500] [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: 11/25/2023] [Accepted: 05/02/2024] [Indexed: 05/23/2024]
Abstract
Endometriosis-related infertility is one of the most debated topics in reproductive medicine. In recent years, prolonged pre-cycle hormonal regimens gained attention as a mean of improving the assisted reproduction technologies (ART) success rates in endometriosis patients. GnRH agonists, dienogest, medroxyprogesterone acetate, and aromatase inhibitors are the most studied medications. Conflicting results and a high risk of bias exist in almost all of the conducted studies in the field. However, current evidence suggests that pre-cycle treatment with GnRH agonists may be beneficial for patients with stage III/IV endometriosis. Dienogest and medroxyprogesterone acetate-based progestin-primed ovarian stimulation protocol was shown to be comparable to the prolonged GnRH agonists protocol. Finally, aromatase inhibitors seem to be of limited benefit to the assisted reproductive outcomes of endometriosis patients. Although it is challenging to draw any clinical conclusions, pre-cycle hormonal treatments seem to be best indicated in endometriosis patients who had previously failed ART treatment.
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Affiliation(s)
- Antoine Naem
- Department of Obstetrics, Gynecology, Gynecologic Oncology and Senology, Bethesda Hospital Duisburg, 47053 Duisburg, Germany; Faculty of Mathematics and Computer Science, University of Bremen, 28359 Bremen, Germany.
| | - Harald Krentel
- Department of Obstetrics, Gynecology, Gynecologic Oncology and Senology, Bethesda Hospital Duisburg, 47053 Duisburg, Germany
| | - Gaby Moawad
- Department of Obstetrics and Gynecology, George Washington University, Washington, DC 20037, USA; The Center for Endometriosis and Advanced Pelvic Surgery, Washington, DC 22101, USA
| | - Joelle Naem
- Faculty of Medicine of Damascus University, Damascus, Syria
| | - Renato Venezia
- Unit of Obstetrics and Gynecology, "Paolo Giaccone" Hospital, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy
| | - Andrea Etrusco
- Unit of Obstetrics and Gynecology, "Paolo Giaccone" Hospital, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy
| | - Sanja Terzic
- Department of Medicine, School of Medicine, Nazarbayev University, Zhanybek-Kerey Khans Street 5/1, Astana 010000, Kazakhstan
| | - Antonio Simone Laganà
- Unit of Obstetrics and Gynecology, "Paolo Giaccone" Hospital, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 90127 Palermo, Italy
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6
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Allegra A, Marino A. Adenomyosis and infertility: a possible glimmer of light in the dark. Fertil Steril 2024; 121:795-796. [PMID: 38355032 DOI: 10.1016/j.fertnstert.2024.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 02/08/2024] [Indexed: 02/16/2024]
Affiliation(s)
- Adolfo Allegra
- ANDROS Day Surgery Clinic, Reproductive Medicine Unit, Palermo, Italy
| | - Angelo Marino
- ANDROS Day Surgery Clinic, Reproductive Medicine Unit, Palermo, Italy
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Alson S, Henic E, Jokubkiene L, Sladkevicius P. Endometriosis diagnosed by ultrasound is associated with lower live birth rates in women undergoing their first in vitro fertilization/intracytoplasmic sperm injection treatment. Fertil Steril 2024; 121:832-841. [PMID: 38246403 DOI: 10.1016/j.fertnstert.2024.01.023] [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: 11/06/2023] [Revised: 01/09/2024] [Accepted: 01/15/2024] [Indexed: 01/23/2024]
Abstract
OBJECTIVE To study the cumulative live birth rate (CLBR) after the first in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI) treatment in women with or without deep-infiltrating endometriosis (DIE) and/or endometrioma diagnosed by transvaginal ultrasonography (TVUS), using the International Deep Endometriosis Analysis (IDEA) group definitions. DESIGN Prospective observational cohort study at a university hospital. PATIENTS(S) In total, 1,040 women with subfertility aged 25 to ≤39 years were undergoing their first IVF/ICSI treatment between January 2019 and October 2022. Of these, 234 (22.5%; 95% confidence interval [CI], 20.0-25.0) women were diagnosed with DIE and/or endometrioma at systematic TVUS before starting their treatment. INTERVENTION(S) All women underwent their first IVF or ICSI treatment. Fresh and/or frozen embryos from the first cycle were used until pregnancy was achieved or no embryos remained. MAIN OUTCOME MEASURE(S) Cumulative live birth rate after the first IVF/ICSI cycle in women with or without DIE and/or endometrioma. RESULT(S) The CLBR after the first IVF/ICSI treatment in the total cohort of women was 426/1,040 (41.0%; 95% CI, 38.0-44.0). Women with DIE and/or endometrioma had a lower CLBR (78/234, 33.3%; 95% CI, 27.3-39.4) than women without the disease (348/806, 43.2%; 95% CI, 39.8-46.6). The crude relative risk (RR) for cumulative live birth for women with DIE and/or endometrioma was 0.77; 95% CI, 0.63-0.94, and after adjustments were made for age, body mass index, s-antimüllerian hormone, stimulation protocol, and day for embryo transfer, the adjusted RR was 0.63; 95% CI, 0.48-0.82. There was no difference in the number of retrieved mature oocytes, fertilization rate, or good quality embryos between the 2 groups. CONCLUSION The presence of DIE and/or endometrioma diagnosed by TVUS lowers the chance of live birth in women undergoing their first IVF/ICSI treatment.
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Affiliation(s)
- Sara Alson
- Obstetric, Gynecological and Prenatal Ultrasound research, Department of Clinical Sciences, Malmö, Lund University, Sweden; Department of Obstetrics and Gynecology, Skåne University Hospital, Malmö, Sweden; Reproductive Medicine Center, Skåne University Hospital, Malmö, Sweden.
| | - Emir Henic
- Reproductive Medicine Center, Skåne University Hospital, Malmö, Sweden; Department of Translational Medicine, Lund University, Malmö, Sweden
| | - Ligita Jokubkiene
- Obstetric, Gynecological and Prenatal Ultrasound research, Department of Clinical Sciences, Malmö, Lund University, Sweden; Department of Obstetrics and Gynecology, Skåne University Hospital, Malmö, Sweden
| | - Povilas Sladkevicius
- Obstetric, Gynecological and Prenatal Ultrasound research, Department of Clinical Sciences, Malmö, Lund University, Sweden; Department of Obstetrics and Gynecology, Skåne University Hospital, Malmö, Sweden
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8
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Jung YM, Wi W, Koo HS, Shim SH, Oh SY, Lee SM, Chung JH, Cho S, Cho H, Oh MJ, Cho GJ, Won HS. The timing of adenomyosis diagnosis and its impact on pregnancy outcomes: a national population-based study. Obstet Gynecol Sci 2024; 67:270-278. [PMID: 38404226 PMCID: PMC11099096 DOI: 10.5468/ogs.23273] [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: 11/20/2023] [Revised: 01/23/2024] [Accepted: 02/07/2024] [Indexed: 02/27/2024] Open
Abstract
OBJECTIVE Adenomyosis impacts pregnancy outcomes, although there is a lack of consensus regarding the actual effects. It is likely, however, that the severity of adenomyosis or ultrasound findings or timing of diagnosis can have different effects on adverse pregnancy outcomes (APOs). METHODS In this study, we aimed to investigate the impact of the timing of adenomyosis diagnosis on pregnancy outcomes. Singleton pregnant women who delivered between 2017 and 2022 were analyzed based on the timing of adenomyosis diagnosis, using a national database. The final cohort was classified into three groups: 1) group 1, without adenomyosis; 2) group 2, those diagnosed with adenomyosis before pregnancy; and 3) group 3, those diagnosed with adenomyosis during pregnancy. RESULTS A total of 1,226,475 cases were ultimately included in this study. Women with a diagnosis of adenomyosis had a significantly higher risk of APOs including hypertensive disorder during pregnancy (HDP), gestational diabetes mellitus (GDM), postpartum hemorrhage, placental abruption, preterm birth, and delivery of a small-for-gestational-age infant even after adjusting for covariates. In particular, concerning HDP, the risk was highest in group 3 (group 2: adjusted odds ratio [aOR], 1.15 vs. group 3: aOR, 1.36). However, the highest GDM risk was in group 2 (GDM; group 2: aOR, 1.24 vs. group 3: aOR, 1.04). CONCLUSION The increased risk of APO differed depending on the timing of adenomyosis diagnosis. Therefore, efforts for more careful monitoring and prevention of APOs may be necessary when such women become pregnant.
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Affiliation(s)
- Young Mi Jung
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Seoul,
Korea
| | - Wonyoung Wi
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Seoul,
Korea
| | - Hwa Seon Koo
- Best of ME Fertility Clinic, Department of Obstetrics and Gynecology, Seoul,
Korea
| | - Seung-Hyuk Shim
- Research Institute of Medical Science, Konkuk University School of Medicine, Seoul,
Korea
| | - Soo-Young Oh
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Seung Mi Lee
- Seoul National University College of Medicine, Seoul,
Korea
| | - Jin Hoon Chung
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Department of Obstetrics and Gynecology, Seoul,
Korea
| | - SiHyun Cho
- Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul,
Korea
| | - Hyunjin Cho
- Haeundae Paik Hospital, Inje University, Busan,
Korea
| | - Min-Jeong Oh
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Seoul,
Korea
| | - Geum Joon Cho
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Seoul,
Korea
| | - Hye-Sung Won
- Asan Medical Center, University of Ulsan College of Medicine, Seoul,
Korea
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Gayete-Lafuente S, Vilà Famada A, Albayrak N, Espinós Gómez JJ, Checa Vizcaíno MÁ, Moreno-Sepulveda J. Indirect markers of oocyte quality in patients with ovarian endometriosis undergoing IVF/ICSI: a systematic review and meta-analysis. Reprod Biomed Online 2024; 49:104075. [PMID: 38943812 DOI: 10.1016/j.rbmo.2024.104075] [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: 10/25/2023] [Revised: 04/08/2024] [Accepted: 04/16/2024] [Indexed: 07/01/2024]
Abstract
This systematic review and meta-analysis aimed to evaluate the impact of ovarian endometriomas (OMA) on indirect markers of oocyte quality in patients undergoing IVF, compared with women without anatomical or functional ovarian abnormalities. The search spanned original randomized controlled trials, case-control studies and cohort studies published in MEDLINE, the Cochrane Controlled Trials Register and the ClinicalTrials.gov database up to October 2023. Thirty-one studies were included in the meta-analysis, showing no significant differences in fertilization (OR 1.10, 95% CI 0.94-1.30), blastulation (OR 0.86, 95% CI 0.64-1.14) and cancellation (OR 1.06, 95% CI 0.78-1.44) rates. However, patients with OMA exhibited significantly lower numbers of total and mature (metaphase II) oocytes retrieved (mean difference -1.59, 95% CI -2.25 to -0.94; mean difference -1.86, 95% CI -2.46 to -1.26, respectively), and lower numbers of top-quality embryos (mean difference -0.49, 95% CI -0.92 to -0.06). The Ovarian Sensitivity Index was similar between the groups (mean difference -1.55, 95% CI -3.27 to 0.18). The lack of data published to date prevented meta-analysis on euploidy rate. In conclusion, although the presence of OMA could decrease the oocyte yield in patients undergoing IVF/intracytoplasmic sperm injection, it does not appear to have an adverse impact on oocyte quality.
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Affiliation(s)
- Sonia Gayete-Lafuente
- Obstetrics and Gynaecology Department, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain; Department of Gynecology, Obstetrics and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA.
| | - Anna Vilà Famada
- Department of Obstetrics and Gynaecology, Catalan Health Institute, Barcelona, Spain
| | - Nazli Albayrak
- Department of Obstetrics and Gynaecology, Acibadem University School of Medicine, Istanbul, Turkey
| | - Juan José Espinós Gómez
- Obstetrics and Gynaecology Department, Universitat Autònoma de Barcelona, Cerdanyola del Vallès, Spain; Fertty Clinic, Barcelona, Spain
| | - Miguel Ángel Checa Vizcaíno
- Fertty Clinic, Barcelona, Spain; Faculty of Medicine and Life Sciences, Pompeu Fabra University, Barcelona, Spain
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10
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Liang Y, Liu M, Zhang J, Mao Z. First-line surgery versus first-line assisted reproductive technology for women with deep infiltrating endometriosis: a systematic review and meta-analysis. Front Endocrinol (Lausanne) 2024; 15:1352770. [PMID: 38699387 PMCID: PMC11063350 DOI: 10.3389/fendo.2024.1352770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Accepted: 04/03/2024] [Indexed: 05/05/2024] Open
Abstract
Background The efficiency of different first-line treatments, such as first-line surgery and assisted reproductive technology (ART), in women with deep infiltrating endometriosis (DIE) is still unclear due to a lack of direct comparative trials. This systematic review and meta-analysis aim to elucidate and compare the efficacies of first-line treatments in patients with DIE, with an emphasis on fertility outcomes. Methods An exhaustive search of PubMed Central, SCOPUS, EMBASE, MEDLINE, Cochrane trial registry, Google Scholar, and Clinicaltrials.gov databases was done to identify studies directly comparing first-line surgery and assisted reproductive technology (ART) for DIE, and reporting fertility-related outcomes. Pooled estimates for each of the binary outcomes were reported as odds ratios (ORs) with 95% confidence intervals (CIs). The results were pooled using a random-effects model with the Mantel-Haenszel technique. Results Our results show that pregnancy rate per patient (OR, 1.47; 95% CI, 0.59 to 3.63), pregnancy rate per cycle (OR, 1.16; 95% CI, 0.45 to 2.99), and live births per patient (OR, 1.66; 95% CI, 0.56 to 4.91) were comparable in DIE patients, treated with surgery or ART as a first line of treatment. When both complete and incomplete surgical DIE excision procedures were taken into account, surgery was associated with a significant enhancement in the pregnancy rate per patient (OR, 1.63; 95% CI, 1.11 to 2.40). Conclusion The available evidence suggests that both first-line surgery and ART can be effective DIE treatments with similar fertility outcomes. However, further analysis reveals that excluding studies involving endometriomas significantly alters the understanding of treatment efficacy between surgery and ART for DIE-associated infertility. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=426061, identifier CRD42023426061.
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Affiliation(s)
- Ying Liang
- Reproductive Center of Changsha Hospital for Maternal and Child Health Care, Changsha, China
- Hunan Key Laboratory of Regional Hereditary Birth Defects Prevention and Control, Changsha Hospital for Maternal Child Health Care Affiliated to Hunan Normal University, Changsha, China
| | - Min Liu
- Reproductive Center of Changsha Hospital for Maternal and Child Health Care, Changsha, China
- Hunan Key Laboratory of Regional Hereditary Birth Defects Prevention and Control, Changsha Hospital for Maternal Child Health Care Affiliated to Hunan Normal University, Changsha, China
| | - Jianmei Zhang
- Reproductive Center of Changsha Hospital for Maternal and Child Health Care, Changsha, China
- Hunan Key Laboratory of Regional Hereditary Birth Defects Prevention and Control, Changsha Hospital for Maternal Child Health Care Affiliated to Hunan Normal University, Changsha, China
| | - Zenghui Mao
- Reproductive Center of Changsha Hospital for Maternal and Child Health Care, Changsha, China
- Hunan Key Laboratory of Regional Hereditary Birth Defects Prevention and Control, Changsha Hospital for Maternal Child Health Care Affiliated to Hunan Normal University, Changsha, China
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11
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Burla L, Sartoretti E, Mannil M, Seidel S, Sartoretti T, Krentel H, De Wilde RL, Imesch P. MRI-Based Radiomics as a Promising Noninvasive Diagnostic Technique for Adenomyosis. J Clin Med 2024; 13:2344. [PMID: 38673617 PMCID: PMC11051471 DOI: 10.3390/jcm13082344] [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: 03/10/2024] [Revised: 04/08/2024] [Accepted: 04/10/2024] [Indexed: 04/28/2024] Open
Abstract
Background: MRI diagnostics are important for adenomyosis, especially in cases with inconclusive ultrasound. This study assessed the potential of MRI-based radiomics as a novel tool for differentiating between uteri with and without adenomyosis. Methods: This retrospective proof-of-principle single-center study included nine patients with and six patients without adenomyosis. All patients had preoperative T2w MR images and histological findings served as the reference standard. The uterus of each patient was segmented in 3D using dedicated software, and 884 radiomics features were extracted. After dimension reduction and feature selection, the diagnostic yield of individual and combined features implemented in the machine learning models were assessed by means of receiver operating characteristics analyses. Results: Eleven relevant radiomics features were identified. The diagnostic performance of individual features in differentiating adenomyosis from the control group was high, with areas under the curve (AUCs) ranging from 0.78 to 0.98. The performance of ML models incorporating several features was excellent, with AUC scores of 1 and an area under the precision-recall curve of 0.4. Conclusions: The set of radiomics features derived from routine T2w MRI enabled accurate differentiation of uteri with adenomyosis. Radiomics could enhance diagnosis and furthermore serve as an imaging biomarker to aid in personalizing therapies and monitoring treatment responses.
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Affiliation(s)
- Laurin Burla
- Department of Gynecology, University Hospital Zurich, 8091 Zurich, Switzerland; (L.B.)
- Department of Gynecology and Obstetrics, Hospital of Schaffhausen, 8208 Schaffhausen, Switzerland
| | | | - Manoj Mannil
- Clinic for Radiology, Muenster University Hospital, 48149 Muenster, Germany
| | - Stefan Seidel
- Institute for Radiology and Nuclear Medicine, Hospital of Schaffhausen, 8208 Schaffhausen, Switzerland
| | | | - Harald Krentel
- Department of Gynecology, Obstetrics and Gynecological Oncology, Bethesda Hospital Duisburg, 47053 Duisburg, Germany
| | - Rudy Leon De Wilde
- Clinic of Gynecology, Obstetrics and Gynecological Oncology, University Hospital for Gynecology, Pius-Hospital Oldenburg, Medical Campus University of Oldenburg, 26121 Oldenburg, Germany
| | - Patrick Imesch
- Department of Gynecology, University Hospital Zurich, 8091 Zurich, Switzerland; (L.B.)
- Clinic for Gynecology, Bethanien Clinic, 8044 Zurich, Switzerland
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12
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Ouyang J, Dong H, Wei C, Yu R, Yang S, Xu H. Reproductive outcome after laparoscopic ovarian cystectomy using barbed sutures versus conventional smooth sutures: A retrospective cohort study. Int J Gynaecol Obstet 2024. [PMID: 38607329 DOI: 10.1002/ijgo.15523] [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: 10/17/2023] [Revised: 03/12/2024] [Accepted: 03/24/2024] [Indexed: 04/13/2024]
Abstract
OBJECTIVE To investigate the effects of barbed and conventional sutures on reproductive outcomes and ovarian reserve after laparoscopic treatment for benign non-endometrioma ovarian cysts. METHODS This retrospective study was conducted at an affiliated women's hospital between May 2017 and December 2019. Patients with benign non-endometriotic ovarian cysts undergoing laparoscopic cystectomy were included. RESULTS Patients received barbed sutures (221 patients) or conventional smooth sutures (203 patients) intraoperatively. The two groups had comparable baseline characteristics. The surgical duration and ovarian suturing time were significantly shorter in the barbed suture group than in the conventional smooth suture group (P < 0.001 and P = 0.002, respectively). The rate of postoperative hemoglobin decline and serum anti-Müllerian hormone decline were similar between the two groups (P > 0.05). A total of 316 (74.53%) patients experienced at least one pregnancy postoperatively: 170 (76.92%) and 146 (71.92%) patients in the barbed suture and conventional smooth suture groups, respectively (χ2 = 1.395, P = 0.238). Multivariate Poisson regression demonstrated that barbed sutures had no significant effect on the overall postoperative pregnancy rate (adjusted incidence rate ratio, 1.10; 95% confidence interval, 0.93-1.36; P = 0.382). CONCLUSION In patients with benign non-endometriotic ovarian cysts undergoing laparoscopic ovarian cystectomy, barbed sutures had a reproductive outcome similar to that of conventional smooth sutures while providing higher surgical efficiency without adverse effects on the postoperative ovarian reserve. Barbed sutures are probably a viable option to conventional smooth sutures.
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Affiliation(s)
- Jing Ouyang
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Huan Dong
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Chenxuan Wei
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Ruoer Yu
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Siqin Yang
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
| | - Hong Xu
- The International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
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13
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Li L, Zhang Y, Zhou J, Wang J, Wang L. A systematic review of the mechanistic actions of microRNAs within integrated traditional Chinese medicine and western medical treatment for endometriosis. Drug Discov Ther 2024; 18:1-9. [PMID: 38417896 DOI: 10.5582/ddt.2024.01004] [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] [Indexed: 03/01/2024]
Abstract
Endometriosis (EM), also known as Zhengjia in traditional Chinese medicine, is a common disease that significantly impacts women's health. An integrated treatment approach combining traditional Chinese medicine (TCM) and western medicine has demonstrated significant clinical efficacy in the management of this condition. Specifically, it has been effective in addressing blood circulation and other diseases. MicroRNAs (miRNAs), which are molecules important in gene regulation, have been implicated in various physiologic and pathologic processes. In this review, we systematically summarized the potential mechanisms underlying the integrated EM treatment, with a focus on the role of microRNAs (miRNAs). Current research suggests that integrated TCM and western medicine treatment may exert their therapeutic effects on EM by influencing the expression of miRNAs. Through miRNA modulation, such a treatment approach may inhibit the growth of ectopic lesions and alleviate clinical symptoms. This review will shed light on the specific miRNAs that have been implicated in the integrated treatment of EM, as well as their potential mechanisms of action. By consolidating the existing evidence, we aim to provide clinicians and researchers with a clearer understanding of the therapeutic benefits of the integrated approach and potentially identify new avenues for improving clinical treatment outcomes. Ultimately, this review will contribute to the growing body of knowledge in this field, providing a basis for further research and the development of more targeted and efficient treatment strategies for EM.
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Affiliation(s)
- Lisha Li
- Laboratory for Reproductive Immunology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
- The Academy of Integrative Medicine of Fudan University, Shanghai, China
- Shanghai Key Laboratory of Female Reproductive Endocrine-related Diseases, Shanghai, China
| | - Yiqin Zhang
- Department of Obstetrics and Gynecology, International Peace Maternity and Child Health Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
- Shanghai Key Laboratory Embryo Original Diseases, Shanghai, China
| | - Jing Zhou
- Laboratory for Reproductive Immunology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
- The Academy of Integrative Medicine of Fudan University, Shanghai, China
- Shanghai Key Laboratory of Female Reproductive Endocrine-related Diseases, Shanghai, China
| | - Jing Wang
- Laboratory for Reproductive Immunology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
- The Academy of Integrative Medicine of Fudan University, Shanghai, China
- Shanghai Key Laboratory of Female Reproductive Endocrine-related Diseases, Shanghai, China
| | - Ling Wang
- Laboratory for Reproductive Immunology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
- The Academy of Integrative Medicine of Fudan University, Shanghai, China
- Shanghai Key Laboratory of Female Reproductive Endocrine-related Diseases, Shanghai, China
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14
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Giorgi M, Raimondo D, Pacifici M, Bartiromo L, Candiani M, Fedele F, Pizzo A, Valensise H, Seracchioli R, Raffone A, Martire FG, Centini G, Zupi E, Lazzeri L. Adenomyosis among patients undergoing postpartum hysterectomy for uncontrollable uterine bleeding: A multicenter, observational, retrospective, cohort study on histologically-based prevalence and clinical characteristics. Int J Gynaecol Obstet 2024. [PMID: 38494900 DOI: 10.1002/ijgo.15452] [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: 12/13/2023] [Revised: 02/09/2024] [Accepted: 02/18/2024] [Indexed: 03/19/2024]
Abstract
OBJECTIVE To assess the prevalence of adenomyosis at pathologic examination, and its association with obstetric complications, peripartum maternal clinical characteristics and neonatal birth weight in patients undergoing postpartum hysterectomy due to postpartum hemorrhage (PPH). METHODS A multicenter, observational, retrospective, cohort study was carried out including all women who underwent postpartum hysterectomy due to PPH at gestational week 23+0 or later, between January 2010 and May 2023. Patients were categorized into two groups based on the presence of adenomyosis at pathologic examination, and were compared for obstetric complications, peripartum maternal clinical characteristics, and neonatal birth weight. RESULTS The histologically-based prevalence of adenomyosis in patients undergoing postpartum hysterectomy due to PPH was 39.4%. Adenomyosis was associated with a longer hospitalization time (regression coefficient: 4.43 days, 95% CI: 0.34-8.52, P = 0.034) and a higher risk of hypertensive disorders (OR: 5.82, 95% CI: 1.38-24.46, P = 0.016), threatened preterm labor (OR: 3.34, 95% CI: 1.08-10.31, P = 0.036), urgent/emergency C-section (OR: 24.15, 95% CI: 2.60-223.96, P = 0.005), postpartum maternal complications (OR: 4.96, 95% CI: 1.48-16.67, P = 0.012), maternal intensive care unit admission (OR: 3.56, 95% CI: 1.05-12.05, P = 0.041), and low birth weight neonates (OR: 3.8, 95% CI: 1.32-11.02, P = 0.013). CONCLUSION In patients undergoing postpartum hysterectomy due to PPH, adenomyosis is a highly prevalent condition among, and is associated with adverse obstetric, maternal, and neonatal outcomes.
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Affiliation(s)
- Matteo Giorgi
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, Siena, Italy
| | - Diego Raimondo
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Martina Pacifici
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, Siena, Italy
| | - Ludovica Bartiromo
- Gynecology/Obstetrics Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Candiani
- Gynecology/Obstetrics Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Francesco Fedele
- Department of Obstetrics and Gynecology, Fondazione "Policlinico-Mangiagalli-Regina Elena" University of Milan, Milan, Italy
| | - Alessandra Pizzo
- Division of Obstetrics and Gynecology, Department of Surgery, University of Rome, Policlinico Casilino, Rome, Italy
| | - Herbert Valensise
- Division of Obstetrics and Gynecology, Department of Surgery, University of Rome, Policlinico Casilino, Rome, Italy
| | - Renato Seracchioli
- Division of Gynecology and Human Reproduction Physiopathology, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Antonio Raffone
- Gynecology and Obstetrics Unit, Department of Neuroscience, Reproductive Sciences and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
| | - Francesco Giuseppe Martire
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, Siena, Italy
| | - Gabriele Centini
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, Siena, Italy
| | - Errico Zupi
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, Siena, Italy
| | - Lucia Lazzeri
- Department of Molecular and Developmental Medicine, Obstetrics and Gynecological Clinic, University of Siena, Siena, Italy
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15
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Yao Y, Liu W, Zhang X, Su N, Huang L, Nong Y, Xiao X, Liu F. Normal weight obesity is associated with lower AFC and adverse IVF outcomes. Front Endocrinol (Lausanne) 2024; 15:1332995. [PMID: 38455649 PMCID: PMC10917978 DOI: 10.3389/fendo.2024.1332995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 02/08/2024] [Indexed: 03/09/2024] Open
Abstract
Background Body weight could be classified into underweight, normal weight and overweight according to percentage of body fat (%BF), and normal weight obesity (NWO) is defined as a normal BMI but a high %BF. While the impact of NWO in women fecundity remain unknow. Therefore, this study aimed to investigate the associations between %BF and reproductive outcomes among in vitro fertilization (IVF) women with normal BMI. Methods A total of 469 women were included in this study and were classified into low %BF, normal %BF and high %BF according to previous study. Multivariate generalized regression models were employed to evaluate the associations of %BF with ovarian reserve parameters, IVF outcomes and early pregnancy outcomes. We further run sensitivity analyses by restricted the analysis to young women and those only with tubal factor, respectively. Results About 32.2% of normal BMI women were misclassified according %BF, with 16.4% of them were low %BF and 15.8% were high %BF. The high %BF group had significantly lower antral follicle count (AFC) than normal %BF groups, and the AFC showed a tendency of decrease as %BF increased. In sensitivity analysis in young women, high %BF group also had significantly lower number of good-quality embryos when compared to normal %BF groups. The results expanded to all IVF outcomes when analysis restricted to tubal factor women. Conclusion In summary, misclassifications of body weight status based on BMI are common according to %BF, and NWO is associated with adverse reproductive outcomes.
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Affiliation(s)
- Yangcheng Yao
- Department of Obstetrics and Gynecology, The First Affiliated Hospital, Jinan University, Guangzhou, China
- Center for Reproductive Medicine, Guangdong Women and Children Hospital, Guangzhou, China
| | - Wenjuan Liu
- Center for Reproductive Medicine, Guangdong Women and Children Hospital, Guangzhou, China
| | - Xiqian Zhang
- Center for Reproductive Medicine, Guangdong Women and Children Hospital, Guangzhou, China
| | - Nianjun Su
- Center for Reproductive Medicine, Guangdong Women and Children Hospital, Guangzhou, China
| | - Li Huang
- Center for Reproductive Medicine, Guangdong Women and Children Hospital, Guangzhou, China
| | - Yingqi Nong
- Center for Reproductive Medicine, Guangdong Women and Children Hospital, Guangzhou, China
| | - Xiaomin Xiao
- Department of Obstetrics and Gynecology, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Fenghua Liu
- Center for Reproductive Medicine, Guangdong Women and Children Hospital, Guangzhou, China
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16
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Park W, Kim M, Kim HS, Song G, Park SJ, Lim W, Park S. Alteration in Effects of Endometriosis on Fecundity According to Pregnancy Experience in Mouse Model. Reprod Sci 2024; 31:404-412. [PMID: 38180609 DOI: 10.1007/s43032-023-01426-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 12/08/2023] [Indexed: 01/06/2024]
Abstract
This study is aimed at identifying variations in the effect of endometriosis on fecundity in a mouse model based on prior pregnancy experience. Endometriosis is one of the most prevalent gynecological diseases and is known to impact female fecundity adversely. In this study, an endometriosis mouse model was established by allografting uterine horn tissue using Pelch's method. The effect of endometriosis on fecundity was confirmed in primiparous and multiparous female mice. As fecundity indicators, the pregnancy rate, number of litters, pregnancy period, and survival rate of the pups were investigated. As a result of the experiment, the pregnancy rate decreased, and the pregnancy period tended to be shorter in primiparous female mice. However, there was no significant change in the multiparous mice. In addition, it has been established that correlations exist between the size of lesions and certain fecundity indicators of the lesion, even among primiparous and multiparous females with endometriosis. The study attempted to demonstrate a link between pregnancy experience and fecundity changes caused by endometriosis by experimentally reproducing clinical results using mouse models. These results suggest strategies for identifying several pathophysiological characteristics of endometriosis.
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Affiliation(s)
- Wonhyoung Park
- Institute of Animal Molecular Biotechnology and Department of Biotechnology, College of Life Sciences and Biotechnology, Korea University, Seoul, 02841, Republic of Korea
| | - Miji Kim
- Institute of Animal Molecular Biotechnology and Department of Biotechnology, College of Life Sciences and Biotechnology, Korea University, Seoul, 02841, Republic of Korea
| | - Hee Seung Kim
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, 03080, Republic of Korea
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, 03080, Republic of Korea
| | - Gwonhwa Song
- Institute of Animal Molecular Biotechnology and Department of Biotechnology, College of Life Sciences and Biotechnology, Korea University, Seoul, 02841, Republic of Korea
| | - Soo Jin Park
- Department of Obstetrics and Gynecology, Seoul National University Hospital, Seoul, 03080, Republic of Korea.
| | - Whasun Lim
- Department of Biological Sciences, College of Science, Sungkyunkwan University, Suwon, 16419, Republic of Korea.
| | - Sunwoo Park
- Department of Plant & Biomaterials Science, Gyeongsang National University, Jinju, 52725, Republic of Korea.
- Department of GreenBio Science, Gyeongsang National University, Jinju, 52725, Republic of Korea.
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17
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Leone Roberti Maggiore U, Chiappa V, Ceccaroni M, Roviglione G, Savelli L, Ferrero S, Raspagliesi F, Spanò Bascio L. Epidemiology of infertility in women with endometriosis. Best Pract Res Clin Obstet Gynaecol 2024; 92:102454. [PMID: 38183767 DOI: 10.1016/j.bpobgyn.2023.102454] [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: 11/19/2023] [Accepted: 12/21/2023] [Indexed: 01/08/2024]
Abstract
Endometriosis is a benign, chronic, inflammatory condition affecting up to 10 % of women and characterised by the presence of glands and stroma tissue outside the uterus. Epidemiological and clinical studies demonstrate a consistent association between endometriosis and infertility. However, this relationship is far to be clearly understood and several mechanisms are involved. Available data show that patients with endometriosis have an increased estimated risk of infertility between two and four times compared with the general population. On the other hand, the probability of patients with infertility to have endometriosis is reported up to about 50 % of the cases. Future studies should aim to better elucidate the mechanisms behind endometriosis-associated infertility in order to offer the more appropriate and tailored management for the patients.
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Affiliation(s)
| | - Valentina Chiappa
- Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
| | - Marcello Ceccaroni
- Department of Obstetrics and Gynecology, Gynecologic Oncology and Minimally Invasive Pelvic Surgery, International School of Surgical Anatomy, IRCCS "Sacro Cuore - Don Calabria" Hospital, Negrar di Valpolicella, Verona, Italy
| | - Giovanni Roviglione
- Department of Obstetrics and Gynecology, Gynecologic Oncology and Minimally Invasive Pelvic Surgery, International School of Surgical Anatomy, IRCCS "Sacro Cuore - Don Calabria" Hospital, Negrar di Valpolicella, Verona, Italy
| | - Luca Savelli
- Obstetrics and Gynecology Unit, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - Simone Ferrero
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DiNOGMI), University of Genoa, Genoa, Italy; Academic Unit of Obstetrics and Gynecology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Francesco Raspagliesi
- Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale Dei Tumori, Milan, Italy
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18
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Gadenne C, Miquel L, Faust C, Berbis J, Perrin J, Courbiere B. Impact of a positive Chlamydia trachomatis serology on cumulative IVF live birth rate. Reprod Biomed Online 2024; 48:103586. [PMID: 38113763 DOI: 10.1016/j.rbmo.2023.103586] [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: 03/24/2023] [Revised: 09/22/2023] [Accepted: 09/28/2023] [Indexed: 12/21/2023]
Abstract
RESEARCH QUESTION Does positive Chlamydia trachomatis serology have an impact on the cumulative live birth rate from IVF? DESIGN A retrospective matched cohort study compared women with positive Chlamydia trachomatis serology (group A) who underwent IVF treatment between January 2016 and December 2021 with a control group of women with negative Chlamydia trachomatis serology (group B). The main outcome measures were the cumulative live birth rate per IVF cycle and the live birth rate per embryo transfer. Secondary outcomes were the cumulative rates of clinical pregnancy, ectopic pregnancy and pregnancy loss calculated per IVF cycle and per embryo transfer. RESULTS A total of 151 women in group A were matched 1:2 to 302 women in group B, representing 220 and 440 IVF cycles, respectively. Women with a history of Chlamydia trachomatis infection had a significantly higher rate of tubal obstruction (P < 0.001), excluded or operated hydrosalpinx (P = 0.002) and/or history of chronic endometritis (P < 0.001). There were no statistically significant differences between the two groups in the mean number of mature oocytes retrieved, fertilization rate or implantation rate. The IVF cumulative live birth rate per cycle was similar in the two groups (36.7% in group A versus 34.9% in group B, P = 0.692). The cumulative rates of clinical pregnancy, pregnancy loss, biochemical pregnancy and ectopic pregnancy were comparable between the two groups. CONCLUSION Positive Chlamydia trachomatis serology has no impact on IVF pregnancy outcomes.
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Affiliation(s)
- Clara Gadenne
- Department of Gynecology-Obstetric and Reproductive Medicine, Assistance Publique - Hôpitaux de Marseille, La Conception University Hospital, Aix-Marseille Univ, Marseille, France.
| | - Laura Miquel
- Department of Gynecology-Obstetric and Reproductive Medicine, Assistance Publique - Hôpitaux de Marseille, La Conception University Hospital, Aix-Marseille Univ, Marseille, France
| | - Cindy Faust
- Public Health Department, Assistance Publique - Hôpitaux de Marseille, Aix-Marseille Univ, Marseille, France
| | - Julie Berbis
- Public Health Department, Assistance Publique - Hôpitaux de Marseille, Aix-Marseille Univ, Marseille, France
| | - Jeanne Perrin
- Department of Gynecology-Obstetric and Reproductive Medicine, Assistance Publique - Hôpitaux de Marseille, La Conception University Hospital, Aix-Marseille Univ, Marseille, France; IMBE, CNRS, IRD, Avignon Univ, Marseille, France
| | - Blandine Courbiere
- Department of Gynecology-Obstetric and Reproductive Medicine, Assistance Publique - Hôpitaux de Marseille, La Conception University Hospital, Aix-Marseille Univ, Marseille, France; IMBE, CNRS, IRD, Avignon Univ, Marseille, France
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19
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Istrate-Ofiţeru AM, Mogoantă CA, Zorilă GL, Roşu GC, Drăguşin RC, Berbecaru EIA, Zorilă MV, Comănescu CM, Mogoantă SȘ, Vaduva CC, Brătilă E, Iliescu DG. Clinical Characteristics and Local Histopathological Modulators of Endometriosis and Its Progression. Int J Mol Sci 2024; 25:1789. [PMID: 38339066 PMCID: PMC10855449 DOI: 10.3390/ijms25031789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 01/27/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
Endometriosis (E) and adenomyosis (A) are associated with a wide spectrum of symptoms and may present various histopathological transformations, such as the presence of hyperplasia, atypia, and malignant transformation occurring under the influence of local inflammatory, vascular and hormonal factors and by the alteration of tumor suppressor proteins and the inhibition of cell apoptosis, with an increased degree of lesion proliferation. MATERIAL AND METHODS This retrospective study included 243 patients from whom tissue with E/A or normal control uterine tissue was harvested and stained by histochemical and classical immunohistochemical staining. We assessed the symptomatology of the patients, the structure of the ectopic epithelium and the presence of neovascularization, hormone receptors, inflammatory cells and oncoproteins involved in lesion development. Atypical areas were analyzed using multiple immunolabeling techniques. RESULTS The cytokeratin (CK) CK7+/CK20- expression profile was present in E foci and differentiated them from digestive metastases. The neovascularization marker cluster of differentiation (CD) 34+ was increased, especially in areas with malignant transformation of E or A foci. T:CD3+ lymphocytes, B:CD20+ lymphocytes, CD68+ macrophages and tryptase+ mast cells were abundant, especially in cases associated with malignant transformation, being markers of the proinflammatory microenvironment. In addition, we found a significantly increased cell division index (Ki67+), with transformation and inactivation of tumor suppressor genes p53, B-cell lymphoma 2 (BCL-2) and Phosphatase and tensin homolog (PTEN) in areas with E/A-transformed malignancy. CONCLUSIONS Proinflammatory/vascular/hormonal changes trigger E/A progression and the onset of cellular atypia and malignant transformation, exacerbating symptoms, especially local pain and vaginal bleeding. These triggers may represent future therapeutic targets.
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Affiliation(s)
- Anca-Maria Istrate-Ofiţeru
- Department of Histology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (A.-M.I.-O.); (G.-C.R.)
- Research Centre for Microscopic Morphology and Immunology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
- Department of Obstetrics and Gynecology, University Emergency County Hospital, 200642 Craiova, Romania; (R.C.D.); (D.G.I.)
| | - Carmen Aurelia Mogoantă
- ENT Department, Faculty of Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - George-Lucian Zorilă
- Department of Obstetrics and Gynecology, University Emergency County Hospital, 200642 Craiova, Romania; (R.C.D.); (D.G.I.)
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Gabriela-Camelia Roşu
- Department of Histology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania; (A.-M.I.-O.); (G.-C.R.)
- Research Centre for Microscopic Morphology and Immunology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Roxana Cristina Drăguşin
- Department of Obstetrics and Gynecology, University Emergency County Hospital, 200642 Craiova, Romania; (R.C.D.); (D.G.I.)
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | | | - Marian Valentin Zorilă
- Department of Forensic Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | | | | | - Constantin-Cristian Vaduva
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
| | - Elvira Brătilă
- Department of Obstetrics and Gynecology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
| | - Dominic Gabriel Iliescu
- Department of Obstetrics and Gynecology, University Emergency County Hospital, 200642 Craiova, Romania; (R.C.D.); (D.G.I.)
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania;
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20
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Tsikouras P, Oikonomou E, Bothou A, Chaitidou P, Kyriakou D, Nikolettos K, Andreou S, Gaitatzi F, Nalbanti T, Peitsidis P, Michalopoulos S, Zervoudis S, Iatrakis G, Nikolettos N. The Impact of Endometriosis on Pregnancy. J Pers Med 2024; 14:126. [PMID: 38276248 PMCID: PMC10820275 DOI: 10.3390/jpm14010126] [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: 11/04/2023] [Revised: 12/14/2023] [Accepted: 01/21/2024] [Indexed: 01/27/2024] Open
Abstract
Despite the increased frequency of endometriosis, it remains one of the most enigmatic disorders regarding its effects on pregnancy. Endometriosis adversely affects both natural and assisted conception. Impaired folliculogenesis, which causes follicular dysfunction and low egg quality, as well as luteal phase problems, reduced fertilization, and abnormal embryogenesis, are some of the mechanisms advocated to explain reproductive dysfunction. There is a rising need for a comprehensive study of the potential negative consequences of this condition on pregnancy outcomes, including the postpartum period, as more women with a medical history of endometriosis become pregnant. Obstetrical complications (small for gestational age [SGA], cesarean section [CS], miscarriage, hemorrhage, low placental adhesion, and preterm delivery) are statistically elevated in women with endometriosis. Furthermore, ruptured ovarian endometrioma, appendicitis, intestinal perforation, and hemoperitoneum have been described in pregnancy. Obstetricians are largely unfamiliar with these complications, as they have not been thoroughly investigated. The development and pathogenesis of endometriosis is an important field of study and has not yet been fully elucidated. Finding these mechanisms is crucial for the development of new and more effective strategies to treat this condition. Endometriosis can have an impact on obstetric and neonatal outcomes of pregnancy, in addition to its potential effects on conception. To date, no additional monitoring is recommended for pregnancies with a history of endometriosis. However, more studies are urgently needed to assess the need for the tailored pregnancy monitoring of women with endometriosis.
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Affiliation(s)
- Panagiotis Tsikouras
- Department of Obstetrics and Gynecology, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (E.O.); (A.B.); (P.C.); (D.K.); (K.N.); (S.A.); (F.G.); (T.N.); (P.P.); (S.Z.); (G.I.); (N.N.)
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21
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Fan D, Lin D, Rao J, Li P, Chen G, Zhou Z, Sun L, Liu L, Ma Y, Guo X, Liu Z. Factors and outcomes for placental anomalies: An umbrella review of systematic reviews and meta-analyses. J Glob Health 2024; 14:04013. [PMID: 38236697 PMCID: PMC10795857 DOI: 10.7189/jogh.14.04013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2024] Open
Abstract
Background Placental anomalies, including placenta previa (PP), placenta accreta spectrum disorders (PAS), and vase previa (VP), are associated with several adverse foetal-neonatal and maternal complications. However, there is still a lack of robust evidence on the pathogenesis and adverse outcomes of the diseases. Through this umbrella review, we aimed to systematically review existing meta-analyses exploring the factors and outcomes for pregnancy women with placental anomalies. Methods We searched PubMed, Embase, Web of Science, and the Cochrane Library from inception to February 2023. We used AMSTAR 2 to assess the quality of the reviews and estimated the pooled risk and 95% confidence intervals (CIs) for each meta-analysis. Results We included 34 meta-analyses and extracted 55 factors (27 for PP, 22 for PAS, and 6 for VP) and 16 outcomes (12 for PP, and 4 for VP) to assess their credibility. Seven factors (maternal cocaine use (for PP), uterine leiomyoma (for PP), prior abortion (spontaneous) (PP), threatened miscarriage (PP), maternal obesity (PP), maternal smoking (PAS), male foetus (PAS)) had high epidemiological evidence. Twelve factors and six outcomes had moderate epidemiological evidence. Twenty-two factors and eight outcomes showed significant association, but with weak credibility. Conclusions We found varying levels of evidence for placental anomalies of different factors and outcomes in this umbrella review. Registration PROSPERO: CRD42022300160.
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Affiliation(s)
- Dazhi Fan
- Foshan Fetal Medicine Research Institute, Foshan Women and Children Hospital, Foshan, Guangdong, China
- Department of Obstetrics, Foshan Women and Children Hospital, Foshan, Guangdong, China
| | - Dongxin Lin
- Foshan Fetal Medicine Research Institute, Foshan Women and Children Hospital, Foshan, Guangdong, China
| | - Jiaming Rao
- Foshan Fetal Medicine Research Institute, Foshan Women and Children Hospital, Foshan, Guangdong, China
| | - Pengsheng Li
- Foshan Fetal Medicine Research Institute, Foshan Women and Children Hospital, Foshan, Guangdong, China
| | - Gengdong Chen
- Foshan Fetal Medicine Research Institute, Foshan Women and Children Hospital, Foshan, Guangdong, China
| | - Zixing Zhou
- Foshan Fetal Medicine Research Institute, Foshan Women and Children Hospital, Foshan, Guangdong, China
| | - Li Sun
- Department of Library, Foshan Women and Children Hospital, Foshan, Guangdong, China
| | - Li Liu
- Department of Library, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Yubo Ma
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Xiaoling Guo
- Foshan Fetal Medicine Research Institute, Foshan Women and Children Hospital, Foshan, Guangdong, China
- Department of Obstetrics, Foshan Women and Children Hospital, Foshan, Guangdong, China
| | - Zhengping Liu
- Foshan Fetal Medicine Research Institute, Foshan Women and Children Hospital, Foshan, Guangdong, China
- Department of Obstetrics, Foshan Women and Children Hospital, Foshan, Guangdong, China
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22
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Bourdon M, Maget AS, Jeljeli M, Doridot L, Marcellin L, Thomas M, Chêne C, Chouzenoux S, Batteux F, Chapron C, Santullli P. Reduced fertility in an adenomyosis mouse model is associated with an altered immune profile in the uterus during the implantation period. Hum Reprod 2024; 39:119-129. [PMID: 38011900 DOI: 10.1093/humrep/dead246] [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: 01/03/2023] [Revised: 11/03/2023] [Indexed: 11/29/2023] Open
Abstract
STUDY QUESTION Does a reduction in fertility and/or systemic immune cell change occur during the early implantation period in a mouse model of adenomyosis? SUMMARY ANSWER A reduction in fertility was observed in mice with adenomyosis, coinciding with local and systemic immune changes observed during the implantation period. WHAT IS KNOWN ALREADY Adenomyosis is a pathology responsible for impaired fertility in humans, with a still unclear pathophysiology. One hypothesis is that changes in immune cells observed in adenomyosis-affected uteri may alter fertility, notably the physiological immune environment necessary for successful implantation and a healthy pregnancy. STUDY DESIGN, SIZE, DURATION Randomly selected CD-1 female neonatal pups were orally dosed by administration of tamoxifen to induce adenomyosis (TAM group), while others received solvent only (control group). From 6 weeks of life, CD-1 mice of both groups were mated to study impaired fertility and related local and/or systemic immune cell changes during the early implantation period. PARTICIPANTS/MATERIALS, SETTINGS, METHODS To evaluate fertility and pregnancy outcomes, ultrasound imaging was performed at E (embryonic day) 7.5 and E11.5 to count the number of gestational sacs and the number of resorptions in eight mice of the TAM group and 16 mice of the control group. The mice were sacrificed at E18.5, and morphometric, functional (quantitative reverse transcription PCR; RT-qPCR), and histological analyses were performed on the placentas. To identify local and/or systemic immune changes during the early implantation period, 8 mice of the TAM group and 12 mice of the control group were sacrificed at E4.5. Uterine horns and spleens were collected for flow cytometry and RT-qPCR analyses to study the immune cell populations. To investigate the profile of the cytokines secreted during the early implantation period at the systemic level, supernatants from stimulated spleen cells were analyzed by multiplex immunoassay analysis. MAIN RESULTS AND THE ROLE OF CHANCE By ultrasound imaging, we observed a lower number of implantation sites (P < 0.005) and a higher number of resorptions (P < 0.001) in the TAM group, leading to smaller litters (average number of fetuses per litter: 1.00 [0.00; 5.25] in the TAM group versus 12.00 [9.50; 13.75] in the control group (P < 0.001). Histological and morphometric analyses of the placentas at E18.5 showed a higher junctional/labyrinthine area ratio in the TAM group (P = 0.005). The expression levels of genes that play a role in vascularization and placental growth (Vegf (P < 0.001), Plgf (P < 0.005), Pecam (P < 0.0001), and Igf2 (P = 0.002)) were reduced in the TAM group. In the TAM group, the percentages of macrophages, natural killer (NK) cells, and dendritic cells (DC) were significantly decreased in the uterus around the implantation period. However, the number of M1 macrophages was increased. Both macrophages and DC had an increased activation profile (higher expression of MCHII, P = 0.012; CD80, P = 0.015; CCR7, P = 0.043 for macrophages, and higher expression of CD206, P = 0.018; CXCR4, P = 0.010; CCR7, P = 0.006, MCHII, P = 0.010; and CD80, P = 0.012 for DC). In spleen, an increase in the activation of macrophages (CCR7, P = 0.002; MCHII, P = 0.001; and CD80, P = 0.034) and DC was observed in the TAM group (CCR7, P = 0.001; MCHII, P = 0.001; Ly6C, P = 0.015). In the uteri and the spleen, we observed increased percentages of CD4+ T lymphocytes (P = 0.0237 and P = 0.0136, respectively) in the TAM group and, in the uteri, an increased number of regulatory T cells (P = 0.036) compared with the controls. LARGE SCALE DATA Not applicable. LIMITATIONS, REASONS FOR CAUTION This study is limited by the use of an animal model and the lack of intervention. WIDER IMPLICATIONS OF THE FINDINGS These data support involvement of innate and adaptive immune cells in the implantation failure and the increased rate of resorption observed in the mouse model of adenomyosis. This substantiates the need for additional research in this domain, with the goal of addressing fertility challenges in women affected by this condition. STUDY FUNDING/COMPETING INTEREST(S) None.
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Affiliation(s)
- M Bourdon
- Department of Gynaecology Obstetrics and Reproductive Medicine, Assistance Publique-Hopitaux de Paris (AP-HP), Centre Hospitalier Universitaire (CHU), Université Paris Cité, Paris, France
- Institut Cochin, INSERM, CNRS, Paris, France
| | - A S Maget
- Department of Gynaecology Obstetrics and Reproductive Medicine, Assistance Publique-Hopitaux de Paris (AP-HP), Centre Hospitalier Universitaire (CHU), Université Paris Cité, Paris, France
- Institut Cochin, INSERM, CNRS, Paris, France
| | - M Jeljeli
- Institut Cochin, INSERM, CNRS, Paris, France
- Department of Immunology, Assistance Publique-Hopitaux de Paris (AP-HP), Centre Hospitalier Universitaire (CHU), Université Paris Cité, Paris, France
| | - L Doridot
- Institut Cochin, INSERM, CNRS, Paris, France
| | - L Marcellin
- Department of Gynaecology Obstetrics and Reproductive Medicine, Assistance Publique-Hopitaux de Paris (AP-HP), Centre Hospitalier Universitaire (CHU), Université Paris Cité, Paris, France
- Institut Cochin, INSERM, CNRS, Paris, France
| | - M Thomas
- Institut Cochin, INSERM, CNRS, Paris, France
| | - C Chêne
- Institut Cochin, INSERM, CNRS, Paris, France
| | | | - F Batteux
- Institut Cochin, INSERM, CNRS, Paris, France
- Department of Immunology, Assistance Publique-Hopitaux de Paris (AP-HP), Centre Hospitalier Universitaire (CHU), Université Paris Cité, Paris, France
| | - C Chapron
- Department of Gynaecology Obstetrics and Reproductive Medicine, Assistance Publique-Hopitaux de Paris (AP-HP), Centre Hospitalier Universitaire (CHU), Université Paris Cité, Paris, France
- Institut Cochin, INSERM, CNRS, Paris, France
| | - P Santullli
- Department of Gynaecology Obstetrics and Reproductive Medicine, Assistance Publique-Hopitaux de Paris (AP-HP), Centre Hospitalier Universitaire (CHU), Université Paris Cité, Paris, France
- Institut Cochin, INSERM, CNRS, Paris, France
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23
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de Rozario T, Jochum F, Schwaab T, Garbin O, Roy C, Host A. Adenomyosis and obstetric complications: A retrospective case-control study. Eur J Obstet Gynecol Reprod Biol 2024; 292:120-124. [PMID: 37992424 DOI: 10.1016/j.ejogrb.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 11/09/2023] [Indexed: 11/24/2023]
Abstract
OBJECTIVE Adenomyosis is a uterine pathology affecting an increasing number of women of childbearing age. Its diagnosis is based upon histology or imaging [ultrasound or magnetic resonance imaging (MRI)]. Several studies have investigated the impact of adenomyosis on obstetric complications, with its diagnosis based on clinical symptoms, ultrasound or composite criteria. The aim of this study was to identify potential obstetric complications related to adenomyosis in women with an MRI-confirmed diagnosis. METHODS A single centre retrospective case-control study was undertaken in pregnant patients with an MRI-confirmed diagnosis of adenomyosis between January 2013 and December 2017 at the University Hospitals of Strasbourg. Controls were matched in a 4:1 ratio for age, parity and body mass index. Multivariate analysis was performed to identify obstetric complications. RESULTS In total, 291 women with an MRI-confirmed diagnosis of adenomyosis were identified during the study period. Of these, 89 patients achieved pregnancy after 24 weeks of gestation. The mean age of patients was 30.8 years. The adenomyosis group and the control group were comparable for matching criteria. Adenomyosis was found to be associated with increased risk of caesarean section [odds ratio (OR) 1.1, 95 % confidence interval (CI) 1.0-1.2; p = 0.03], intrauterine growth restriction (OR 1.3, 95 % CI 1.1-1.4; p < 0.001), postpartum haemorrhage (OR 1.2, 95 % CI 1.1- 1.4; p < 0.01), pre-eclampsia (OR 1.3, 95 % CI 1.0-1.6; p = 0.004) and previous spontaneous miscarriage (OR 2.09, 95 % CI 1.36-3.33; p < 0.001). Premature rupture of membranes, preterm delivery, severe intrauterine growth restriction and the risk of placenta praevia were not significantly higher in the adenomyosis group compared with the control group on multivariate analysis. CONCLUSION This study demonstrates increased risk of several obstetric complications (caesarean section, intrauterine growth restriction, postpartum haemorrhage, pre-eclampsia, history of spontaneous miscarriage) in women with adenomyosis. To the authors' knowledge, this is the first study to use MRI as the sole criterion for diagnosis. These results could be complemented by larger-scale prospective studies in order to manage these patients more effectively during pregnancy.
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Affiliation(s)
| | - Floriane Jochum
- Centre médico-chirurgical et obstétrical, Schiltigheim, France
| | - Thomas Schwaab
- Centre médico-chirurgical et obstétrical, Schiltigheim, France
| | - Olivier Garbin
- Centre médico-chirurgical et obstétrical, Schiltigheim, France
| | - Catherine Roy
- Department of Radiology, Nouvel Hôpital Civil, Strasbourg, France
| | - Aline Host
- Centre médico-chirurgical et obstétrical, Schiltigheim, France
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24
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Hashimoto A, Iriyama T, Sayama S, Okamura A, Kato K, Fujii T, Kubota K, Ichinose M, Sone K, Kumasawa K, Nagamatsu T, Hirota Y, Osuga Y. Differences in the incidence of obstetric complications depending on the extent and location of adenomyosis lesions. J Matern Fetal Neonatal Med 2023; 36:2226789. [PMID: 37787637 DOI: 10.1080/14767058.2023.2226789] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 10/31/2022] [Accepted: 03/08/2023] [Indexed: 10/04/2023]
Abstract
OBJECTIVES Although adenomyosis is reportedly associated with adverse pregnancy outcomes, clinical factors related to the high risk of obstetric complications are unclear. This study aimed to elucidate the characteristics of adenomyosis lesions associated with the increased incidence of obstetric complications based on imaging findings. METHODS This was a retrospective, observational cohort study conducted in a tertiary perinatal care center. Eighty-eight singleton pregnant women with adenomyosis were included in the study. Based on magnetic resonance imaging or ultrasonography before and/or during pregnancy, patients were classified according to three types of image characteristics: the extent of adenomyosis lesion (focal type or diffuse type), location of the lesion (extrinsic type, intrinsic type, or indeterminate type), the positional relationship between the lesion and the placenta (placenta distant from adenomyosis or placenta over adenomyosis), and the incidence of obstetric complications were examined. RESULTS Patients with diffuse type adenomyosis are significantly more likely to have spontaneous second-trimester miscarriage (diffuse type vs. focal type: 16.7 vs. 0%, p < .01), preterm premature rupture of membranes (19.4 vs. 1.9%, p < .01), and preeclampsia (25.0 vs. 7.7%, p = .02), as compared to those with focal type adenomyosis. In a comparison of the three location types, the incidence of placental malposition was higher in patients with the extrinsic type adenomyosis (extrinsic type vs. intrinsic type vs. indeterminate type: 20.0 vs. 6.7 vs. 2.3%, p = .03). Comparisons between the types of the placenta over or distant from adenomyosis lesion displayed no significant differences in the frequencies of obstetric complications. CONCLUSIONS We demonstrated that the frequency of obstetric complications related to adenomyosis varies depending on the extent and location of the lesion; patients with diffuse type adenomyosis have an increased risk of spontaneous second-trimester miscarriage, preterm premature rupture of membranes, and preeclampsia, while patients with extrinsic type adenomyosis have an increased risk of placental malposition. Imaging evaluation of adenomyosis prior to conception or early in pregnancy may be useful for the obstetrical risk assessment among patients with adenomyosis.
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Affiliation(s)
- Ayako Hashimoto
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Takayuki Iriyama
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Seisuke Sayama
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Asuka Okamura
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Kosuke Kato
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Tatsuya Fujii
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Kaori Kubota
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Mari Ichinose
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Kenbun Sone
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Keiichi Kumasawa
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Takeshi Nagamatsu
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Yasushi Hirota
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Yutaka Osuga
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
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25
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Yuan Y, Li Y, Zhao W, Hu Y, Zhou C, Long T, Long L. WNT4 promotes macrophage polarization via granulosa cell M-CSF and reduces granulosa cell apoptosis in endometriosis. Cytokine 2023; 172:156400. [PMID: 37839333 DOI: 10.1016/j.cyto.2023.156400] [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: 08/08/2023] [Revised: 10/04/2023] [Accepted: 10/05/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND WNT4 gene polymorphism are common in endometriosis and may functionally link estrogen and estrogen receptor signaling. Previous study confirmed estrogen and estrogen receptor signaling recruit macrophage to promote the pathogenesis of endometriosis. To investigate the effect of WNT4 in endometriosis involved in macrophage polarization and whether WNT4 could reduce the apoptosis of granulosa cells. METHODS An observational study consisting of 8 cases of women with endometriosis (diagnosed by surgery and histology) and 22 mice of endometriosis animal model was conducted. Granulosa cells were isolated from 16 patients with endometriosis and co-cultured with macrophage under WNT4 treatment using TUNEL assay, quantitative reverse transcription PCR, flow cytometry and ELISA analysis. 22 mice of endometriosis animal model confirmed the WNT4 treatment effects using histology and immunohistochemistry, Western blot and flow cytometry. RESULTS We observed that the apoptotic proportion of granulosa cells was significantly decreased and M2 macrophage was significantly increased after WNT4 treatment during the granulosa cell and macrophage co-culture system. To reveal the underlying mechanism for this, we conducted a series of experiments and found that high expression of granulosa cell M-CSF led to the M2 polarization of macrophages. The animal model also suggested that the anti-apoptotic effect of WNT4 on granulosa cells were conducted by the M2 polarized macrophage. CONCLUSIONS WNT4 could reduce granulosa cell apoptosis and improve ovarian reserve by promoting macrophage polarization in endometriosis. M-CSF secreted by granulosa cell after WNT4 treatment was the main mediator of macrophage polarization.
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Affiliation(s)
- Yuan Yuan
- Reproductive Medicine Center, The First Affiliated Hospital of Sun Yat-sen University, 1 Zhongshan Road II, Guangzhou, Guangdong 510080, China
| | - Yubin Li
- Reproductive Medicine Center, The First Affiliated Hospital of Sun Yat-sen University, 1 Zhongshan Road II, Guangzhou, Guangdong 510080, China
| | - Wen Zhao
- Reproductive Medicine Center, The First Affiliated Hospital of Sun Yat-sen University, 1 Zhongshan Road II, Guangzhou, Guangdong 510080, China
| | - Yue Hu
- Translational Medicine Center, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan Road II, Guangzhou, Guangdong 510080, China
| | - Canquan Zhou
- Reproductive Medicine Center, The First Affiliated Hospital of Sun Yat-sen University, 1 Zhongshan Road II, Guangzhou, Guangdong 510080, China
| | - Tengfei Long
- Department of Gynaecology and Obstetrics, Sun Yat-sen Memorial Hospital, 107 Yanjiang West Road, Guangzhou, Guangdong 510120, China.
| | - Lingli Long
- Clinical Research Center, The First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan Road II, Guangzhou, Guangdong 510080, China.
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26
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Somigliana E, Piani LL, Paffoni A, Salmeri N, Orsi M, Benaglia L, Vercellini P, Vigano' P. Endometriosis and IVF treatment outcomes: unpacking the process. Reprod Biol Endocrinol 2023; 21:107. [PMID: 37936154 PMCID: PMC10629090 DOI: 10.1186/s12958-023-01157-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 10/26/2023] [Indexed: 11/09/2023] Open
Abstract
Advanced endometriosis is associated with a reduction of IVF success. Surgical damage to the ovarian reserve following the excision of endometriomas has been claimed as a critical factor in the explanation of this detrimental effect. However, it is generally inferred that other mechanisms might also hamper IVF success in affected women. They include diminished responsiveness to ovarian stimulation, altered steroidogenesis, a decline in oocyte quality, reduced fertilization and embryo development, and impaired implantation. To navigate these limitations, we scrutinized available literature for studies specifically designed to address distinct phases of the IVF process. Utmost consideration was given to intra-patient ovarian response comparisons in women with unilateral endometriomas and to studies applying a meticulous matching to control confounders. The following observations have been drawn: 1) endometriosis has a negligible impact on ovarian response. A slight reduction in stimulation response can only be observed for endometriomas larger than 4 cm. Follicular steroidogenesis is unaffected; 2) oocyte quality is not hampered. Fertilization rates are similar, and intracytoplasmic sperm injection (ICSI) is not justified. Embryonic development is uncompromised, with no increase in aneuploidy rate; 3) endometrial receptivity is either unaffected or only slightly impacted. In conclusion, our study suggests that, aside from the well-known negative effect on ovarian reserve from excisional endometrioma surgeries, endometriosis does not significantly affect IVF outcomes.
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Affiliation(s)
- Edgardo Somigliana
- Academic Center for Research on Adenomyosis and Endometriosis, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
- Dipartimento Area Materno Infantile, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Letizia Li Piani
- Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
| | | | - Noemi Salmeri
- Gynecology and Obstetrics Unit, IRCCS San Raffaele Scientific Institute and Vita-Salute San Raffaele University, Milan, Italy
| | - Michele Orsi
- Dipartimento Area Materno Infantile, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Laura Benaglia
- Dipartimento Area Materno Infantile, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paolo Vercellini
- Academic Center for Research on Adenomyosis and Endometriosis, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy
- Dipartimento Area Materno Infantile, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Paola Vigano'
- Dipartimento Area Materno Infantile, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
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27
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Sayama S, Iriyama T, Hashimoto A, Suzuki K, Ariyoshi Y, Yano E, Toshimitsu M, Ichinose M, Seyama T, Sone K, Kumasawa K, Hirota Y, Osuga Y. Possible risks and benefits of adenomyomectomy on pregnancy outcomes: a retrospective analysis. AJOG GLOBAL REPORTS 2023; 3:100265. [PMID: 37771974 PMCID: PMC10523262 DOI: 10.1016/j.xagr.2023.100265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/30/2023] Open
Abstract
BACKGROUND Adenomyosis is associated with unfavorable perinatal outcomes; however, the effect of an adenomyomectomy on pregnancy outcomes remains unclear. Pregnancy following an adenomyomectomy has been reported to be associated with a high risk for uterine rupture; however, the actual incidence remains unknown. OBJECTIVE This study aimed to evaluate the effect of an adenomyomectomy on pregnancy outcomes by retrospectively comparing the pregnancy outcomes of women who underwent an adenomyomectomy with those of women with adenomyosis. STUDY DESIGN This was a single-center retrospective study in which the pregnancy outcomes of women who underwent an adenomyomectomy and for whom complete resection of the affected tissue under laparotomy was achieved were compared with those of women with adenomyosis. The following pregnancy outcomes were examined: second-trimester miscarriage, preterm prelabor rupture of membranes, preterm delivery, spontaneous preterm delivery, preeclampsia, rate of cesarean delivery, blood loss during cesarean delivery, incidence of placenta accreta spectrum, neonatal body weight, and small for gestational age infants. RESULTS A total of 18 pregnant women who underwent an adenomyomectomy and 105 pregnant women with adenomyosis were included in this study. All women who underwent an adenomyomectomy delivered via cesarean delivery, and among them, 1 had a uterine rupture at 30 weeks of gestation. Although there was no significant difference between pregnant women who underwent an adenomyomectomy and those with adenomyosis in the incidence of second-trimester miscarriage (0% [0/18] vs 7.6% [8/105], respectively; P=.22), preterm delivery (50% [9/18] vs 32% [34/105], respectively; P=.15), and spontaneous preterm delivery (6% [1/18] vs 15% [16/105], respectively; P=.26), a significant decrease in preterm prelabor rupture of membrane (0% [0/18] vs 12% [13/105], respectively; P<.05), preeclampsia (0% [0/18] vs 12% [13/105], respectively; P<.05), and small for gestational infants (0% [0/18] vs 15% [16/105], respectively; P<.05), as well as a significant increase in the incidence of placenta accreta spectrum (50% [9/18] vs 0% [0/105], respectively; P<.01) and blood loss during cesarean delivery (1748 mL vs 1330 mL, respectively; P<.05) were observed. CONCLUSION Uterine rupture following an adenomyomectomy may occur because of the high incidence of placenta accreta spectrum. However, an adenomyomectomy may reduce adverse pregnancy outcomes associated with adenomyosis, such as preterm prelabor rupture of membranes, preeclampsia, and small for gestational age infants. An adenomyomectomy may be a viable option for women among whom the procedure is inevitable before conception.
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Affiliation(s)
- Seisuke Sayama
- Faculty of Medicine, Department of Obstetrics and Gynecology, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Takayuki Iriyama
- Faculty of Medicine, Department of Obstetrics and Gynecology, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Ayako Hashimoto
- Faculty of Medicine, Department of Obstetrics and Gynecology, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Kensuke Suzuki
- Faculty of Medicine, Department of Obstetrics and Gynecology, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Yu Ariyoshi
- Faculty of Medicine, Department of Obstetrics and Gynecology, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Eriko Yano
- Faculty of Medicine, Department of Obstetrics and Gynecology, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Masatake Toshimitsu
- Faculty of Medicine, Department of Obstetrics and Gynecology, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Mari Ichinose
- Faculty of Medicine, Department of Obstetrics and Gynecology, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Takahiro Seyama
- Faculty of Medicine, Department of Obstetrics and Gynecology, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Kenbun Sone
- Faculty of Medicine, Department of Obstetrics and Gynecology, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Keiichi Kumasawa
- Faculty of Medicine, Department of Obstetrics and Gynecology, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Yasushi Hirota
- Faculty of Medicine, Department of Obstetrics and Gynecology, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
| | - Yutaka Osuga
- Faculty of Medicine, Department of Obstetrics and Gynecology, The University of Tokyo, Bunkyo-ku, Tokyo, Japan
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Yang XC, Liu Y, Sun WW, Shi G, Wu Y, Xu C, Meng QW, Hao ZP, Han Q, Zhao RH. Efficacy of Chinese Herbal Medicines on Pregnancy Outcomes in Patients with Endometriosis in Long-Term Management: A Multicenter Retrospective Cohort Study. Chin J Integr Med 2023; 29:971-979. [PMID: 37118531 DOI: 10.1007/s11655-023-3736-z] [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] [Accepted: 02/08/2023] [Indexed: 04/30/2023]
Abstract
OBJECTIVE To analyze the factors related to pregnancy of endometriosis and whether Chinese herbal medicines (CHMs) can improve pregnancy outcomes in patients with endometriosis in long-term management. METHODS This multicenter cohort study retrospectively analyzed the clinical data of endometriosis patients with fertility needs from January 2019 to November 2019. A total of 252 patients with endometriosis from 5 level-III Grade A hospitals in Beijing were included in this study. Univariate and multivariate logistic regression analysis were performed for the relevant factors. The propensity score matching (PSM) function of SPSS software was used to match the CHMs group with the non-CHMs group. The pregnancy rate and live birth rate were analyzed. RESULTS The results of univariate analysis showed that age, disease course, presence of infertility, presence of adenomyosis, time after surgery or use of gonadotropin-releasing hormone agonist (GnRH-a), use of CHMs and follow-up time were influencing factors of pregnancy in endometriosis patients (P<0.05). The results of multivariate analysis showed that age, presence of adenomyosis, time after surgery or use of GnRH-a, use of CHMs and follow-up time were independent factors affecting pregnancy in endometriosis patients, among which, age ⩾35 years old, presence of adenomyosis and follow-up time >6 months were independent risk factors (OR=0.445, 0.348, 0.140, respectively, P<0.05), time after surgery or use of GnRH-a ⩽6 months and use of CHMs were independent protective factors (OR=3.839, 3.842, respectively, P<0.05). After PSM, 99 pairs of two groups were matched successfully. The pregnancy rate of the CHMs group was higher than that of the non-CHMs group [55.56% (55/99) vs. 36.36% (36/99), P<0.05]. The live birth rate of the CHMs group was higher than that of the non-CHMs group [49.49% (49/99) vs. 35.35% (35/99), P<0.05]. CONCLUSION CHMs can effectively improve clinical pregnancy rate and live birth rate of patients with endometriosis in the chronic disease management.
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Affiliation(s)
- Xin-Chun Yang
- Department of Gynecology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Yong Liu
- Department of Gynecology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Wei-Wei Sun
- Department of Gynecology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Guang Shi
- Department of Gynecology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China
| | - Ying Wu
- Department of Traditional Chinese Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, 100026, China
| | - Cai Xu
- Department of Gynecology, Dongfang Hospital, Beijing University of Chinese Medicine, Beijing, 100078, China
| | - Qing-Wei Meng
- Department of Obstetrics and Gynecology, Beijing Hospital, Beijing, 100730, China
| | - Zeng-Ping Hao
- Department of Obstetrics and Gynecology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - Qian Han
- Department of Traditional Chinese Medicine, Beijing Obstetrics and Gynecology Hospital, Capital Medical University, Beijing, 100026, China
| | - Rui-Hua Zhao
- Department of Gynecology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, 100053, China.
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Hiraoka T, Osuga Y, Hirota Y. Current perspectives on endometrial receptivity: A comprehensive overview of etiology and treatment. J Obstet Gynaecol Res 2023; 49:2397-2409. [PMID: 37527810 DOI: 10.1111/jog.15759] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 07/23/2023] [Indexed: 08/03/2023]
Abstract
Recurrent implantation failure (RIF) remains a challenging problem in assisted reproductive technology (ART). Further insights into uterine abnormalities that can disturb embryo implantation should be obtained. This review provides an overview of the effects of organic and non-organic uterine disorders on endometrial receptivity. The results suggest that various uterine pathologies can lead to defective embryo implantation via multiple mechanisms. In particular, uterine adenomyosis dysregulates molecular and cellular interactions that are vital for successful embryo implantation with a background of chronic inflammation, which may be alleviated by pretreatment with a gonadotropin-releasing hormone agonist. Uterine myomas can cause endometrial deformation and adverse alterations in uterine contractility. Nonetheless, the effectiveness of myomectomy remains debated, and endometrial polyp removal may be considered, particularly in patients with RIF. Chronic endometritis abrogates the appropriate uterine immunological environment critical for embryo implantation. Abnormal endometrial microbiota have been suggested to influence endometrial receptivity; however, supporting evidence is currently scarce. Platelet-rich plasma therapy may be a potential treatment for thin endometria; nevertheless, further validation is required. Endometrial receptivity analysis can detect dysregulation of the window of implantation, and new non-invasive methods for predicting endometrial receptivity have recently been proposed. However, numerous issues still need to be fully clarified. Further clinical and basic studies are necessary to investigate the pathophysiology of defective endometrial receptivity and identify optimal treatments for patients undergoing ART, especially those with RIF.
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Affiliation(s)
- Takehiro Hiraoka
- Department of Obstetrics and Gynecology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yutaka Osuga
- Department of Obstetrics and Gynecology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yasushi Hirota
- Department of Obstetrics and Gynecology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Li Y, Ge L, Yang X, Cui L, Chen ZJ. Effects of duration of long-acting GnRH agonist downregulation on assisted reproductive technology outcomes in patients with adenomyosis: a retrospective cohort study. Front Med (Lausanne) 2023; 10:1248274. [PMID: 37822471 PMCID: PMC10562545 DOI: 10.3389/fmed.2023.1248274] [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: 06/27/2023] [Accepted: 09/12/2023] [Indexed: 10/13/2023] Open
Abstract
Objectives To elucidate the relationship between long-acting GnRH agonist (GnRHa) downregulation and assisted reproductive technology (ART) outcomes and identify the optimal duration of downregulation in patients with adenomyosis. Design Retrospective cohort study. Participants The study was designed to evaluate ART outcomes in adenomyosis patients with and without GnRHa downregulation between January 2016 and December 2020. A total of 374 patients with adenomyosis (621 cycles) were included with 281 cycles in downregulation group versus 340 cycles in non-downregulation group. After 1:1 propensity score matching (PSM), a sample size of 272 cycles in each group was matched. The matched downregulation group was further divided into 1-month (147 cycles), 2-months (72 cycles), and ≥3 months downregulation (53 cycles) subgroups. Stratification analysis was conducted on pregnancy outcomes in 239 fresh embryo transfer (ET) cycles and 305 frozen embryo transfer (FET) cycles. Results The downregulation group had larger mean diameter of initial uterus and higher proportion of severer dysmenorrhea compared to non-downregulation group. The pregnancy-related parameters in GnRHa downregulation group were similar to those in non-downregulation group, except for higher late miscarriage rate (MR) (13.4% vs. 3.1%, P = 0.003). The subgroup comparisons in fresh ET cycles indicated that implantation rate (75.0% vs. 39.2%, P = 0.002), biochemical pregnancy rate (91.7% vs. 56.0%, P = 0.036) and clinical pregnancy rate (83.3% vs. 47.0%, P = 0.016) could be improved by prolonged GnRHa downregulation (≥3 months), whereas late MR was difficult to be reversed (30.0% vs. 3.2%, P = 0.017). In FET cycles, higher MR (53.6% vs. 29.9%, P = 0.029; 58.8% vs. 29.9%, P = 0.026) and lower live birth rate (18.8% vs. 34.1%, P = 0.023; 17.1% vs. 34.1%, P = 0.037) were observed in the 1-month and ≥3 months downregulation group, while no differences were found in the 2-months downregulation group compared to the non-downregulation group. Conclusion In patients with severer adenomyosis, long-acting GnRHa downregulation might be correlated with improved ART outcomes. In fresh ET cycles, prolonged downregulation (≥3 months) might be beneficial to improve live birth rate, which needed to be verified by further study with larger sample. In FET cycles, the optimal duration of downregulation was not certain and still needed further exploration.
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Affiliation(s)
- Yexing Li
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Research Unit of Gametogenesis and Health of ART-Offspring, Chinese Academy of Medical Sciences (No. 2021RU001), Jinan, Shandong, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong, China
- Shandong Key Laboratory of Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, Shandong, China
- Shandong Technology Innovation Center for Reproductive Health, Jinan, Shandong, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong, China
| | - Li Ge
- Center for Reproductive Medicine, The Second Hospital of Shandong University, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Xiaohe Yang
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Research Unit of Gametogenesis and Health of ART-Offspring, Chinese Academy of Medical Sciences (No. 2021RU001), Jinan, Shandong, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong, China
- Shandong Key Laboratory of Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, Shandong, China
- Shandong Technology Innovation Center for Reproductive Health, Jinan, Shandong, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong, China
| | - Linlin Cui
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Research Unit of Gametogenesis and Health of ART-Offspring, Chinese Academy of Medical Sciences (No. 2021RU001), Jinan, Shandong, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong, China
- Shandong Key Laboratory of Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, Shandong, China
- Shandong Technology Innovation Center for Reproductive Health, Jinan, Shandong, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong, China
| | - Zi-Jiang Chen
- Center for Reproductive Medicine, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
- Research Unit of Gametogenesis and Health of ART-Offspring, Chinese Academy of Medical Sciences (No. 2021RU001), Jinan, Shandong, China
- Key Laboratory of Reproductive Endocrinology of Ministry of Education, Shandong University, Jinan, Shandong, China
- Shandong Key Laboratory of Reproductive Medicine, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, China
- Shandong Provincial Clinical Research Center for Reproductive Health, Jinan, Shandong, China
- Shandong Technology Innovation Center for Reproductive Health, Jinan, Shandong, China
- National Research Center for Assisted Reproductive Technology and Reproductive Genetics, Shandong University, Jinan, Shandong, China
- Shanghai Key Laboratory for Assisted Reproduction and Reproductive Genetics, Shanghai, China
- Center for Reproductive Medicine, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Aguiar LDF, da Cunha GDSP, Cordido KAAT, Coelho1 FAC, Carvalho TMO. Randomized prospective study comparing conventional In Vitro Fertilization technique to Intravaginal Culture with the INVOCELL™ device for 3 and 5 days. JBRA Assist Reprod 2023; 27:360-366. [PMID: 37014952 PMCID: PMC10712802 DOI: 10.5935/1518-0557.20220042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 09/16/2022] [Indexed: 08/02/2023] Open
Abstract
OBJECTIVE The objective was to analyse and compare the formation and quality of the embryos developed using conventional in vitro fertilization (IVF) and IVC techniques with an INVOCell™ device. METHODS Two groups were formed, with eight couples in each, one in culture for three days (D3) and another in culture for five days (D5), using intravaginal culture technique with an INVOcell device and a conventional in vitro fertilization technique. RESULTS Embryo formation in Group D5 showed 46.7% (IVC) and 40% (IVF) of recovered blastocysts. In the group D5, the conventional IVF, better embryo development dynamics was observed, with 66% of expanded blastocysts, against 28% in the IVC. Group D3 showed 75% (IVC) and 53% (IVF) of embryo formation. Embryonic quality in Group D3 demonstrated that IVF embryos had a better synchrony in the number and quality of blastomeres. All embryos recovered in Group D3, in both techniques, did not show fragmentation. The pH of the medium contained in the INVOCell™ device in both Groups D5 and D3 showed no differences. The means were 7.26 and 7.25, respectively. The pH of the medium used in IVF was 7.29 in both groups. Microbiological analyzes of the culture media contained in the INVOCell™ devices used in Group D5 were negative. CONCLUSIONS The results showed that the IVC technique, using the INVOCell™ device, provided a healthy and balanced environment for the development and obtaining of quality embryos with three and five days of culture.
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Affiliation(s)
- Lilian de Freitas Aguiar
- Centro de Infertilidade e Medicina Fetal do Norte Fluminense,
Campos dos Goytacazes, RJ, Brasil
- Instituto de Biofísica Carlos Chagas Filho, Universidade
Federal do Rio de Janeiro, UFRJ, RJ, Brasil
| | - Gisele dos Santos Pessanha da Cunha
- Centro de Infertilidade e Medicina Fetal do Norte Fluminense,
Campos dos Goytacazes, RJ, Brasil
- Instituto de Biofísica Carlos Chagas Filho, Universidade
Federal do Rio de Janeiro, UFRJ, RJ, Brasil
| | | | - Francisco Augusto Colucci Coelho1
- Centro de Infertilidade e Medicina Fetal do Norte Fluminense,
Campos dos Goytacazes, RJ, Brasil
- Faculdade de Medicina de Campos, Campos dos Goytacazes, RJ,
Brasil
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Zimmermann A, Faust C, Miquel L, Berbis J, Perrin J, Courbiere B. Impact of moderate-to-severe endometriosis on IVF cumulative live birth rate: a retrospective matched cohort study. Reprod Biomed Online 2023; 47:103186. [PMID: 37429766 DOI: 10.1016/j.rbmo.2023.02.012] [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: 11/21/2022] [Revised: 02/03/2023] [Accepted: 02/23/2023] [Indexed: 03/06/2023]
Abstract
RESEARCH QUESTION Does moderate-to-severe endometriosis have an impact on cumulative live birth rates (cLBR) and IVF outcomes? DESIGN In this retrospective matched cohort study, women with moderate-to-severe endometriosis undergoing IVF or intracytoplasmic sperm injection treatment from January 2015 to December 2020 were matched 1:2 to women with other causes of infertility (control group). The main outcome was cLBR per cycle and per woman, and secondary outcomes were number of oocytes retrieved and number of mature oocytes, fertilization rate, total number of embryos and usable embryos, implantation rate, clinical pregnancy rate and miscarriage rate per cycle. RESULTS In total, 195 women with endometriosis were matched with 390 women without endometriosis (323 and 646 cycles, respectively). Women with endometriosis had significantly fewer oocytes retrieved than women in the control group (P=0.003) despite higher doses of gonadotropins, but had a similar number of mature oocytes, fertilization rate, and total number of embryos and usable embryos. cLBR per cycle and per women did not differ significantly between the endometriosis group and the control group (19.8% versus 24.3%, P = 0.12; 32.3% versus 37.2%, P = 0.24, respectively). In women with endometrioma, a history of cystectomy did not impact cLBR per cycle (28.3% versus 31.9%, P = 0.68). We did not observe any significant impact of tobacco use in the endometriosis group compared with the control group (16.4% versus 25.9%, P = 0.13). CONCLUSION This matched cohort study did not observe a significant impact of moderate-to-severe endometriosis on cLBR among women undergoing IVF. These data are reassuring for the counselling of infertile women with endometriosis before IVF.
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Affiliation(s)
- Appoline Zimmermann
- Department of Gynaecology, Obstetric and Reproductive Medicine, AP-HM, La Conception University Hospital, Marseille, France.
| | - Cindy Faust
- Public Health Department, AP-HM, Aix Marseille University, Marseille, France
| | - Laura Miquel
- Department of Gynaecology, Obstetric and Reproductive Medicine, AP-HM, La Conception University Hospital, Marseille, France
| | - Julie Berbis
- Public Health Department, AP-HM, Aix Marseille University, Marseille, France
| | - Jeanne Perrin
- Department of Gynaecology, Obstetric and Reproductive Medicine, AP-HM, La Conception University Hospital, Marseille, France; IMBE, CNRS, IRD, Avignon University, Marseille, France
| | - Blandine Courbiere
- Department of Gynaecology, Obstetric and Reproductive Medicine, AP-HM, La Conception University Hospital, Marseille, France; IMBE, CNRS, IRD, Avignon University, Marseille, France
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Rao AR, Duraikannan UP, Rao DR, Giridhar P, Chinnasamy SN. Fertility and Obstetric Outcomes of Assisted Reproductive Technology (ART) in Women With Adenomyosis Following Gonadotropin-Releasing Hormone Agonist Therapy: A Single-Center Experience. Cureus 2023; 15:e44691. [PMID: 37809195 PMCID: PMC10552683 DOI: 10.7759/cureus.44691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2023] [Indexed: 10/10/2023] Open
Abstract
INTRODUCTION Adenomyosis is an ambiguous disorder causing a wide variety of implications from dysmenorrhea, heavy menstrual bleeding, and infertility to pregnancy complications. Adenomyosis is associated with altered endocrine and inflammatory milieu, resulting in impaired implantation and reduced fertility potential. It is also associated with increased incidence of obstetric complications such as miscarriage, antepartum hemorrhage, placental mal-position, hypertensive disorders, small for gestational age-intrauterine growth restriction (SGA-IUGR), cesarean section, preterm labor, preterm premature rupture of membranes (PPROM), and neonatal intensive care unit (NICU) admissions. OBJECTIVE The aim of our study was to investigate the fertility and obstetric outcomes in women with adenomyosis treated with GnRH agonists compared to controls with normal uteri undergoing in-vitro fertilization (IVF) at our center, thereby establishing the role of gonadotropin-releasing hormone (GnRH) agonists in managing sub-fertile women with adenomyosis. MATERIALS AND METHODS We carried out a retrospective cohort study at our hospital to analyze the effects of adenomyosis on IVF and pregnancy outcomes. This study (n=83) involves women with adenomyosis between the ages of 21 and 37 years who were followed up at our center between 2013 and 2022. The controls (n=83) were selected from women who underwent IVF-intracytoplasmic sperm injection (IVF-ICSI) for tubal or mild male factor infertility with normal appearing uterus within the same time frame. Women with adenomyosis were given GnRH agonist as long/ultralong agonist protocol before controlled ovarian stimulation or as down-regulated frozen embryo transfer (FET). The length of suppression was between one and six months based on the size of the uterus and response to treatment. Fertility and obstetric outcomes were analyzed. RESULTS The implantation rates were found to be equivocal: 54.2% and 53% in the adenomyosis and control groups, respectively (p=0.208). The cumulative live birth rate was 50.6% and 48.2% in the study and control groups, respectively (p=0.341). The biochemical pregnancy rate and the first- and second-trimester miscarriage rates were not significantly different between the group with adenomyosis and the group with normal uterus. The incidence of preterm deliveries and antepartum hemorrhage was found to be significantly increased in the study group. CONCLUSION Medical management in women with adenomyosis optimizes the live birth rates giving results at par with the control population.
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Affiliation(s)
- Asha R Rao
- Department of Assisted Reproductive Technology, Rao Hospital, Coimbatore, IND
| | | | - Damodar R Rao
- Department of Assisted Reproductive Technology, Rao Hospital, Coimbatore, IND
| | - Padmashri Giridhar
- Department of Assisted Reproductive Technology, Rao Hospital, Coimbatore, IND
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Carusi DA, Gopal D, Cabral HJ, Racowsky C, Stern JE. A risk factor profile for placenta accreta spectrum in pregnancies conceived with assisted reproductive technology. F S Rep 2023; 4:279-285. [PMID: 37719100 PMCID: PMC10504550 DOI: 10.1016/j.xfre.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 05/16/2023] [Accepted: 05/18/2023] [Indexed: 09/19/2023] Open
Abstract
Objective To identify independent risk factors for placenta accreta spectrum among pregnancies conceived with assisted reproductive technology. Design Retrospective cohort study. Setting Tertiary hospital. Patients Individuals who conceived with assisted reproductive technology and reached 20 weeks' gestation or later from 2011 to 2017. Interventions Patient and cycle data was abstracted from hospital records and supplemented with state-level data. Poisson regression was used for multivariate analyses and reported as adjusted relative risks (aRR). Main Outcome Measures Clinical or histologic placenta accreta spectrum. Results Of 1,975 qualifying pregnancies, 44 (2.3%) met criteria for accreta spectrum at delivery. In the multivariate model, significant risk factors included low-lying placenta at delivery (aRR, 15.44; 95% CI 7.76-30.72), uterine factor infertility or prior uterine surgery (aRR, 4.68; 95% CI, 2.72-8.05), initial low-lying placentation that resolved (aRR, 3.83; 95% CI, 1.90-7.73), and use of frozen embryos (aRR, 3.02; 95% CI, 1.66-5.48). When the fresh vs frozen variable was replaced with controlled ovarian hyperstimulation, the final model did not change (aRR, 2.40 for unstimulated cycles, 95% CI, 1.32-4.38). With frozen transfers, the accreta rate was 16% when the endometrial thickness was < 6mm vs 3.8% with thicker endometrium (P=.02). Conclusions Among pregnancies conceived with assisted reproductive technology, accreta spectrum is associated with low placental implantation (even when resolved), uterine factor infertility and prior uterine surgery, and the use of frozen embryo transfer or unstimulated cycles.
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Affiliation(s)
- Daniela A. Carusi
- Department of Obstetrics and Gynecology, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
| | - Daksha Gopal
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Howard J. Cabral
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Catherine Racowsky
- Department of Obstetrics and Gynecology, Brigham and Women’s Hospital and Harvard Medical School, Boston, Massachusetts
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hospital Foch, Suresnes, France (Present Address)
| | - Judy E. Stern
- Department of Obstetrics and Gynecology, Dartmouth-Hitchcock, Lebanon, New Hampshire
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Ahmadi H, Aghebati-Maleki L, Rashidiani S, Csabai T, Nnaemeka OB, Szekeres-Bartho J. Long-Term Effects of ART on the Health of the Offspring. Int J Mol Sci 2023; 24:13564. [PMID: 37686370 PMCID: PMC10487905 DOI: 10.3390/ijms241713564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 08/29/2023] [Accepted: 08/29/2023] [Indexed: 09/10/2023] Open
Abstract
Assisted reproductive technologies (ART) significantly increase the chance of successful pregnancy and live birth in infertile couples. The different procedures for ART, including in vitro fertilization (IVF), intracytoplasmic sperm injection (ICSI), intrauterine insemination (IUI), and gamete intrafallopian tube transfer (GIFT), are widely used to overcome infertility-related problems. In spite of its inarguable usefulness, concerns about the health consequences of ART-conceived babies have been raised. There are reports about the association of ART with birth defects and health complications, e.g., malignancies, high blood pressure, generalized vascular functional disorders, asthma and metabolic disorders in later life. It has been suggested that hormonal treatment of the mother, and the artificial environment during the manipulation of gametes and embryos may cause genomic and epigenetic alterations and subsequent complications in the health status of ART-conceived babies. In the current study, we aimed to review the possible long-term consequences of different ART procedures on the subsequent health status of ART-conceived offspring, considering the confounding factors that might account for/contribute to the long-term consequences.
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Affiliation(s)
- Hamid Ahmadi
- Department of Medical Biology and Central Electron Microscope Laboratory, Medical School, Pécs University, 7624 Pécs, Hungary; (H.A.); (T.C.)
| | - Leili Aghebati-Maleki
- Department of Immunology, School of Medicine, Tabriz University of Medical Sciences, Tabriz 5165665931, Iran;
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz 5165665931, Iran
| | - Shima Rashidiani
- Department of Medical Biochemistry, Medical School, Pécs University, 7624 Pécs, Hungary;
| | - Timea Csabai
- Department of Medical Biology and Central Electron Microscope Laboratory, Medical School, Pécs University, 7624 Pécs, Hungary; (H.A.); (T.C.)
- János Szentágothai Research Centre, Pécs University, 7624 Pécs, Hungary
- Endocrine Studies, Centre of Excellence, Pécs University, 7624 Pécs, Hungary
- National Laboratory of Human Reproduction, 7624 Pécs, Hungary
| | - Obodo Basil Nnaemeka
- Department of Laboratory Diagnostics, Faculty of Health Sciences, Pécs University, 7621 Pécs, Hungary;
| | - Julia Szekeres-Bartho
- Department of Medical Biology and Central Electron Microscope Laboratory, Medical School, Pécs University, 7624 Pécs, Hungary; (H.A.); (T.C.)
- János Szentágothai Research Centre, Pécs University, 7624 Pécs, Hungary
- Endocrine Studies, Centre of Excellence, Pécs University, 7624 Pécs, Hungary
- National Laboratory of Human Reproduction, 7624 Pécs, Hungary
- MTA—PTE Human Reproduction Research Group, 7624 Pecs, Hungary
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Fan W, Yuan Z, Li M, Zhang Y, Nan F. Decreased oocyte quality in patients with endometriosis is closely related to abnormal granulosa cells. Front Endocrinol (Lausanne) 2023; 14:1226687. [PMID: 37664845 PMCID: PMC10469306 DOI: 10.3389/fendo.2023.1226687] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 08/01/2023] [Indexed: 09/05/2023] Open
Abstract
Infertility and menstrual abnormalities in endometriosis patients are frequently caused by aberrant follicular growth or a reduced ovarian reserve. Endometriosis typically does not directly harm the oocyte, but rather inhibits the function of granulosa cells, resulting in a decrease in oocyte quality. Granulosa cells, as oocyte nanny cells, can regulate meiosis, provide the most basic resources required for oocyte development, and influence ovulation. Endometriosis affects oocyte development and quality by causing granulosa cells apoptosis, inflammation, oxidative stress, steroid synthesis obstacle, and aberrant mitochondrial energy metabolism. These aberrant states frequently interact with one another, however there is currently relatively little research in this field to understand the mechanism of linkage between abnormal states.
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Affiliation(s)
- Weisen Fan
- The First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Zheng Yuan
- Department of Gynecology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Muzhen Li
- College of Acupuncture and Tuina, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Yingjie Zhang
- The First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Fengjuan Nan
- Department of Gynecology, Affiliated Hospital of Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
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Tuominen A, Saavalainen L, Niinimäki M, Gissler M, But A, Härkki P, Heikinheimo O. First live birth before surgical verification of endometriosis-a nationwide register study of 18 324 women. Hum Reprod 2023:dead120. [PMID: 37403272 PMCID: PMC10391315 DOI: 10.1093/humrep/dead120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 05/22/2023] [Indexed: 07/06/2023] Open
Abstract
STUDY QUESTION Do women with endometriosis have lower first live birth rate before surgical diagnosis than women without verified endometriosis? SUMMARY ANSWER Compared to reference women, the incidence of first live birth was lower in women prior to surgical verification of endometriosis irrespective of the type of endometriosis. WHAT IS KNOWN ALREADY Endometriosis is associated with pain and reduced fertility. The mechanism of infertility is partly explained by anatomical, endocrinological, and immunological changes. Over the past decades, the treatment of both endometriosis and infertility has evolved. Knowledge of fertility far before surgical diagnosis of endometriosis in large cohorts and of different types of endometriosis has been lacking. The diagnostic delay of endometriosis is long, 6-7 years. STUDY DESIGN, SIZE, DURATION Retrospective population-based cohort study focused on the time period before the surgical verification of endometriosis. All women with surgical verification of endometriosis in 1998-2012 were identified from the Finnish Hospital Discharge Register and the reference cohort from the Central Population Register. Data on deliveries, gynecological care, and sociodemographic factors before the surgical diagnosis were gathered from Finnish national registers maintained by the Finnish Institute for Health and Welfare, the Digital and Population Data Services Agency, and Statistics Finland. PARTICIPANTS/MATERIALS, SETTING, METHODS All women aged 15-49 years at the time of surgical verification of endometriosis (ICD-10: N80.1-N80.9) in Finland during 1998-2012 were identified (n = 21 620). Of them, we excluded women born in 1980-1999 due to the proximity of the surgical diagnosis (n = 3286) and women left without reference (n = 10) for the final endometriosis cohort of 18 324 women. From the final cohort, we selected sub-cohorts of women with isolated diagnosis of ovarian (n = 6384), peritoneal (n = 5789), and deep (n = 1267) endometriosis. Reference women were matched by age and residence and lacked registered clinical or surgical diagnosis of endometriosis (n = 35 793). The follow-up started at the age of 15 years and ended at the first birth, sterilization, bilateral oophorectomy, hysterectomy, or until the surgical diagnosis of endometriosis or corresponding index day-whichever came first. Incidence rate (IR) and the incidence rate ratio (IRR) of first live birth before the surgical verification of endometriosis with corresponding CIs were calculated. In addition, we reported the fertility rate of parous women (the number of all children divided by the number of parous women in the cohort) until the surgical verification of endometriosis. The trends in first births were analysed according to the women's birth cohort, type of endometriosis, and age. MAIN RESULTS AND THE ROLE OF CHANCE Surgical diagnosis of endometriosis was set at the median age of 35.0 years (IQR 30.0-41.4). Altogether 7363 women (40.2%) with endometriosis and 23 718 (66.3%) women without endometriosis delivered a live born infant before the index day (surgery). The IRs of the first live birth per 100 person-years were 2.64 (95% CI 2.58-2.70) in the endometriosis cohort and 5.21 (95% CI 5.15-5.28) in the reference cohort. Between the endometriosis sub-cohorts, the IRs were similar. The IRR of the first live birth was 0.51 (95% CI 0.49-0.52) between the endometriosis and reference cohorts. Fertility rate per parous woman before the surgical diagnosis was 1.93 (SD 1.00) and 2.16 (SD 1.15) in the endometriosis and reference cohorts (P < 0.01). The median age at the first live birth was 25.5 (IQR 22.3-28.9) and 25.5 (IQR 22.3-28.6) years (P = 0.01), respectively. Between the endometriosis sub-cohorts, women in the ovarian sub-cohort were the oldest at the time of surgical diagnosis with the median age of 37.2 years (IQR 31.4-43.3), (P < 0.001). Altogether 44.1% (2814) of the women with ovarian, 39.4% (2282) with peritoneal, and 40.8% (517) with deep endometriosis delivered a live born infant before the diagnosis. IRRs between the endometriosis sub-cohorts did not differ. Fertility rate per parous woman was lowest, 1.88 (SD 0.95), in the ovarian sub-cohort compared to 1.98 (SD 1.07) in the peritoneal and 2.04 (SD 0.96) in deep endometriosis (P < 0.001). Women with ovarian endometriosis were oldest at first live birth compared to women in other sub-cohorts with a median age of 25.8 years (IQR 22.6-29.1) (P < 0.001). Cumulative distributions of first live birth were presented according to age at first live birth and birth cohorts of the participants. LIMITATIONS, REASONS FOR CAUTION The increasing age at first live birth, increasing practice of clinical diagnostics, conservative treatment of endometriosis, a possible effect of coexisting adenomyosis, and use of artificial reproductive treatments should be considered when assessing the results. In addition, the study is limited due to possible confounding effects of socioeconomic factors, such as level of education. It should be noted that, in this study, we assessed parity only during the years preceding the surgical verification of endometriosis. WIDER IMPLICATIONS OF THE FINDINGS The need for early diagnosis and relevant treatment of endometriosis appears clear given the impairment of fertility prior to its surgical verification. STUDY FUNDING/COMPETING INTEREST(S) The study was funded by the Hospital District of Helsinki and Uusimaa and by Finska Läkaresällskapet. The authors report no conflicts of interest. All authors have completed the ICMJE Disclosure form. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- A Tuominen
- Department of Obstetrics and Gynecology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Department of Obstetrics and Gynecology, Hyvinkää Hospital, Hyvinkää, Finland
| | - L Saavalainen
- Department of Obstetrics and Gynecology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - M Niinimäki
- Department of Obstetrics and Gynecology, Oulu University Hospital, Wellbeing Services County of North Ostrobothnia, Oulu, Finland
- Research Unit of Clinical Medicine, University of Oulu, Oulu, Finland
- Medical Research Center Oulu (MRC Oulu), University of Oulu, Oulu University Hospital, Wellbeing Services County of North Ostobothnia, Oulu, Finland
| | - M Gissler
- Department of Knowledge Brokers, Finnish Institute for Health and Welfare, Helsinki, Finland
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
- Academic Primary Health Care Center, Stockholm, Sweden
| | - A But
- Department of Biostatistics, University of Helsinki, Helsinki, Finland
| | - P Härkki
- Department of Obstetrics and Gynecology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - O Heikinheimo
- Department of Obstetrics and Gynecology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
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Jiang L, Han Y, Song Z, Li Y. Pregnancy Outcomes after Uterus-sparing Operative Treatment for Adenomyosis: A Systematic Review and Meta-analysis. J Minim Invasive Gynecol 2023; 30:543-554. [PMID: 36972750 DOI: 10.1016/j.jmig.2023.03.015] [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: 01/18/2023] [Revised: 03/02/2023] [Accepted: 03/20/2023] [Indexed: 03/29/2023]
Abstract
OBJECTIVE A meta-analysis was conducted to evaluate the overall pregnancy outcomes after uterus-sparing operative treatment in patients with adenomyosis (AD). DATA SOURCES We searched PubMed, Web of Science, Cochrane Library, and Embase for literature from January 2000 to January 2022. METHODS OF STUDY SELECTION We included all studies reporting reproductive outcomes of uterine-sparing surgery for patients with AD with fertility requirements. Surgical treatment was classified as complete excision or incomplete removal of AD and nonexcisional techniques for induction of necrosis in AD. The latter included physically removing the tissue where pathology is present or disrupting the blood flow to the affected area, involving high-intensity focused ultrasound, microwave ablation, radiofrequency ablation, and uterine artery embolization. Two independent researchers performed study selection according to the screening criteria. TABULATION, INTEGRATION, AND RESULTS A total of 13 studies with 1319 patients with AD were included in this study, comprising 795 women wishing fertility. Pooled estimates of pregnancy, miscarriage, and live-birth rates after excisional treatment for women attempting to conceive were 40% (95% confidence interval [CI], 29-52), 21% (95% CI, 16-27), and 70% (95% CI, 64-76), respectively, and corresponding rates after nonexcisional treatment were 51% (95% CI, 42-60), 22% (95% CI, 13-34), and 71% (95% CI, 57-83), respectively. The differences were not statistically significant. CONCLUSION Excisional treatment could be a treatment consideration for patients with symptomatic AD and infertility for several years or repeated failure of assisted reproductive technology. Nonexcisional techniques may be considered probably for AD-related infertility.
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Affiliation(s)
- Lijuan Jiang
- From the Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shengyang, Liaoning, China (all authors)
| | - Yue Han
- From the Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shengyang, Liaoning, China (all authors)
| | - Zixuan Song
- From the Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shengyang, Liaoning, China (all authors)
| | - Yan Li
- From the Department of Obstetrics and Gynecology, Shengjing Hospital of China Medical University, Shengyang, Liaoning, China (all authors)..
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Rees CO, van Vliet H, Siebers A, Bulten J, Huppelschoten A, Westerhuis M, Mischi M, Schoot B. The ADENO study: ADenomyosis and its Effect on Neonatal and Obstetric outcomes: a retrospective population-based study. Am J Obstet Gynecol 2023; 229:49.e1-49.e12. [PMID: 36539028 DOI: 10.1016/j.ajog.2022.12.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 12/07/2022] [Accepted: 12/12/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Adenomyosis is a benign gynecologic condition arising from the uterine junctional zone. Recent studies suggest a relationship between adenomyosis and adverse obstetrical outcomes, but evidence remains conflicting. There is no large-scale study investigating obstetrical outcomes in women with adenomyosis using the gold standard of histopathologic diagnosis. OBJECTIVE This study aimed to investigate the prevalence of adverse obstetrical and neonatal outcomes in women with histopathologic adenomyosis and that of the general (Dutch) population. STUDY DESIGN This retrospective population-based study used 2 Dutch national databases (Perined, the perinatal registry, and the nationwide pathology databank [Pathologisch Anatomisch Landelijk Geautomiseerd Archief], from 1995 to 2018) to compare obstetrical outcomes in women before histopathologic adenomyosis diagnosis to the general Dutch population without registered histopathologic adenomyosis. The adjusted odds ratios (95% confidence interval) were calculated for adverse obstetrical outcomes. The outcomes were adjusted for maternal age, parity, ethnicity, year of registered birth, induction of labor, hypertensive disorders in previous pregnancies, multiple gestation, and low socioeconomic status. RESULTS The pregnancy outcomes of 7925 women with histopathologic adenomyosis were compared with that of 4,615,803 women without registered adenomyosis. When adjusted for confounders, women with adenomyosis had adjusted odds ratios of 1.37 (95% confidence interval, 1.25-1.50) for hypertensive disorders, 1.37 (95% confidence interval, 1.25-1.51) for preeclampsia, 1.15 (95% confidence interval, 1.07-1.25) for small-for-gestational-age infants, 1.54 (95% confidence interval, 1.41-1.68) for emergency cesarean delivery, 1.24 (95% confidence interval, 1.12-1.37) for failure to progress, 1.29 (95% confidence interval, 1.10-1.48) for placental retention, and 1.23 (95% confidence interval, 1.10-1.38) for postpartum hemorrhage. No increased risk of HELLP (hemolysis, elevated liver enzymes, and low platelet count) syndrome, placental abruption, or operative vaginal delivery or need for oxytocin stimulation was found. CONCLUSION Women with a histopathologic diagnosis of adenomyosis showed an increased prevalence of hypertensive disorders of pregnancy and small-for-gestational-age infants, failure to progress in labor, and placental retention compared with the general population in previous pregnancies. This suggests that uterine (contractile) function in labor and during pregnancy is impaired in women with adenomyosis.
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Affiliation(s)
- Connie O Rees
- Department of Gynecology and Obstetrics, Catharina Hospital, Eindhoven, Eindhoven, The Netherlands; Department of Reproductive Medicine, Ghent University Hospital, Ghent, Belgium; Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands.
| | - Hubertus van Vliet
- Department of Gynecology and Obstetrics, Catharina Hospital, Eindhoven, Eindhoven, The Netherlands; Department of Reproductive Medicine, Ghent University Hospital, Ghent, Belgium
| | - Albertus Siebers
- Pathologisch Anatomisch Landelijk Geautomiseerd Archief, Nationwide Network and Registry of Histo- and Cytopathology in the Netherlands, Houten, The Netherlands
| | - Johan Bulten
- Department of Pathology, Radboud University, Nijmegen, The Netherlands
| | - Aleida Huppelschoten
- Department of Gynecology and Obstetrics, Catharina Hospital, Eindhoven, Eindhoven, The Netherlands
| | - Michelle Westerhuis
- Department of Gynecology and Obstetrics, Catharina Hospital, Eindhoven, Eindhoven, The Netherlands
| | - Massimo Mischi
- Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Benedictus Schoot
- Department of Gynecology and Obstetrics, Catharina Hospital, Eindhoven, Eindhoven, The Netherlands; Department of Reproductive Medicine, Ghent University Hospital, Ghent, Belgium; Department of Electrical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
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Findeklee S, Urban L, Sima RM, Baus SL, Halfmann A, Wagenpfeil G, Solomayer EF, Haj Hamoud B. The Impact of the Microbiological Vaginal Swab on the Reproductive Outcome in Infertile Women. Life (Basel) 2023; 13:1251. [PMID: 37374032 DOI: 10.3390/life13061251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 05/19/2023] [Accepted: 05/23/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND The thesis on which this paper is based intended to investigate whether the result of the microbiological vaginal swab has an influence on the outcome of the fertility treatment. METHODS The microbiological vaginal swabs of patients who received fertility treatment at Saarland University Hospital were evaluated. Depending on the microorganisms detected, the swab result was classified as inconspicuous, intermediate, or conspicuous. The SPSS software was used to determine the correlation between the swab result and the outcome of the fertility treatment. RESULTS Dysbiosis was associated with a worse outcome of fertility treatment. The pregnancy rate with a conspicuous swab was 8.6%, whereas it was 13.4% with an inconspicuous swab. However, this association was not statistically significant. Furthermore, an association of endometriosis with dysbiosis was found. Endometriosis was more frequent with a conspicuous swab result than with an inconspicuous result (21.1% vs. 17.7%), yet the correlation was not statistically significant. However, the absence of lactobacilli was significantly associated with endometriosis (p = 0.021). The association between endometriosis and a lower pregnancy rate was also statistically significant (p = 0.006). CONCLUSION The microbiological vaginal and cervical swabs can be used as predictors for the success of fertility treatments. Further studies are needed to assess the impact of transforming a dysbiotic flora into a eubiotic environment on the success of fertility treatments.
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Affiliation(s)
- Sebastian Findeklee
- Department of Obstetrics and Gynecology, Faculty of Medicine, Saarland University Hospital, 66424 Homburg, Germany
| | - Lena Urban
- Department of Obstetrics and Gynecology, Faculty of Medicine, Saarland University Hospital, 66424 Homburg, Germany
| | - Romina-Marina Sima
- Department of Obstetrics and Gynecology, UMF Carol Davila Bucharest, Bucur Maternity, 050474 Bucharest, Romania
| | - Simona Lucia Baus
- Department of Obstetrics and Gynecology, Faculty of Medicine, Saarland University Hospital, 66424 Homburg, Germany
| | - Alexander Halfmann
- Department of Medical Microbiology and Hygiene, Faculty of Medicine, Saarland University Hospital, 66424 Homburg, Germany
| | - Gudrun Wagenpfeil
- Institute of Medical Biometry, Epidemiology and Medical Informatics, Saarland University Hospital, 66424 Homburg, Germany
| | - Erich-Franz Solomayer
- Department of Obstetrics and Gynecology, Faculty of Medicine, Saarland University Hospital, 66424 Homburg, Germany
| | - Bashar Haj Hamoud
- Department of Obstetrics and Gynecology, Faculty of Medicine, Saarland University Hospital, 66424 Homburg, Germany
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Yan N, Yuan X, Huang S, Jie H, Wang J, Yuan Y. Ovarian endometrioma increases the embryo aneuploid rate: an analysis of 7092 biopsied blastocysts from fertile monogenetic disease carriers. BMC Womens Health 2023; 23:244. [PMID: 37161418 PMCID: PMC10170813 DOI: 10.1186/s12905-023-02406-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 05/03/2023] [Indexed: 05/11/2023] Open
Abstract
BACKGROUND Endometriosis affects many reproductive aged patients with fertility decline and poor outcomes of assisted reproductive treatments, mainly by decreased ovarian reserve and lower fertilization and implantation rates. In recent decade, altered oocyte microenvironments and abnormal spindle organization have been reported to be critical to oocyte chromosomal segregation, organization and aneuploid formation. However, clinical evidences are still limited on whether endometriosis influences oocyte and embryo development. We aimed to figure out the impact of endometrioma on embryo aneuploid formation. METHOD This retrospective cohort study included 1,021 patients (7,092 biopsied embryos) from January 2012 to December 2020. Fertile patients without a history of miscarriage who underwent PGT-M treatment with aneuploid screening were included. Patients with ovarian endometrioma were defined as the study group, while patients without endometriosis were defined as the control group. All demographic, controlled ovarian stimulation treatment and aneuploid screening data were recorded and compared. RESULTS The incidence of endometrioma in our study population was 6.5%. There were 7,092 embryos biopsied in total, with 308 embryos in the study group and 6,784 embryos in the control groups. The demographic characteristics were comparable between the two groups except the basal FSH level (6.02 IU/L vs. 5.52 IU/L, p = 0.012). The euploid rate of the study group was significantly lower than that of the control group (52.6% vs. 61.8%, p = 0.012), while the oocyte maturation, fertilization, usable embryo and blastocyst formation rates were comparable. Adjusted for basal FSH level, starting stimulating gonadotropin dosage, total gonadotropin dosage and FSH level on hCG day, euploid rate was still negatively related to endometrioma status. CONCLUSIONS Endometrioma status disturbs oocyte and embryo development. For infertile patients with endometrioma who require assisted reproductive treatment, pre-treatment is necessary to improve treatment outcomes. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Niwei Yan
- Reproductive Medicine Center, The First Affiliated Hospital, Sun Yat-Sen University, 1, Zhongshan Road II, Guangzhou, 510080, China
| | - Xi Yuan
- Department of Obstetrics and Gynecology, National University Hospital, 5 Lower Kent Ridge Road, Singapore, 119228, Singapore
| | - Sunxing Huang
- Reproductive Medicine Center, The First Affiliated Hospital, Sun Yat-Sen University, 1, Zhongshan Road II, Guangzhou, 510080, China
| | - Huiying Jie
- Reproductive Medicine Center, The First Affiliated Hospital, Sun Yat-Sen University, 1, Zhongshan Road II, Guangzhou, 510080, China
| | - Jing Wang
- Reproductive Medicine Center, The First Affiliated Hospital, Sun Yat-Sen University, 1, Zhongshan Road II, Guangzhou, 510080, China
| | - Yuan Yuan
- Reproductive Medicine Center, The First Affiliated Hospital, Sun Yat-Sen University, 1, Zhongshan Road II, Guangzhou, 510080, China.
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Dedes I, Kolovos G, Arrigo F, Toub D, Vaineau C, Lanz S, Imboden S, Feki A, Mueller MD. Radiofrequency Ablation for Adenomyosis. J Clin Med 2023; 12:jcm12093069. [PMID: 37176514 PMCID: PMC10179480 DOI: 10.3390/jcm12093069] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 04/10/2023] [Accepted: 04/20/2023] [Indexed: 05/15/2023] Open
Abstract
Adenomyosis is a common benign gynecologic condition characterized by ectopic endometrial glands and stroma in the myometrium causing pain (dysmenorrhea) and abnormal uterine bleeding. New interventional techniques have been introduced over recent years. This study evaluates the treatment success and side effects of radiofrequency ablation. An electronic literature search in the PubMed, Scopus, and ScienceDirect databases was carried out on the outcomes of pain reduction and, secondarily, on abnormal uterine bleeding, reintervention, reproductive outcome, imaging outcome, and complications. There was a mean decrease in dysmenorrhea pain scores by -63.4 ± 9.0% at 12 months. Data on other outcome parameters were sparse. No major complications were reported. Radiofrequency ablation represents a promising minimally invasive and organ-preserving treatment in patients with symptomatic adenomyosis. It is associated with clinically meaningful improvement of adenomyosis-related pain in the short term.
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Affiliation(s)
- Ioannis Dedes
- Department of Obstetrics and Gynecology, University Hospital of Bern, University of Bern, 3010 Bern, Switzerland
| | - Georgios Kolovos
- Department of Obstetrics and Gynecology, University Hospital of Bern, University of Bern, 3010 Bern, Switzerland
| | - Fruscalzo Arrigo
- Department of Gynecology and Obstetrics, University Hospital of Fribourg, 1752 Fribourg, Switzerland
| | - David Toub
- Gynesonics®, Redwood City, CA 94063, USA
| | - Cloé Vaineau
- Department of Obstetrics and Gynecology, University Hospital of Bern, University of Bern, 3010 Bern, Switzerland
| | - Susanne Lanz
- Department of Obstetrics and Gynecology, University Hospital of Bern, University of Bern, 3010 Bern, Switzerland
| | - Sara Imboden
- Department of Obstetrics and Gynecology, University Hospital of Bern, University of Bern, 3010 Bern, Switzerland
| | - Anis Feki
- Department of Gynecology and Obstetrics, University Hospital of Fribourg, 1752 Fribourg, Switzerland
| | - Michael D Mueller
- Department of Obstetrics and Gynecology, University Hospital of Bern, University of Bern, 3010 Bern, Switzerland
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Chen LH, Lo WC, Huang HY, Wu HM. A Lifelong Impact on Endometriosis: Pathophysiology and Pharmacological Treatment. Int J Mol Sci 2023; 24:ijms24087503. [PMID: 37108664 PMCID: PMC10139092 DOI: 10.3390/ijms24087503] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/06/2023] [Accepted: 04/16/2023] [Indexed: 04/29/2023] Open
Abstract
Endometriosis is a chronic inflammatory disease associated with bothersome symptoms in premenopausal women and is complicated with long-term systemic impacts in the post-menopausal stage. It is generally defined by the presence of endometrial-like tissue outside the uterine cavity, which causes menstrual disorders, chronic pelvic pain, and infertility. Endometriotic lesions can also spread and grow in extra-pelvic sites; the chronic inflammatory status can cause systemic effects, including metabolic disorder, immune dysregulation, and cardiovascular diseases. The uncertain etiologies of endometriosis and their diverse presentations limit the treatment efficacy. High recurrence risk and intolerable side effects result in poor compliance. Current studies for endometriosis have paid attention to the advances in hormonal, neurological, and immunological approaches to the pathophysiology and their potential pharmacological intervention. Here we provide an overview of the lifelong impacts of endometriosis and summarize the updated consensus on therapeutic strategies.
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Affiliation(s)
- Liang-Hsuan Chen
- Department of Obstetrics and Gynecology, Linkou Medical Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan 33305, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
| | - Wei-Che Lo
- Department of Obstetrics and Gynecology, Linkou Medical Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan 33305, Taiwan
| | - Hong-Yuan Huang
- Department of Obstetrics and Gynecology, Linkou Medical Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan 33305, Taiwan
| | - Hsien-Ming Wu
- Department of Obstetrics and Gynecology, Linkou Medical Center, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan 33305, Taiwan
- Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan
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Orozco R, Vilches JC, Brunel I, Lozano M, Hernández G, Pérez-Del Rey D, Meloni L, Alcázar JL. Adenomyosis in Pregnancy-Should It Be Managed in High-Risk Obstetric Units? Diagnostics (Basel) 2023; 13:diagnostics13061184. [PMID: 36980492 PMCID: PMC10047483 DOI: 10.3390/diagnostics13061184] [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: 02/08/2023] [Revised: 03/14/2023] [Accepted: 03/16/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND Uterine adenomyosis is an increasingly frequent disorder. Our study aimed to demonstrate the presence of obstetric complications in the population affected by this condition to demonstrate the need for follow-up in high-risk obstetric units. MATERIAL AND METHODS The data for the study were obtained from TriNetX, LLC, between 2010 and 2020. The outcomes analyzed were intrauterine growth restriction (IUGR), preterm delivery, cesarean delivery, hypertension, abruption placentae, and spontaneous abortion. Seven thousand six hundred and eight patients were included in the cohort of pregnant patients with adenomyosis, and 566,153 women in the cohort of pregnant patients without any history of endometriosis. RESULTS Upon calculating the total risk of presenting any of these problems during pregnancy, we obtained an OR = 1.521, implying that a pregnancy with adenomyosis was 52.1% more likely to present some complication. We found: IUGR OR = 1.257 (95% CI: 1.064-1.485) (p = 0.007); preterm delivery OR = 1.422 (95% CI: 1.264-1.600) (p = 0.0001); cesarean delivery OR = 1.099 (95% CI: 1.002-1.205) (p = 0.046); hypertensive disorders OR = 1.177 (95% CI: 1.076-1.288) (p = 0.0001); abruption placentae OR = 1.197 (95% CI: 1.008-1.422) (p = 0.040), and spontaneous abortion OR = 1.529 (95% CI: 1.360-1.718) (p = 0.0001). CONCLUSION We conclude that the review carried out and the data we obtained on increased risk provide sufficient evidence to recommend that patients with adenomyosis should be managed in obstetric high-risk units.
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Affiliation(s)
- Rodrigo Orozco
- Department of Obstetrics and Gynecology, Hospital QuirónSalud, 29004 Malaga, Spain
| | - José Carlos Vilches
- Department of Obstetrics and Gynecology, Hospital QuirónSalud, 29004 Malaga, Spain
| | - Ignacio Brunel
- Department of Obstetrics and Gynecology, Hospital QuirónSalud, 29004 Malaga, Spain
| | - Manuel Lozano
- Department of Obstetrics and Gynecology, Hospital QuirónSalud, 29004 Malaga, Spain
| | - Gema Hernández
- Department of Computer Engineering, Universidad Politécnica, 28040 Madrid, Spain
| | - David Pérez-Del Rey
- Biomedical Informatics Group, Department of Artificial Intelligence, Computer Engineering, Universidad Politécnica, 28040 Madrid, Spain
| | | | - Juan Luis Alcázar
- Department of Obstetrics and Gynecology, Clínica Universidad de Navarra, 31008 Pamplona, Spain
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He M, Chen Q, He J, Zhao Q, Jiang H, Xia Y. Reproductive outcomes of women with moderate to severe intrauterine adhesions after transcervical resection of adhesion: A systematic review and meta-analysis. Medicine (Baltimore) 2023; 102:e33258. [PMID: 36930133 PMCID: PMC10019229 DOI: 10.1097/md.0000000000033258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 02/22/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Intrauterine adhesions (IUA) refers to the adhesion of the inner wall of the uterus, resulting in complete or partial occlusion of the uterine cavity, which causes a series of symptoms. Transcervical resection of adhesion (TCRA) is the standard surgical method for patients with IUA. However, the recurrence rate of women with moderate to severe IUA is high and it has raised a big concern about the reproductive outcomes. METHODS We conducted a scoping review by using 4 databases, including Google Scholar, PubMed, Scopus, Embase, and web of science, to retrieve relevant literature from September 1, 2001, to February 1, 2023, and to explore the reproductive outcomes in women with moderate to severe IUA after TCRA treatment. Following defined guidelines, data extraction was carried out by 2 researchers, and the findings were examined by 2 senior academics. The papers were evaluated by 2 reviewers using the inclusion and exclusion criteria. Using a form developed especially for this study, pertinent information was retrieved, including the first author, research design, study duration, age, intervention measurement, pregnancy rate, techniques of conception, and live birth rate. Two researchers conducted a quality assessment to determine any potential bias using the Cochrane technique and the Newcastle-Ottawa scale. RevMan 5.4.1 (The Cochrane Collaboration, London, United Kingdom) was used for data analysis, while I2 was used to evaluate heterogeneity. RESULTS In total, this study included 2099 participants. After a detailed systematic review and meta-analyses, the results showed that pregnancy and live birth rates were increased significantly after TCRA, and the risk difference of the pregnancy rate was 1.75 [1.17, 2.62]. Besides, in 2 retrospective studies, the risk difference of live birth rate was 2.26, with a 95% confidence interval of 1.99 to 2.58. Moreover, the menstrual status of women also was improved, and the risk difference of hypermenorrhoea and amenorrhea were -0.28 [-0.37, -0.19] and -0.06 [0.26, 0.13], respectively. CONCLUSIONS Taken together, TCRA is the useful strategy for the treatment of moderate to severe IUA to enhance the reproductive outcomes in women.
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Affiliation(s)
- Meifang He
- Department of Gynecology, Women and Children Healthcare Hospital of Zhuzhou, Zhuzhou, Hunan, China
| | - Qiuli Chen
- Department of Research and Development, Zhejiang Zhongwei Medical Research Center, Hangzhou, Zhejiang, China
| | - Jinlian He
- Department of Gynecology and Obstetrics, Maternal and Child Health Hospital of Fuzhou, Fuzhou, Fujian, China
| | - Qingqing Zhao
- Department of Research and Development, Zhejiang Zhongwei Medical Research Center, Hangzhou, Zhejiang, China
| | - Hong Jiang
- Department of Gynecology and Obstetrics, Maternal and Child Health Hospital of Fuzhou, Fuzhou, Fujian, China
| | - Yong Xia
- Department of Gynecology and Obstetrics, Maternal and Child Health Hospital of Fuzhou, Fuzhou, Fujian, China
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Bertucci E, Sileo FG, Diamanti M, Alboni C, Facchinetti F, La Marca A. How adenomyosis changes throughout pregnancy: A retrospective cohort study. Int J Gynaecol Obstet 2023; 160:856-863. [PMID: 35929196 PMCID: PMC10087478 DOI: 10.1002/ijgo.14383] [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: 04/13/2022] [Revised: 07/15/2022] [Accepted: 07/28/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To study how adenomyosis changes during pregnancy and to possibly correlate these changes to maternal and fetal outcomes. METHODS Retrospective exploratory cohort study including 254 women with a pre-conceptional/first-trimester scan to document adenomyosis and known obstetric outcome. If visible, adenomyosis signs were documented in each trimester and postpartum. Mann-Whitney U tests or χ2 tests were used for continuous and categorical variables, respectively. RESULTS A globular uterus was reported in 79% (n = 52) of women with adenomyosis in the first trimester, in 38% (n = 20) and 2% (n = 1) of women in the second and third trimesters, respectively, and postpartum in 77% (n = 34) of women. Asymmetrical thickening (n = 20, 30%) and cysts (n = 15, 23%) were only visible in 1st trimester. Adenomyosis was associated with miscarriage (odds ratio [OR] 5.9, 95% confidence interval [CI] 2.4-14.9, P < 0.001) also in normal conception only (OR 5.1, 95% CI 1.8-14.2, P = 0.002) or adjusting for maternal age (adjusted OR 5.9, 95% CI 2.3-15.2, P < 0.001). Gestational age at delivery was lower in adenomyosis (P = 0.004); the cesarean section rate was higher than in controls (OR 2.5, 95% CI 1.3-4.8, P = 0.007) also adjusting for age (adjusted OR 2.07, 95% CI 1.06-4.08, P = 0.035). CONCLUSIONS Signs of adenomyosis were visible but progressively disappeared in pregnancy; adenomyosis was associated with an increased risk of early miscarriage. Prospective studies are needed to confirm our results.
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Affiliation(s)
- Emma Bertucci
- Prenatal Medicine Unit, Obstetrics and Gynecology Unit, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
| | - Filomena G Sileo
- Department of Biomedical, Metabolic and Neural Sciences, International Doctorate School in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy.,Unit of Obstetrics and Gynecology, Azienda Unità Sanitaria Locale-IRCCS, Reggio Emilia, Italy
| | - Marialaura Diamanti
- Obstetrics and Gynecology Unit, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
| | - Carlo Alboni
- Obstetrics and Gynecology Unit, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
| | - Fabio Facchinetti
- Obstetrics and Gynecology Unit, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
| | - Antonio La Marca
- Obstetrics and Gynecology Unit, Department of Medical and Surgical Sciences for Mother, Child and Adult, University of Modena and Reggio Emilia, Modena, Italy
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47
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Kröncke T. An update on uterine artery embolization for uterine leiomyomata and adenomyosis of the uterus. Br J Radiol 2023; 96:20220121. [PMID: 36222200 PMCID: PMC9975358 DOI: 10.1259/bjr.20220121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 06/11/2022] [Accepted: 09/29/2022] [Indexed: 11/07/2022] Open
Abstract
Uterine artery embolization (UAE) is an established technique to treat benign diseases of the uterus such as uterine leiomyomata (fibroids) and adenomyosis. This article reviews the use of UAE in these conditions and summarizes the evidence regarding safety and efficacy of the technique based on the current literature.
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Affiliation(s)
- Thomas Kröncke
- Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany
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48
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Han B, Liang T, Zhang W, Ma C, Qiao J. The effect of adenomyosis types on clinical outcomes of IVF embryo transfer after ultra-long GnRH agonist protocol. Reprod Biomed Online 2023; 46:346-351. [PMID: 36549997 DOI: 10.1016/j.rbmo.2022.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/26/2022] [Accepted: 09/22/2022] [Indexed: 02/07/2023]
Abstract
RESEARCH QUESTION What is the effect of adenomyosis types on IVF and embryo transfer (IVF-ET) after ultra-long gonadotrophin-releasing hormone (GnRH) agonist protocol? DESIGN Patients who underwent the first cycle of IVF-ET with ultra-long GnRH agonist protocol were included in this retrospective cohort study. They were divided into three groups: (A) 428 patients with diffuse adenomyosis; (B) 718 patients with focal adenomyosis; and (C) 519 patients with tubal infertility. Reproduction outcomes were analysed. RESULTS Logistic regression analysis revealed that, compared with focal adenomyosis and tubal infertility, diffuse adenomyosis was negatively associated with clinical pregnancy and live birth (clinical pregnancy: A versus B: OR 0.708, 95% CI 0.539 to 0.931, P = 0.013; A versus C: OR 0.663, 95% CI 0.489 to 0.899, P = 0.008; live birth: A versus B: OR 0.530, 95% CI 0.385 to 0.730, P < 0.001; A versus C: OR 0.441, 95% CI 0.313 to 0.623, P < 0.001), but positively associated with miscarriage (A versus B: OR 1.727, 95% CI 1.056 to 2.825, P = 0.029; A versus C: OR 2.549, 95% CI 1.278 to 5.082, P = 0.008). Compared with patients with tubal infertility, focal adenomyosis was also a risk factor for miscarriage (B versus C: OR 1.825, 95% CI 1.112 to 2.995, P = 0.017). CONCLUSIONS Compared with patients with focal adenomyosis or tubal infertility, the reproduction outcomes of IVF-ET in patients with diffuse adenomyosis seems to be worse.
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Affiliation(s)
- Bing Han
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital Beijing 100000, China; National Clinical Research Center for Obstetrics and Gynecology (Peking University Third Hospital) Beijing 100000, China; Key Laboratory of Assisted Reproduction, Ministry of Education (Peking University) Beijing 100000, China; Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology Beijing 100000, China
| | - Tingting Liang
- Department of Obstetrics and Gynecology, The Second Hospital of Shanxi Medical University, Taiyuan City 030000, China
| | - Wen Zhang
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital Beijing 100000, China; National Clinical Research Center for Obstetrics and Gynecology (Peking University Third Hospital) Beijing 100000, China; Key Laboratory of Assisted Reproduction, Ministry of Education (Peking University) Beijing 100000, China; Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology Beijing 100000, China
| | - Caihong Ma
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital Beijing 100000, China; National Clinical Research Center for Obstetrics and Gynecology (Peking University Third Hospital) Beijing 100000, China; Key Laboratory of Assisted Reproduction, Ministry of Education (Peking University) Beijing 100000, China; Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology Beijing 100000, China.
| | - Jie Qiao
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital Beijing 100000, China; National Clinical Research Center for Obstetrics and Gynecology (Peking University Third Hospital) Beijing 100000, China; Key Laboratory of Assisted Reproduction, Ministry of Education (Peking University) Beijing 100000, China; Beijing Key Laboratory of Reproductive Endocrinology and Assisted Reproductive Technology Beijing 100000, China; Department of Obstetrics and Gynecology, The Second Hospital of Shanxi Medical University, Taiyuan City 030000, China; Beijing Advanced Innovation Center for Genomics Beijing 100000, China; Peking-Tsinghua Center for Life Science Beijing 100000, China.
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Drummond K, Danesh NM, Arseneault S, Rodrigues J, Tulandi T, Raina J, Suarthana E. Association between Endometriosis and Risk of Preeclampsia in Women Who Conceived Spontaneously: A Systematic Review and Meta-analysis. J Minim Invasive Gynecol 2023; 30:91-99. [PMID: 36403695 DOI: 10.1016/j.jmig.2022.11.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Revised: 11/14/2022] [Accepted: 11/14/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate the association between endometriosis and the risk of preeclampsia and other maternal outcomes in spontaneously conceived women. DATA SOURCES PubMed, MEDLINE, Embase, Scopus, Cochrane Library, Web of Science, and Google Scholar were systemically searched for studies published from inception to November 2021 (CRD42020198741). Observational studies published in English or French that investigated the risk of preeclampsia in women with endometriosis who conceived spontaneously were included. METHODS OF STUDY SELECTION A total of 610 articles were reviewed once duplicates were removed. Inclusion criteria included spontaneous conception and surgical and/or imaging ascertainment of an endometriosis diagnosis. Exclusion criteria included conception using assisted reproductive technologies, multiple pregnancies, chronic hypertension, and unclear diagnoses of endometriosis. TABULATION, INTEGRATION, AND RESULTS Data of selected studies were extracted, and analysis was performed on Review Manager, version 5.4. Quality assessment of included studies for potential risk of bias was evaluated using the Newcastle-Ottawa Scale for cohort studies. Three cohort studies of spontaneous pregnancies were included. Endometriosis was associated with an increased risk of preeclampsia (risk ratio [RR] = 1.47, 95% CI 1.13 -1.89, p = .003; I2 = 0%; n = 3 studies). A sensitivity analysis excluding a study with adenomyosis cases yielded similar risk (RR = 1.44; 95% CI, 1.11-1.87; p = .006; I2 = 0%; n = 2 studies). Having endometriosis did not significantly increase risk of cesarean delivery (RR = 1.38; 95% CI, 0.99-1.92; p = .06; I2 = 80%; n = 2 studies) or postpartum hemorrhage (RR = 1.16; 95% CI, 0.46-2.91; p = .76; I2 = 50%; n = 2 studies). CONCLUSION We detected an increased risk of preeclampsia in women with endometriosis who conceived spontaneously. Endometriosis did not seem to increase the risk of cesarean delivery and postpartum hemorrhage, but the number of studies was limited, and the heterogeneity was high.
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Affiliation(s)
- Katherine Drummond
- Medicine and Health Sciences (Ms. Drummond, Dr. Danesh, Ms. Arseneault, and Drs. Tulandi, Raina, and Suarthana); Department of Obstetrics and Gynecology (Ms. Drummond and Drs. Danesh, Tulandi, Raina, and Suarthana)
| | - Neda Mohammadi Danesh
- Medicine and Health Sciences (Ms. Drummond, Dr. Danesh, Ms. Arseneault, and Drs. Tulandi, Raina, and Suarthana); Department of Obstetrics and Gynecology (Ms. Drummond and Drs. Danesh, Tulandi, Raina, and Suarthana)
| | - Sophie Arseneault
- Medicine and Health Sciences (Ms. Drummond, Dr. Danesh, Ms. Arseneault, and Drs. Tulandi, Raina, and Suarthana); Faculty of Arts (Ms. Arseneault), and Department of Family Medicine (Ms. Rodrigues), McGill University, Montreal, Quebec, Canada
| | - Julia Rodrigues
- Faculty of Arts (Ms. Arseneault), and Department of Family Medicine (Ms. Rodrigues), McGill University, Montreal, Quebec, Canada
| | - Togas Tulandi
- Medicine and Health Sciences (Ms. Drummond, Dr. Danesh, Ms. Arseneault, and Drs. Tulandi, Raina, and Suarthana); Department of Obstetrics and Gynecology (Ms. Drummond and Drs. Danesh, Tulandi, Raina, and Suarthana)
| | - Jason Raina
- Medicine and Health Sciences (Ms. Drummond, Dr. Danesh, Ms. Arseneault, and Drs. Tulandi, Raina, and Suarthana); Department of Obstetrics and Gynecology (Ms. Drummond and Drs. Danesh, Tulandi, Raina, and Suarthana)
| | - Eva Suarthana
- Medicine and Health Sciences (Ms. Drummond, Dr. Danesh, Ms. Arseneault, and Drs. Tulandi, Raina, and Suarthana); Department of Obstetrics and Gynecology (Ms. Drummond and Drs. Danesh, Tulandi, Raina, and Suarthana).
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50
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Alsbjerg B, Kesmodel US, Humaidan P. Endometriosis patients benefit from high serum progesterone in hormone replacement therapy-frozen embryo transfer cycles: a cohort study. Reprod Biomed Online 2023; 46:92-98. [PMID: 36216661 DOI: 10.1016/j.rbmo.2022.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 08/14/2022] [Accepted: 09/02/2022] [Indexed: 01/31/2023]
Abstract
RESEARCH QUESTION What is the optimal serum progesterone cut-off level in patients with endometriosis undergoing hormone replacement therapy frozen embryo transfer (HRT-FET) with intensive progesterone luteal phase support? DESIGN A cohort study, including 262 HRT-FET cycles in 179 patients all diagnosed with endometriosis either by laparoscopy or by ultrasound in patients with visible endometriomas. Pre-treatment consisted of 42 days of oral contraceptive pills and 5 days' wash-out, followed by 6 mg oral oestrogen daily. Exogenous progesterone supplementation with vaginal progesterone gel 90 mg/12h commenced when the endometrium was 7 mm or thicker. From the fourth day of vaginal progesterone supplementation, patients also received intramuscular progesterone 50 mg daily. Blastocyst transfer was scheduled for the sixth day of progesterone supplementation. RESULTS The overall positive HCG, live birth (LBR) and total pregnancy loss rates were 60%, 39% and 34%, respectively. The optimal progesterone cut-off level was 118 nmol/l (37.1 ng/ml) defined as the maximum of the Youden index. The unadjusted LBR was significantly higher in patients with progesterone measuring 118 nmol/l or above compared with patients with progesterone measuring less than 118 nmol/l (51% [44/86] versus 34% [59/176], P = 0.01), whereas the adjusted odds ratio for a live birth was 2.1 (95% CI 1.2 to 3.7) after adjusting for age, body mass index, blastocyst score, blastocyst age, quality and number of blastocysts transferred. CONCLUSIONS Serum progesterone levels above 118 nmol/l (37.1ng/ml) resulted in significantly higher LBR compared with lower serum progesterone levels, suggesting that a threshold for optimal serum progesterone exists.
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Affiliation(s)
- Birgit Alsbjerg
- The Fertility Clinic, Skive Regional Hospital, Resenvej 25, Skive 7800, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.
| | - Ulrik Schiøler Kesmodel
- Department of Obstetrics and Gynaecology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Peter Humaidan
- The Fertility Clinic, Skive Regional Hospital, Resenvej 25, Skive 7800, Denmark; Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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