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Pecorella G, Nigdelis MP, Sparic R, Morciano A, Tinelli A. Adenomyosis and fertility-sparing surgery: A literature appraisal. Int J Gynaecol Obstet 2024; 166:512-526. [PMID: 38287707 DOI: 10.1002/ijgo.15389] [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: 08/13/2023] [Revised: 01/06/2024] [Accepted: 01/09/2024] [Indexed: 01/31/2024]
Abstract
Adenomyosis is an intricate pathological condition that negatively impacts the uterus. It is closely related to the more well-known endometriosis, with which it shares parallels in terms of diagnosis, therapy, and both microscopic and macroscopic features. The purpose of this narrative review is to give a clear univocal definition and outlook on the different, patient-adapted, surgical treatments. MEDLINE and PubMed searches on these topics were conducted from 1990 to 2022 using a mix of selected keywords. Papers and articles were identified and included in this narrative review after authors' revision and evaluation. From the literature analysis, authors reported the following surgical techniques: laparoscopic double/triple-flap method, laparotomic wedge resection of the uterine wall, laparotomic transverse H-incision of the uterine wall, laparotomic wedge-shaped excision, and laparotomic complete debulking excision by asymmetric dissection technique. Each of these techniques has strengths and weaknesses, but the literature data on the pregnancy rate are somewhat limited. The only certain information is the risk of uterine rupture up to 6.0% after surgical treatment for uterine adenomyosis. Over the years, the surgical approach continued to reach a positive result by minimally invasive treatment, with less hospitalization, less postoperative pain, and less blood loss. Over the years, the gynecological surgeon has gained the skills, training and increasingly sophisticated surgical techniques to target effective therapy. That's why a hysterectomy is no longer the only surgical resource to treat adenomyosis, but in patients who wish to preserve the fertility, there is a wide variety of surgical alternatives.
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Affiliation(s)
- Giovanni Pecorella
- Department of Gynecology, Obstetrics and Reproduction Medicine, Saarland University, Homburg, Germany
| | - Meletios P Nigdelis
- Department of Gynecology, Obstetrics and Reproduction Medicine, Saarland University, Homburg, Germany
| | - Radmila Sparic
- Clinic for Gynecology and Obstetrics, University Clinical Centre of Serbia, Belgrade, Serbia
- Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Andrea Morciano
- Department of Gynecology and Obstetrics, Pia Fondazione "Card. G. Panico", Lecce, Italy
| | - Andrea Tinelli
- Department of Obstetrics and Gynecology, and CERICSAL (CEntro di RIcerca Clinico SALentino), "Veris delli Ponti Hospital", Lecce, Italy
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Moawad G, Youssef Y, Fruscalzo A, Faysal H, Merida M, Pirtea P, Guani B, Ayoubi JM, Feki A. The Impact of Conservative Surgical Treatment of Adenomyosis on Fertility and Perinatal Outcomes. J Clin Med 2024; 13:2531. [PMID: 38731060 PMCID: PMC11084146 DOI: 10.3390/jcm13092531] [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: 01/18/2024] [Revised: 03/28/2024] [Accepted: 04/08/2024] [Indexed: 05/13/2024] Open
Abstract
Adenomyosis is a benign condition commonly encountered in patients with infertility. While the definitive surgical management is hysterectomy, conservative surgical management is gaining attention in patients desiring future fertility. This review explores whether the surgical treatment of adenomyosis affects fertility outcomes for patients trying to conceive. The PubMed and Medline databases were searched using the keywords: "adenomyosis", "surgery", "radiofrequency", "infertility", "pregnancy", "sterility", "conception", "miscarriage", and "endometrial receptivity". Abstracts were screened, and relevant articles were selected for review. This review reveals that surgery appears to improve fertility outcomes with or without medical therapy; however, the risk of uterine rupture remains high and the best technique to reduce this risk is still not known. More studies are needed to formulate the best surgical approach for preserving fertility in treating adenomyosis and to establish standardized guidelines.
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Affiliation(s)
- Gaby Moawad
- Department of Obstetrics and Gynecology, The George Washington University Hospital, Washington, DC 20037, USA
- The Center for Endometriosis and Advanced Pelvic Surgery, Washington, DC 22101, USA
| | - Youssef Youssef
- Division of Minimally Invasive Gynecology, Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY 11219, USA
| | - Arrigo Fruscalzo
- Department of Obstetrics and Gynecology, HFR—Hòpital Fribourgeois, Chemin des Pensionnats 2-6, 1708 Fribourg, Switzerland
| | - Hani Faysal
- Department of Obstetrics and Gynecology, Indiana University, Indianapolis, IN 46204, USA
| | - Manuel Merida
- Department of Obstetrics and Gynecology, Hurley Medical Center, Michigan State University, Flint, MI 48503, USA
| | - Paul Pirtea
- Department of Obstetrics and Gynecology and Reproductive Medicine, Faculté de Médecine Paris, Hopital Foch, 92150 Suresnes, France
| | - Benedetta Guani
- Department of Obstetrics and Gynecology, HFR—Hòpital Fribourgeois, Chemin des Pensionnats 2-6, 1708 Fribourg, Switzerland
| | - Jean Marc Ayoubi
- Department of Obstetrics and Gynecology and Reproductive Medicine, Faculté de Médecine Paris, Hopital Foch, 92150 Suresnes, France
| | - Anis Feki
- Department of Obstetrics and Gynecology, HFR—Hòpital Fribourgeois, Chemin des Pensionnats 2-6, 1708 Fribourg, Switzerland
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Ono Y, Ota H, Fukushi Y, Tagaya H, Okuda Y, Yoshino O, Yamada H, Hirata S, Wada S. Effectiveness of Laparoscopic Adenomyomectomy on Perinatal Outcomes. Gynecol Minim Invasive Ther 2023; 12:211-217. [PMID: 38034106 PMCID: PMC10683966 DOI: 10.4103/gmit.gmit_45_22] [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: 04/18/2022] [Revised: 07/29/2022] [Accepted: 08/10/2022] [Indexed: 01/18/2023] Open
Abstract
Objectives The objective of this study was to observe the influence of laparoscopic adenomyomectomy on perinatal outcomes. Materials and Methods The retrospective cohort study included 43 pregnant cases with adenomyosis who did not undergo laparoscopic surgery before pregnancy (nonsurgery group; 26 cases) and did (surgery group; 17 cases). To evaluate the impact of surgery on perinatal outcomes, nine obstetric complications including preterm delivery, hypertensive disorder of pregnancy, placental malposition, oligohydramnios, gestational diabetes mellitus, uterine rupture, abruptio placentae, and postpartum hemorrhage were selected. One obstetric complication was counted as one point (Maximum 9 points for one person). The obstetrical morbidity was compared by adding up the number of relevant events (0-9) between the two groups. Apgar score, umbilical artery pH (UApH), neonatal intensive care unit (NICU) admission, and neonatal death were also examined. Results The surgery group had a significantly lower prevalence of fetal growth restriction compared to the nonsurgery group (nonsurgery vs. surgery; 26.9%, 7/26 vs. 0%, 0/17: P = 0.031). No differences were found in the morbidity of the nine obstetric complications (19.2%, 45/234 vs. 13.7%, 21/153), gestational weeks (mean ± standard deviation, 37.2 ± 2.4 vs. 36.4 ± 3.2), birth weight (2573.6 ± 557.9 vs. 2555.4 ± 680.8 g), Apgar score (1, 5 min; 8.0 ± 0.7 vs. 7.7 ± 1.2, 8.9 ± 0.6 vs. 8.5 ± 1.8), UApH (7.28 ± 0.08 vs. 7.28 ± 0.06), NICU admission (26.9%, 7/26 vs. 41.2%, 7/17), and neonatal death (0%, 0%) between both groups. Conclusion Laparoscopic adenomyomectomy may not increase obstetric complications, although attention must be paid to uterine rupture during pregnancy.
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Affiliation(s)
- Yosuke Ono
- Department of Obstetrics and Gynecology, University of Yamanashi, Chuo, Japan
- Department of Obstetrics and Gynecology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Hajime Ota
- Department of Obstetrics and Gynecology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Yoshiyuki Fukushi
- Department of Obstetrics and Gynecology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Hikaru Tagaya
- Department of Obstetrics and Gynecology, University of Yamanashi, Chuo, Japan
| | - Yasuhiko Okuda
- Department of Obstetrics and Gynecology, University of Yamanashi, Chuo, Japan
| | - Osamu Yoshino
- Department of Obstetrics and Gynecology, University of Yamanashi, Chuo, Japan
| | - Hideto Yamada
- Center for Recurrent Pregnancy Loss, Teine Keijinkai Hospital, Sapporo, Japan
| | - Shuji Hirata
- Department of Obstetrics and Gynecology, University of Yamanashi, Chuo, Japan
| | - Shinichiro Wada
- Department of Obstetrics and Gynecology, Teine Keijinkai Hospital, Sapporo, Japan
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Wu R, Zeng L, Hu Q, Qu X, He F, Bao J, Wei W, Zhang W, Dai W, Li H, Du H, Li C. Outcome of uterine functional structures protection by fertility preservative PUSH surgery in diffuse adenomyosis. HUM FERTIL 2023; 26:720-732. [PMID: 37913797 DOI: 10.1080/14647273.2023.2260102] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 08/14/2023] [Indexed: 11/03/2023]
Abstract
This study reports the outcomes of an innovative fertility-preserving surgery for the treatment of diffuse adenomyosis that is known as a surgery for protection of uterine structure for healing (PUSH Surgery). Developed at Peking University Shenzhen Hospital, PUSH Surgery aims to achieve radical excision of adenomyotic lesions by reconstructing the uterus with overlapping muscle flaps to promote optimal healing of the uterine wall and reduce the risk of scar rupture in subsequent pregnancies. PUSH Surgery was performed on 146 patients with diffuse adenomyosis, with uteri measuring from 8 to 16 gestational weeks and an average volume of 230 ± 150cm³. Regular follow-up was conducted for up to 156 months, revealing a significant reduction in VAS pain scores from 9.4 ± 1.2 before the surgery to 0.3 ± 0.8 and 0.6 ± 1.0 at 1 and 2 years post-surgery, respectively, with a continuous alleviation rate of 96.4% after the operations. Notably, 100% of patients with severe menorrhagia reported normal menstruation volumes within 2 years. Additionally, 31 patients attempted to conceive, resulting in a 58% postoperative pregnancy rate and a 60.0% intrauterine live embryo rate. Operation-related complications occurred in 2.7% of patients, with a 3.6% recurrence rate after more than 2 years of follow-up. Importantly, no cases of uterine rupture or severe complications were observed in the pregnant patients. In conclusion, PUSH Surgery offers a promising approach for the radical excision of adenomyotic lesions, promoting improved tissue healing and significant symptom relief.
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Affiliation(s)
- Ruifang Wu
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, P. R. China
- Institute of Obstetrics and Gynecology, Shenzhen PKU-HKUST Medical Center, Shenzhen, P. R. China
- Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecologic Diseases, Shenzhen, P. R. China
| | - Liping Zeng
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, P. R. China
- Institute of Obstetrics and Gynecology, Shenzhen PKU-HKUST Medical Center, Shenzhen, P. R. China
- Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecologic Diseases, Shenzhen, P. R. China
| | - Qicai Hu
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, P. R. China
- Institute of Obstetrics and Gynecology, Shenzhen PKU-HKUST Medical Center, Shenzhen, P. R. China
- Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecologic Diseases, Shenzhen, P. R. China
| | - Xinfeng Qu
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, P. R. China
- Institute of Obstetrics and Gynecology, Shenzhen PKU-HKUST Medical Center, Shenzhen, P. R. China
- Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecologic Diseases, Shenzhen, P. R. China
| | - Fang He
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, P. R. China
- Institute of Obstetrics and Gynecology, Shenzhen PKU-HKUST Medical Center, Shenzhen, P. R. China
- Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecologic Diseases, Shenzhen, P. R. China
| | - Juncui Bao
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, P. R. China
- Institute of Obstetrics and Gynecology, Shenzhen PKU-HKUST Medical Center, Shenzhen, P. R. China
- Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecologic Diseases, Shenzhen, P. R. China
| | - Weixia Wei
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, P. R. China
- Institute of Obstetrics and Gynecology, Shenzhen PKU-HKUST Medical Center, Shenzhen, P. R. China
- Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecologic Diseases, Shenzhen, P. R. China
| | - Wei Zhang
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, P. R. China
- Institute of Obstetrics and Gynecology, Shenzhen PKU-HKUST Medical Center, Shenzhen, P. R. China
- Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecologic Diseases, Shenzhen, P. R. China
| | - Wenkui Dai
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, P. R. China
- Institute of Obstetrics and Gynecology, Shenzhen PKU-HKUST Medical Center, Shenzhen, P. R. China
- Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecologic Diseases, Shenzhen, P. R. China
| | - Huan Li
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, P. R. China
- Institute of Obstetrics and Gynecology, Shenzhen PKU-HKUST Medical Center, Shenzhen, P. R. China
- Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecologic Diseases, Shenzhen, P. R. China
| | - Hui Du
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, P. R. China
- Institute of Obstetrics and Gynecology, Shenzhen PKU-HKUST Medical Center, Shenzhen, P. R. China
- Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecologic Diseases, Shenzhen, P. R. China
| | - Changzhong Li
- Department of Obstetrics and Gynecology, Peking University Shenzhen Hospital, Shenzhen, P. R. China
- Institute of Obstetrics and Gynecology, Shenzhen PKU-HKUST Medical Center, Shenzhen, P. R. China
- Shenzhen Key Laboratory on Technology for Early Diagnosis of Major Gynecologic Diseases, Shenzhen, P. R. China
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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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Harada T, Taniguchi F, Guo S, Choi YM, Biberoglu KO, Tsai SS, Alborzi S, Al‐Jefout M, Chalermchokcharoenkit A, Sison‐Aguilar AG, Fong Y, Senanayake H, Popov A, Hestiantoro A, Kaufman Y. The Asian Society of Endometriosis and Adenomyosis guidelines for managing adenomyosis. Reprod Med Biol 2023; 22:e12535. [PMID: 37701076 PMCID: PMC10493363 DOI: 10.1002/rmb2.12535] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 08/03/2023] [Indexed: 09/14/2023] Open
Abstract
This is the first guidelines for adenomyosis from the Asian Society of Endometriosis and Adenomyosis.
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Affiliation(s)
| | | | - Sun‐Wei Guo
- OB/GYN HospitalFudan UniversityShanghaiChina
| | | | | | | | | | - Moamar Al‐Jefout
- United Arab Emirates University, College of Medicine and Health SciencesAbu DhabiUAE
| | | | | | - Yoke‐Fai Fong
- National University of SingaporeSingapore CitySingapore
| | | | - Alexander Popov
- Moscow Regional Scientific Research Institute of Obstetrics and GynecologyMoscowRussia
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Khan KN, Fujishita A, Mori T. Pathogenesis of Human Adenomyosis: Current Understanding and Its Association with Infertility. J Clin Med 2022; 11:4057. [PMID: 35887822 PMCID: PMC9316454 DOI: 10.3390/jcm11144057] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/22/2022] [Accepted: 07/11/2022] [Indexed: 12/10/2022] Open
Abstract
The aim of this review article was to summarize our current understanding on the etiologies and pathogenesis of human adenomyosis and to clarify the relative association between adenomyosis and infertility. The exact pathogenesis of adenomyosis is still elusive. Among different reported concepts, direction invagination of gland cells from the basalis endometrium deep into myometrium is the most widely accepted opinion on the development of adenomyosis. According to this concept, endometrial epithelial cells and changed fibroblasts, abnormally found in the myometrium in response to repeated tissue injury and/or disruption at the endometrium-myometrium interface (EMI), elicit hyperplasia and hypertrophy of the surrounding smooth muscle cells. In this review, a comprehensive review was performed with a literature search using PubMed for all publications in English and Japanese (abstract in English), related to adenomyosis and infertility, from inception to April 2021. As an estrogen-regulated factor, hepatocyte growth factor (HGF) exhibits multiple functions in endometriosis, a disease commonly believed to arise from the functionalis endometrium. As a mechanistic basis of gland invagination, we investigated the role of HGF, either alone or in combination with estrogen, in the occurrence of epithelial-mesenchymal transition (EMT) in adenomyosis. Aside from microtrauma at the EMI, metaplasia of displaced Müllerian remnants, differentiation of endometrial stem/progenitor cells within the myometrium and somatic mutation of some target genes have been put forward to explain how adenomyosis develops. In addition, the possible role of microRNAs in adenomyosis is also discussed. Besides our knowledge on the conventional classification (focal and diffuse), two recently proposed classifications (intrinsic and extrinsic) of adenomyosis and the biological differences between them have been described. Although the mechanistic basis is unclear, the influence of adenomyosis on fertility outcome is important, especially considering the recent tendency to delay pregnancy among women. Besides other proposed mechanisms, a recent transmission election microscopic (TEM) study indicated that microvilli damage and an axonemal alteration in the apical endometria of human adenomyosis, in response to endometrial inflammation, may be involved in negative fertility outcomes. We present a critical analysis of the literature data concerning the mechanistic basis of infertility in women with adenomyosis and its impact on fertility outcome.
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Affiliation(s)
- Khaleque N. Khan
- Department of Obstetrics and Gynecology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan;
| | - Akira Fujishita
- Department of Gynecology, Saiseikai Nagasaki Hospital, Nagasaki 850-0003, Japan;
| | - Taisuke Mori
- Department of Obstetrics and Gynecology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto 602-8566, Japan;
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8
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Zhou Y, Shen L, Wang Y, Yang M, Chen Z, Zhang X. Long-Term Pregnancy Outcomes of Patients with Diffuse Adenomyosis after Double-Flap Adenomyomectomy. J Clin Med 2022; 11:jcm11123489. [PMID: 35743559 PMCID: PMC9224895 DOI: 10.3390/jcm11123489] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Revised: 06/13/2022] [Accepted: 06/14/2022] [Indexed: 02/01/2023] Open
Abstract
Although many studies show that patients with diffuse adenomyosis who underwent fertility-sparing surgery can have a successful pregnancy, their pregnancy outcomes are still controversial. The objective of this study was to determine long-term pregnancy outcomes and possible influencing factors after double-flap adenomyomectomy for patients with diffuse adenomyosis. A total of 137 patients with diffuse adenomyosis who underwent double-flap adenomyomectomy between January 2011 and December 2019 were studied, and correlations between pregnancy outcomes and clinical data, including age and junctional zone measured by magnetic resonance imaging (JZmax-A), were analyzed. The results show that 56 patients (40.9%, 56/137) had 62 pregnancies, including 35 natural pregnancies and 27 assisted reproduction pregnancies, after operation. A univariate regression analysis showed that the pregnancy outcomes were related to age at surgery, visual analog scale (VAS) score of preoperative dysmenorrhea, parity experience, length of infertility, and postoperative JZmax-A. A multivariate regression analysis showed that age at surgery, VAS score of preoperative dysmenorrhea, and postoperative JZmax-A were the independent indicators correlated with pregnancy outcomes. A receiver operating characteristic curve analysis showed that postoperative JZmax-A was the most valuable indicator for predicting pregnancy outcomes. Cumulative pregnancy rates during the first 3 years were 70.1% and 20.9% in the postoperative JZmax-A ≤ 8.5 mm and the postoperative JZmax-A > 8.5 mm groups, respectively. In conclusion, double-flap adenomyomectomy could improve fertility for diffuse adenomyosis, and postoperative JZmax-A might be a promising indicator for predicting pregnancy outcomes.
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9
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Cozzolino M, Tartaglia S, Pellegrini L, Troiano G, Rizzo G, Petraglia F. The Effect of Uterine Adenomyosis on IVF Outcomes: a Systematic Review and Meta-analysis. Reprod Sci 2022; 29:3177-3193. [PMID: 34981458 DOI: 10.1007/s43032-021-00818-6] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 12/01/2021] [Indexed: 11/28/2022]
Abstract
To investigate the impact of uterine adenomyosis on in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) clinical outcomes and also to evaluate the impact of gonadotropin-releasing hormone agonist (GnRHa) and surgical treatments. Infertile women with adenomyosis undergoing conventional IVF or ICSI were compared with women without adenomyosis. Fertility outcomes were evaluated in two patients with adenomyosis untreated and treated surgically or medically therapy. The review protocol was registered in PROSPERO (CRD42020214586). We consider the live birth rate (LBR) as the primary outcome. The analysis showed that women with adenomyosis had lower LBR (OR 0.59, 95% CI 0.37-0.92, p = 0.02), clinical pregnancy rate (OR 0.66, 95% CI 0.48-0.90), and ongoing pregnancy rate (OR 0.43, 95% CI 0.21-0.88) compared to those without adenomyosis, and miscarriage rate was higher in women with adenomyosis (OR 2.11, 95% CI 1.33-3.33). Surgical treatment increases natural conception in women with adenomyosis although the paucity of data (only two studies), and conversely, treatment with GnRHa does not increase the IVF outcomes. Women with adenomyosis have decreased IVF clinical outcomes. Pretreatment with the use of long-term GnRHa could not be beneficial, even though only three studies were included in the meta-analysis. The major part of the studies has not divided focal and diffuse adenomyosis, and this represents a relevant source of bias: studies conducted with standardized diagnostic criteria for adenomyosis are still needed to determine if the different clinical presentations of such condition could compromise IVF outcomes.
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Affiliation(s)
- Mauro Cozzolino
- IVIRMA Rome, Largo Ildebrando Pizzetti 1, 00197, Rome, Italy.
- Universidad Rey Juan Carlos, Calle Tulipán, 28933, Móstoles, Madrid, Spain.
- Department of Obstetrics, Gynaecology and Reproductive Sciences, Yale School of Medicine, 310 Cedar St, New Haven, CT, 06510, USA.
| | - Silvio Tartaglia
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Viale Montpellier 1, 00133, Rome, Italy
- U.O.C. Di Ostetricia E Patologia Ostetrica, Dipartimento Di Scienza Della Salute Della Donna E del Bambino E Di Sanità Pubblica, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168, Rome, Italy
| | | | | | - Giuseppe Rizzo
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Viale Montpellier 1, 00133, Rome, Italy
- Department of Obstetrics and Gynaecology, Fondazione Policlinico Tor Vergata, Rome, Italy
- Department of Obstetrics and Gynecology, The First IM Sechenov, Moscow State University, Moscow, Russian Federation
| | - Felice Petraglia
- Department of Experimental and Clinical Biomedical Sciences "M. Serio", The University of Florence, Florence, Italy
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Khan KN, Fujishita A, Ogawa K, Koshiba A, Mori T, Itoh K, Nakashima M, Kitawaki J. Occurrence of chronic endometritis in different types of human adenomyosis. Reprod Med Biol 2021; 21:e12421. [PMID: 35386364 PMCID: PMC8967303 DOI: 10.1002/rmb2.12421] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/04/2021] [Accepted: 10/05/2021] [Indexed: 02/02/2023] Open
Abstract
Purpose Human adenomyosis has an adverse effect on female fertility. Exact mechanistic basis is still unclear. We investigated the occurrence of chronic endometritis (CE) in different types of human adenomyosis. Methods This is a prospective non‐randomized observational study enrolling patients with focal (n = 30), diffuse (n = 26), intrinsic (n = 23), and extrinsic (n = 10) adenomyosis. Endometrial biopsy samples were collected from hysterectomy specimens. Immunohistochemical analysis was performed using antibody against CD68 (Mφ marker) with biopsy samples of intrinsic/extrinsic adenomyosis and CD138 (Syndecan‐1), a marker of plasma cells, in all biopsy samples. Results In GnRHa‐untreated groups, a higher trend in the occurrence of CE, as characterized by infiltration of ≥1 plasma cells in endometrial stroma, was found in women with focal (58.8%, p = 0.0849) and diffuse adenomyosis (60.0%, p = 0.0841) comparing to control women (10.0%). In women with focal adenomyosis, ipsilateral side showed a significantly higher occurrence of CE (58.8%) than on the contralateral side (11.7%) (p = 0.043). Tissue infiltration of macrophages in endometria was significantly higher in intrinsic than in extrinsic adenomyosis (p = 0.03) without showing any significant difference in the occurrence of CE between these two variants of adenomyosis. Conclusion A variable occurrence of CE in different types of adenomyosis may be involved in adverse reproductive outcome.
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Affiliation(s)
- Khaleque N. Khan
- Department of Obstetrics and Gynecology Graduate School of Medical Science Kyoto Prefectural University of Medicine Kyoto Japan
| | - Akira Fujishita
- Department of Gynecology Saiseikai Nagasaki Hospital Nagasaki Japan
| | - Kanae Ogawa
- Department of Obstetrics and Gynecology Graduate School of Medical Science Kyoto Prefectural University of Medicine Kyoto Japan
| | - Akemi Koshiba
- Department of Obstetrics and Gynecology Graduate School of Medical Science Kyoto Prefectural University of Medicine Kyoto Japan
| | - Taisuke Mori
- Department of Obstetrics and Gynecology Graduate School of Medical Science Kyoto Prefectural University of Medicine Kyoto Japan
| | - Kyoko Itoh
- Department of Pathology and Applied Neurobiology Kyoto Prefectural University of Medicine Kyoto Japan
| | - Masahiro Nakashima
- Department of Molecular and Diagnostic Pathology Atomic Bomb Disease Institute Nagasaki University School of Medicine Nagasaki Japan
| | - Jo Kitawaki
- Department of Obstetrics and Gynecology Graduate School of Medical Science Kyoto Prefectural University of Medicine Kyoto Japan
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Influence of nodular and severe forms of diffuse adenomyosis on reproductive function: a review of reproductive outcomes of surgical interventions and IVF. ACTA BIOMEDICA SCIENTIFICA 2021. [DOI: 10.29413/abs.2021-6.3.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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12
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Sudhakar P, Manivannan S, Kandasamy D, Jayapal K. Does Adenomyosis Influence ICSI Clinical Outcome? A Systematic Analysis and Impact of GnRH Agonist Pretreatment for Women with Adenomyosis in ICSI–FET Cycle: A Retrospective Cohort Study. J Obstet Gynaecol India 2021; 72:236-242. [DOI: 10.1007/s13224-021-01504-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 05/22/2021] [Indexed: 11/29/2022] Open
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13
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Khan KN, Fujishita A, Suematsu T, Ogawa K, Koshiba A, Mori T, Itoh K, Teramukai S, Matsuda K, Nakashima M, Kitawaki J. An axonemal alteration in apical endometria of human adenomyosis. Hum Reprod 2021; 36:1574-1589. [PMID: 33889963 DOI: 10.1093/humrep/deab090] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 03/19/2021] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION Is there any change in the distribution of microvilli and microtubules in the apical endometria of women with adenomyosis? SUMMARY ANSWER We observed microvilli damage in the apical endometria and an axonemal alteration characterized by abnormal distribution of longitudinal bundles of microtubules within microvilli in women with adenomyosis. WHAT IS KNOWN ALREADY Human adenomyosis has a negative impact on female fertility. Abnormal utero-tubal sperm transport, tissue inflammation and toxic effect of chemical mediators have been proposed as contributing factors. Inflammation-induced damage of mucosal cilia in the Fallopian tube has been reported. However, information on inflammation-induced damage of microvilli on the apical endometrial cells and its core bundles of microtubules in adenomyosis remains unknown. STUDY DESIGN, SIZE, DURATION This is a prospective cohort study with subjects undergoing laparoscopic surgery or hysterectomy for clinical indication and evaluations of endometrial biopsy samples in two academic university hospitals. During the period between March 2015 and December 2018, endometrial biopsy samples were prospectively collected from 15 control women and 45 women with adenomyosis for immunohistochemical analysis and a separate cohort of 10 control women with cervical intraepithelial neoplasia Grade 3 (CIN3) and 20 women with adenomyosis for analysis by immunohistochemistry and transmission electron microscopy (TEM). PARTICIPANTS/MATERIALS, SETTING, METHODS For immunohistochemical study, endometrial biopsy samples were prospectively collected from 15 control women with fibroids, 25 women with focal adenomyosis and 20 women with diffuse adenomyosis after surgery. The diagnosis of fibroid and adenomyosis was made clinically by transvaginal ultrasonography and magnetic resonance imaging and confirmed by histology. Immunohistochemical analysis was performed retrospectively using antibody against CD68 (marker of macrophages) in endometrial biopsy specimens of women with and without adenomyosis. TEM was performed with the apical endometria collected from a separate cohort of 10 control women with CIN3 and 20 women with focal and diffuse adenomyosis for the identification of any change in the distribution of microvilli and longitudinal bundles of microtubules within microvilli. MAIN RESULTS AND ROLE OF CHANCE Comparing to control endometria and contralateral side, tissue infiltration of macrophages (Mφ) in the endometria was significantly higher on the ipsilateral side of focal adenomyosis (P = 0.02 and P = 0.03, respectively) and anterior/posterior walls of diffuse adenomyosis (P = 0.01 for both). In a subgroup analysis of patients with focal adenomyosis with and without symptoms, the endometria of symptomatic women displayed a tendency of higher Mφ infiltration on the ipsilateral side than in asymptomatic women (P = 0.07). Comparing to contralateral side endometria of symptomatic women, Mφ infiltration was significantly higher in the endometria of symptomatic women collected from the ipsilateral side of focal adenomyosis (P = 0.03). We found a significantly less tissue infiltration of Mφ in the endometria of women with CIN3 than that in endometria of women with focal adenomyosis. TEM analysis showed that number of microvilli in the endometria was significantly decreased on the ipsilateral side (P = 0.003) comparing to that on the contralateral side of focal adenomyosis. The Chi-squared test indicated that cases with abnormal (disruption in the normal arrangement of 9 peripheral pairs + 1 central pair) microtubules (MT) were significantly higher in women with adenomyosis than in cases with normal patterns (P = 0.0016). While contralateral side displayed significantly less abnormal MT (P = 0.0002), ipsilateral side of focal adenomyosis showed significantly higher abnormal MT (P = 0.0164) comparing to normal patterns. Cases with symptomatic adenomyosis showed significantly higher abnormal MT than normal MT (P = 0.0004). An axonemal alteration characterized by abnormal structural distribution of microtubules within microvilli in the apical endometria in response to endometrial inflammation may be involved in adverse reproductive outcome in women with adenomyosis. LIMITATIONS, REASONS FOR CAUTION The average age of women in this study was high that may be associated with overall decline in fertility regardless of the presence or absence of adenomyosis or endometriosis. We collected endometrial biopsy samples from two completely separate cohorts of women for analysis by immunohiostochemistry and TEM. We need future follow-up study with increased sample size and from the same patients to precisely clarify the mechanistic link between axonemal alteration and negative fertility outcome. WIDER IMPLICATIONS OF THE FINDINGS Our current findings may have some biological implication to better understand the endometrial epithelial biology and pathology in women with adenomyosis and may open the avenue for future study in other reproductive diseases. The ultra-structural abnormalities of microvilli and microtubules in the apical endometria in response to tissue inflammatory reaction may clarify the possible association between negative fertility outcome and adenomyosis. Our findings may be clinically useful during counseling with symptomatic patients with adenomyosis desiring pregnancy. STUDY FUNDING/COMPETING INTEREST (S) This work was supported by Grants-in-Aid for Scientific Research from the Ministry of Education, Sports, Culture, Science and Technology of Japan. There is no conflict of interest related to this study. TRIAL REGISTRATION NUMBER N/A.
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Affiliation(s)
- Khaleque N Khan
- Department of Obstetrics and Gynecology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Akira Fujishita
- Department of Gynecology, Saiseikai Nagasaki Hospital, Nagasaki, Japan
| | - Takashi Suematsu
- Central Electron Microscopy Laboratory, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Kanae Ogawa
- Department of Obstetrics and Gynecology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Akemi Koshiba
- Department of Obstetrics and Gynecology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Taisuke Mori
- Department of Obstetrics and Gynecology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Kyoko Itoh
- Department of Pathology and Applied Neurobiology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Satoshi Teramukai
- Department of Biostatistics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Katsuya Matsuda
- Department of Molecular and Diagnostic Pathology, Atomic Bomb Disease Institute, Nagasaki University School of Medicine, Nagasaki, Japan
| | - Masahiro Nakashima
- Department of Molecular and Diagnostic Pathology, Atomic Bomb Disease Institute, Nagasaki University School of Medicine, Nagasaki, Japan
| | - Jo Kitawaki
- Department of Obstetrics and Gynecology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
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Devesa-Peiro A, Sebastian-Leon P, Pellicer A, Diaz-Gimeno P. Guidelines for biomarker discovery in endometrium: correcting for menstrual cycle bias reveals new genes associated with uterine disorders. Mol Hum Reprod 2021; 27:gaab011. [PMID: 33576824 PMCID: PMC8063681 DOI: 10.1093/molehr/gaab011] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 01/27/2021] [Indexed: 12/11/2022] Open
Abstract
Transcriptomic approaches are increasingly used in reproductive medicine to identify candidate endometrial biomarkers. However, it is known that endometrial progression in the molecular biology of the menstrual cycle is a main factor that could affect the discovery of disorder-related genes. Therefore, the aim of this study was to systematically review current practices for considering the menstrual cycle effect and to demonstrate its bias in the identification of potential biomarkers. From the 35 studies meeting the criteria, 31.43% did not register the menstrual cycle phase. We analysed the menstrual cycle effect in 11 papers (including 12 studies) from Gene Expression Omnibus: three evaluating endometriosis, two evaluating recurrent implantation failure, one evaluating recurrent pregnancy loss, one evaluating uterine fibroids and five control studies, which collected endometrial samples throughout menstrual cycle. An average of 44.2% more genes were identified after removing menstrual cycle bias using linear models. This effect was observed even if studies were balanced in the proportion of samples collected at different endometrial stages or only in the mid-secretory phase. Our bias correction method increased the statistical power by retrieving more candidate genes than per-phase independent analyses. Thanks to this practice, we discovered 544 novel candidate genes for eutopic endometriosis, 158 genes for ectopic ovarian endometriosis and 27 genes for recurrent implantation failure. In conclusion, we demonstrate that menstrual cycle progression masks molecular biomarkers, provides new guidelines to unmask them and proposes a new classification that distinguishes between biomarkers of disorder or/and menstrual cycle progression.
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Affiliation(s)
- Almudena Devesa-Peiro
- Department of Genomic & Systems Reproductive Medicine, IVI-RMA IVI Foundation, Valencia, Spain—Instituto de Investigación Sanitaria Hospital Universitario y Politécnico La Fe, Valencia 46026, Spain
- Department of Pediatrics, Obstetrics and Gynaecology, Universidad de Valencia, Valencia 46010, Spain
| | - Patricia Sebastian-Leon
- Department of Genomic & Systems Reproductive Medicine, IVI-RMA IVI Foundation, Valencia, Spain—Instituto de Investigación Sanitaria Hospital Universitario y Politécnico La Fe, Valencia 46026, Spain
| | - Antonio Pellicer
- Department of Genomic & Systems Reproductive Medicine, IVI-RMA IVI Foundation, Valencia, Spain—Instituto de Investigación Sanitaria Hospital Universitario y Politécnico La Fe, Valencia 46026, Spain
- Department of Pediatrics, Obstetrics and Gynaecology, Universidad de Valencia, Valencia 46010, Spain
- IVI-RMA IVI Rome, Reproductive medicine clinic, Largo Ildebrando Pizzetti, 1, Rome 00197, Italy
| | - Patricia Diaz-Gimeno
- Department of Genomic & Systems Reproductive Medicine, IVI-RMA IVI Foundation, Valencia, Spain—Instituto de Investigación Sanitaria Hospital Universitario y Politécnico La Fe, Valencia 46026, Spain
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15
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Li X, Pan N, Zhang W, Wang Y, Ge Y, Wei H, Lin Y, Ma C. Association between uterine volume and pregnancy outcomes in adenomyosis patients undergoing frozen-thawed embryo transfer. Reprod Biomed Online 2020; 42:384-389. [PMID: 33243661 DOI: 10.1016/j.rbmo.2020.10.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 09/13/2020] [Accepted: 10/05/2020] [Indexed: 01/13/2023]
Abstract
RESEARCH QUESTION What is the relationship between uterine volume before frozen-thawed embryo transfer (FET) and reproductive outcomes among adenomyosis patients? DESIGN Clinical characteristics and outcomes of adenomyosis patients undergoing IVF and FET in a tertiary academic hospital were retrospectively analysed. Only first blastocyst transfer cycles were included. The main outcome measures included clinical pregnancy rate (CPR), miscarriage rate and live birth rate (LBR). RESULTS A total of 158 adenomyosis patients were enrolled. Receiver operating characteristic (ROC) curve analysis indicated that uterine volume before FET was negatively related to LBR, with area under the curve of 0.622 (95% confidence interval [CI] = 0.531-0.712, P = 0.012). The cut-off value for the curve was 98.81 cm3. Grouped by the cut-off of uterine volume, 83 women were included in group A (≤98.81 cm3) and 75 in group B (>98.81 cm3). No significant difference was found in CPR between two groups. Compared with group A, the incidence of miscarriage in group B was significantly increased (51.28% versus 16.28%, P = 0.001). LBR in group B was markedly lower than in group A (25.33% versus 43.37%, P = 0.020). Logistic regression analysis revealed that, after adjusting for potential confounders, uterine volume before FET was not associated with CPR (odds ratio [OR] 1.149, 95% CI 0.577-2.286, P = 0.693) but was positively related to miscarriage rate (OR 8.509, 95% CI 2.290-2.575, P = 0.001). CONCLUSIONS Adenomyosis patients with larger uterine volume (>98.81 cm3) before FET might have a lower LBR due to higher incidence of miscarriage. Reduction of uterine volume before embarking on FET procedures should be recommended.
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Affiliation(s)
- Xiaoxue Li
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital Beijing, China; National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital Beijing, China; Key Laboratory of Assisted Reproduction, Peking University, Ministry of Education Beijing, China; Beijing Key Laboratory of Assisted Reproductive Endocrinology and Assisted Reproductive Technology, Peking University Third Hospital Beijing, China
| | - Ningning Pan
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital Beijing, China; National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital Beijing, China
| | - Wen Zhang
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital Beijing, China; National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital Beijing, China; Key Laboratory of Assisted Reproduction, Peking University, Ministry of Education Beijing, China; Beijing Key Laboratory of Assisted Reproductive Endocrinology and Assisted Reproductive Technology, Peking University Third Hospital Beijing, China
| | - Yang Wang
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital Beijing, China; National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital Beijing, China
| | - Yimeng Ge
- Peking University School of Basic Medical Sciences Beijing, China
| | - Hongyi Wei
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital Beijing, China; National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital Beijing, China; Key Laboratory of Assisted Reproduction, Peking University, Ministry of Education Beijing, China; Beijing Key Laboratory of Assisted Reproductive Endocrinology and Assisted Reproductive Technology, Peking University Third Hospital Beijing, China; Department of Obstetrics and Gynecology, Peking University International Hospital Beijing, China
| | - Yihua Lin
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital Beijing, China; National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital Beijing, China; Key Laboratory of Assisted Reproduction, Peking University, Ministry of Education Beijing, China; Beijing Key Laboratory of Assisted Reproductive Endocrinology and Assisted Reproductive Technology, Peking University Third Hospital Beijing, China
| | - Caihong Ma
- Center for Reproductive Medicine, Department of Obstetrics and Gynecology, Peking University Third Hospital Beijing, China; National Clinical Research Center for Obstetrics and Gynecology, Peking University Third Hospital Beijing, China; Key Laboratory of Assisted Reproduction, Peking University, Ministry of Education Beijing, China; Beijing Key Laboratory of Assisted Reproductive Endocrinology and Assisted Reproductive Technology, Peking University Third Hospital Beijing, China.
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16
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Li Q, Yuan M, Li N, Zhen Q, Chen C, Wang G. The efficacy of medical treatment for adenomyosis after adenomyomectomy. J Obstet Gynaecol Res 2020; 46:2092-2099. [PMID: 32725682 DOI: 10.1111/jog.14376] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 05/27/2020] [Accepted: 06/13/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Qiuju Li
- Department of Obstetrics and Gynecology Qilu Hospital of Shandong University Jinan China
| | - Ming Yuan
- Department of Obstetrics and Gynecology Qilu Hospital of Shandong University Jinan China
| | - Ni Li
- Department of Obstetrics and Gynecology Qilu Hospital of Shandong University Jinan China
| | - Qianwei Zhen
- Department of Obstetrics and Gynecology Qilu Hospital of Shandong University Jinan China
| | - Chang Chen
- Department of Obstetrics and Gynecology Qilu Hospital of Shandong University Jinan China
| | - Guoyun Wang
- Department of Obstetrics and Gynecology Qilu Hospital of Shandong University Jinan China
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17
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The Outcome of Fertility-Sparing and Nonfertility-Sparing Surgery for the Treatment of Adenomyosis. A Systematic Review and Meta-analysis. J Minim Invasive Gynecol 2020; 27:309-331.e3. [DOI: 10.1016/j.jmig.2019.08.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 07/26/2019] [Accepted: 08/04/2019] [Indexed: 12/25/2022]
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18
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Nam JH. Pregnancy and symptomatic relief following ultrasound-guided transvaginal radiofrequency ablation in patients with adenomyosis. J Obstet Gynaecol Res 2019; 46:124-132. [PMID: 31646731 DOI: 10.1111/jog.14145] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 09/28/2019] [Indexed: 11/27/2022]
Abstract
AIM To report the reproductive results and symptomatic relief of patients with adenomyosis who attempted to conceive after ultrasound-guided radiofrequency ablation (RFA). METHODS Of 182 consecutive patients with adenomyosis who had undergone RFA, only 81 patients were eligible for this study. Pregnancy outcomes, postoperative complications, preoperative and postoperative pictorial blood loss assessment chart scores, and pain scores were evaluated. RESULTS Of these 81 patients, 74 were infertile and seven were single at the time of RFA. The mean age at the time of operation was 35.8 years. The mean duration from the time of RFA to conception was 18.9 months (range, 2-72 months). Fifty-nine patients tried natural conception, while 22 patients attempted conception with assisted reproductive techniques. Twenty-nine (35.8%) patients achieved 39 pregnancies. Except for the 23 patients who did not actively try to conceive and who inevitably or arbitrarily discontinued pregnancy attempts, the pregnancy success rate reached 50%. Twenty-two (84.6%) of the 29 patients delivered 24 (66.7%) live babies (nine vaginal deliveries and 15 cesarean sections). Twelve (33.3%) pregnancies ended in spontaneous abortions. No uterine ruptures occurred. Paired sample t-tests revealed that preoperative pictorial blood loss assessment chart and pain scores were significantly (P < 0.05) different from the postoperative scores at 1-, 3- and 6-months. CONCLUSION RFA could be considered a minimally-invasive treatment option for patients with adenomyosis who desire to maintain fertility and alleviate symptoms.
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Affiliation(s)
- Jang-Hyun Nam
- Naam Clinic for Women's Health, Seoul, Republic of Korea
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Dessouky R, Gamil SA, Nada MG, Mousa R, Libda Y. Management of uterine adenomyosis: current trends and uterine artery embolization as a potential alternative to hysterectomy. Insights Imaging 2019; 10:48. [PMID: 31030317 PMCID: PMC6486932 DOI: 10.1186/s13244-019-0732-8] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 03/14/2019] [Indexed: 12/31/2022] Open
Abstract
Adenomyosis is a challenging clinical condition that is commonly being diagnosed in women of reproductive age. To date, many aspects of the disease have not been fully understood, making management increasingly difficult. Over time, minimally invasive diagnostic and treatment methods have developed as more women desire uterine preservation for future fertility or to avoid major surgery. Several uterine-sparing treatment options are now available, including medication, hysteroscopic resection or ablation, conservative surgical methods, and high-intensity focused ultrasound each with its own risks and benefits. Uterine artery embolization is an established treatment option for uterine fibroids and has recently gained ground as a safe and cost-effective method for treatment of uterine adenomyosis with promising results. In this review, we discuss current trends in the management of uterine adenomyosis with a special focus on uterine artery embolization as an alternative to hysterectomy.
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Affiliation(s)
- Riham Dessouky
- Radiology Department, Faculty of Medicine, Zagazig University, Koliat Al Tob Street, Zagazig, 44519, Egypt.
| | - Sherif A Gamil
- Radiology Department, Al-Ahrar Teaching Hospital, Zagazig, Egypt
| | - Mohamad Gamal Nada
- Radiology Department, Faculty of Medicine, Zagazig University, Koliat Al Tob Street, Zagazig, 44519, Egypt
| | - Rola Mousa
- Radiology Department, Faculty of Medicine, Zagazig University, Koliat Al Tob Street, Zagazig, 44519, Egypt
| | - Yasmine Libda
- Radiology Department, Faculty of Medicine, Zagazig University, Koliat Al Tob Street, Zagazig, 44519, Egypt
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Khan KN, Fujishita A, Koshiba A, Mori T, Kuroboshi H, Ogi H, Itoh K, Nakashima M, Kitawaki J. Biological differences between focal and diffuse adenomyosis and response to hormonal treatment. Reprod Biomed Online 2019; 38:634-646. [DOI: 10.1016/j.rbmo.2018.12.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 11/01/2018] [Accepted: 12/11/2018] [Indexed: 11/25/2022]
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21
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Biological differences between intrinsic and extrinsic adenomyosis with coexisting deep infiltrating endometriosis. Reprod Biomed Online 2019; 39:343-353. [PMID: 31160242 DOI: 10.1016/j.rbmo.2019.03.210] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 03/04/2019] [Accepted: 03/11/2019] [Indexed: 11/21/2022]
Abstract
RESEARCH QUESTION Is there a biological difference between intrinsic and extrinsic adenomyosis with coexisting deep infiltrating endometriosis (DIE)? DESIGN In this prospective controlled study, biopsy specimens were collected after surgery from 23 women with intrinsic adenomyosis and 10 women with extrinsic adenomyosis with coexisting DIE lesions. Histological evaluation was carried out by immunoreaction to Ber-EP4 (epithelial cell marker) and CD10 (stromal cell marker). Tissue expression of oestrogen and progesterone receptors was analysed by immunohistochemistry. Tissue fibrosis was examined by Masson's trichrome staining with computer-based image analysis of fibrosis in respective samples. RESULTS The detection rate of coexistent DIE was significantly higher in women with extrinsic adenomyosis (9/10 [90.0%]) than in women with intrinsic adenomyosis (3/23 [13.0%]; P < 0.001). The pattern of Ber-EP4-stained glands and CD10-stained stromal cells of extrinsic adenomyosis was similar to that of coexistent DIE lesions. In contrast, the pattern of gland and stromal cells was similar to the endometrium in the cases with intrinsic adenomyosis. Unlike extrinsic adenomyosis, progesterone receptor expression was significantly decreased in both gland cells (P < 0.05) and stromal cells (P < 0.05) of intrinsic adenomyosis. Although relatively more fibrosis was seen in biopsy samples of extrinsic adenomyosis and coexistent DIE than in intrinsic adenomyosis and their coexistent DIE, no significant difference was found. CONCLUSIONS Extrinsic adenomyosis may be considered as adenomyosis externa based on a close histological and biological relationship between extrinsic adenomyosis and coexistent DIE. Our findings may contribute to the understanding of a possible biological origin of two newly classified intrinsic and extrinsic adenomyosis.
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Cozzolino M, Basile F, Pontrelli G. Effects of adenomyosis on obstetric outcomes. ACTA ACUST UNITED AC 2019; 71:146-154. [DOI: 10.23736/s0026-4784.18.04318-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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23
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Tskhay VB, Schindler AE, Mikailly GT. Diffuse massive adenomyosis and infertility. Is it possible to treat this condition? Horm Mol Biol Clin Investig 2019; 37:hmbci-2018-0026. [PMID: 30753160 DOI: 10.1515/hmbci-2018-0026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 07/11/2018] [Indexed: 01/04/2023]
Abstract
Background Severe forms of adenomyosis are a serious gynecological problem. In most cases, conservative treatment of this pathology is unsuccessful. Adenomyomectomy by Osada's approach seems to be the most promising solution. The present study evaluated the follow-up results of this type of surgery in patients with adenomyosis and infertility. Materials and methods The prospective study included 26 patients with severe forms of adenomyosis who underwent an adenomyomectomy using Osada's approach. In 18 patients (69%), infertility was the main indication for surgical treatment. The follow-up period lasted from July 2012 to January 2018. Results The median post-operative follow-up period was 18 months. For the first 12 months patients received hormonal therapy. In all postoperative patients, the menstrual cycle had normalized, and other symptoms of the disease had disappeared. Seven patients continue to receive postoperative hormonal treatment. Three individuals got spontaneously pregnant; two of them delivered full-term babies by cesarean section. Six patients are planning a pregnancy with assisted reproductive technology. Conclusion In the present study, the organ-preserving surgery of severe adenomyosis performed using Osada's method appeared to be a good alternative to hysterectomy. It stopped the development of pathological symptoms of the disease and restored the patient's reproductive function.
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Affiliation(s)
- Vitaly B Tskhay
- Department of Perinatology, Obstetrics and Gynecology, Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russia, Phone: +7923287 21 34
| | | | - Gyulnar T Mikailly
- Department of Perinatology, Obstetrics and Gynecology, Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russia
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Actual considerations concerning the contribution of histeroscopy to diagnosis and treatment of adenomyosis in infertile patients. GINECOLOGIA.RO 2019. [DOI: 10.26416/gine.25.3.2019.2496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Gordts S, Grimbizis G, Campo R. Symptoms and classification of uterine adenomyosis, including the place of hysteroscopy in diagnosis. Fertil Steril 2018; 109:380-388.e1. [PMID: 29566850 DOI: 10.1016/j.fertnstert.2018.01.006] [Citation(s) in RCA: 102] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 01/03/2018] [Accepted: 01/05/2018] [Indexed: 12/28/2022]
Abstract
Where histology used the presence of glands and/or stroma in the myometrium as pathognomonic for adenomyosis, imaging uses the appearance of the myometrium, the presence of striations, related to the presence of endometrial tissue within the myometrium, the presence of intramyometrial cystic structures and the size and asymmetry of the uterus to identify adenomyosis. Preliminary reports show a good correlation between the features detected by imaging and the histological findings. Symptoms associated with adenomyosis are abnormal uterine bleeding, pelvic pain (dysmenorrhea, chronic pelvic pain, dyspareunia), and impaired reproduction. However a high incidence of existing comorbidity like fibroids and endometriosis makes it difficult to attribute a specific pathognomonic symptom to adenomyosis. Heterogeneity in the reported pregnancy rates after assisted reproduction is due to the use of different ovarian stimulation protocols and absence of a correct description of the adenomyotic pathology. Current efforts to classify the disease contributed a lot in elucidated the potential characteristics that a classification system should be relied on. The need for a comprehensive, user friendly, and clear categorization of adenomyosis including the pattern, location, histological variants, and the myometrial zone seems to be an urgent need. With the uterus as a possible unifying link between adenomyosis and endometriosis, exploration of the uterus should not only be restricted to the hysteroscopic exploration of the uterine cavity but in a fusion with ultrasound.
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Affiliation(s)
- Stephan Gordts
- Leuven Institute for Fertility & Embryology, Leuven, Belgium; Life Expert Centre, Schipvaartstraat 4, Leuven, Belgium.
| | - Grigoris Grimbizis
- 1st Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Rudi Campo
- Leuven Institute for Fertility & Embryology, Leuven, Belgium; Life Expert Centre, Schipvaartstraat 4, Leuven, Belgium
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Tan J, Moriarty S, Taskin O, Allaire C, Williams C, Yong P, Bedaiwy MA. Reproductive Outcomes after Fertility-Sparing Surgery for Focal and Diffuse Adenomyosis: A Systematic Review. J Minim Invasive Gynecol 2018; 25:608-621. [DOI: 10.1016/j.jmig.2017.12.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 12/02/2017] [Accepted: 12/23/2017] [Indexed: 01/10/2023]
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Soave I, Wenger JM, Pluchino N, Marci R. Treatment options and reproductive outcome for adenomyosis-associated infertility. Curr Med Res Opin 2018; 34:839-849. [PMID: 29046066 DOI: 10.1080/03007995.2017.1393404] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE Adenomyosis is a benign gynecological disease mostly diagnosed in the forth and fifth decades. The recent improvement of the diagnostic tools and a better understanding of the pathology allowed clinicians to postulate a possible relationship between adenomyosis and infertility and to diagnose it in younger asymptomatic women during infertility work-up. Purpose of this article is to review the different theories regarding the possible correlation between adenomyosis and infertility and to discuss the treatment options and the final reproductive outcome after the treatment. MATERIALS AND METHODS We search Pubmed for articles published in the English language with the use of the following MeSH search terms: "adenomyosis" combined with "treatment" and "fertility outcome" with the restriction to the human species. A manual search of review articles and cross-references completed the search. All selected articles were assessed for study design, patients characteristic, diagnosis of adenomyosis, type of treatment, post-treatment rates of conception, full-term pregnancy and completeness of information of the data sets. RESULTS Limited data are available concerning the efficacy of the different treatment options of adenomyosis on fertility outcome and the only ones published are retrospective evaluations or small case series. CONCLUSIONS Adenomyosis represents a common gynecological disorder with a negative impact on fertility. However, it remains challenging to establish if adenomyosis is the only cause of the infertility or not, because patients, in both case and control groups, may be affected by concomitant endometriosis. Further studies are required to determine the reason of implantation failure in women with adenomyosis and the impact of adenomyosis on infertile women with or without endometriosis.
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Affiliation(s)
- Ilaria Soave
- a Department of Morphology, Surgery and Experimental Medicine , University of Ferrara , Ferrara , Italy
| | - Jean-Marie Wenger
- b Division of Obstetrics and Gynecology , University Hospital of Geneva , Geneva , Switzerland
| | - Nicola Pluchino
- b Division of Obstetrics and Gynecology , University Hospital of Geneva , Geneva , Switzerland
| | - Roberto Marci
- a Department of Morphology, Surgery and Experimental Medicine , University of Ferrara , Ferrara , Italy
- b Division of Obstetrics and Gynecology , University Hospital of Geneva , Geneva , Switzerland
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Osada H. Uterine adenomyosis and adenomyoma: the surgical approach. Fertil Steril 2018; 109:406-417. [DOI: 10.1016/j.fertnstert.2018.01.032] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 01/14/2018] [Accepted: 01/20/2018] [Indexed: 11/28/2022]
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Dueholm M. Minimally invasive treatment of adenomyosis. Best Pract Res Clin Obstet Gynaecol 2018; 51:119-137. [PMID: 29555380 DOI: 10.1016/j.bpobgyn.2018.01.016] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 01/23/2018] [Indexed: 12/15/2022]
Abstract
The aim of the present review is to give a comprehensive overview of minimal invasive treatment options and suggest a minimally invasive approach in women with adenomyosis (AD). A review of relevant literature on medical and surgical treatment options is performed. Surgical options include endometrial ablation, hysteroscopic endometrial and adenomyoma resection, laparoscopic resection of AD, high-intensity focused ultrasonography (HIFU), and uterine artery embolization (UAE). This review summarizes treatment strategies for the management of AD and highlights the present lack of knowledge, which makes suggestions of evidence-based treatment difficult.
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Affiliation(s)
- Margit Dueholm
- Department of Gynecology and Obstetrics, Aarhus University Hospital, Palle Juhl Jensensvej 100, 8200 Aarhus N, Denmark.
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Younes G, Tulandi T. Conservative Surgery for Adenomyosis and Results: A Systematic Review. J Minim Invasive Gynecol 2018; 25:265-276. [DOI: 10.1016/j.jmig.2017.07.014] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2017] [Revised: 07/15/2017] [Accepted: 07/17/2017] [Indexed: 11/17/2022]
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Oliveira MAP, Crispi CP, Brollo LC, Crispi CP, De Wilde RL. Surgery in adenomyosis. Arch Gynecol Obstet 2017; 297:581-589. [PMID: 29197987 DOI: 10.1007/s00404-017-4603-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 11/20/2017] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Adenomyosis is defined as the presence of endometrial glands and stroma within the myometrium. The true prevalence is unknown and has been reported to range from 1 to 70%. It has a significantly negative impact on women's quality of life, causing abnormal uterine bleeding, dysmenorrhea, and chronic pelvic pain. The definitive treatment for adenomyosis is hysterectomy, although it does not contemplate patients who wish to preserve their fertility. The aim of this paper is to discuss the latest evidence on the surgical techniques for the treatment of adenomyosis published in medical-scientific databases. METHOD A comprehensive literature search for articles published from 1996 to 2017 related to surgery for adenomyosis was made in Pubmed, Medline, the Cochrane Library, and Google Scholar, in English, by the following MeSH terms: adenomyosis, surgery, pathogenesis, dysmenorrhea and infertility. RESULTS There is extensive evidence on several surgical approaches for the improvement of adenomyosis-related symptoms; however, there is no robust evidence that they are effective for infertility. CONCLUSION The management of adenomyosis is quite complex and controversial. Complications after extensive uterine reconstruction, such as uterine rupture, should be considered and discussed with the patient. There are still limited data to support surgery effectiveness, especially for infertility, and further well-designed studies are required.
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Affiliation(s)
- Marco Aurelio Pinho Oliveira
- Department of Gynecology, State University of Rio de Janeiro, Rio de Janeiro, Brazil. .,, Rua Dois de Dezembro 78/803, Flamengo, Rio de Janeiro, Brazil.
| | | | - Leila Cristina Brollo
- Department of Gynecology, State University of Rio de Janeiro, Rio de Janeiro, Brazil
| | | | - Rudy Leon De Wilde
- Clinic of Gynecology, Obstetrics and Gynecological Oncology, Pius Hospital, University Hospital for Gynecology, Carl von Ossietzky University Medical School, Oldenburg, Germany
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Vlahos NF, Theodoridis TD, Partsinevelos GA. Myomas and Adenomyosis: Impact on Reproductive Outcome. BIOMED RESEARCH INTERNATIONAL 2017; 2017:5926470. [PMID: 29234680 PMCID: PMC5694987 DOI: 10.1155/2017/5926470] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 08/19/2017] [Accepted: 08/30/2017] [Indexed: 12/26/2022]
Abstract
Among uterine structural abnormalities, myomas and adenomyosis represent two distinct, though frequently coexistent entities, with a remarkable prevalence in women of reproductive age. Various mechanisms have been proposed to explain the impact of each of them on reproductive outcome. In respect to myomas, current evidence implies that submucosal ones have an adverse effect on conception and early pregnancy. A similar effect yet is not quite clear and has been suggested for intramural myomas. Still, it seems reasonable that intramural myomas greater than 4 cm in diameter may negatively impair reproductive outcome. On the contrary, subserosal myomas do not seem to have a significant impact, if any, on reproduction. The presence of submucosal and/or large intramural myomas has also been linked to adverse pregnancy outcomes. In particular increased risk for miscarriage, fetal malpresentation, placenta previa, preterm birth, placenta abruption, postpartum hemorrhage, and cesarean section has been reported. With regard to adenomyosis, besides the tentative coexistence of adenomyosis and infertility, to date a causal relationship among these conditions has not been fully confirmed. Preterm birth and preterm premature rupture of membranes, uterine rupture, postpartum hemorrhage due to uterine atony, and ectopic pregnancy have all been reported in association with adenomyosis. Further research on the impact of adenomyosis on reproductive outcome is welcome.
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Affiliation(s)
- Nikos F. Vlahos
- 2nd Department of Obstetrics and Gynecology, Aretaieion Hospital, National and Kapodistrian University of Athens, School of Medicine, 76 Vasilissis Sofias Av., 11528 Athens, Greece
| | - Theodoros D. Theodoridis
- 1st Department of Obstetrics and Gynecology, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Faculty of Health Sciences, School of Medicine, Ring Road, Municipality of Pavlos Melas, Area of N. Efkarpia, 56403 Thessaloniki, Greece
| | - George A. Partsinevelos
- Assisted Reproduction-IVF Unit, MITERA Hospital, 6 Erithrou Stavrou Str., Marousi, 15123 Athens, Greece
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Effects of adenomyosis on in vitro fertilization treatment outcomes: a meta-analysis. Fertil Steril 2017; 108:483-490.e3. [DOI: 10.1016/j.fertnstert.2017.06.025] [Citation(s) in RCA: 115] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 06/15/2017] [Accepted: 06/19/2017] [Indexed: 11/21/2022]
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The Role of Hysteroscopy in the Diagnosis and Treatment of Adenomyosis. BIOMED RESEARCH INTERNATIONAL 2017; 2017:2518396. [PMID: 28852646 PMCID: PMC5568620 DOI: 10.1155/2017/2518396] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 05/21/2017] [Accepted: 07/03/2017] [Indexed: 12/22/2022]
Abstract
Uterine adenomyosis is a common gynecologic disorder in women of reproductive age, characterized by the presence of ectopic endometrial glands and stroma within the myometrium. Dysmenorrhea, abnormal uterine bleeding, chronic pelvic pain, and deep dyspareunia are common symptoms of this pathological condition. However, adenomyosis is often an incidental finding in specimens obtained from hysterectomy or uterine biopsies. The recent evolution of diagnostic imaging techniques, such as transvaginal sonography, hysterosalpingography, and magnetic resonance imaging, has contributed to improving accuracy in the identification of this pathology. Hysteroscopy offers the advantage of direct visualization of the uterine cavity while giving the option of collecting histological biopsy samples under visual control. Hysteroscopy is not a first-line treatment approach for adenomyosis and it represents a viable option only in selected cases of focal or diffuse “superficial” forms. During office hysteroscopy, it is possible to enucleate superficial focal adenomyomas or to evacuate cystic haemorrhagic lesions of less than 1.5 cm in diameter. Instead, resectoscopic treatment is indicated in cases of superficial adenomyotic nodules > 1.5 cm in size and for diffuse superficial adenomyosis. Finally, endometrial ablation may be performed with the additional removal of the underlying myometrium.
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Dueholm M. Uterine adenomyosis and infertility, review of reproductive outcome after in vitro fertilization and surgery. Acta Obstet Gynecol Scand 2017; 96:715-726. [DOI: 10.1111/aogs.13158] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Accepted: 04/20/2017] [Indexed: 02/06/2023]
Affiliation(s)
- Margit Dueholm
- Department of Gynecology and Obstetrics; Aarhus University Hospital; Aarhus Denmark
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Guo S, Lu X, Gu R, Zhang D, Sun Y, Feng Y. Transcriptome analysis of endometrial tissues following GnRH agonist treatment in a mouse adenomyosis model. DRUG DESIGN DEVELOPMENT AND THERAPY 2017; 11:695-704. [PMID: 28331289 PMCID: PMC5352156 DOI: 10.2147/dddt.s127889] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Purpose Adenomyosis is a common, benign gynecological condition of the female reproductive tract characterized by heavy menstrual bleeding and dysmenorrhea. Gonadotropin-releasing hormone (GnRH) agonists are one of the medications used in adenomyosis treatment; however, their underlying mechanisms are poorly understood. Moreover, it is difficult to obtain endometrial samples from women undergoing such treatment. To overcome this, we generated an adenomyosis mouse model, which we treated with an GnRH agonist to determine its effect on pregnancy outcomes. We also analyzed endometrial gene expression following GnRH agonist treatment to determine the mechanisms that may affect pregnancy outcome in individuals with adenomyosis. Methods Neonatal female mice were divided into a control group, an untreated adenomyosis group, and an adenomyosis group treated with a GnRH agonist (n=6 each). The pregnancy outcome was observed and compared among the groups. Then, three randomly chosen transcriptomes from endometrial tissues from day 4 of pregnancy were analyzed between the adenomyosis group and the GnRH agonist treatment group by RNA sequencing and quantitative reverse transcription polymerase chain reaction (PCR). Results The litter size was significantly smaller in the adenomyosis group than in the control group (7±0.28 vs 11±0.26; P<0.05). However, the average live litter size was increased (10±0.28 vs 7±0.28; P<0.05) after GnRH agonist treatment. Three hundred and fifty-nine genes were differentially expressed in the GnRH agonist-treated group compared with the untreated group (218 were downregulated and 141 were upregulated). Differentially expressed genes were related to diverse biological processes, including estrogen metabolism, cell cycle, and metabolite biosynthesis. Conclusion GnRH agonist treatment appears to improve the pregnancy outcome of adenomyosis in a mouse model. Besides pituitary down-regulation, other possible mechanisms such as the regulation of cell proliferation may play a role in this. These new insights into GnRH agonist mechanisms will be useful for future adenomyosis treatment.
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Affiliation(s)
- Song Guo
- Department of Obstetrics and Gynecology, Reproductive Medicine Center, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Xiaowei Lu
- Department of Obstetrics and Gynecology, Reproductive Medicine Center, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
| | - Ruihuan Gu
- Gynecology, Shanghai Ji Ai Genetics & In Vitro Fertilization Institute, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, People's Republic of China
| | - Di Zhang
- Department of Gynecology and Obstetrics, Jinan Military General Hospital, Jinan, People's Republic of China
| | - Yijuan Sun
- Gynecology, Shanghai Ji Ai Genetics & In Vitro Fertilization Institute, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, People's Republic of China
| | - Yun Feng
- Department of Obstetrics and Gynecology, Reproductive Medicine Center, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, People's Republic of China
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Abstract
Until recently, adenomyosis has been associated with multiparity, not impaired fertility. Currently, adenomyosis is diagnosed with increasing frequency in infertile patients since women delay their first pregnancy until their late 30s or early 40s. Although an association between adenomyosis and infertility has not been fully established, based on the available information, recent studies suggested that adenomyosis has a negative impact on female fertility. Several uncontrolled studies with limited data also suggested that treatment of adenomyosis may improve fertility. This article discusses (i) the hypothesis and epidemiology of adenomyosis, (ii) diagnostic techniques, (iii) clinical evidence of correlation between adenomyosis and infertility, (iv) proposed mechanism of infertility in women with adenomyosis, (v) different treatment strategies and reproductive outcomes, and (vi) assisted reproductive technology outcome in women with adenomyosis.
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Tsui KH, Lee FK, Seow KM, Chang WC, Wang JW, Chen SU, Chao HT, Yen MS, Wang PH. Conservative surgical treatment of adenomyosis to improve fertility: Controversial values, indications, complications, and pregnancy outcomes. Taiwan J Obstet Gynecol 2015; 54:635-40. [DOI: 10.1016/j.tjog.2015.05.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2015] [Indexed: 01/03/2023] Open
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Chen YJ, Li YT, Huang BS, Yen MS, Sheu BC, Chow SN, Wang PH. Medical treatment for heavy menstrual bleeding. Taiwan J Obstet Gynecol 2015; 54:483-8. [DOI: 10.1016/j.tjog.2015.08.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2015] [Indexed: 12/12/2022] Open
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Abstract
Adenomyosis is described as the benign invasion of endometrium into the myometrium, with endometrial glands and stroma surrounded by the hypertrophic and hyperplastic myometrium. It may affect 20% of female population and most widely seen among perimenopausal and multiparous women. Its etiopathogenesis, diagnosis, clinical findings and current various treatment options will be discussed in this article.
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Affiliation(s)
- Levent M Senturk
- Department of Obstetrics & Gynecology, Division of Reproductive Endocrinology, IVF Unit, Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey.,Barbaros Bulvari, 69/8-10, Besiktas, Istanbul, 34330, Turkey
| | - Metehan Imamoglu
- Department of Obstetrics & Gynecology, Istanbul University Cerrahpasa School of Medicine, Istanbul, Turkey
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Hunjan T, Davidson A. An unexpected diagnosis of adenomyosis in the subfertile woman. BMJ Case Rep 2015; 2015:bcr-2014-209012. [PMID: 25725032 DOI: 10.1136/bcr-2014-209012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 38-year-old nulliparous female presented to an assisted conception clinic with subfertility and a long-standing history of dysmenorrhoea. Transvaginal ultrasound revealed two lesions in the body of the uterus, which were presumed to be fibroids. A decision was made to remove these lesions prior to attempting in vitro fertilisation (IVF). However, on laparotomy, deeply penetrating adenomyosis was discovered, resulting in an unexpected hysterectomy and significant blood loss. Based on our experience, we highlight the importance of suspecting a diagnosis of adenomyosis preoperatively and the methods by which this diagnosis can be made, in order to avoid potential unforeseen outcomes as described in this case. We discuss conservative management options for this condition, particularly in women wishing to preserve fertility.
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Affiliation(s)
- Tia Hunjan
- Department of Obstetrics & Gynaecology, St Mary's Hospital, Imperial College Healthcare NHS Trust, London, UK
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Khan KN, Kitajima M, Hiraki K, Fujishita A, Nakashima M, Masuzaki H. Involvement of Hepatocyte Growth Factor-Induced Epithelial-Mesenchymal Transition in Human Adenomyosis1. Biol Reprod 2015; 92:35. [DOI: 10.1095/biolreprod.114.124891] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
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Bourdel N, Alves J, Pickering G, Ramilo I, Roman H, Canis M. Systematic review of endometriosis pain assessment: how to choose a scale? Hum Reprod Update 2014; 21:136-52. [PMID: 25180023 DOI: 10.1093/humupd/dmu046] [Citation(s) in RCA: 211] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Numerous studies concerning endometriosis and pain have been reported. However, there is no consensus on the best method to evaluate pain in endometriosis and many scales have been used. Moreover, there are only a few descriptions of minimal clinically important differences after treatment (MCID) to evaluate variations in pain. In our study, we aim to identify pain scales used in endometriosis pain treatment, to address their strong and weak points and to define which would be the ideal scale to help clinicians and researchers to evaluate endometriosis-related pain. METHODS A search of the MEDLINE and EMBASE databases was carried out for publications in English, French or Portuguese from 1980 to December 2012, for the words: endometriosis, treatment, pain. Studies were selected if they studied an endometriosis treatment and a pain scale was specified. A quantitative and a qualitative analysis of each scale was performed to define strong and weak points of each scale (systematic registration number: CRD42013005336). RESULTS A total of 736 publications were identified. After excluding duplications and applying inclusion criteria 258 studies remained. We found that the visual analog scale (VAS) is the most frequently used scale. Both VAS and the numerical rating scale (NRS) show a good balance between strong and weak points in comparison with others such as the Biberoglu and Behrman scale. Concerning MCID, only VAS, NRS and Brief Pain Inventory scales have reported MCID and, among these, only VAS MCID has been studied in endometriosis patients (VAS MCID = 10 mm). Adding the Clinical Global Impression score (CGI) to the pain scale allows calculation of the MCID. CONCLUSIONS When using pain scales their strengths and weaknesses must be known and included in the analysis. VAS is the most frequently used pain scale and, together with NRS, seems the best adapted for endometriosis pain measurement. The use of VAS or NRS for each type of typical pain related to endometriosis (dysmenorrhea, deep dyspareunia and non-menstrual chronic pelvic pain), combined with the CGI and a quality-of-life scale will provide both clinicians and researchers with tools to evaluate treatment response.
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Affiliation(s)
- Nicolas Bourdel
- Department of Gynecologic Surgery, CHU Estaing Clermont Ferrand, 63058 Clermont Ferrand Cedex 1, France Faculté de medicine, ISIT - Université d'Auvergne, Place Henri Dunant, 63000 Clermont-Ferrand, France
| | - João Alves
- Department of Gynecologic Surgery, CHU Estaing Clermont Ferrand, 63058 Clermont Ferrand Cedex 1, France
| | - Gisele Pickering
- Centre de Pharmacologie Clinique, CHU Clermont Ferrand, Inserm CIC 501, Inserm, U1107 Neuro-Dol, F-63003 Clermont-Ferrand, France
| | - Irina Ramilo
- Department of Gynecologic Surgery, CHU Estaing Clermont Ferrand, 63058 Clermont Ferrand Cedex 1, France
| | - Horace Roman
- Department of Gynecology and Obstetrics, Rouen University Hospital-Charles Nicolle, 1 rue de Germont, 76031 Rouen, France
| | - Michel Canis
- Department of Gynecologic Surgery, CHU Estaing Clermont Ferrand, 63058 Clermont Ferrand Cedex 1, France Faculté de medicine, ISIT - Université d'Auvergne, Place Henri Dunant, 63000 Clermont-Ferrand, France
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Tsui KH, Lee WL, Seow KM, Yang LW, Wang SY, Wang PH, Chang CL, Yen MS, Cheng JT, Chen CP. Effect of gonadotropin-releasing hormone agonist on ES-2 ovarian cancer cells. Taiwan J Obstet Gynecol 2014; 53:35-42. [PMID: 24767644 DOI: 10.1016/j.tjog.2013.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2013] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE Gonadotropin-releasing hormone (GnRH) receptor is found in the ovarian tissue, including epithelial ovarian cancer (EOC), suggesting that GnRH agonists may have direct action on EOC. MATERIALS AND METHODS Ovarian clear cell cancer (ES-2) cells were treated with low-dose GnRH agonist with/without low-dose paclitaxel (1 μM D-Lys(6) with/without 0.5 μM or 1.0 μM paclitaxel). Growth and behavior of ES-2 cells were evaluated. RESULTS Use of either D-Lys(6) or paclitaxel or a combination of the two did not affect the morphology and growth pattern of ES-2 cells. However, ability of migration and invasion of ES-2 cells was significantly decreased in either use of D-Lys(6) or paclitaxel and more apparent with the combination. Type I GnRH receptor expression of ES-2 was not altered significantly by the combination. CONCLUSION GnRH agonist might modify the ES-2 ovarian cancer cells, and its role might be independent, additional or synergistic, suggesting the potential role of the use of GnRH agonist in the management of clear cell type of the ovarian cancer. However, the results of this study were derived using ES-2 ovarian cancer cells, and might not be valid in other cell types of ovarian cancers.
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Affiliation(s)
- Kuan-Hao Tsui
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Biological Science, National Sun Yat-Sen University, Kaohsiung, Taiwan; Department of Obstetrics and Gynecology, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Wen-Ling Lee
- Department of Obstetrics and Gynecology, National Yang-Ming University School of Medicine, Taipei, Taiwan; Department of Medicine, Cheng-Hsin General Hospital, Taipei, Taiwan; Department of Nursing, Oriental Institute of Technology, New Taipei City, Taiwan
| | - Kok-Min Seow
- Department of Obstetrics and Gynecology, National Yang-Ming University School of Medicine, Taipei, Taiwan; Department of Obstetrics and Gynecology, Shih Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Lin-Wei Yang
- Department of Obstetrics and Gynecology, National Yang-Ming University School of Medicine, Taipei, Taiwan; Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shih-Yi Wang
- Department of Obstetrics and Gynecology, National Yang-Ming University School of Medicine, Taipei, Taiwan; Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Peng-Hui Wang
- Department of Obstetrics and Gynecology, National Yang-Ming University School of Medicine, Taipei, Taiwan; Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Immunology Center, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.
| | - Chi-Lun Chang
- Department of Obstetrics and Gynecology, National Yang-Ming University School of Medicine, Taipei, Taiwan; Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ming-Shyen Yen
- Department of Obstetrics and Gynecology, National Yang-Ming University School of Medicine, Taipei, Taiwan; Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jiin-Tsuey Cheng
- Department of Biological Science, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Chih-Ping Chen
- Department of Obstetrics and Gynecology, National Yang-Ming University School of Medicine, Taipei, Taiwan; Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan; Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
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Uterine-sparing surgery for adenomyosis and/or adenomyoma. Taiwan J Obstet Gynecol 2014; 53:3-7. [DOI: 10.1016/j.tjog.2014.01.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2014] [Indexed: 11/18/2022] Open
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Grimbizis GF, Mikos T, Tarlatzis B. Uterus-sparing operative treatment for adenomyosis. Fertil Steril 2014; 101:472-87. [DOI: 10.1016/j.fertnstert.2013.10.025] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Revised: 10/15/2013] [Accepted: 10/15/2013] [Indexed: 10/26/2022]
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Chang WH, Wang KC, Lee NR, Huang N, Su WH, Chao HT, Yen MS, Fuh JL, Wang PH. Reproductive performance of severely symptomatic women with uterine adenomyoma who wanted preservation of the uterus and underwent combined surgical–medical treatment. Taiwan J Obstet Gynecol 2013; 52:39-45. [DOI: 10.1016/j.tjog.2013.01.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2012] [Indexed: 12/23/2022] Open
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Long-term follow-up of severely symptomatic women with adenomyoma treated with combination therapy. Taiwan J Obstet Gynecol 2013; 52:85-9. [DOI: 10.1016/j.tjog.2012.12.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2012] [Indexed: 11/18/2022] Open
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Kishi Y, Suginami H, Kuramori R, Yabuta M, Suginami R, Taniguchi F. Four subtypes of adenomyosis assessed by magnetic resonance imaging and their specification. Am J Obstet Gynecol 2012; 207:114.e1-7. [PMID: 22840719 DOI: 10.1016/j.ajog.2012.06.027] [Citation(s) in RCA: 162] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2012] [Revised: 04/24/2012] [Accepted: 06/13/2012] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The aim of the present study was to differentiate and specify the subtypes of adenomyosis. STUDY DESIGN Surgically treated adenomyosis (n = 152) was subcategorized retrospectively into 4 subtypes on the basis of magnetic resonance imaging geography. Subtype I (n = 59) consisted of adenomyosis that occurs in the uterine inner layer without affecting the outer structures. Subtype II (n = 51) consisted of adenomyosis that occurs in the uterine outer layer without affecting the inner structures. Subtype III (n = 22) consisted of adenomyosis that occurs solitarily without relationship to structural components. Adenomyosis that did not satisfy these criteria composed subtype IV (n = 20). Stepwise logistic regression analysis was used for specification of the subtypes. RESULTS Subtypes I-III were suggested as a product of direct endometrial invasion, endometriotic invasion from the outside, and de novo metaplasia, respectively. Subtype IV was a heterogeneous mixture of far advanced disease. CONCLUSION Adenomyosis appears to consist of 3 distinct subtypes of different causes and an additional subtype of indeterminate cause.
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Fertility outcome of infertile women with adenomyosis treated with the combination of a conservative microsurgical technique and GnRH agonist: Long-term follow-up in a series of nine patients. Taiwan J Obstet Gynecol 2012; 51:212-6. [DOI: 10.1016/j.tjog.2012.04.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2012] [Indexed: 11/19/2022] Open
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