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Mathyk BA, Cetin E, Youssef Y, Imudia AN, Encalada Soto D, Mikhail E, Moawad G. Beyond the surface: Does stage I-II endometriosis impact fertility? Exploring the challenges of mild disease. Best Pract Res Clin Obstet Gynaecol 2024:102501. [PMID: 38760260 DOI: 10.1016/j.bpobgyn.2024.102501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 04/21/2024] [Accepted: 05/02/2024] [Indexed: 05/19/2024]
Abstract
Endometriosis is one of the most common gynecologic conditions that women face throughout their lives. Despite advances in technology, diagnosis and treatment of this relapsing and remitting condition is still challenging for many women. This review focuses on literature pertaining to minimal/mild (stage I/II) endometriosis and its impact on fertility. The effectiveness of medical interventions to improve infertility and obstetric outcomes in both natural and assisted reproductive technologies cycles remains debated. The recent ESHRE guidelines suggests that operative laparoscopy could be considered for rASRM stage I/II endometriosis as it improves ongoing pregnancy rates.
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Affiliation(s)
- Begum Aydogan Mathyk
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of South Florida Morsani College of Medicine, Tampa, FL, USA.
| | - Esra Cetin
- Department of Obstetrics and Gynecology, Hurley Medical Center, Michigan State University, 1 Hurley Plaza, Flint, MI, 48503, USA
| | - Youssef Youssef
- Division of Minimally Invasive Gynecology, Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY, 11220, USA
| | - Anthony N Imudia
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Diana Encalada Soto
- Division of Gynecologic Subspecialties, Department of Obstetrics and Gynecology, University of South Florida, Morsani College of Medicine, Tampa, FL, USA
| | - Emad Mikhail
- Division of Gynecologic Subspecialties, Department of Obstetrics and Gynecology, University of South Florida, Morsani College of Medicine, Tampa, FL, USA
| | - Gaby Moawad
- Department of Obstetrics and Gynecology, George Washington University, Washington, DC, 20037, USA; The Center for Endometriosis and Advanced Pelvic Surgery, Washington, DC, 22101, USA
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2
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Jung YM, Wi W, Koo HS, Shim SH, Oh SY, Lee SM, Chung JH, Cho S, Cho H, Oh MJ, Cho GJ, Won HS. The timing of adenomyosis diagnosis and its impact on pregnancy outcomes: a national population-based study. Obstet Gynecol Sci 2024; 67:270-278. [PMID: 38404226 PMCID: PMC11099096 DOI: 10.5468/ogs.23273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Revised: 01/23/2024] [Accepted: 02/07/2024] [Indexed: 02/27/2024] Open
Abstract
OBJECTIVE Adenomyosis impacts pregnancy outcomes, although there is a lack of consensus regarding the actual effects. It is likely, however, that the severity of adenomyosis or ultrasound findings or timing of diagnosis can have different effects on adverse pregnancy outcomes (APOs). METHODS In this study, we aimed to investigate the impact of the timing of adenomyosis diagnosis on pregnancy outcomes. Singleton pregnant women who delivered between 2017 and 2022 were analyzed based on the timing of adenomyosis diagnosis, using a national database. The final cohort was classified into three groups: 1) group 1, without adenomyosis; 2) group 2, those diagnosed with adenomyosis before pregnancy; and 3) group 3, those diagnosed with adenomyosis during pregnancy. RESULTS A total of 1,226,475 cases were ultimately included in this study. Women with a diagnosis of adenomyosis had a significantly higher risk of APOs including hypertensive disorder during pregnancy (HDP), gestational diabetes mellitus (GDM), postpartum hemorrhage, placental abruption, preterm birth, and delivery of a small-for-gestational-age infant even after adjusting for covariates. In particular, concerning HDP, the risk was highest in group 3 (group 2: adjusted odds ratio [aOR], 1.15 vs. group 3: aOR, 1.36). However, the highest GDM risk was in group 2 (GDM; group 2: aOR, 1.24 vs. group 3: aOR, 1.04). CONCLUSION The increased risk of APO differed depending on the timing of adenomyosis diagnosis. Therefore, efforts for more careful monitoring and prevention of APOs may be necessary when such women become pregnant.
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Affiliation(s)
- Young Mi Jung
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Seoul,
Korea
| | - Wonyoung Wi
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Seoul,
Korea
| | - Hwa Seon Koo
- Best of ME Fertility Clinic, Department of Obstetrics and Gynecology, Seoul,
Korea
| | - Seung-Hyuk Shim
- Research Institute of Medical Science, Konkuk University School of Medicine, Seoul,
Korea
| | - Soo-Young Oh
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul,
Korea
| | - Seung Mi Lee
- Seoul National University College of Medicine, Seoul,
Korea
| | - Jin Hoon Chung
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine, Department of Obstetrics and Gynecology, Seoul,
Korea
| | - SiHyun Cho
- Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul,
Korea
| | - Hyunjin Cho
- Haeundae Paik Hospital, Inje University, Busan,
Korea
| | - Min-Jeong Oh
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Seoul,
Korea
| | - Geum Joon Cho
- Department of Obstetrics and Gynecology, Korea University Guro Hospital, Seoul,
Korea
| | - Hye-Sung Won
- Asan Medical Center, University of Ulsan College of Medicine, Seoul,
Korea
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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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Huang L, Li Y, Chen M, Wang Z, Zhou C. Serum levels of cancer antigen 125 before hormone replacement therapy are not associated with clinical outcome of frozen embryo transfer in women with adenomyosis. J Int Med Res 2021; 49:3000605211005878. [PMID: 33887984 PMCID: PMC8072100 DOI: 10.1177/03000605211005878] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Aim This retrospective study aimed to evaluate the predictive value of serum
cancer antigen 125 (CA125) levels before hormone replacement therapy on
pregnancy outcomes in women with adenomyosis undergoing frozen embryo
transfer. Methods A total of 509 women with adenomyosis were screened and 84 patients receiving
a total of 114 cycles of frozen embryo transfer were included, based on the
inclusion and exclusion criteria. Patients were divided into two groups
based on their CA125 levels (≤ or >35 IU/mL) before hormone replacement
therapy. The basic characteristics and main outcomes of the two groups were
compared. Receiver operating characteristic curve and subgroup analyses were
also conducted. Results There were no significant differences in clinical outcomes of frozen embryo
transfer cycles in patients with different serum CA125 levels before hormone
replacement therapy. Receiver operating characteristic curve analysis
demonstrated that CA125 levels before hormone replacement therapy were not
predictive of clinical pregnancy outcomes. Conclusions Serum CA125 levels before hormone replacement therapy are not associated with
the clinical outcomes of frozen embryo transfer among women with
adenomyosis.
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Affiliation(s)
- Ling Huang
- Reproductive Medicine Center, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China.,Guangdong Provincial Key Laboratory of Reproductive Medicine, Guangzhou, Guangdong, China
| | - Yubin Li
- Reproductive Medicine Center, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China
| | - Minghui Chen
- Reproductive Medicine Center, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China.,Guangdong Provincial Key Laboratory of Reproductive Medicine, Guangzhou, Guangdong, China
| | - Zengyan Wang
- Reproductive Medicine Center, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China.,Guangdong Provincial Key Laboratory of Reproductive Medicine, Guangzhou, Guangdong, China
| | - Canquan Zhou
- Reproductive Medicine Center, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China.,Guangdong Provincial Key Laboratory of Reproductive Medicine, Guangzhou, Guangdong, China
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Szubert M, Koziróg E, Olszak O, Krygier-Kurz K, Kazmierczak J, Wilczynski J. Adenomyosis and Infertility-Review of Medical and Surgical Approaches. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:1235. [PMID: 33573117 PMCID: PMC7908401 DOI: 10.3390/ijerph18031235] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 01/22/2021] [Accepted: 01/26/2021] [Indexed: 11/17/2022]
Abstract
The aim of this review is to clarify the relative association between adenomyosis and infertility and the possible treatment for an infertile patient. Although adenomyosis is detected more often in women of late reproductive age, its influence on pregnancy rates is important, especially considering the tendency to delay pregnancy among women in developed countries. In this article, we present a critical analysis of the literature data concerning the impact of adenomyosis on fertility. The possible effects of treatment on the pregnancy rate will also be discussed. We conducted a literature search; publications from Pubmed, Embase and Cochrane databases published from 1982 to 2019 were retrieved using terms 'adenomyosis and infertility' and 'adenomyosis and pregnancy outcomes', extensively studied in the aspects of diagnosis, pathogenesis of infertility and possible treatment methods. Molecular studies have given deep insight into the pathogenesis of adenomyosis in the recent few years, but there is a huge discrepancy between in vitro studies and praxis. Oral contraceptive pills, anti-prostaglandins, oral or parenteral progestins, danazol and gonadotrophin-releasing hormone (GnRH) analogues have all been used to control menstrual pain and menorrhagia in women with adenomyosis, but they temporarily suppress the menstrual cycle. Additionally, endometrial ablation and hysterectomy used to alleviate pain caused by adenomyosis exclude pregnancy planning. The development of imaging techniques-ultrasound and MRI-enables the diagnosis of adenomyosis with very high accuracy nowadays, but the methods of treatment mentioned above have not given satisfactory results in women planning pregnancy. For these patients, the high-intensity-focused ultrasound method (HIFU) and combined treatment before assisted reproductive techniques can prove beneficial in adenomyosis patients.
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Affiliation(s)
- Maria Szubert
- Clinic of Surgical and Oncologic Gynecology, 1st Department of Gynecology and Obstetrics, Medical University of Lodz, 90-419 Lodz, Poland
| | - Edward Koziróg
- Clinic of Surgical and Oncologic Gynecology, 1st Department of Gynecology and Obstetrics, Medical University of Lodz, 90-419 Lodz, Poland
| | - Olga Olszak
- Clinic of Perinatology, 1st Department of Gynecology and Obstetrics, Medical University of Lodz, 90-419 Lodz, Poland
| | - Klaudia Krygier-Kurz
- Clinic of Surgical and Oncologic Gynecology, 1st Department of Gynecology and Obstetrics, Medical University of Lodz, 90-419 Lodz, Poland
| | - Jakub Kazmierczak
- Clinic of Surgical and Oncologic Gynecology, 1st Department of Gynecology and Obstetrics, Medical University of Lodz, 90-419 Lodz, Poland
| | - Jacek Wilczynski
- Clinic of Surgical and Oncologic Gynecology, 1st Department of Gynecology and Obstetrics, Medical University of Lodz, 90-419 Lodz, Poland
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Schippert C, Witte Y, Bartels J, Garcia-Rocha GJ, Jentschke M, Hillemanns P, Kundu S. Reproductive capacity and recurrence of disease after surgery for moderate and severe endometriosis - a retrospective single center analysis. BMC Womens Health 2020; 20:144. [PMID: 32660473 PMCID: PMC7358195 DOI: 10.1186/s12905-020-01016-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 07/07/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Endometriosis can be associated with considerable pain and sterility. After surgical excision of moderate or severe endometriosis lesions, the rate of recurrence reaches up to 67%. The objective of this retrospective study was to establish the recurrence and pregnancy rates following surgical resection of stage III/IV endometriosis lesions. Indications for operation were endometriosis symptoms, sonographic findings and/or infertility. METHODS A total of 456 patients who underwent stage III/IV endometriosis surgery between 2004 and 2014 were sent a questionnaire relating to their postoperative medical treatment, pregnancies, relief of symptoms and recurrence. Responses of 206 patients (45.2%) and their clinical data were analysed for this study. RESULTS A total of 66.5% (N = 137) of patients had stage III disease, and 33.5% (N = 69) had stage IV disease. The average age was 37 years (17-59). A total of 63.1% (N = 130) of surgeries were performed by laparoscopy, 21.8% (N = 45) were performed by laparotomy and 15% (N = 31) were performed by conversion. Complete resection of endometriosis lesions was achieved in 90.8% of patients (N = 187). After surgery, 48.5% (N = 100) of the women did not receive hormonal treatment; the main reason was the desire for children in 53%. Complete or partial relief in complaints was achieved in 93.2% (N = 192). The rate of recurrence was 21.8% (N = 45). The statistically significant factors that was associated with a higher risk to develop recurrence was an age < 35 (p < 0.005). After surgery, 65.8% (79/120) of patients who wished to have children became pregnant. There was a statistically significant association among a higher postoperative pregnancy rate and age < 35 (p < 0.003) in multivariate logistic regression analysis and laparoscopic surgical access in univariate logistic regression analysis (p < 0.01). CONCLUSION We assessed the high percentage of complete or partial relief of symptoms of 93.2%, the high postoperative pregnancy rate of 65.8% and the low rate of recurrence of 21.8% compared to international literature to be very encouraging for women suffering from moderate and severe endometriosis. Though laparoscopy is considered the 'gold standard'of endometriosis surgery, laparotomy still may be indicated in patients with extensive endometriosis especially to preserve reproductive function.
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Affiliation(s)
- Cordula Schippert
- Department of Obstetrics and Gynaecology, Hanover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany.
| | - Yvonne Witte
- Department of Obstetrics and Gynaecology, Hanover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Janina Bartels
- Department of Obstetrics and Gynaecology, Hanover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Guillermo-José Garcia-Rocha
- Department of Obstetrics and Gynaecology, Hanover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Matthias Jentschke
- Department of Obstetrics and Gynaecology, Hanover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Peter Hillemanns
- Department of Obstetrics and Gynaecology, Hanover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
| | - Sudip Kundu
- Department of Obstetrics and Gynaecology, Hanover Medical School, Carl-Neuberg-Straße 1, 30625, Hannover, Germany
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Effect of GnRH agonist before IVF on outcomes in infertile endometriosis patients: a randomized controlled trial. Reprod Biomed Online 2020; 41:653-662. [PMID: 32782170 DOI: 10.1016/j.rbmo.2020.06.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 06/03/2020] [Accepted: 06/30/2020] [Indexed: 01/22/2023]
Abstract
RESEARCH QUESTION Does 3-months of gonadotrophin releasing hormone agonist (GnRHa) treatment before IVF improve clinical pregnancy rate in infertile patients with endometriosis? DESIGN Single-blind, placebo-controlled clinical trial of 200 infertile women with endometriosis assigned to use GnRHa (study group) or placebo (control group) for 3 months before IVF. Clinical, embryological outcomes and stimulation parameters were analysed. Clinical pregnancy rate was the primary endpoint. In a subgroup of 40 patients, follicular fluid levels of oestradiol, testosterone and androstendione were measured. Gene expression profile of CYP19A1 was analysed in cumulus and mural granulosa cells. RESULTS Implantation or clinical pregnancy rate were not significantly different between the two groups. Clinical pregnancy rates were 25.3% and 33.7% in the study and control groups, respectively (P = 0.212). Cumulative live birth rate was not significantly different: 22.0% (95% CI 13.0 to 31.0) in the study group and 33.7% (95% CI 24.0 to 44.0) in the control group (P = 0.077). Ovarian stimulation was significantly longer and total dose of gonadotrophins significantly higher in the study group (both P < 0.001). Serum oestradiol levels on the day of HCG were significantly lower in the study group (P = 0.001). Cancellation rate was significantly higher in the study group (P = 0.042), whereas cleavage embryos were significantly more numerous in the control group (P = 0.023). No significant differences in the expression of CYP19A1 gene in mural or cumulus granulosa cells or steroid levels in follicular fluid between the two groups were observed, but testosterone was significantly lower in the study group (P < 0.001). CONCLUSION Three-months of GnRHa treatment before IVF does not improve clinical pregnancy rate in women with endometriosis.
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8
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Cao X, Chang HY, Xu JY, Zheng Y, Xiang YG, Xiao B, Geng XJ, Ni LL, Chu XY, Tao SB, He Y, Mao GH. The effectiveness of different down-regulating protocols on in vitro fertilization-embryo transfer in endometriosis: a meta-analysis. Reprod Biol Endocrinol 2020; 18:16. [PMID: 32113479 PMCID: PMC7049222 DOI: 10.1186/s12958-020-00571-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Accepted: 02/10/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND To investigate the effectiveness of the GnRH-a ultra-long protocol, GnRH-a long protocol, and GnRH-a short protocol used in in vitro fertilization-embryo transfer (IVF-ET) in infertile women with endometriosis. METHODS We searched PubMed, Embase, Web of Science, Cochrane Library, Elsevier Science Direct, OA Library, Google Scholar, China National Knowledge Infrastructure (CNKI), Wanfang Data Knowledge Service Platform, China Science and Technology Journal database, and the China Biology Medicine disc for randomized controlled trials (RCTs) and observational studies (non-RCTs) to evaluate the efficacy of the GnRH-a ultra-long protocol, GnRH-a long protocol, and GnRH-a short protocol in IVF-ET in infertile patients with endometriosis. RESULTS A total of 21 studies in compliance with the standard literature were included, and RCT and non-RCT studies were analyzed separately. This meta-analysis showed that the GnRH-a ultra-long protocol could improve the clinical pregnancy rate of infertile patients in RCT studies, especially in patients with stages III-IV endometriosis (RR = 2.04, 95% CI: 1.37~3.04, P < 0.05). However, subgroup analysis found the different down-regulation protocols provided no significant difference in improving clinical outcomes in patients with endometriosis in the non-RCT studies. CONCLUSION This study suggests that the GnRH-a ultra-long protocol can improve the clinical pregnancy rate of the patients with stages III-IV endometriosis in RCT studies. Although it is generally believed that the results of RCT are more reliable, the conclusions of the non-RCT studies cannot be easily neglect, which let us draw conclusions more cautious.
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Affiliation(s)
- Xue Cao
- Reproductive Medical Center, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, 450014, China
| | - Hong-Yang Chang
- Reproductive Medical Center, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, 450014, China
| | - Jun-Yan Xu
- Reproductive Medical Center, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, 450014, China
| | - Yi Zheng
- Wuhan Institute of Dermatology and Venerology, Wuhan, China
| | - Yun-Gai Xiang
- Reproductive Medical Center, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, 450014, China
| | - Bing Xiao
- Reproductive Medical Center, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, 450014, China
| | - Xu-Jing Geng
- Reproductive Medical Center, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, 450014, China
| | - Li-Li Ni
- Reproductive Medical Center, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, 450014, China
| | - Xi-Ying Chu
- Reproductive Medical Center, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, 450014, China
| | - Shi-Bo Tao
- Reproductive Medical Center, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, 450014, China
| | - Yan He
- Teaching Office, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, 450014, China.
| | - Gen-Hong Mao
- Reproductive Medical Center, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, 450014, China.
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Guo S, Li Z, Yan L, Sun Y, Feng Y. GnRH agonist improves pregnancy outcome in mice with induced adenomyosis by restoring endometrial receptivity. DRUG DESIGN DEVELOPMENT AND THERAPY 2018; 12:1621-1631. [PMID: 29922037 PMCID: PMC5995291 DOI: 10.2147/dddt.s162541] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Purpose Adenomyosis has a negative impact on female fertility. GnRH agonist treatment can improve pregnancy outcomes in women with adenomyosis. However, the impact of GnRH agonist upon endometrium receptivity of patients with adenomyosis remains unclear. In this study, endometrial receptivity and pregnancy outcome were investigated using a mouse model of adenomyosis. Materials and methods Adenomyosis was induced in 12 female ICR mice, neonatally treated with tamoxifen, while another six female mice (control group) received solvent only. At 75 days, the induced adenomyosis group was randomly divided into two groups: an untreated group and a group treated with GnRH agonist (n = 6 each). Sixty days later, the mice were mated and pregnancy outcomes were observed and compared among the three groups (n = 6 each). In a parallel experiment using the same treatment regimes, uterus samples were collected on day 4 of pregnancy for immunohistochemistry, gene (quantitative polymerase chain reaction) and protein expression (Western blot), and scanning electron microscopy analyses. Results We found that the average live litter size was reduced in the adenomyosis compared with control group (8 ± 0.56 versus 13 ± 0.71; P = 0.03). However, the litter size was significantly increased in the treated with GnRH agonist group compared with the untreated group (12 ± 0.35 versus 8 ± 0.56; P = 0.04). The uterine expression levels of Hoxa10, Hoxa11, Lif and integrin b3 mRNA and protein were decreased in the adenomyosis group, and were significantly increased after GnRH agonist treatment. Additionally, pinopodes were reduced in number and poorly developed in mice with induced adenomyosis. However, pinopodes were abundant and well-developed in the GnRH agonist treatment group. Conclusion Adenomyosis may have an adverse impact on endometrial receptivity and reduce pregnancy outcomes in mice. However, GnRH agonist may improve the pregnancy outcome by partially restoring endometrial receptivity.
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Affiliation(s)
- Song Guo
- Department of Gynaecology and Obstetrics, Qianfoshan Hospital, Shandong University, Jinan, China
| | - Zhichao Li
- Gynecology, Shanghai Ji Ai Genetics & In Vitro Fertilization Institute, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Li Yan
- Department of Gynaecology and Obstetrics, Qianfoshan Hospital, Shandong University, Jinan, China
| | - Yijuan Sun
- Gynecology, Shanghai Ji Ai Genetics & In Vitro Fertilization Institute, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China
| | - Yun Feng
- Reproductive Medicine Center, Department of Obstetrics and Gynecology, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China
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Al-Rubae'i SHN, Naji TS, Turki KM. Common variation of the CYP17 gene in Iraqi women with endometriosis disease. GENOMICS DATA 2016; 11:55-59. [PMID: 27981034 PMCID: PMC5144748 DOI: 10.1016/j.gdata.2016.11.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 11/15/2016] [Accepted: 11/22/2016] [Indexed: 11/29/2022]
Abstract
Common variants among genes coding for enzymes in sex steroid biosynthetic pathways may influence the risk of endometriosis in Iraqi women patients in the last years. Cytochrome P450c17a1 (CYP17), a gene that codes for a key enzyme (cytochrome P450c17a1) in a rate-limiting step of estrogen biosynthesis has attracted considerable attention as an important gene for endometriosis. To evaluate the relationship between common genetic variations in CYP17 and endometriosis risk and determine the main effects of those variations on the gene expression. A women-based case control study of Iraqi women aged range (23–46), the associations between selected single-nucleotide polymorphisms (SNPs) in the CYP17 gene and endometriosis diagnosis in fifty women and thirty disease-free controls were evaluated. The study found a significant association (P ≤ 0.01)between endometriosis and selected SNPs of CYP17 gene, with the homozygous genotype conferring decreased risk. A highly significant difference (P ≤ 0.01) in CYP17 gene expression from women with versus without endometriosis and increased by 1.56-fold in women with endometriosis. These findings suggest that variation in or around CYP17 may be associated with endometriosis development in the Iraqi women.
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Affiliation(s)
- Salwa H N Al-Rubae'i
- Chemistry Department, College of Science, Al-Mustansiriyah University, Baghdad, Iraq
| | - Tamara Sami Naji
- Chemistry Department, College of Science, Al-Mustansiriyah University, Baghdad, Iraq
| | - Kisma M Turki
- College of Medicine, Baghdad University, Baghdad, Iraq
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11
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Bratu D, Chicea R, Ciprian T, Beli L, Dan S, Mihetiu A, Adrian B. A rare case of ileus caused by ileum endometriosis. Int J Surg Case Rep 2016; 26:24-6. [PMID: 27434884 PMCID: PMC4954939 DOI: 10.1016/j.ijscr.2016.06.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Revised: 06/14/2016] [Accepted: 06/14/2016] [Indexed: 01/07/2023] Open
Abstract
We experience a case of relatively rare small bowel obstruction caused by terminal ileum endometriosis. Multiple lesions were also located in Douglas pouch, causing partial rectal stenosis. Correct surgical and medical approach is required.
Introduction We report our experience involving a rare case of ileum endometriosis complicated with small bowel obstruction. Presentation of case 33 years old female patient, admitted to emergency service with abdominal pain, abdominal distension, and vomiting. Abdominal X-ray showed dilated small bowel loops. Computerized tomography scan showed dilated small intestine segments excepting last ileum loop, gastric distension, enlarged ovaries. Emergency laparotomy was performed, showing acute bowel obstruction due to a stenotic tumor placed on the terminal ileum, cecum tumors, multiple tumors in Douglas pouch, multiple mesenteric enlarged lymph nodes. Right colectomy is performed with an ileo-transverso stomy placed in right hypochondrium. Postoperative evolution without complication, patient discharged after 13-days hospitalization. After hormonal treatment, she returned for a second look and ileotransverso anastomosis. Discussion Gastrointestinal involvement of endometriosis has been found in 3%–37% of menstruating women. Ileum localization is very rare (1%–7%), causing intestinal obstruction 7%–23% of cases. Intraoperative differential diagnosis is difficult, predisposing at confusion with other types of tumors. In the absence of fast microscopic exam, the tumor was considered malignant and imposed a right hemicolectomy. Conclusion Intestinal obstruction due to ileum endometriosis is a rare condition, however, it should always be considered in the differential diagnosis in women of reproductive age.
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Affiliation(s)
- Dan Bratu
- Lucian Blaga University-Faculty of Medicine Sibiu, Second Surgery Clinic Academic Emergency Hospital Sibiu Romania, Romania
| | - Radu Chicea
- Lucian Blaga University-Faculty of Medicine Sibiu, Obstetrics and Gynecology Clinic Academic Emergency Hospital Sibiu Romania, Romania.
| | - Tanasescu Ciprian
- Lucian Blaga University-Faculty of Medicine Sibiu, First Surgery Clinic Academic Emergency Hospital Sibiu Romania, Romania
| | - Laurentiu Beli
- Lucian Blaga University-Faculty of Medicine Sibiu, Second Surgery Clinic Academic Emergency Hospital Sibiu Romania, Romania
| | - Sabau Dan
- Lucian Blaga University-Faculty of Medicine Sibiu, Second Surgery Clinic Academic Emergency Hospital Sibiu Romania, Romania
| | - Alin Mihetiu
- Lucian Blaga University-Faculty of Medicine Sibiu, Second Surgery Clinic Academic Emergency Hospital Sibiu Romania, Romania
| | - Boicean Adrian
- Lucian Blaga University-Faculty of Medicine Sibiu, First Medical Clinic Academic Emergency Hospital Sibiu Romania, Romania
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