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Lessey BA, Dong A, Deaton JL, Angress D, Savaris RF, Walker SJ. Inflammatory Changes after Medical Suppression of Suspected Endometriosis for Implantation Failure: Preliminary Results. Int J Mol Sci 2024; 25:6852. [PMID: 38999962 PMCID: PMC11241468 DOI: 10.3390/ijms25136852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Revised: 06/10/2024] [Accepted: 06/13/2024] [Indexed: 07/14/2024] Open
Abstract
Unexplained euploid embryo transfer failure (UEETF) is a frustrating and unanswered conundrum accounting for 30 to 50% of failures in in vitro fertilization using preimplantation genetic testing for aneuploidy (PGT-A). Endometriosis is thought by many to account for most of such losses and menstrual suppression or surgery prior to the next transfer has been reported to be beneficial. In this study, we performed endometrial biopsy in a subset of women with UEETF, testing for the oncogene BCL6 and the histone deacetylase SIRT1. We compared 205 PGT-A cycles outcomes and provide those results following treatment with GnRH agonist versus controls (no treatment). Based on these and previous promising results, we next performed a pilot randomized controlled trial comparing the orally active GnRH antagonist, elagolix, to oral contraceptive pill (OCP) suppression for 2 months before the next euploid embryo transfer, and monitored inflammation and miRNA expression in blood, before and after treatment. These studies support a role for endometriosis in UEETF and suggest that medical suppression of suspected disease with GnRH antagonist prior to the next transfer could improve success rates and address underlying inflammatory and epigenetic changes associated with UEETF.
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Affiliation(s)
- Bruce A Lessey
- Department of OBGYN, Atrium Health Wake Forest Baptist, Winston-Salem, NC 27157, USA
| | - Allan Dong
- Department of OBGYN, Atrium Health Wake Forest Baptist, Winston-Salem, NC 27157, USA
| | - Jeffrey L Deaton
- Department of OBGYN, Atrium Health Wake Forest Baptist, Winston-Salem, NC 27157, USA
| | | | - Ricardo F Savaris
- Department of OBGYN, School of Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre 90035-003, RS, Brazil
| | - Stephen J Walker
- Wake Forest Institute for Regenerative Medicine, Winston-Salem, NC 27101, USA
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Van Gestel H, Bafort C, Meuleman C, Tomassetti C, Vanhie A. The prevalence of endometriosis in unexplained infertility: a systematic review. Reprod Biomed Online 2024; 49:103848. [PMID: 38943813 DOI: 10.1016/j.rbmo.2024.103848] [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: 03/23/2023] [Revised: 11/19/2023] [Accepted: 01/22/2024] [Indexed: 07/01/2024]
Abstract
In 15-30% of couples with infertility, no abnormalities are found after the initial diagnostic work-up. The aim of this study was to investigate the prevalence of endometriosis in patients with unexplained infertility undergoing diagnostic laparoscopy in the current era of improved imaging and assisted reproductive technology. A systematic search of PubMed, Embase and Cochrane Central was conducted to identify all studies reporting on pelvic pathologies found by laparoscopy in couples diagnosed with unexplained infertility. Normal ovulatory cycles, normal semen analysis and an infertility period of ≥12 months were the minimum requirements for a study population to be included. The prevalence of endometriosis was 44%, and most lesions were classified as minimal or mild (74%). The prevalence rates of tubal factors and adhesions were 20% and 16%, respectively. The detection rate for pelvic abnormalities was higher in women with prior fertility treatment (75%) compared with women without prior fertility treatment (53%). Despite the significant improvements in imaging for the diagnosis of endometriosis and tubal factors over the last decades, the prevalence rates of endometriosis and tubal abnormalities remain high in patients with unexplained infertility. The high prevalence of endometriosis in this population is important for decision-making in patients who also suffer from pain symptoms suggestive of endometriosis.
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Affiliation(s)
- Hanne Van Gestel
- Leuven University Fertility Centre, Department of Gynaecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
| | - Celine Bafort
- Leuven University Fertility Centre, Department of Gynaecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium; Laboratory for Endometrium, Endometriosis and Reproductive Medicine; Department of Development and Regeneration, Group Biomedical Sciences, Leuven University, Leuven, Belgium
| | - Christel Meuleman
- Leuven University Fertility Centre, Department of Gynaecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium; Laboratory for Endometrium, Endometriosis and Reproductive Medicine; Department of Development and Regeneration, Group Biomedical Sciences, Leuven University, Leuven, Belgium
| | - Carla Tomassetti
- Leuven University Fertility Centre, Department of Gynaecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium; Laboratory for Endometrium, Endometriosis and Reproductive Medicine; Department of Development and Regeneration, Group Biomedical Sciences, Leuven University, Leuven, Belgium
| | - Arne Vanhie
- Leuven University Fertility Centre, Department of Gynaecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium; Laboratory for Endometrium, Endometriosis and Reproductive Medicine; Department of Development and Regeneration, Group Biomedical Sciences, Leuven University, Leuven, Belgium.
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3
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Avery JC, Deslandes A, Freger SM, Leonardi M, Lo G, Carneiro G, Condous G, Hull ML. Noninvasive diagnostic imaging for endometriosis part 1: a systematic review of recent developments in ultrasound, combination imaging, and artificial intelligence. Fertil Steril 2024; 121:164-188. [PMID: 38101562 DOI: 10.1016/j.fertnstert.2023.12.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 12/06/2023] [Indexed: 12/17/2023]
Abstract
Endometriosis affects 1 in 9 women and those assigned female at birth. However, it takes 6.4 years to diagnose using the conventional standard of laparoscopy. Noninvasive imaging enables a timelier diagnosis, reducing diagnostic delay as well as the risk and expense of surgery. This review updates the exponentially increasing literature exploring the diagnostic value of endometriosis specialist transvaginal ultrasound (eTVUS), combinations of eTVUS and specialist magnetic resonance imaging, and artificial intelligence. Concentrating on literature that emerged after the publication of the IDEA consensus in 2016, we identified 6192 publications and reviewed 49 studies focused on diagnosing endometriosis using emerging imaging techniques. The diagnostic performance of eTVUS continues to improve but there are still limitations. eTVUS reliably detects ovarian endometriomas, shows high specificity for deep endometriosis and should be considered diagnostic. However, a negative scan cannot preclude endometriosis as eTVUS shows moderate sensitivity scores for deep endometriosis, with the sonographic evaluation of superficial endometriosis still in its infancy. The fast-growing area of artificial intelligence in endometriosis detection is still evolving, but shows great promise, particularly in the area of combined multimodal techniques. We finalize our commentary by exploring the implications of practice change for surgeons, sonographers, radiologists, and fertility specialists. Direct benefits for endometriosis patients include reduced diagnostic delay, better access to targeted therapeutics, higher quality operative procedures, and improved fertility treatment plans.
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Affiliation(s)
- Jodie C Avery
- Robinson Research Institute, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia.
| | - Alison Deslandes
- Robinson Research Institute, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia
| | - Shay M Freger
- Department of Obstetrics and Gynecology McMaster University, Hamilton, ON, Canada
| | - Mathew Leonardi
- Robinson Research Institute, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia; Department of Obstetrics and Gynecology McMaster University, Hamilton, ON, Canada
| | - Glen Lo
- Curtin Medical School, Curtin University, Perth, Western Australia, Australia
| | - Gustavo Carneiro
- Robinson Research Institute, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia; Centre for Vision, Speech and Signal Processing (CVSSP), School of Computer Science and Electronic Engineering, University of Surrey, Guildford, United Kingdom
| | - G Condous
- Robinson Research Institute, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia; Gynaecology Department, Omni Ultrasound and Gynaecological Care, Sydney, New South Wales, Australia
| | - Mary Louise Hull
- Robinson Research Institute, Adelaide Medical School, University of Adelaide, Adelaide, South Australia, Australia; Gynaecology Department, Embrace Fertility, Adelaide, South Australia, Australia
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Nezhat C, Khoyloo F, Tsuei A, Armani E, Page B, Rduch T, Nezhat C. The Prevalence of Endometriosis in Patients with Unexplained Infertility. J Clin Med 2024; 13:444. [PMID: 38256580 DOI: 10.3390/jcm13020444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 01/01/2024] [Accepted: 01/08/2024] [Indexed: 01/24/2024] Open
Abstract
Endometriosis, a systemic ailment, profoundly affects various aspects of life, often eluding detection for over a decade. This leads to enduring issues such as chronic pain, infertility, emotional strain, and potential organ dysfunction. The prolonged absence of diagnosis can contribute to unexplained obstetric challenges and fertility issues, necessitating costly and emotionally taxing treatments. While biopsy remains the gold standard for diagnosis, emerging noninvasive screening methods are gaining prominence. These tests can indicate endometriosis in cases of unexplained infertility, offering valuable insights to patients and physicians managing both obstetric and non-obstetric conditions. In a retrospective cross-sectional study involving 215 patients aged 25 to 45 with unexplained infertility, diagnostic laparoscopy was performed after unsuccessful reproductive technology attempts. Pathology results revealed tissue abnormalities in 98.6% of patients, with 90.7% showing endometriosis, confirmed by the presence of endometrial-like glands and stroma. The study underscores the potential role of endometriosis in unexplained infertility cases. Although the study acknowledges selection bias, a higher than previously reported prevalence suggests evaluating endometriosis in patients who have not responded to previous reproductive interventions may be justified. Early detection holds significance due to associations with ovarian cancer, prolonged fertility drug use, pregnancy complications, and elevated post-delivery stroke risk.
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Affiliation(s)
- Camran Nezhat
- Stanford University Medical Center, Palo Alto, CA 94305, USA
- University of California San Francisco, San Francisco, CA 94143, USA
- Camran Nezhat Institute, Center for Special Minimally Invasive and Robotic Surgery, Woodside, CA 94061, USA
| | - Farrah Khoyloo
- Camran Nezhat Institute, Center for Special Minimally Invasive and Robotic Surgery, Woodside, CA 94061, USA
- University of California Berkeley, Berkeley, CA 94720, USA
| | - Angie Tsuei
- Stanford University Medical Center, Palo Alto, CA 94305, USA
- Camran Nezhat Institute, Center for Special Minimally Invasive and Robotic Surgery, Woodside, CA 94061, USA
| | - Ellie Armani
- Camran Nezhat Institute, Center for Special Minimally Invasive and Robotic Surgery, Woodside, CA 94061, USA
| | - Barbara Page
- Camran Nezhat Institute, Center for Special Minimally Invasive and Robotic Surgery, Woodside, CA 94061, USA
- University of California Berkeley, Berkeley, CA 94720, USA
| | - Thomas Rduch
- Laboratory for Particles Biology Interactions, Swiss Federal Laboratories for Materials Science and Technology (Empa), CH-9014 St. Gallen, Switzerland
- Department of Gynecology and Obstetrics, Cantonal Hospital St. Gallen (KSSG), CH-9007 St. Gallen, Switzerland
| | - Ceana Nezhat
- Nezhat Medical Center, Atlanta Center for Special Minimally Invasive Surgery and Reproductive Medicine, Atlanta, GA 30342, USA
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Adur MK, Braundmeier-Fleming AG, Lessey BA, Nowak RA. Altered eutopic endometrial T-regulatory and T-helper 17 lymphocyte ratio in women with unexplained subfertility. JOURNAL OF ENDOMETRIOSIS AND PELVIC PAIN DISORDERS 2021; 13:185-194. [PMID: 34354965 PMCID: PMC8330881 DOI: 10.1177/22840265211018544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
PROBLEM Perturbations in T-helper lymphocyte profiles have previously been associated with endometriosis related subfertility and conception failure. Hence a retrospective in vitro study was conducted to evaluate the relationship between T-regulatory (Treg) and T-helper 17 (Th17) lymphocytes in the eutopic endometrium of women with unexplained subfertility and correlate these profiles to their conception status. METHOD OF STUDY Eutopic endometrial biopsies were collected during the mid-secretory phase of the menstrual cycle, from women with unexplained subfertility. These samples were evaluated immunohistochemically for Treg and Th17 lymphocytes as well as the related proinflammatory cytokine, Interleukin-17 (IL-17). These eutopic endometrial T lymphocyte subpopulations were compared to the patients' conception status in subsequent cycles. RESULTS Though Treg cells were not indicative of conception success in subsequent cycles, patients who maintained their subfertile (no conception) status were observed to have a higher Th17 cell count in their eutopic endometrium. The ratio of Treg:Th17 cell counts was significantly correlated to patient conception status as well. These trends stayed consistent irrespective of concurrent endometriosis. CONCLUSION Patients with a high proinflammatory Th17 lymphocyte profile and low Treg:Th17 ratio in their eutopic endometrium during the secretory phase of their menstrual cycle are more likely to not conceive in subsequent cycles.
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Affiliation(s)
- Malavika K Adur
- Department of Animal Science, University of Illinois at Urbana-Champaign, Urbana, IL, USA
- Department of Animal Science, Iowa State University, Ames, IA, USA
| | - Andrea G Braundmeier-Fleming
- Department of Animal Science, University of Illinois at Urbana-Champaign, Urbana, IL, USA
- Department of Medical Microbiology, Immunology and Cell Biology, SIU School of Medicine, Springfield, IL, USA
- Department of Obstetrics and Gynecology, SIU School of Medicine, Springfield, IL, USA
| | - Bruce A Lessey
- Department of Obstetrics and Gynecology, Greenville Hospital System, Greenville, SC, USA
- Department of Obstetrics and Gynecology, Wake Forest Baptist Health, Winston-Salem, NC, USA
| | - Romana A Nowak
- Department of Animal Science, University of Illinois at Urbana-Champaign, Urbana, IL, USA
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6
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Hysterolaparoscopy: A Gold Standard for Diagnosing and Treating Infertility and Benign Uterine Pathology. J Clin Med 2021; 10:jcm10163749. [PMID: 34442042 PMCID: PMC8396885 DOI: 10.3390/jcm10163749] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/08/2021] [Accepted: 08/20/2021] [Indexed: 12/29/2022] Open
Abstract
Background: Combined hysteroscopy and laparoscopy is a valuable method for diagnosing and treating infertility and benign uterine pathology. Both procedures are minimally invasive, reliable, and safe, with a low complication rate. Aim: In this review, we expose the efficiency and safety of hysterolaparoscopy in the management of infertility and other benign uterine pathologies. Method: We performed a systematic literature review on several databases: PubMed®/MEDLINE, PMC, Crossref.org, and Web of Science in the last 10 years. Inclusion criteria: Women of reproductive age with primary or secondary infertility and/or benign uterine pathology. Exclusion criteria: pre-puberty, menopause, couple with male infertility. Conclusion: Hysterolaparoscopy is a useful tool to assess infertility and simultaneously diagnose and treat pelvic and uterine lesions.
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Satwik R, Kochhar M. Unexplained infertility categorization based on female laparoscopy and total motile sperm count, and its impact on cumulative live-births after one in-vitro fertilization cycle. A retrospective cohort study involving 721 cycles. Reprod Med Biol 2021; 20:190-198. [PMID: 33850452 PMCID: PMC8022093 DOI: 10.1002/rmb2.12368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 12/18/2020] [Accepted: 01/10/2021] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To determine how subcategorizing unexplained infertility based on female laparoscopy and total-motile-sperm-count assessment would impact cumulative live-births after one in-vitro fertilization (IVF) cycle. METHODS Seven hundred twenty one IVF cycles from Jan 2014-April 2019 performed at a single-center were retrospectively analyzed. Couples with unexplained infertility having normal uterine and endometrial morphology were subcategorized into three cohorts, UI (1): those with no tuboperitoneal pathology on laparoscopy and total-motile-sperm-count (TMSC) ≧20 million: n = 103; UI (2): tuboperitoneal pathology on laparoscopy or TMSC <20 million, n = 86; and UI(3): tuboperitoneal status not known: n = 114. Controls were severe male factor, bilateral tubal block, and grade 3/4 endometriosis: n = 418. Primary Outcome was cumulative-live-birth-per-initiated-IVF cycle (CLBR). Odds ratio for live-births were adjusted for confounding factors. RESULTS The CLBR in UI1 cohort was significantly lower than controls (29.1% vs 39; OR = 0.62; 95%CI = 0.39-0.98; P = .04); but similar in UI2 and UI3 vs. controls. (37.2% vs 39.95%; OR = 0.89, 95%CI = 0.55-1.44; P = .89) and (38.6% vs 39.95%; OR = 0.98, 95%CI = 0.64-1.55; P = .98). After adjusting for age, infertility duration, past live-births, and AMH, the adjusted odds for CLBR in UI1 was 0.48 (95%CI = 0.28-0.82; P = .007). CONCLUSIONS Unexplained infertility when defined after a normal laparoscopy and TMSC significantly lowered cumulative-live-births-per-initiated-IVF cycle when compared with traditional diagnosis of tubal, endometriosis, or male factor infertility. In UI subcategory with abnormal laparoscopy or TMSC, CLBR remained unaffected. This information could be useful for counseling couples prior to IVF. Large-scale prospective studies are needed to confirm this observation.
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Affiliation(s)
- Ruma Satwik
- Centre of IVF and Human ReproductionInstitute of Obstetrics and GynaecologySir Ganga Ram HospitalNew DelhiIndia
| | - Mohinder Kochhar
- Centre of IVF and Human ReproductionInstitute of Obstetrics and GynaecologySir Ganga Ram HospitalNew DelhiIndia
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Han SJ, Lee JE, Cho YJ, Park MJ, O’Malley BW. Genomic Function of Estrogen Receptor β in Endometriosis. Endocrinology 2019; 160:2495-2516. [PMID: 31504401 PMCID: PMC6773435 DOI: 10.1210/en.2019-00442] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 08/20/2019] [Indexed: 02/06/2023]
Abstract
Estrogen receptor (ER) β plays a critical role in endometriosis progression because cytoplasmic ERβ stimulates proinflammatory signaling in ectopic lesions and prevents apoptosis to promote their survival. However, the role of "nuclear ERβ" in endometriosis progression is not known. This critical knowledge gap obscures our understanding of the full molecular etiology of ERβ-mediated endometriosis progression. To fill this void, we generated an ERβ-regulated transcriptome and ERβ cistrome in ectopic lesions and the eutopic endometrium of mice with endometriosis by using a new endometrium-specific FLAG-tagged human ERβ overexpression mouse model. The integration of these omics data sets revealed that ERβ stimulated the proliferation activities of ectopic lesions and the eutopic endometrium by directly upregulating MYC and E2 transcription factor target genes and genes associated with the G2/M transition. Additionally, ERβ stimulated gene expression associated with TNFα/nuclear factor κB (NF-κB) signaling, epithelial-mesenchymal transition, reactive oxygen species signaling, IL-6/Janus kinase (JAK)/signal transducer and activator of transcription (STAT)3 signaling, and hypoxia signaling and suppressed IFNα signaling in ectopic lesions to enhance endometriosis progression. ERβ also stimulated gene expression associated with the unfolded protein response and IL-6/JAK/STAT3 inhibitory signaling and suppressed TNFα/NF-κB signaling in the eutopic endometrium to cause endometriosis-associated endometrial dysfunction. Therefore, nuclear ERβ-regulated gene networks provide critical clues to understand the molecular etiology and complexity of endometriosis and endometriosis-associated endometrial dysfunction.
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Affiliation(s)
- Sang Jun Han
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, Texas
- Center for Reproductive Medicine, Baylor College of Medicine, Houston, Texas
- Correspondence: Sang Jun Han, PhD, Baylor College of Medicine, One Baylor Plaza, Houston, Texas 77030. E-mail:
| | - Jiyeun E Lee
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, Texas
| | - Yeon Jean Cho
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, Texas
- Department of Obstetrics and Gynecology, College of Medicine, Dong-A University, Busan, Republic of Korea
| | - Mi Jin Park
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, Texas
| | - Bert W O’Malley
- Department of Molecular and Cellular Biology, Baylor College of Medicine, Houston, Texas
- Center for Reproductive Medicine, Baylor College of Medicine, Houston, Texas
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Pantou A, Simopoulou M, Sfakianoudis K, Giannelou P, Rapani A, Maziotis E, Grigoriadis S, Tsioulou P, Syrkos S, Souretis K, Koutsilieris M, Pantos K. The Role of Laparoscopic Investigation in Enabling Natural Conception and Avoiding in vitro Fertilization Overuse for Infertile Patients of Unidentified Aetiology and Recurrent Implantation Failure Following in vitro Fertilization. J Clin Med 2019; 8:E548. [PMID: 31013645 PMCID: PMC6517944 DOI: 10.3390/jcm8040548] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 04/18/2019] [Accepted: 04/19/2019] [Indexed: 12/12/2022] Open
Abstract
The present study aims to explore the effectiveness of laparoscopic surgery on women presenting with infertility, of unidentified aetiology according to the standard infertility investigation, and recurrent failed In Vitro Fertilization (IVF) attempts. Identifying and correcting possible underlying pathologies by laparoscopy may subsequently enable natural conception in an effort to address infertility and avoid IVF overuse. One-hundred and seven (107) women with unidentified aetiology of infertility and recurrent failed IVF attempts met the inclusion criteria. Laparoscopic surgery was performed as the endpoint of the patients' diagnostic journey, aiming to identify a possible underlying factor as the cause of infertility. Sixty-two (62) out of 107 patients (57.94%) that underwent laparoscopy were diagnosed with endometriosis, 25 out of the 107 patients (23.3%) were diagnosed with periadnixal and pelvic adhesions, and 20 cases (18.69%) presented with no pathology and remained unexplained. Following identification and correction of endometriosis and pelvic adhesions, patients were invited to conceive naturally. For the patients that laparoscopic investigation failed to reveal any pathology they were categorized as unexplained infertility and were subjected to a single IVF cycle. Natural conception success rate within the first postoperative year was the primary outcome. Within the first postoperative year, 30 out of 62 patients (48.38%) diagnosed with endometriosis following laparoscopic investigation achieved a natural conception, and 28 out of them (93.4%) reported live-births. Additionally, 11 out of 25 patients (44%) diagnosed with periadnixal and pelvic adhesions achieved natural conception within the first operative year. Regarding the group of unexplained infertility patients, only four out of the 20 patients (20%) achieved clinical pregnancy in the first post-operative IVF cycle. In conclusion, laparoscopy appears to be a promising approach, addressing infertility, providing significant diagnostic findings, while avoiding IVF overuse regarding patients of unidentified infertility presenting with recurrent failed IVF attempts.
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Affiliation(s)
- Agni Pantou
- Centre for Human Reproduction, Genesis Athens Clinic Athens, 14-16 Papanikoli, 15232 Athens, Greece.
| | - Mara Simopoulou
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias, 11527 Athens, Greece.
| | - Konstantinos Sfakianoudis
- Centre for Human Reproduction, Genesis Athens Clinic Athens, 14-16 Papanikoli, 15232 Athens, Greece.
| | - Polina Giannelou
- Centre for Human Reproduction, Genesis Athens Clinic Athens, 14-16 Papanikoli, 15232 Athens, Greece.
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias, 11527 Athens, Greece.
| | - Anna Rapani
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias, 11527 Athens, Greece.
| | - Evangelos Maziotis
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias, 11527 Athens, Greece.
| | - Sokratis Grigoriadis
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias, 11527 Athens, Greece.
| | - Petroula Tsioulou
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias, 11527 Athens, Greece.
| | - Stephen Syrkos
- Centre for Human Reproduction, Genesis Athens Clinic Athens, 14-16 Papanikoli, 15232 Athens, Greece.
| | - Kyriakos Souretis
- Harris Birthright Research Centre for Fetal Medicine, King's College Hospital, Denmark Hill, 16-20, Windsor Walk, London SE5 8BB, UK.
| | - Michael Koutsilieris
- Department of Physiology, Medical School, National and Kapodistrian University of Athens, 75, Mikras Asias, 11527 Athens, Greece.
| | - Konstantinos Pantos
- Centre for Human Reproduction, Genesis Athens Clinic Athens, 14-16 Papanikoli, 15232 Athens, Greece.
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Likes CE, Cooper LJ, Efird J, Forstein DA, Miller PB, Savaris R, Lessey BA. Medical or surgical treatment before embryo transfer improves outcomes in women with abnormal endometrial BCL6 expression. J Assist Reprod Genet 2019; 36:483-490. [PMID: 30610661 PMCID: PMC6439015 DOI: 10.1007/s10815-018-1388-x] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 12/14/2018] [Indexed: 12/11/2022] Open
Abstract
PURPOSE To evaluate the effect of medical or surgical treatment prior to embryo transfer in women with elevated endometrial BCL6 expression and suspected endometriosis in a prospective, cohort study design at a university-associated infertility clinic. METHODS All subjects had at least 1 year of unexplained infertility (UI) and each prospectively underwent endometrial biopsy and immunostaining for the oncogene BCL6, prior to embryo transfer during an assisted reproductive technology (ART) cycle. To be included, subjects had to have an abnormal BCL6 result, defined by elevated HSCORE ≥ 1.4. Women that were pre-treated with laparoscopy or medical suppression with GnRH agonist (depot leuprolide acetate; Lupron®, Abbvie, Inc., Chicago, IL) for 2 months were compared to a group that went untreated (controls). Endpoints included implantation rate (IR), clinical pregnancy rate (CPR), and live birth rate (LBR), and as well as cycle characteristics. Miscarriage rate were also compared between treatment and control group. RESULTS Women in each group had similar characteristics. Those treated by medical suppression and those undergoing laparoscopy for endometriosis had a significantly higher LBR, (5/10; 50%; 95%CI 23.7 to 76.3%) and (11/21; 52.4%; 95%CI 32.4 to 71.7), respectively, compared to controls (4/54; 7.4%; 95%CI 2.9 to 17.6). An absolute benefit of 44.2% (16/31; 95%CI 24.6 to 61.2) and a number need to treat of 3 for those that received treatment (medical suppression and laparoscopy), compared to no treatment. Miscarriages were significantly more common in the control group. CONCLUSIONS Women with suspected endometriosis and aberrant endometrial BCL6 expression have worse reproductive outcomes following embryo transfer, including a high miscarriage rate, poor IR, and low LBR and CPR compared to cycles pre-treated with medical and surgical management.
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Affiliation(s)
- Creighton E Likes
- Department of Obstetrics and Gynecology, Greenville Health System, 890 W. Faris Rd, Ste 470, Greenville, SC, 29605, USA
| | - Leah J Cooper
- Obstetrics and Gynecology, University of South Carolina SOM-Greenville, 900 Grove Rd, Greenville, SC, USA
| | - Jessica Efird
- Obstetrics and Gynecology, University of South Carolina SOM-Greenville, 900 Grove Rd, Greenville, SC, USA
| | - David A Forstein
- Department of Obstetrics and Gynecology, Greenville Health System, 890 W. Faris Rd, Ste 470, Greenville, SC, 29605, USA
| | - Paul B Miller
- Department of Obstetrics and Gynecology, Greenville Health System, 890 W. Faris Rd, Ste 470, Greenville, SC, 29605, USA
| | - Ricardo Savaris
- Departamento de Ginecologia e Obstetrícia, Universidade Federal do Rio Grande do Sul, Porto Alegre, RS, 90035-903, Brazil
| | - Bruce A Lessey
- Department of Obstetrics and Gynecology, Greenville Health System, 890 W. Faris Rd, Ste 470, Greenville, SC, 29605, USA.
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Clinical Characteristics and Outcomes of Laparoscopic Surgery in Ovarian Endometrioma Cases Treated at a Gynecology Clinic. SISLI ETFAL HASTANESI TIP BULTENI 2018; 52:1-5. [PMID: 32595363 PMCID: PMC7315077 DOI: 10.14744/semb.2017.04706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Accepted: 10/13/2017] [Indexed: 11/20/2022]
Abstract
Objectives: The aim of this study was to retrospectively investigate the clinical and surgical outcomes of patients diagnosed with ovarian endometrioma in a hospital gynecology clinic and to investigate the safety and efficacy of treatment with laparoscopic surgery. Methods: The data of 44 patients who were operated on for ovarian endometrioma were analyzed retrospectively. Results: The mean age of the patients was 30.1±5.3 years. The mean cyst size was 7.0±5.3 cm. In all, 54% of the patients had dysmenorrhea, and 29.5% of the patients were infertile. Laparoscopy was successfully performed in all of the patients, and no complications were observed in any patient. Furthermore, it was found that ovarian reserve tests in the infertile patients were not negatively affected. Conclusion: With sufficient experience, laparoscopy is a very safe and effective method of surgery in ovarian endometrioma. If a laparoscopic cystectomy is performed with the proper technique, it does not adversely affect ovarian reserve.
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Lessey BA, Kim JJ. Endometrial receptivity in the eutopic endometrium of women with endometriosis: it is affected, and let me show you why. Fertil Steril 2017; 108:19-27. [PMID: 28602477 PMCID: PMC5629018 DOI: 10.1016/j.fertnstert.2017.05.031] [Citation(s) in RCA: 157] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 05/23/2017] [Indexed: 12/14/2022]
Abstract
The endometrium maintains complex controls on proliferation and apoptosis as part of repetitive menstrual cycles that prepare the endometrium for the window of implantation and pregnancy. The reliance on inflammatory mechanisms for both implantation and menstruation creates the opportunity in the setting of endometriosis for establishment of chronic inflammation that is disruptive to endometrial receptivity, causing both infertility and abnormal bleeding. Clinically, there can be little doubt that the endometrium of women with endometriosis is less receptive to embryo implantation, and strong evidence exists to suggest that endometrial changes are associated with decreased cycle fecundity as a result of this disease. Here we provide unifying concepts regarding those changes and how they are coordinated to promote progesterone resistance and estrogen dominance through aberrant cell signaling pathways and reduced expression of key homeostatic proteins in eutopic endometrium of women with endometriosis.
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Affiliation(s)
- Bruce A Lessey
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Greenville Health System, Greenville, South Carolina.
| | - J Julie Kim
- Division of Reproductive Science in Medicine, Department of Obstetrics and Gynecology, and Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois
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Expectant management may reduce overtreatment in women affected by unexplained infertility confirmed by diagnostic laparoscopy. Arch Gynecol Obstet 2016; 295:427-433. [PMID: 27873054 DOI: 10.1007/s00404-016-4246-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Accepted: 11/15/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE To determine whether the mini-invasive surgery still play a role in the diagnostic workup and in the management of the couples affected by unexplained infertility. METHODS 170 infertile women (age range 25-38 years) with documented normal ovarian, tubal and uterine function underwent combined hysteroscopic and laparoscopic surgery; 100 women refused surgery or ART treatment (control group) choosing expectant management. A retrospective assessment questionnaire was proposed to enrolled women to collect the rate of spontaneous or ART-induced pregnancies. RESULTS The combined surgery revealed pelvic pathologies in 49.4% of patients, confirming the diagnosis of unexplained infertility only in 86 of studied patients. In this group of 86 selected women, 28 of them achieved a spontaneous pregnancy and 23 women obtained pregnancy after ART. The Chi-square analysis shows that the pregnancy rate was not influenced by the employment of ART. In the group of 100 control women, only 14 (14%) achieved a spontaneous pregnancy after 18 months of expectant management. CONCLUSIONS Combined laparoscopy and hysteroscopy in women with unexplained infertility may reveal previously undiagnosed pathologies that could require ART, and in those without abnormal surgical finding, ART does not improve pregnancy rate.
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Evans-Hoeker E, Lessey BA, Jeong JW, Savaris RF, Palomino WA, Yuan L, Schammel DP, Young SL. Endometrial BCL6 Overexpression in Eutopic Endometrium of Women With Endometriosis. Reprod Sci 2016; 23:1234-41. [PMID: 27222232 PMCID: PMC5933165 DOI: 10.1177/1933719116649711] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The objective of this study was to examine B-cell CLL/lymphoma 6 (BCL6) expression in human eutopic endometrium across the menstrual cycle in women with and without endometriosis and to establish a cutoff for future studies. This design was a series of case-control studies in tertiary University teaching hospitals. We examined BCL6 expression by messenger RNA and immunohistochemically in prospectively collected samples in both the proliferative (P) and the secretory phases. BCL6 is minimally increased in the mid-secretory phase of the menstrual cycle compared to the P phase in normal patients. BCL6 protein expression was significantly higher in the secretory phase of patients with endometriosis (n = 29) versus fertile controls without endometriosis at laparoscopy (n = 20; P < .0001). Normal fertile controls (n = 28) recruited for endometrial biopsy also had low levels of secretory phase BCL6 expression compared to women with unexplained infertility (UI; n = 119). A receiving-operator characteristic analysis of these data revealed an area under the curve of 94% (95% confidence interval 85%-100%; P < .0001) with an HSCORE cutoff of 1.4 to differentiate cases with and without endometriosis. Using this cutoff value, BCL6 was positive in 88% of cases with UI. Laparoscopic examination of a subset of 65 patients confirmed abnormalities in 98% of cases; 61 (93.8%) were found to have endometriosis, 3 (4.6%) with hydrosalpinx, and 1 (1.5%) with a normal pelvis. These data suggest that BCL6 is a promising candidate as a single diagnostic biomarker for detection of endometriosis in women with otherwise UI and may be associated with endometrial dysfunction, including progesterone resistance.
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Affiliation(s)
- Emily Evans-Hoeker
- Obstetrics and Gynecology, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA Obstetrics and Gynecology, Carilion Clinic, Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Bruce A Lessey
- Obstetrics and Gynecology, Greenville Health System, Greenville, SC, USA
| | - Jae Wook Jeong
- Obstetrics, Gynecology and Reproductive Biology of Michigan State University, Grand Rapids, MI, USA Department of Women's Health, Spectrum Health System, Grand Rapids, MI, USA
| | - Ricardo F Savaris
- Departamento de Ginecologia e Obstetricia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | - Wilder A Palomino
- Institute for Maternal and Child Research, University of Chile, Santiago, Chile
| | - Lingwen Yuan
- Obstetrics and Gynecology, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
| | - David P Schammel
- Pathology Associates, Greenville Health System, Greenville, SC, USA
| | - Steven L Young
- Obstetrics and Gynecology, University of North Carolina-Chapel Hill, Chapel Hill, NC, USA
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Tsuji I, Fujinami N, Kotani Y, Tobiume T, Aoki M, Murakami K, Kanto A, Takaya H, Ukita M, Shimaoka M, Nakai H, Suzuki A, Mandai M. Reproductive Outcome of Infertile Patients with Fibroids Based on the Patient and Fibroid Characteristics; Optimal and Personalized Management. Gynecol Obstet Invest 2015; 81:325-32. [DOI: 10.1159/000441788] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 10/15/2015] [Indexed: 11/19/2022]
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Berker B, Şükür YE, Aytaç R, Atabekoğlu CS, Sönmezer M, Özmen B. Infertility work-up: To what degree does laparoscopy change the management strategy based on hysterosalpingography findings? J Obstet Gynaecol Res 2015; 41:1785-90. [DOI: 10.1111/jog.12803] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 05/26/2015] [Accepted: 06/09/2015] [Indexed: 11/27/2022]
Affiliation(s)
- Bülent Berker
- Department of Obstetrics and Gynecology; Ankara University School of Medicine; Ankara Turkey
| | - Yavuz Emre Şükür
- Department of Obstetrics and Gynecology; Ankara University School of Medicine; Ankara Turkey
| | - Ruşen Aytaç
- Department of Obstetrics and Gynecology; Ankara University School of Medicine; Ankara Turkey
| | - Cem Somer Atabekoğlu
- Department of Obstetrics and Gynecology; Ankara University School of Medicine; Ankara Turkey
| | - Murat Sönmezer
- Department of Obstetrics and Gynecology; Ankara University School of Medicine; Ankara Turkey
| | - Batuhan Özmen
- Department of Obstetrics and Gynecology; Ankara University School of Medicine; Ankara Turkey
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Boujenah J, Montforte M, Hugues J, Sifer C, Poncelet C. Y a-t-il une place pour la cœlioscopie dans le parcours en assistance médicale à la procréation ? ACTA ACUST UNITED AC 2015; 43:604-11. [DOI: 10.1016/j.gyobfe.2015.07.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 07/16/2015] [Indexed: 10/23/2022]
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Mishra VV, Gaddagi RA, Aggarwal R, Choudhary S, Sharma U, Patel U. Prevalence; Characteristics and Management of Endometriosis Amongst Infertile Women: A One Year Retrospective Study. J Clin Diagn Res 2015; 9:QC01-3. [PMID: 26266170 PMCID: PMC4525559 DOI: 10.7860/jcdr/2015/13687.6125] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2015] [Accepted: 04/27/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND Endometriosis appears to affect every aspect of a women's reproductive system resulting in infertility and spontaneous pregnancy loss. This study aims to find out the prevalence & clinical characteristics of endometriosis amongst infertile women. SETTINGS AND DESIGN A Hospital based retrospective study over a period of one year. MATERIALS AND METHODS It is a retrospective study conducted in the gynaecology department in Institute of Kidney Diseases & Research Centre; Ahmedabad from April 2012 to March 2013 amongst women with a primary complaint of infertility (Primary/Secondary).A total of 372 patients underwent diagnostic hysterolaparoscopy and of these 180 patients who had laparoscopic evidence of endometriosis was included in the study. All of these patients and their findings were analysed with respect to the clinical signs and symptoms. The outcome after appropriate management was analysed in subsequent follow up. STATISTICAL ANALYSIS All collected data was entered into the SPSS version 20. Categorical data are expressed in frequency or percentage. Chi-Square test and Fisher-Exact test has been performed to carry out p-value for categorical data. P-value <0.05 shows statistically significant difference. RESULTS The frequency of endometriosis among women with infertility subjected to diagnostic hysterolaparoscopy was found to be 48.38%. Statistical significant association with severity of disease was associated with symptoms like dysmenorrhea, chronic pelvic pain, restricted uterine mobility and adnexal tenderness. (p <0.01) Ultrasound finding of endometrioma with ground glas appearance also had statistical significant association with staging of disease (p <0.01). CONCLUSION Endometriosis amongst infertile women is increasingly being detected due to greater use of laparoscopy in evaluation of infertility.Though most signs do not correlate with severity of disease however the presence of restricted uterine mobility, adnexal tenderness & chronic pelvic pain should always raise the suspicion of endometriosis. Laparoscopy remains the gold standard for diagnosing and staging endometriosis.
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Affiliation(s)
- Vineet V Mishra
- Professor and HOD, Department of Obstetrics and Gynaecology, Institute of Kidney Diseases and Research Centre, Ahmedabad, India
| | - Rashmi A Gaddagi
- Clinical Fellow, Department of Obstetrics and Gynaecology, Institute of Kidney Diseases and Research Centre, Ahmedabad, India
| | - Rohina Aggarwal
- Associate Professor, Department of Obstetrics and Gynaecology, Institute of Kidney Diseases and Research Centre, Ahmedabad, India
| | - Sumesh Choudhary
- Assistant Professor, Department of Obstetrics and Gynaecology, Institute of Kidney Diseases and Research Centre, Ahmedabad, India
| | - Urmila Sharma
- Clinical Fellow, Department of Obstetrics and Gynaecology, Institute of Kidney Diseases and Research Centre, Ahmedabad, India
| | - Ushma Patel
- Clinical Fellow, Department of Obstetrics and Gynaecology, Institute of Kidney Diseases and Research Centre, Ahmedabad, India
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De Fr�ne V, Gerris J, Weyers S, Dhont M, Vansteelandt S, Annemans L, De Sutter P. Gonadotropin Therapy versus Laparoscopic Ovarian Drilling in Clomiphene Citrate-Resistant Polycystic Ovary Syndrome Patients: A Retrospective Cost-Effectiveness Analysis. Gynecol Obstet Invest 2015; 80:164-9. [DOI: 10.1159/000373888] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 01/07/2015] [Indexed: 11/19/2022]
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20
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Clinical and endocrine features of Brazilian infertile women with or without endometriosis: A comparative cross-sectional study. ASIAN PACIFIC JOURNAL OF REPRODUCTION 2014. [DOI: 10.1016/s2305-0500(14)60039-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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21
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Firmal P, Yadav R, Agrawal S. A prospective study to evaluate the role of laparohysteroscopy in unexplained infertility. J OBSTET GYNAECOL 2014; 35:386-8. [DOI: 10.3109/01443615.2014.960821] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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22
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Salama AH, Hassan SS, Abo El Maged AEH. Laparoscopic assessment of infertile women with normal hysterosalpingogram. EVIDENCE BASED WOMENʼS HEALTH JOURNAL 2014; 4:122-126. [DOI: 10.1097/01.ebx.0000435392.67105.c8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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23
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Zhang E, Zhang Y, Fang L, Li Q, Gu J. Combined hysterolaparoscopy for the diagnosis of female infertility: a retrospective study of 132 patients in china. Mater Sociomed 2014; 26:156-7. [PMID: 25126006 PMCID: PMC4130695 DOI: 10.5455/msm.2014.26.156-157] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2014] [Accepted: 06/20/2014] [Indexed: 11/05/2022] Open
Abstract
Objectives: To evaluate the effects and safeness of combined hysterolaparoscopy on evaluation the causes of infertility. Methods: This retrospective study was conducted at the Department of Gynecology (The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, Guangdong, China) from January 2011 to April 2014. Patients aged 21–43 years with infertility were included in this study. The prevalence of different lesions was collected to analyze. Results: 132 infertile patients were included, 71 (53.8%) women had primary infertility and the rest 61 (46.2%) had secondary infertility. Laparoscopic abnormalites were more common than hysteroscopy abnormalites both in primary infertility group and secondary infertility group. Pelvic inflammatory disease (59.09 %) and endometriosis (29.55%) were the most common abnormalities in two groups. The most common intrauterine pathology was uterine polyps and the most common uterine malformation was uterine septum in two groups. Out of 12 patients having malformation uterus, only one was double uterus and double cervical with double vagina. There was no major surgical or anesthetic complication in any of our patients, other than mild abdominal pain. Conclusion: Hysterolaparoscopy is an effective and safe tool in comprehensive evaluation of infertility to diagnosis and treat the lesions of pelvic and uterus in the same time. Hysterolaparoscopy may be recommended as the first and final procedure for evaluation of female infertility.
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Affiliation(s)
- Erhong Zhang
- Department of Infertility and Sexual Medicine, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yanan Zhang
- Department of Infertility and Sexual Medicine, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Li Fang
- Department of Gynecology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Qingdong Li
- Department of Gynecology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Jian Gu
- Department of Gynecology, The Third Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
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Younas K, Majoko F, Sheard K, Edwards C, Bunkheila A. Select and treat at laparoscopy and dye test improves the spontaneous pregnancy. HUM FERTIL 2014; 17:56-9. [PMID: 24564499 DOI: 10.3109/14647273.2014.880522] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Infertility affects 1 in 7 couples in the UK. Tubal patency tests are an important part of infertility investigations. We conducted this observational study to determine the interval between a laparoscopy and dye test and spontaneous conception in women with unexplained infertility and minimal to mild endometriosis and pelvic adhesions treated during the procedure. The clinical records of 432 women coded as having had a laparoscopy and dye test or laparoscopy and tubal patency test between April 2007 and March 2010 were retrieved from a computerised theatre database. Pregnancies were identified through a computerised maternity booking system. Spontaneous pregnancies were recorded in 162 women following surgery (37.5%). There was a significant difference in conception rates between women with unexplained infertility and those with minor abnormalities treated at the time of diagnosis (43% vs. 58%, p = 0.019). Eighty percent of women who conceived spontaneously achieved their pregnancy within 18 months of surgery. A high proportion of women with unexplained infertility or minor abnormalities treated at the time of a laparoscopy and dye test conceived spontaneously within 12 months.
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Affiliation(s)
- Kinza Younas
- Department of Obstetric and Gynaecology, Singleton Hospital , Swansea, Wales , UK
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Nayak PK, Mahapatra PC, Mallick J, Swain S, Mitra S, Sahoo J. Role of diagnostic hystero-laparoscopy in the evaluation of infertility: A retrospective study of 300 patients. J Hum Reprod Sci 2013; 6:32-4. [PMID: 23869148 PMCID: PMC3713574 DOI: 10.4103/0974-1208.112378] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2012] [Revised: 11/04/2012] [Accepted: 02/27/2013] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE: To determine the role of diagnostic hysterolaparoscopy in the evaluation of infertility in tertiary care centres. MATERIALS AND METHODS: This retrospective study was conducted at two tertiary care centres (the infertility clinics of Sriram Chandra Bhanj Medical College and Prachi hospital at Cuttack, Odisha) throughout the year in 2008. Women aged 20-40 years with normal hormone profile without male factor infertility were included. RESULTS: Out of 300 cases, 206 (69%) patients had primary infertility. While laparoscopy detected abnormalities in 34% of the cases, significant hysteroscopy findings were noted in 18% of cases. Together, diagnostic hysterolaparoscopy detected abnormalities in 26% of the infertile patients in both groups. While the most common laparoscopic abnormality was endometriosis (14%) and adnexal adhesion (12%) in primary and secondary infertile patients, respectively, hysteroscopy found intrauterine septum as the most common abnormality in both groups. CONCLUSIONS: Hysterolaparoscopy is an effective diagnostic tool for evaluation of certain significant and correctable tubo-peritoneal and intrauterine pathologies like peritoneal endometriosis, adnexal adhesions, and subseptate uterus, which are usually missed by other imaging modalities.
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Affiliation(s)
- Prasanta K Nayak
- Department of Obstetrics and Gynaecology, Sriram Chandra Bhanj Medical College, Odisha, India
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Canny GO, Lessey BA. The role of lipoxin A4 in endometrial biology and endometriosis. Mucosal Immunol 2013; 6:439-50. [PMID: 23485944 PMCID: PMC4062302 DOI: 10.1038/mi.2013.9] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Lipoxin A4 (LXA4), an endogenous anti-inflammatory and immunomodulatory mediator studied in many disease states, is recently appreciated as a potentially significant player in the endometrium. This eicosanoid, synthesized from arachidonic acid via the action of lipoxygenase enzymes, is likely regulated in endometrial tissue during the menstrual cycle. Recent studies revealed that LXA4 acts as an estrogen receptor agonist in endometrial epithelial cells, antagonizing some estrogen-mediated activities in a manner similar to the weak estrogen estriol, with which it shares structural similarity. LXA4 may also be an anti-inflammatory molecule in the endometrium, though its precise function in various physiological and pathological scenarios remains to be determined. The expression patterns for LXA4 and its receptor in the female reproductive tract suggest a role in pregnancy. The present review provides an oversight of its known and putative roles in the context of immuno-endocrine crosstalk. Endometriosis, a common inflammatory condition and a major cause of infertility and pain, is currently treated by surgery or anti-hormone therapies that are contraceptive and associated with undesirable side effects. LXA4 may represent a potential therapeutic and further research to elucidate its function in endometrial tissue and the peritoneal cavity will undoubtedly provide valuable insights.
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Affiliation(s)
- GO Canny
- Geneva Foundation for Medical Education and Research, Versoix, Switzerland
| | - BA Lessey
- University of South Carolina School of Medicine—Greenville, Greenville, SC, USA
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Tsuji I, Ami K, Fujinami N, Hoshiai H. The significance of laparoscopy in determining the optimal management plan for infertile patients with suspected tubal pathology revealed by hysterosalpingography. TOHOKU J EXP MED 2013; 227:105-8. [PMID: 22687706 DOI: 10.1620/tjem.227.105] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The fallopian tube has numerous functions, including ovum pick-up, the place of fertilization of the ovum and cleavage of the embryo, and transfer of the embryo to the uterus. Tubal pathology impairs functions of the fallopian tube and reduces fertility. The degree of tubal pathology determines the possibility for fertility. The evaluation of the fallopian tube is necessary to determine the management plan of infertility. Hysterosalpingography (HSG) is often performed as a first line approach to assess tubal patency and the presence of adhesions; however, HSG has limitations in detecting tubal pathology. In the current study, we evaluated the significance of laparoscopy in determining the optimal management plan for infertile patients with suspected tubal pathology revealed by HSG. Between 1997 and 2009, 127 patients with suspected tubal pathology as demonstrated by HSG underwent laparoscopy at Kinki University Hospital, and a retrospective analysis was performed. Of 87 patients with unilateral tubal pathology revealed by HSG, 20 patients (23.0%) were given an indication for assisted reproductive technology (ART), based on the laparoscopic findings. Of 40 patients with bilateral tubal pathology revealed by HSG, 33 patients (82.5%) with bilateral tubal pathology detected by laparoscopy were given a high indication for ART. Laparoscopy enables exact evaluation of the fallopian tube and selection of the optimal management plan in infertile patients with suspected tubal pathology revealed by HSG. Therefore, laparoscopy should be performed in infertile patients with suspected tubal pathology revealed by HSG, as it is of diagnostic importance.
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Affiliation(s)
- Isao Tsuji
- Department of Obstetrics and Gynecology, Kinki University Faculty of Medicine, Osakasayama, Osaka, Japan.
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28
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de Medeiros SF, Yamamoto MMW, Galera BB, de Medeiros MAS, Barbosa JS. Reassessment of the laparoscopy role in the investigation of infertility and treatment plan determination. ASIAN PACIFIC JOURNAL OF REPRODUCTION 2012. [DOI: 10.1016/s2305-0500(13)60056-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Bonneau C, Chanelles O, Sifer C, Poncelet C. Use of laparoscopy in unexplained infertility. Eur J Obstet Gynecol Reprod Biol 2012; 163:57-61. [PMID: 22512828 DOI: 10.1016/j.ejogrb.2012.03.036] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Revised: 11/21/2011] [Accepted: 03/22/2012] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The use of laparoscopy in unexplained infertility work-up is still a subject of debate, although laparoscopy remains the gold standard for diagnosis and treatment of several pelvic pathologies. The objective of this study was to assess the rates and types of pelvic pathologies observed during diagnostic laparoscopy, and the pregnancy rate in couples with unexplained infertility following laparoscopy. STUDY DESIGN Prospective study, from November 2003 to October 2009, including 114 infertile, spontaneously ovulating women with normal clinical examination, ovarian reserve assessment, pelvic ultrasound scan and patent tubes on hysterosalpingography. Semen analyses were normal according to the World Health Organization criteria. After three cycles of ovulation induction with or without intra-uterine insemination and no pregnancy, women were referred for diagnostic laparoscopy. RESULTS Laparoscopy revealed pelvic pathology in 95 patients. Endometriosis, pelvic adhesions and tubal disease were observed and treated in 72, 46 and 24 patients, respectively. Following laparoscopy, bilateral and unilateral tubal patencies were observed in 107 and five patients, respectively. Pregnancy was observed in 77 out of 102 patients who tried to conceive after surgery, 35 of whom conceived using their own tubes. CONCLUSION Diagnostic laparoscopy should be strongly considered in unexplained infertility work-up, and tubal efficiency should not be underestimated.
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Affiliation(s)
- C Bonneau
- Department of Obstetrics and Gynaecology, Pôle Femme-et-Enfant, CHU Jean Verdier, APHP, Bondy, France
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Abstract
OBJECTIVE To provide a focused review of the scientific literature pertaining to endometrial receptivity. DESIGN Review of the literature and appraisal of relevant articles. SETTING Academic teaching hospital. PATIENT(S) Women with infertility. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Critical review of the literature. RESULT(S) Although a consensus has been achieved regarding the existence of a temporally defined period during which embryo attachment and invasion can occur (called the "window of implantation"), reliable methods to assess "receptivity" have not been established or adequately validated. In women with certain gynecologic disorders, including endometriosis, tubal disease, and polycystic ovary syndrome, endometrial receptivity seems to be compromised, leading to infertility and pregnancy loss. The establishment of reliable biomarkers for the detection of defects in endometrial receptivity has been a long-sought goal that remains an elusive target. The validation of endometrial biomarkers will require properly designed and implemented studies based on the recognition that endometrial receptivity defects are not equally distributed in women with endometriosis or these other conditions. CONCLUSION(S) Rapidly advancing technologies are bringing new biomarkers to the clinical arena that promise to further reveal the complexities of the implantation process.
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31
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[Should a laparoscopy be necessary in case of infertility with normal tubes at hysterosalpingography?]. ACTA ACUST UNITED AC 2011; 39:504-8. [PMID: 21820937 DOI: 10.1016/j.gyobfe.2011.07.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2011] [Accepted: 06/06/2011] [Indexed: 11/24/2022]
Abstract
The aetiological assessment of an infertile couple includes several complementary biological and morphological examinations. Initial exploration of the female genital tract requires the performance of pelvic ultrasound and hysterosalpingography. The value of systematic laparoscopy in infertility assessment is still subject to debate. The aim of the present review is to evaluate arguments against the systematic use of laparoscopy and to define the place of the other tests as Chlamydia Trachomatis serology, hysterosalpingosonography and MR-IRM. In our opinion, laparoscopy is of course indicated in infertility assessments not only when anomalies are revealed by hysterosalpingography but also in the following circumstances: past history of infection (especially a positive Chlamydia antibody blood test) and/or pelvic surgery (a significant risk of adhesions), unexplained secondary infertility, unexplained infertility after the age of 38 (when choosing between artificial insemination and direct enrolment in an IVF programme) and failure of 3 cycles of good-quality intra-uterine inseminations (with ovarian stimulation and a sufficient number of spermatozoids).
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Current practice in tubal surgery and adhesion management: a review. Reprod Biomed Online 2011; 23:53-62. [DOI: 10.1016/j.rbmo.2011.03.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2010] [Revised: 03/13/2011] [Accepted: 03/22/2011] [Indexed: 11/19/2022]
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