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Bouko-Levy E, Vialaret C, Sallée C, Marquet P, Margueritte F, Dion L, Lavoue V, Gauthier T. Estimation of the prevalence of uterine infertility and its different causes in France according to data from a literature review. J Gynecol Obstet Hum Reprod 2023; 52:102684. [PMID: 37866776 DOI: 10.1016/j.jogoh.2023.102684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 10/20/2023] [Indexed: 10/24/2023]
Abstract
INTRODUCTION Uterine infertility (UI) is defined as the complete absence of a uterus (absolute uterine infertility or AUI) or the presence of a non functional uterus (non-absolute uterine infertility or NAUI). The exact prevalence of uterine infertility is currently unknown. Our aim was to assess the number of French women concerned by Uterine Infertility according to a recent literature review. MATERIALS AND METHODS We have previously conducted a systematic review of the literature on UI and its various causes in the world. Based on these study and demographic data of 2022 from INSEE (Institut National de la Statistique et des Études Économiques), we attempted to estimate the number of women under 40 years of age in France affected by potential UI using direct standardization. RESULTS AND DISCUSSION Based on the estimation from INSEE data, approximately 2066 women of childbearing age would have MRKH syndrome in France, 380 the Androgen Insensitivity Syndrome and 3700 had an haemostasis hysterectomy in France. We did not find data on the prevalence of hysterectomies before the age of 40 in France. For the following pathologies: uterine malformations, radiation uterus, synechiae, myomas and adenomyosis there was a huge amount of missing data, which does not allow us to estimate the number of potentially infertile patients. CONCLUSION Prevalence of UI is poorly known. UI probably concerns several thousand patients in France. The creation of a UI registry would make enable to assess the number of patients potentially eligible for adoption, uterus transplantation or even surrogacy.
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Affiliation(s)
- E Bouko-Levy
- Department of Gynecology and Obstetrics, Mother and Child Hospital, University Hospital Center of Limoges, Limoges 87000, France
| | - C Vialaret
- Department of Gynecology and Obstetrics, Mother and Child Hospital, University Hospital Center of Limoges, Limoges 87000, France
| | - C Sallée
- Department of Gynecology and Obstetrics, Mother and Child Hospital, University Hospital Center of Limoges, Limoges 87000, France
| | - P Marquet
- Pharmacology and Transplantation, INSERM U1248, Université de Limoges, 2 Rue du Pr Descottes, Limoges 87000, France
| | - F Margueritte
- Department of Gynecology and Obstetrics, Mother and Child Hospital, University Hospital Center of Limoges, Limoges 87000, France
| | - L Dion
- Department of Obstetrics and Gynecology, Hopital Universitaire de Rennes, Rennes 35000, France
| | - V Lavoue
- Department of Obstetrics and Gynecology, Hopital Universitaire de Rennes, Rennes 35000, France
| | - T Gauthier
- Department of Gynecology and Obstetrics, Mother and Child Hospital, University Hospital Center of Limoges, Limoges 87000, France; Pharmacology and Transplantation, INSERM U1248, Université de Limoges, 2 Rue du Pr Descottes, Limoges 87000, France.
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Cao Y, Sun H, Zhu H, Zhu X, Tang X, Yan G, Wang J, Bai D, Wang J, Wang L, Zhou Q, Wang H, Dai C, Ding L, Xu B, Zhou Y, Hao J, Dai J, Hu Y. Allogeneic cell therapy using umbilical cord MSCs on collagen scaffolds for patients with recurrent uterine adhesion: a phase I clinical trial. Stem Cell Res Ther 2018; 9:192. [PMID: 29996892 PMCID: PMC6042450 DOI: 10.1186/s13287-018-0904-3] [Citation(s) in RCA: 134] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 03/14/2018] [Accepted: 05/14/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intrauterine adhesions (IUA) are the most common cause of uterine infertility and are caused by endometrium fibrotic regeneration following severe damage to the endometrium. Although current stem cell treatment options using different types of autologous stem cells have exhibited some beneficial outcomes in IUA patients, the reported drawbacks include variable therapeutic efficacies, invasiveness and treatment unavailability. Therefore, the development of new therapeutic stem cell treatments is critical to improving clinical outcomes. METHODS Twenty-six patients who suffered from infertility caused by recurrent IUA were enrolled in this prospective, non-controlled, phase I clinical trial with a 30-month follow-up. During the procedure, 1 × 107 umbilical cord-derived mesenchymal stromal cells (UC-MSCs), loaded onto a collagen scaffold, were transplanted into the uterine cavity following an adhesion separation procedure. Medical history, physical examination, endometrial thickness, intrauterine adhesion score and the biological molecules related to endometrial proliferation and differentiation were assessed both before and 3 months after cell therapy. RESULTS No treatment-related serious adverse events were found. Three months after the operation, the average maximum endometrial thickness in patients increased, and the intrauterine adhesion score decreased compared to those before the treatment. A histological study showed the upregulation of ERα (estrogen receptor α), vimentin, Ki67 and vWF (von Willebrand factor) expression levels and the downregulation of ΔNP63 expression level, which indicates an improvement in endometrial proliferation, differentiation and neovascularization following treatment. DNA short tandem repeat (STR) analysis showed that the regenerated endometrium contained patient DNA only. By the end of the 30-month follow-up period, ten of the 26 patients had become pregnant, and eight of them had delivered live babies with no obvious birth defects and without placental complications, one patient in the third trimester of pregnancy, and one had a spontaneous abortion at 7 weeks. CONCLUSIONS Transplanting clinical-grade UC-MSCs loaded onto a degradable collagen scaffold into the uterine cavity of patients with recurrent IUA following adhesiolysis surgery is a safety and effective therapeutic method. TRIAL REGISTRATION Clinicaltrials.gov . NCT02313415 , Registered December 6, 2014.
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Affiliation(s)
- Yun Cao
- The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Haixiang Sun
- The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Hui Zhu
- The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Xianghong Zhu
- The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Xiaoqiu Tang
- The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Guijun Yan
- The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Jingmei Wang
- The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Donghui Bai
- Institute of Zoology, Chinese Academy of Sciences, 1 West Beichen Road, Chaoyang district, Beijing, 100101, China
| | - Juan Wang
- Institute of Zoology, Chinese Academy of Sciences, 1 West Beichen Road, Chaoyang district, Beijing, 100101, China
| | - Liu Wang
- Institute of Zoology, Chinese Academy of Sciences, 1 West Beichen Road, Chaoyang district, Beijing, 100101, China
| | - Qi Zhou
- Institute of Zoology, Chinese Academy of Sciences, 1 West Beichen Road, Chaoyang district, Beijing, 100101, China
| | - Huiyan Wang
- The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Chengyan Dai
- The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Lijun Ding
- The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Biyun Xu
- The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China
| | - Yan Zhou
- University of California, San Francisco, CA, USA
| | - Jie Hao
- Institute of Zoology, Chinese Academy of Sciences, 1 West Beichen Road, Chaoyang district, Beijing, 100101, China.
| | - Jianwu Dai
- Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, 3 Nanyitiao, Zhongguancun, Beijing, 100190, China.
| | - Yali Hu
- The Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, China. .,Department of Obstetrics and Gynecology, Nanjing Drum Tower Hospital and Jiangsu Key Laboratory for Molecular Medicine, Nanjing University Medical School, 321 Zhongshan Road, Nanjing, China.
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Gauthier T, Garnault D, Therme JF, Piver P, Essig M, Pichon N, Marquet P, Aubard Y. [Uterine transplantation: is there a real demand?]. ACTA ACUST UNITED AC 2015; 43:133-8. [PMID: 25595943 DOI: 10.1016/j.gyobfe.2014.12.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 12/17/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To study the demand there is for uterus transplantation (UTx). PATIENTS AND METHODS Recent media coverage of developments in UTx prompted associations of patients with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome and of women suffering from UI to contact us. We sent them anonymous questionnaires devised to sound out their attitude towards UTx and towards adoption and gestational surrogacy (GS). A clinical psychologist also carried out a qualitative discourse analysis. RESULTS Sixty patients answered the questionnaire. Thirty-eight patients were married or living with a male partner. Seven patients had had a hysterectomy. Fifty-one patients had uterine agenesis. Of the 60 patients, 19 and 21, respectively, had ruled out the option of adoption or GS, and 11 would not envisage either possibility. Thirty-five patients were willing to take part in a clinical study into UTx despite the uncertainty of the outcome and the potential risks involved. Of these 35 volunteers, 23 were in a heterosexual relationship and aged ≤35 years. DISCUSSION AND CONCLUSION For women with UI the condition is all the more distressing because there is no medical solution for it. UTx could hold out hope for some of these patients despite the complexity of the procedure and the attendant risks. Because of the feelings of vulnerability engendered by UI, any UTx programme should provide full information to patients and ensure they are carefully screened and selected.
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