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Objective: To explore the feasibility of the "cuff-sleeve" suture method in improving the uterine blood supply after radical trachelectomy (RT). Study design: Patients in the "cuff-sleeve" (n = 25) and traditional group (n = 10) underwent computed tomography angiography (CTA) to evaluate the residual uterine blood supply pattern after the surgery, and the preoperative group patients (n = 20) underwent CTA before the procedure. Results: The uteri of the 20 patients in the preoperative group were all supplied by bilateral uterine arteries of average diameter, 2.25 ± 0.35 mm. The uterine artery-supplying, hybrid supplying, and ovarian artery-supplying patterns accounted for 40 %, 36 %, and 24 % in the "cuff-sleeve" group and 20 %, 50 %, and 30 %, respectively, in the traditional group. The average diameter of the uterine arteries among the uterine artery-supplying pattern in the "cuff-sleeve" group (1.98 ± 0.36 mm) was more extensive than that in the traditional group (1.73 ± 0.15 mm) (p = 0.049). As also, the ovarian artery diameter of the hybrid supplying pattern in the "cuff-sleeve" group (1.65 ± 0.25 mm) was significantly larger than that in the traditional group (1.50 ± 0.35 mm) (p = 0.010). Additionally, while the pregnancy rate in the "cuff-sleeve" group (50.0 %) was higher than that in the traditional group (25.0 %), this difference was not statistically significant. Conclusions: The "cuff-sleeve" suture method was associated with increased diameter of the uterine and ovarian vessels and may be a feasible method to improve the uterine blood supply and pregnancy rate after radical trachelectomy. It still warrants further evaluation for both fertility and oncologic outcomes.
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BACKGROUND: Intrauterine adhesions (IUA) are a challenging clinical problem in reproductive infertility. The most common causes are intrauterine surgery and abortions. We aimed to investigate whether early second-look office hysteroscopy can prevent IUA. METHODS: A single-center, prospective, two-armed, randomized controlled trial was designed to explore the efficacy of early office hysteroscopy after first-trimester induced abortion (suction dilatation and curettage [D&C]) and to further analyze fertility outcomes. Women aged 20-45 years undergoing suction D&C and desiring to conceive were recruited. Between October 2019 and September 2022, 66 women were enrolled, of whom 33 were allocated to group A (early hysteroscopy intervention). The women in intervention group A were planned to receive 2 times of hysteroscopies (early and late). In group B, women only underwent late (6 months post suction D&C) hysteroscopy. RESULTS: The primary outcome was the IUA rate assessed using office hysteroscopy 6 months after artificial abortion. Secondary outcomes included menstrual amount/durations and fertility outcomes. In intervention group A, 31 women underwent the first hysteroscopy examination, and 15 completed the second. In group B (late hysteroscopy intervention, 33 patients), 16 completed the hysteroscopic exam 6 months after an artificial abortion. Twenty-one women did not receive late hysteroscopy due to pregnancy. The IUA rate was 16.1% (5/31) at the first hysteroscopy in group A, and no IUA was detected during late hysteroscopy. Neither group showed statistically significant differences in the follow-up pregnancy and live birth rates. CONCLUSIONS: Early hysteroscopy following suction D&C can detect intrauterine lesions. IUA detected early by hysteroscopy can disappear on late examination and become insignificant for future pregnancies. Notably, the pregnancy outcomes showed a favorable trend in the early hysteroscopy group, but there were no statistically significant differences. TRIAL REGISTRATION: ClinicalTrials.gov , ID: NCT04166500. Registered on 2019-11-10. https://clinicaltrials.gov/ct2/show/NCT04166500 .
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Aborto Induzido , Histeroscopia , Doenças Uterinas , Humanos , Feminino , Histeroscopia/métodos , Histeroscopia/efeitos adversos , Aderências Teciduais/prevenção & controle , Adulto , Doenças Uterinas/diagnóstico , Doenças Uterinas/cirurgia , Doenças Uterinas/prevenção & controle , Gravidez , Aborto Induzido/efeitos adversos , Aborto Induzido/métodos , Estudos Prospectivos , Pessoa de Meia-Idade , Adulto Jovem , Dilatação e Curetagem/métodos , Dilatação e Curetagem/efeitos adversosRESUMO
High-intensity focused ultrasound (HIFU) is commonly used to treat uterine fibroids and adenomyosis, but there is no evidence using metadata to compare fertility outcomes between conventional laparoscopic procedures and HIFU. The purpose of this study analysis is that evidence-based fertility outcomes may provide better treatment options for clinicians and patients considering fertility. The literature on fertility data for HIFU surgery versus laparoscopic myomectomy was searched in seven English language databases from January 1, 2010, to November 23, 2022. A total of 1375 articles were received in the literature, 14 of which were selected. We found that women who underwent HIFU surgery had higher rates of spontaneous pregnancy, higher rates of spontaneous delivery, and higher rates of full-term delivery but may have higher rates of miscarriage or postpartum complications than women who underwent laparoscopic myomectomy. Looking forward to future studies, it is hoped that the literature will examine endometrial differences in women who undergo HIFU and laparoscopic myomectomy to demonstrate the ability of endometrial repair. The location of fibroids in the sample should also be counted to allow for attribution statistics on the cause of miscarriage.
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BACKGROUND: Homeobox genes A10 (HOXA10) and A11 (HOXA11), members of the abdominal B gene family, are responsible for embryonic survival and implantation. This study was planned to investigate whether endometrial injury alters the expression of both transcripts in women with implantation failure. METHODS: A total of 54 women with implantation failure were divided into two equal groups as experimental (scratching) and sham (no scratching). Participants in the scratching group were exposed to endometrial injury in the mid-luteal phase, and those in the sham group were exposed to endometrial flushing. The scratching group, but not the sham group, underwent prior endometrial sampling. A second endometrial sampling was performed on the scratching group in the mid-luteal phase of the following cycle. The mRNA and protein levels of the HOXA10 and 11 transcripts were determined in endometrial samples collected before and after injury/flushing. Participants in each group underwent IVF/ET in the cycle after the second endometrial sampling. RESULTS: Endometrial injury caused a 60.1-fold (p < 0.01) increase in HOXA10 mRNA and a 9.0-fold increase in HOXA11 mRNA (p < 0.02). Injury resulted in a significant increase in both HOXA10 (p < 0.001) and HOXA11 protein expression (p < 0.003). There was no significant change in HOXA10 and 11 mRNA expressions after flushing. Clinical pregnancy, live birth, and miscarriage rates of the both groups were similar. CONCLUSIONS: Endometrial injury increases homeobox transcript expression at both mRNA and protein levels.
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Implantação do Embrião , Infertilidade Feminina , Feminino , Humanos , Gravidez , Implantação do Embrião/genética , Endométrio/metabolismo , Infertilidade Feminina/genética , Nascido Vivo , Fatores de Transcrição/metabolismoRESUMO
OBJECTIVES: To quantify the effect of carnitine on glucose and lipid metabolic profiles and fertility outcomes in women with Polycystic ovary syndrome (PCOS). DESIGN: A systematic review and meta-analysis were conducted. PATIENTS: Women with PCOS diagnosed by Rotterdam or Androgen Excess Society (AES) criteria and taking carnitine supplement were assessment. MEASUREMENTS: Fertility outcomes (ovulation, clinical pregnancy, live birth, and miscarriage), lipid parameters (BMI, triglyceride, total cholesterol, high-density lipoprotein, low-density lipoprotein), fasting glucose and insulin, and Homeostatic Model Assessment for Insulin Resistance (HOMA-IR). RESULTS: In total, 839 participants were included in this analysis. The dosage of carnitine and treatment duration reported by studies varied from 250 mg to 3000 mg daily and 84 to 90 days, respectively. The publication bias was absent. Compared with placebo, carnitine significantly improved ovulation rates (RR 3.42, 95% CI 2.39 to 4.89, I2 = 0%) and pregnancy rates (RR 11.05, 95% CI 1.21 to 100.58, I2 = 79%). None of included studies reported live birth. After treatment, carnitine resulted in significant reductions relative to baseline in body mass index (BMI, MD -0.93 kg/m2, 95% CI -1.15 to -0.70, I2 = 55.0%), insulin levels (MD -2.47 mIU/L, 95% CI -4.49 to -0.45, I2 = 0%) and the Homeostasis Model Assessment index (MD -0.67, 95% CI -1.20 to -0.14, I2 = 0%) than placebo, but not for lipid profiles including triglyceride, total cholesterol, and low-density lipoprotein. CONCLUSION: With the available literature, carnitine seems to improve ovulation and clinical pregnancy and insulin resistance, BMI in women with PCOS. These effects are warranted to be further validated, due to insufficient statistical power.
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Resistência à Insulina , Síndrome do Ovário Policístico , Gravidez , Feminino , Humanos , Síndrome do Ovário Policístico/tratamento farmacológico , Glucose , Carnitina , Fertilidade , Insulina , Lipoproteínas LDL , Triglicerídeos , Colesterol , LipídeosRESUMO
Objective: To investigate the changes in serum ghrelin and leptin levels in patients with clomiphene-resistant polycystic ovary syndrome (PCOS). Materials and Methods: Thirty-five patients who could not achieve ovulation or pregnancy despite using 150 mg/day of clomiphene citrate (CC) participated in the study. Thirty-five patients who were compatible with the study group in terms of age and body mass index (BMI) but did not have clinical and laboratory findings of PCOS constituted the control group. On the third day of the cycle, in addition to the basal hormone profile, ghrelin and leptin levels were also measured. Patients in both groups went to IVF/ICSI. Basal hormone values, leptin, ghrelin, metabolic, demographic parameters, and clinical pregnancy rates were correlated. Results: Patients in both groups were recorded to be similar in terms of age (29.4±0.11 vs 28.5±7.30), BMI (24.3±3.07 vs 23.8±1.55), and infertility time (6.14±4.30 vs 6.03±1.28). Serum ghrelin levels of the PCOS group were significantly lower than the control group (0.48±2.21 vs 1.19±4.02) Serum leptin levels of the PCOS group were significantly higher than the control patients (45.6±304 vs 16.5±0.32). Serum leptin levels and BMI (r=0.65, p<0.01) A positive correlation was found between luteinizing hormone (LH) (r=0.53, p<0.02), and insulin resistance (r=0.74, p<0.03). There was a negative (r=-0.76, p<0.03) correlation between serum ghrelin and LH. A positive and significant correlation was found between serum ghrelin, testosterone, mature oocyte, and implantation rates. Conclusion: Serum ghrelin correlates with fertility outcomes in women with CC-resistant PCOS undergoing IVF/ICSI.
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The objective was to investigate whether the method of treatment (surgical or medical) affects achieving a new pregnancy, as well as the time to and prognosis of the new pregnancy, in women with ectopic pregnancy (EP). Information on patients treated in our hospital between 2013 and 2014 for EP was retrieved from the computerized patient records. Data on whether these patients achieved pregnancy after EP treatment, time from treatment to new pregnancy, and prognosis of pregnancy were collected by phone interviews. A total of 101 women were analyzed. In addition to descriptive analysis, the χ2-test and Kruskal Wallis test were used to compare the groups. A new pregnancy was present in 84 (83.2%) of the women after EP treatment. There was no significant difference among the women having undergone medical treatment (methotrexate), surgical treatment, medical treatment followed by surgical treatment, or observational management approach in terms of achieving a new pregnancy after treatment and time to and prognosis of the new pregnancy. The study could not determine which treatment method would be superior in women with EP and in planning future pregnancy, but concluded that close clinical and laboratory monitoring is appropriate before deciding on aggressive interventions.
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Gravidez Ectópica , Gravidez Tubária , Feminino , Fertilidade , Humanos , Gravidez , Gravidez Tubária/diagnóstico , Gravidez Tubária/cirurgia , Prognóstico , RecidivaRESUMO
STUDY QUESTION: What is the impact of uterine malformations on reproductive and neonatal outcomes of IVF/ICSI-frozen embryo transfer? SUMMARY ANSWER: Unification defective uteri are associated with poorer neonatal outcomes including higher preterm delivery rate and lower birthweight, and septate uteri are associated with worse fertility outcomes including higher miscarriage and lower live birth rates (LBRs). WHAT IS KNOWN ALREADY: Several studies have investigated the negative effects of uterine malformations on pregnancy outcomes. However, an all-round and definitive conclusion has not been reached yet owing to the relatively low incidence of the disease and the heterogeneity of study populations, especially among women undergoing ART. STUDY DESIGN, SIZE, DURATION: This was a retrospective cohort study including 411 women with congenital uterine anomalies and 14â936 women with a normal uterus who underwent first frozen-thawed embryo transfer cycles of IVF/ICSI from July 2008 to August 2019. We compared reproductive outcomes. PARTICIPANTS/MATERIALS, SETTING, METHODS: Reproductive outcomes of women with uterine malformations were studied through three propensity score-matched comparisons (patients with bicorporeal uterus, septate uterus and hemi-uterus [bicorporeal, septate and hemi-uterus groups, respectively] along with corresponding control groups without uterine malformations). We also compared pregnancy and neonatal outcomes, and performed subgroup analysis addressing didelphus, bicornuate uteri and septate uteri before and after surgery independently. MAIN RESULTS AND THE ROLE OF CHANCE: Compared to the matched control group, women with a bicorporeal uterus had a significantly lower LBR (24.4% versus 34.8%, odds ratio (OR) 0.61 [95% CI: 0.37, 1.00], P = 0.048). The incidence of miscarriage and preterm delivery was higher but not statistically significant (29.0% versus 18.1%, OR 1.85 [95% CI: 0.82, 4.19], P = 0.135; 22.6% versus 9.9%, OR 2.64 [95% CI: 1.07, 6.52], P = 0.063, respectively). In addition, the bicorporeal group had a significantly lower gestational age, higher caesarean rate and lower birthweight than bicorporeal control. Women with a septate uterus had comparable clinical pregnancy rates to controls (43.3% versus 49.9%, OR 0.77 [95% CI: 0.57, 1.04], P = 0.091), increased miscarriage rates (23.5% versus 13.0%, OR 2.05 [95% CI: 1.18, 3.58], P = 0.010) and lower LBRs (29.4% versus 42.2%, OR 0.57 [95% CI: 0.41, 0.79], P = 0.001). In both singleton and twins pregnancies, pregnancy and neonatal outcomes were comparable between women with a septate uterus and control. Women with a hemi-uterus had a tendency for lower clinical pregnancy rate (36.8% versus 42.3%, OR 0.80 [95% CI: 0.52, 1.21], P = 0.287) and LBR (29.8% versus 33.1%, OR 0.86 [95% CI: 0.55, 1.34], P = 0.502), compared to women without malformations. The incidences of miscarriage and preterm delivery, respectively, were 16.7% versus 16.6% (OR 1.01 [95% CI: 0.41, 2.47], P = 0.989), and 9.5% versus 11.4% (OR 0.82 [95% CI: 0.27, 2.51], P = 1) in women with a hemi-uterus as compared to control. LIMITATIONS, REASONS FOR CAUTION: This was a single-centre, retrospective study in which neonatal data were extracted from parental questionnaires. The information on uteri septum type and surgery methods was poorly presented, with limited detail. In patients with uterine malformations, the number of babies with birth defects and twin pregnancies was relatively small, limiting the power of the study. WIDER IMPLICATIONS OF THE FINDINGS: Compared to patients with a normal uterus, women with uterine malformation have poorer reproductive outcomes. Pregnant women with a uterine anomaly need to be managed as high-risk pregnancies and followed with appropriate obstetric review. STUDY FUNDING/COMPETING INTEREST(S): This work was supported by the National Ministry of Technology (2018YFC1003000), the Elite Team Project of Ninth People's Hospital affiliated to Shanghai Jiao Tong University School of Medicine (JY201801), Shanghai Sailing Program (21YF1423200) and the Fundamental Research Program Funding of Ninth People's Hospital affiliated to Shanghai Jiao Tong University School of Medicine (JYZZ117). B.W.M. is supported by an NHMRC Investigatorgrant (GNT1176437). B.W.M. reports consultancy (with stock options) for ObsEva. B.W.M. has received research funding from Ferring and Merck. The authors declare no other competing interests. TRIAL REGISTRATION NUMBER: N/A.
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Aborto Espontâneo , Nascimento Prematuro , Aborto Espontâneo/epidemiologia , Aborto Espontâneo/etiologia , Peso ao Nascer , China , Transferência Embrionária/efeitos adversos , Transferência Embrionária/métodos , Feminino , Humanos , Recém-Nascido , Masculino , Gravidez , Taxa de Gravidez , Nascimento Prematuro/epidemiologia , Nascimento Prematuro/etiologia , Estudos Retrospectivos , Injeções de Esperma Intracitoplásmicas/efeitos adversos , Anormalidades Urogenitais , Útero/anormalidades , Útero/cirurgiaRESUMO
STUDY OBJECTIVE: Women with adenomyosis may show a lower pregnancy rate and a higher miscarriage rate than healthy women. There is also a general agreement that leiomyomas, either submucosal or intramural, negatively affect fertility, when compared with women without myomas. Some of these women may benefit from adenomyomectomy, however this cytoreductive procedure is considered invasive and technically challenging especially in severe diffuse cases. The study aimed to compare the clinical and reproductive outcomes of patients who underwent adenomyomectomy with those of patients who underwent intramural myomectomy. DESIGN: A retrospective study. SETTING: Department of Obstetrics & Gynecology, Center of Gynecological Endoscopy and Minimally Invasive surgery, First Faculty of Medicine, General University Hospital in Prague. PATIENTS: A total of 55 women who underwent surgical resection of uterine adenomyosis and 55 patients who underwent myomectomy for intramural uterine myomas were included in this study. All study participants wished to retain and possibly improve their reproductive potential. INTERVENTIONS: Between 2004 and 2019, 110 women underwent laparoscopic or open uterus-sparing surgery for clinically significant uterine adenomyosis (group A) or myomas (group B), respectively. MEASUREMENTS AND MAIN RESULTS: Two groups of women who underwent different fertility-saving procedures were compared. Although all women entering the study had declared their wish to conceive, only 28 patients in group A (group A1) and 24 women in group B (group B1) finally aimed toward pregnancy. The mean age and follow-up period was 35.0 years and 76.81 months, respectively, in group A and 34.8 years and 72.5 months, respectively, in group B. The pregnancy and delivery rates were 75.0% and 46.4%, respectively, in group A1 vs 96.0% and 70.8%, respectively, in group B1, with no significant differences between the 2 groups. The open surgical approach was significantly more frequently employed in group A (47.3% vs 16.4%; p <.01). CONCLUSION: In this study, women who underwent surgery involving the uterine muscularity, including myomectomy or adenomyomectomy, had comparable reproductive outcomes, with no significant differences.
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Adenomiose , Laparoscopia , Leiomioma , Miomectomia Uterina , Neoplasias Uterinas , Adenomiose/cirurgia , Feminino , Humanos , Laparoscopia/métodos , Leiomioma/cirurgia , Gravidez , Estudos Retrospectivos , Resultado do Tratamento , Miomectomia Uterina/métodos , Neoplasias Uterinas/cirurgiaRESUMO
OBJECTIVES: This study was aimed to illustrate the determents of consanguinity and inbreeding coefficient-F (ICF) in the population of Okara district of Pakistan and to elucidate the impact of consanguinity on fertility and birth outcome. METHODS: Through a cross-sectional sampling design, 1,521 married women were recruited from Okara district during 2016-2017. Data on demographic variables, marital union types, subject's fertility, and reproductive outcome, were gathered in face-to-face interviews. Descriptive statistics and multivariable logistic regression were employed. RESULTS: The prevalence of consanguineous unions (CU) was calculated to be 61% yielding ICF=0.0356. Multivariable regression analyses revealed that six variables including younger age at marriage, joint family structure, caste-system of spouse, exchange marriage, matrimonial distance, and parental consanguinity, were significant predictors of consanguinity. The women having CU had significantly higher mean fertility, mean live-births and mean live-born sons compared with subjects having non-consanguineous unions (NCU). However, there were no significant differences in the average mortalities, i.e., prenatal, postnatal and <5 years, between the mothers with CU and NCU. CONCLUSION: The prevalence of consanguineous unions (CU) in Okara district is quite high like other inbred populations of Pakistan. The striking findings of this study are the higher mean fertility and mean live-births in women with CU. The likely reasons underlying this phenomenon have been discussed.
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OBJECTIVE: To describe perioperative adverse events, fertility and obstetric outcome, following a robot assisted laparoscopic approach for treating Cesarean scar pregnancies (CSP). STUDY DESIGN: A retrospective case series of 14 consecutive women with a CSP and a wish for and attempts towards subsequent pregnancies, having undergone minimal invasive surgical treatment at two tertiary referral Swedish centers (Dep's of Obstetrics and Gynecology Skåne University Hospital, Lund, and Södersjukhuset, Stockholm) between 2008 and 2019. The surgery was performed by temporary intraoperative occlusion of the uterine blood supply, removal of the CSP and repair of the niche, by the use of robot assisted laparoscopy (Da Vinci surgical robot, Intuitive Surgical, Sunnyvale, CA). RESULTS: All surgeries were uneventful with a median bleeding of 75 mL. One woman had a postoperative Clavien-Dindo complication grade IIIa (hysteroscopic resection of an isthmic synechiae). During follow up nine women (64 %) conceived naturally; eight of these had an uneventful pregnancy and a full-term Cesarean delivery and one had recurrent CSP and Cesarean with simultaneous hysterectomy in gestational week 33. CONCLUSION: A robotic removal of a CSP with simultaneous repair of the defect is a feasible option with acceptable reproductive outcome and should be considered when counseling women with a wish for future childbirth in cases of a live CSP and a thin, or absent, myometrium in the niche. A temporary intraoperative occlusion of the uterine blood supply may be useful in cases of live pregnancies and/or high serum ß-hCG levels.
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Laparoscopia , Procedimentos Cirúrgicos Robóticos , Robótica , Cicatriz/cirurgia , Feminino , Humanos , Gravidez , Estudos Retrospectivos , Resultado do TratamentoRESUMO
OBJECTIVE: To compare short-term fertility rates after medical and surgical management of early miscarriage. DESIGN: Observational cohort study. SETTING: Academic tertiary-care medical center. PATIENT(S): A total of 203 patients were enrolled between June 2017 and May 2018, comprising 106 surgical evacuations and 97 medical evacuations. INTERVENTION(S): Either surgical or medical evacuation of the uterine cavity. MAIN OUTCOME MEASURE(S): Conception rates 6 months after miscarriage. RESULT(S): Conception rates 6 months after miscarriage among women who had attempted to become pregnant were similar between the medically and surgically evacuated groups (68.0% vs. 65.1%). There were no significant differences in background characteristics between the groups, apart from younger age and earlier gestational age among the medically treated group. There was no difference in the proportion of women using assisted reproductive technologies between the medically and surgically managed groups (15.5% vs. 12.6%, respectively). The median time-to-conception was 4 ± 2 months in both groups. Cumulative pregnancy rate 12 months after pregnancy loss, live birth rate, and repeat miscarriage rate also were similar between groups. CONCLUSION(S): Modality of uterine evacuation after early miscarriage does not affect short-term fertility outcomes.
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Aborto Espontâneo/epidemiologia , Aborto Espontâneo/cirurgia , Dilatação e Curetagem/estatística & dados numéricos , Taxa de Gravidez , Aborto Espontâneo/reabilitação , Adolescente , Adulto , Estudos de Coortes , Dilatação e Curetagem/reabilitação , Feminino , Fertilidade/fisiologia , Humanos , Recém-Nascido , Israel/epidemiologia , Gravidez , Resultado do Tratamento , Adulto JovemRESUMO
OBJECTIVE: To assess the efficacy of selective salpingography (SSG) with additional tubal catheterization (TC) among infertile patients diagnosed with PTO and analysis of reproductive outcome. STUDY DESIGN: Retrospective cohort study. RESULTS: Of a total of 399 tubes with confirmed proximal tubal occlusion, 383 successfully restored their patency resulting in 96 % technical success rate. Thirty-five percent of oviducts that had their patency restored was treated with SSG and 65% required additional TC. Reproductive outcomes at minimum 12 months following the treatment were collected by a telephone survey. 21/221 women were lost to follow up. Out of remaining 200 patients with at least one patent tube, 80 patients conceived which resulted in 40 % overall pregnancy rate. CONCLUSION: Selective salpingography and tubal canalization offer patient-friendly, minimally invasive and cost-effective alternatives to tubal microsurgery and IVF-ET in women with tubal occlusion with very high technical success rate and promising clinical results which depend also on the complexity of couple infertility. Specific indications and limitations make a careful assessment of fallopian tubes and comprehensive evaluation of partners' reproductive situation prior to therapy an absolute requirement.
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Doenças das Tubas Uterinas , Infertilidade Feminina , Cateterismo , Doenças das Tubas Uterinas/complicações , Doenças das Tubas Uterinas/diagnóstico por imagem , Tubas Uterinas/diagnóstico por imagem , Tubas Uterinas/cirurgia , Feminino , Humanos , Histerossalpingografia , Infertilidade Feminina/diagnóstico por imagem , Infertilidade Feminina/terapia , Gravidez , Taxa de Gravidez , Estudos RetrospectivosRESUMO
With delayed childbearing in women, preservation of fertility is an important issue for reproductive-age patients with epithelial ovarian carcinoma (EOC). Fertility-sparing surgery (FSS) can be considered in patients with early-stage disease in order to preserve fertility and improve quality of life. In order to evaluate oncological safety, attitudes toward childbearing and reproductive outcomes in women with EOC who underwent FSS, this multicenter retrospective study was conducted. Between January 2005 and December 2014, total of 87 young women with FIGO stage I EOC were included, with their clinicopathologic parameters in relation to disease-free survival (DFS) and overall survival (OS) assessed. Attitudes toward childbearing, ovarian function and fertility were studied in women undergoing FSS (n=36). As a result, in contrast to radical surgery, FSS did not affect prognosis by Kaplan-Meier curves (log-rank test; DFS: P=0.484; OS: P=0.125). However, two of the three recurrence cases and both death cases were in FSS group stage IC. All women undergoing FSS resumed regular menstrual periods after chemotherapy. Only 16 (44.44%) had tried to conceive, and 17 pregnancies occurred in 15 (93.75%) women. Among 20 women who did not attempt conception, the most common reason was not being married (70%), followed by already having children (15%). In summary, FSS is considered safe in young women with stage IA EOC. Regular menstruation and good obstetric outcomes can be achieved. This study also provides some insight into the attitudes and social factors regarding fertility in EOC patients.
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Carcinoma Epitelial do Ovário/cirurgia , Preservação da Fertilidade/métodos , Neoplasias Ovarianas/cirurgia , Ovariectomia/métodos , Adolescente , Adulto , Carcinoma Epitelial do Ovário/psicologia , Feminino , Preservação da Fertilidade/psicologia , Humanos , Estadiamento de Neoplasias , Tratamentos com Preservação do Órgão/métodos , Tratamentos com Preservação do Órgão/psicologia , Neoplasias Ovarianas/psicologia , Ovariectomia/psicologia , Gravidez , Taxa de Gravidez , Prognóstico , Qualidade de Vida/psicologia , Estudos Retrospectivos , Análise de Sobrevida , Resultado do Tratamento , Adulto JovemRESUMO
Little attention has been paid to the influence of asymptomatic colonizers of genital tract on female infertility. Albeit, a variety of uropathogens have been known to negatively alter sperm parameters in vitro, but their impact on female fertility outcome under in vivo conditions is not clearly established. Therefore, the present study was intended to investigate the effect of Pseudomonas aeruginosa on sperm parameters and to identify its role in female infertility. The strain of P. aeruginosa was found to reduce sperm motility, viability and sperm Mg++ATPase activity. It could also lead to premature acrosomal loss and induce morphological defect in spermatozoa. For fertility studies, female mice administered intravaginally with 104, 106, 108â¯cfu of P. aeruginosa for 10 consecutive days, were allowed to mate with proven breeder male on day 12. The results showed that group of mice receiving P. aeruginosa were rendered infertile whereas group receiving PBS showed abdominal distension, string of pearls and finally delivered pups at the end of gestation period. Further, no other clinical manifestation could be observed apparently, histologically or immunologically. Thus, it can be concluded that infertility in mice might be attributed to asymptomatic colonization of genital tract with sperm immobilizing P. aeruginosa.
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Infertilidade/etiologia , Infertilidade/microbiologia , Infecções por Pseudomonas/complicações , Pseudomonas aeruginosa/crescimento & desenvolvimento , Vagina/microbiologia , Acrossomo/metabolismo , Administração Oral , Animais , Antibacterianos/farmacologia , ATPase de Ca(2+) e Mg(2+)/metabolismo , Sobrevivência Celular , Citocinas/análise , Modelos Animais de Doenças , Feminino , Humanos , Imobilização , Infertilidade Masculina/etiologia , Inflamação , Masculino , Camundongos , Camundongos Endogâmicos BALB C , Testes de Sensibilidade Microbiana , Infecções por Pseudomonas/tratamento farmacológico , Infecções por Pseudomonas/microbiologia , Infecções por Pseudomonas/patologia , Pseudomonas aeruginosa/efeitos dos fármacos , Pseudomonas aeruginosa/patogenicidade , Reprodução , Aglutinação Espermática , Motilidade dos Espermatozoides , Espermatozoides/citologia , Vagina/patologiaRESUMO
RESEARCH QUESTION: Hox genes are involved in limb formation during normal embryological development. Their modulation by circulating maternal oestrogens and androgens determines the length of the second and fourth fingers of the adult hand. Do these same intrauterine hormone levels also determine fertility outcomes in the adult? DESIGN: To study the association between the length of the second and fourth fingers of both partners undergoing IVF (as a surrogate of their previous intrauterine exposure to oestrogens and androgens) with treatment outcome after IVF, data corresponding to 256 IVF cycles were analysed. Finger length was normalized to the individual height. RESULTS: In the female partner, a longer normalized second finger length of the left (2DLN) hand, reflecting a high intrauterine exposure to oestrogens, was independently and significantly (Pâ¯=â¯0.011) associated with obtaining at least one top-quality embryo in a multivariate model. Conversely, in the male partner a longer normalized fourth finger length of the left hand (4DLN), reflecting a high intrauterine exposure to androgens, was independently and significantly (Pâ¯=â¯0.032) associated with obtaining at least one top-quality embryo in the same multivariate model. In the female partner, 2DLN was inversely and significantly (Pâ¯=â¯0.01) associated with achievement of pregnancy. CONCLUSIONS: Intrauterine exposure to high levels of oestrogens and androgens in females and males, respectively, predisposes to the production of higher-quality embryos under in-vitro conditions during adulthood. Paradoxically, this also seems to result in a lower pregnancy rate.
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Androgênios , Embrião de Mamíferos , Estrogênios , Fertilização in vitro/estatística & dados numéricos , Dedos/anatomia & histologia , Efeitos Tardios da Exposição Pré-Natal , Adulto , Feminino , Genes Homeobox , Humanos , Masculino , Gravidez , Taxa de Gravidez , Estudos ProspectivosRESUMO
BACKGROUND: Even if borderline ovarian tumours (BOTs) in young women treated with fertility-sparing treatment (FST) have an excellent outcome, the type of surgery might affect relapse and fertility. We investigated the effect of surgical approach (open surgery vs. laparoscopy) and type of surgery (salpingo-oophorectomy [SO] vs. cystectomy [Cy]) on oncologic and fertility outcomes in patients with BOT. PATIENTS AND METHODS: Patients with BOT treated at San Gerardo Hospital, Monza, with FST in 1978-2013 period were included. Cox models, stratified by decade of surgery, were used to investigate the association between time to first recurrence or conception and clinical factors. RESULTS: Among 535 patients included, 271 underwent unilateral SO and 264 underwent Cy. Median follow-up was 13.5 years. Ten-year (10-yr) recurrence rate was 23% (95% confidence interval [CI]: 18-29%) for SO and 31% (95% CI: 24-38%) for Cy group (P = 0.10) in patients with unilateral tumour, whereas it was 62% (95% CI: 44-79%) and 72% (95% CI: 59-84%), respectively, (P = 0.35) in patients with bilateral tumour. Multivariable analysis showed no association between recurrence and surgical approach (P = 0.44), type of surgery (P = 0.06) and a negative association with advanced stage (hazard ratio [HR] = 3.18; 95% CI: 2.11-4.78; P < 0.001) and bilateral tumours (HR = 2.48; 95% CI: 1.78-3.47; P < 0.001). Among 252 patients (47.1%) with pregnancy desire, multivariable analysis showed no association between conception success and the type of surgery, surgical approach, histology and tumour laterality. Fertility after surgery was positively associated with prior pregnancy (HR = 1.68; 95% CI: 1.17-2.41; P = 0.005) and negatively associated with the number of surgical procedures (HR = 0.62; 95% CI: 0.53-0.73; P < 0.001). CONCLUSIONS: The type of surgical procedures did not influence recurrence rate or fertility. However, additional surgical procedures decreased the fertility potential. These data can support clinicians in tailoring the best strategy for FST in young patients with BOT.
Assuntos
Cistoadenofibroma/cirurgia , Preservação da Fertilidade/métodos , Fertilidade , Tratamentos com Preservação do Órgão/métodos , Neoplasias Ovarianas/cirurgia , Adulto , Feminino , Humanos , Laparoscopia/métodos , Ovariectomia/métodos , Salpingo-Ooforectomia/métodosRESUMO
OBJECTIVE: To evaluate the result of laparoscopic endometrioma excision in fertility outcome of advanced endometriosis patients. STUDY DESIGN: The study was designated as historical cohort, in a private referral center of advance laparoscopy. 111 infertile patients, diagnosed as endometriosis, were divided in two groups: DIE (deep infiltrative endometriosis) and endometrioma (case group), and patients with only DIE (without endometrioma ((control group). All patients underwent global laparoscopic resection of DIE lesion (both groups) and laparoscopic excisional cystectomy of endometrioma (case groups). Patients were followed for fertility outcomes and data were analyzed by Kaplan-Meier test and COX regression using SPSS software. RESULTS: After adjusting covariates, the Kaplan-Meier analysis of cumulative pregnancy rates (CPR) did not show any statistical significance between cases (35.6%) and controls (39.5%) (Log-rank P-value=0.959). The COX regression analysis of covariates showed there is no significant relationship between cystectomy and fertility outcome. It showed statistical significance effect of age (hazard ratio [HR]=0.772), years of infertility (HR=0.224), and previous endometrioma surgery (HR=0.180), on fertility chance. CONCLUSION: In advanced endometriosis with DIE and infertility, fine excision and stripping of the endometrioma along with radical resection of DIE improves fecundity without any significant adverse effect in comparison with patients with intact ovaries.
Assuntos
Endometriose/cirurgia , Procedimentos Cirúrgicos em Ginecologia , Infertilidade Feminina/cirurgia , Doenças Ovarianas/cirurgia , Adulto , Feminino , Humanos , Laparoscopia , Gravidez , Resultado da Gravidez , Taxa de Gravidez , Estudos RetrospectivosRESUMO
The aim of the study was to analyze all the available evidence from both in vitro and in vivo studies regarding the efficacy of statin therapy in the treatment of endometriosis, evaluating the potential efficacy, side effects, and contraindications of their administration in humans. We focused on defining the potential benefits that the administration of statins may have on patients affected by endometriosis and the possible adverse effects of such a therapy on ovarian function and fertility profile. According to our article selection criteria, we included in the review in vitro and in vivo studies performed on human or animal models. The systematic review of literature identified 24 eligible articles, 12 of which reported evidence regarding the effects of statins on endometrial/endometriotic cells and 12 regarding their effects on ovarian function and fertility. All articles seem to emphasize the utility of statin administration in the treatment of endometriosis due to their anti-proliferative/proapoptotic effects, their ability to reduce cell viability and migration, and the inhibition of angiogenesis and anti-inflammatory activities. Regarding the potential adverse effects on gonadal activities, steroidogenesis and fertility function, no conclusive data were collected in human models (excluding women affected by polycystic ovary syndrome in which significant decline of androgen levels was reported after statin treatment), while contrasting results were reported by studies conducted in in vitro and in vivo in animal models. Despite evidence supporting statins as the potential therapeutic agent for a targeted conservative treatment of endometriosis, the uncertainties regarding their impact on gonadal function may not define them as an appropriate therapy for all young fertile women.
Assuntos
Tratamento Conservador/métodos , Endometriose/tratamento farmacológico , Fertilidade/efeitos dos fármacos , Inibidores de Hidroximetilglutaril-CoA Redutases/administração & dosagem , Inibidores de Hidroximetilglutaril-CoA Redutases/efeitos adversos , Infertilidade Feminina/induzido quimicamente , Animais , Sistemas de Liberação de Medicamentos/métodos , Endometriose/metabolismo , Endometriose/patologia , Feminino , Fertilidade/fisiologia , Humanos , Infertilidade Feminina/metabolismo , Infertilidade Feminina/patologiaRESUMO
OBJECTIVE: 28 women under 35years with early-stage cervical cancer and strong desire for fertility preservation that do not fulfil standard criteria for fertility-sparing surgery (tumour larger than 2cm or with deep of infiltration more than half of stroma) were included in prospective study. METHODS: Dose-dense neoadjuvant chemotherapy (NAC) was performed on all 28 patients in 10-day intervals: cisplatin plus ifosfamide in squamous cell cancer (15 women-53.6%) or cisplatin plus doxorubicin in adenocarcinoma (13 women-46.3%). Patients underwent laparoscopic lymphadenectomy and vaginal simple trachelectomy after NAC. Patients with positive lymph nodes or inadequate free surgical margins underwent radical hysterectomy. RESULTS: No residual disease was found in 6 women (21.4%), microscopic disease was observed in 11 women (39.3%) and macroscopic tumour in was observed in 11 women (39.3%). Ten women (35.7%) lost fertility. Four women (20%) after fertility-sparing surgery recurred, two died of the disease (10%). Fertility was spared in 20 (71.4%) women and 10 of them became pregnant (50%). Eight women delivered ten babies (6 term and four preterm deliveries). There were two miscarriages in second trimester (in one woman) and one in first trimester. One woman underwent four unsuccessful cycles of IVF, one failed to become pregnant and one recurred too early. Two women underwent chemoradiotherapy for recurrence and lost chance for pregnancy. CONCLUSIONS: Downstaging by NAC in IB1 and IB2 cervical cancer before fertility-sparing surgery is still an experimental procedure, but shows some promise. Long-term results in relation to oncological outcome for this concept are still needed.