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OBJECTIVE: To assess fertility outcomes in infertile women after hysteroscopic morcellation of intrauterine lesions. STUDY DESIGN: Retrospective case series from 2 U.S. fertility clinics. Women with intrauterine pathology and infertility (≥6 months' duration if age ≥35, or ≥12 months' duration if age <35) or recurrent pregnancy loss underwent hysteroscopic morcellation of intrauterine lesions. Main outcome mea- sures were postoperative pregnancies, live births, and procedure-related adverse events through 6 months. RESULTS: Of 101 women screened, 62 satisfied inclusion criteria and 44 (71%) conceived, resulting in 39 live births. Women who conceived were 37.1±4.6 years old (range, 28.0-46.8) at intervention; mean treatment-to-pregnancy interval was 8.4? 7.0 months (range, 1-32). Body mass index was lower in women who conceived (24.94.4 kg/M2 versus women who remained infertile (28.9±04 kg/IM2, p=0.0362). Of 67 lesions in women who conceived, fibroids, polyps, and adhesions comprised 21%, 70%, and 9%, respectively. Mean respective fibroid and polyp sizes in women who conceived were 2.1±1.3 and 1.4±0.8 cm, respectively, similar to those in women who did not conceive. Fibroids were 74% type 0 and 26% type 1. Lesion area eradication was 95.8±9.9% for fibroids and 100% for polyps. No serious/severe adverse events occurred. CONCLUSION: Morcellation of intrauterine pathologies in subfertile women undergoing fertility therapy safely supports postopera- tive pregnancy and live birth.
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Infertilidad Femenina , Leiomioma , Morcelación , Neoplasias Uterinas , Adulto , Femenino , Humanos , Leiomioma/cirugía , Pólipos , Embarazo , Estudios Retrospectivos , Neoplasias Uterinas/cirugíaRESUMEN
Background: Hysteroscopic morcellation removes uterine pathology under direct visualization with continuous real-time tissue fragment removal. Objective: The aim of this study was to explore the feasibility of hysteroscopic morcellation across a diverse set of facilities, including both surgical and office-based settings. Design: This was a prospective, single-arm, multicenter registry development (Canadian Task Force classification II-3). Materials and Methods: Thirty-four U.S. obstetrics and gynecology facilities enrolled subjects into the registry. Inclusion criteria were women ages 18-65 with indications for hysteroscopic myomectomy and/or polypectomy who were treated with the MyoSure® Hysteroscopic Tissue Removal System (Hologic Inc., Marlborough, MA). Intrauterine lesion type/size and removal parameters, adverse events (AEs), and physician satisfaction ratings were recorded. Results: A total of 559 pathologies (187 fibroids; 372 polyps) were removed from 278 registered subjects (mean age: 43.9 ± 9.0 years), with 250 procedures (89.9%) performed in an ambulatory surgery center or hospital outpatient setting and 28 (10.1%) in a gynecologic office setting. Most patients (n = 206, 74.1%) were treated for abnormal uterine bleeding, and 42 (15.1%) were treated for infertility. Mean fibroid diameter was 2.2 ± 1.2 cm. Mean polyp diameter was 1.3 ± 1.0 cm. Overall mean percentage of pathology removed was 95.4% (polyps 99.3%, fibroids 86.8%). Five AEs included four incidents of blunt cervical trauma and a single postoperative case of pedal edema; all were considered mild and resolved spontaneously. Postprocedure surveys indicated that 95% of reporting physicians were "satisfied" or "highly satisfied" with device performance. Conclusions: Hysteroscopic morcellation of intrauterine pathology was accomplished safely with a high degree of physician satisfaction in 278 patients treated in diverse healthcare settings that are reflective of general community practice in the United States. (J GYNECOL SURG 32:318).
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Spatial predictions of drift deposits on soil surface were conducted using eight different spatial interpolation methods i.e. classical approaches like the Thiessen method and kriging, and some advanced methods like spatial vine copulas, Karhunen-Loève expansion and INLA. In order to investigate the impact of the number of locations on the prediction, all spatial predictions were conducted using a set of 39 and 47 locations respectively. The analysis revealed that taking more locations into account increases the accuracy of the prediction and the extreme behavior of the data is better modeled. Leave-one-out cross-validation was used to assess the accuracy of the prediction. The Thiessen method has the highest prediction errors among all tested methods. Linear interpolation methods were able to better reproduce the extreme behavior at the first meters from the sprayed border and exhibited lower prediction errors as the number of data points increased. Especially the spatial copula method exhibited an obvious increase in prediction accuracy. The Karhunen-Loève expansion provided similar results as universal kriging and IDW, although showing a stronger change in the prediction as the number of locations increased. INLA predicted the pesticide dispersion to be smooth over the whole study area. Using Delaunay triangulation of the study area, the total pesticide concentration was estimated to be between 2.06% and 2.97% of the total Uranine applied. This work is a first attempt to completely understand and model the uncertainties of the mass balance, therefore providing a basis for future studies.
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Contaminantes Atmosféricos/análisis , Plaguicidas/análisis , Contaminantes del Suelo/análisis , Suelo/química , Colombia , Monitoreo del Ambiente/métodos , Modelos Teóricos , Análisis EspacialRESUMEN
Our objective was to determine whether the presence of motility in surgically obtained sperm samples improves fertilization and pregnancy rates for patients undergoing in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI). This was a retrospective study in a hospital-based infertility center. Sixty-seven couples with a diagnosis of azoospermia or severe oligozoospermia who had undergone a sperm retrieval procedure in conjunction with 100 IVF/ICSI cycles from 1995 to 2004 were evaluated. The impact of sperm motility on fertilization and clinical pregnancy rates was determined. The motile and nonmotile sperm groups differed in the number of mature oocytes retrieved (10.7 +/- 5.8 vs 13.4 +/- 6.0), but fertilization (56.7% vs 59.1%) and embryo cryopreservation rates (35.9% vs 39.3%) were statistically similar. Clinical pregnancy rates did not differ between the motile (38.5%) and nonmotile (31.2%) groups, nor did they differ between obstructive and nonobstructive patients (35.3% vs 26.7%). There was also no statistical difference in pregnancy rates between testicular and epididymal aspiration (35.3% vs 26.7%), although epididymal sperm were significantly more likely to be motile than testicular sperm (100% vs 39.3%, P < .0001). Epididymal aspiration is more likely to produce motile sperm than testicular sperm retrieval. The use of motile sperm from epididymal or testicular samples, however, does not appear to enhance fertilization or clinical pregnancy rates.
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Epidídimo/citología , Fertilización In Vitro , Resultado del Embarazo , Inyecciones de Esperma Intracitoplasmáticas , Motilidad Espermática , Testículo/citología , Adulto , Femenino , Humanos , Masculino , Embarazo , Índice de Embarazo , Estudios RetrospectivosRESUMEN
Targeted disruption [knockout (KO)] of the mouse prolactin (PRL) gene created an animal model of primary isolated PRL deficiency in which there is no detectable PRL bioactivity. Pituitary glands of young adult female PRLKO mice were hyperplastic, and many cells had expanded cytoplasms with granular accumulations of an N-terminal peptide encoded by the disrupted PRL gene (KO/10 peptide). Confocal imaging showed that the pituitaries in PRL(+/+) and PRL(+/-) females contained dense accumulations of apparently Golgi-associated immunoreactive PRL. PRLKO female mice (15-18 months old) developed hyperemic pituitary adenomas. The pituitary tumors in PRLKO mice synthesized the KO/10 peptide, which implies that the tumors arise from the lactotroph lineage. Anchorage-independent growth was observed among pituitary cells from PRLKO mice, aged 8 months or older, but not in cells from 3-month-old PRLKO mice. GH cells appeared to be normal in PRLKO pituitaries, but were displaced by the hyperplastic and hypertrophic growth of KO/10-positive cells. Bromocriptine suppressed mean pituitary weight in 8-month-old PRLKO mice compared with vehicle-treated PRLKO animals (20 +/- 0.01 and 60 +/- 10 mg; P < 0.01). We infer that pituitary lactotrophs of PRLKO mice suffer from a dual pathology that includes hypertrophy resulting from endoplasmic reticulum expansion and hyperplasia, with adenomatous transformation, in part as a consequence of disrupted dopaminergic feedback regulation.