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1.
Rev Med Suisse ; 16(676-7): 42-46, 2020 Jan 15.
Artigo em Francês | MEDLINE | ID: mdl-31961082

RESUMO

Uterine transplant is a novel treatment option for women with absolute uterine infertility. Sixty uterine transplants have been performed worldwide to date. The first live birth happened in 2014 and since then 20 children have been born after this procedure. The procedure has several challenges: The donor is usually a woman alive. Surgery is long and complex for both the donor and the recipient, with a high risk of complications. Embryos have to be obtained through IVF. Pregnancies are at high risk for complications and require cesarean delivery, and transplant is temporary (the transplanted uterus is removed after pregnancy in order to allow discontinuation of immunosuppressive therapy). Uterine transplant is a new hope for women with absolute uterine infertility but a high-risk experimental procedure for the donor, the recipient and the newborns and raises major ethical questions.


Assuntos
Infertilidade Feminina , Útero , Cesárea , Feminino , Humanos , Recém-Nascido , Infertilidade Feminina/cirurgia , Gravidez , Suíça , Doadores de Tecidos , Útero/transplante
2.
Cochrane Database Syst Rev ; 1: CD003857, 2020 01 29.
Artigo em Inglês | MEDLINE | ID: mdl-31995657

RESUMO

BACKGROUND: Fibroids are the most common benign tumours of the female genital tract and are associated with numerous clinical problems including a possible negative impact on fertility. In women requesting preservation of fertility, fibroids can be surgically removed (myomectomy) by laparotomy, laparoscopically or hysteroscopically depending on the size, site and type of fibroid. Myomectomy is however a procedure that is not without risk and can result in serious complications. It is therefore essential to determine whether such a procedure can result in an improvement in fertility and, if so, to then determine the ideal surgical approach. OBJECTIVES: To examine the effect of myomectomy on fertility outcomes and to compare different surgical approaches. SEARCH METHODS: We searched the Cochrane Gynaecology and Fertility Group (CGFG) Specialised Register, CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, Epistemonikos database, World Health Organization (WHO) International Clinical Trials Registry Platform search portal, Database of Abstracts of Reviews of Effects (DARE), LILACS, conference abstracts on the ISI Web of Knowledge, OpenSigle for grey literature from Europe, and reference list of relevant papers. The final search was in February 2019. SELECTION CRITERIA: Randomised controlled trials (RCTs) examining the effect of myomectomy compared to no intervention or where different surgical approaches are compared regarding the effect on fertility outcomes in a group of infertile women suffering from uterine fibroids. DATA COLLECTION AND ANALYSIS: Data collection and analysis were conducted in accordance with the procedure suggested in the Cochrane Handbook for Systematic Reviews of Interventions. MAIN RESULTS: This review included four RCTs with 442 participants. The evidence was very low-quality with the main limitations being due to serious imprecision, inconsistency and indirectness. Myomectomy versus no intervention One study examined the effect of myomectomy compared to no intervention on reproductive outcomes. We are uncertain whether myomectomy improves clinical pregnancy rate for intramural (odds ratio (OR) 1.88, 95% confidence interval (CI) 0.57 to 6.14; 45 participants; one study; very low-quality evidence), submucous (OR 2.04, 95% CI 0.62 to 6.66; 52 participants; one study; very low-quality evidence), intramural/subserous (OR 2.00, 95% CI 0.40 to 10.09; 31 participants; one study; very low-quality evidence) or intramural/submucous fibroids (OR 3.24, 95% CI 0.72 to 14.57; 42 participants; one study; very low-quality evidence). Similarly, we are uncertain whether myomectomy reduces miscarriage rate for intramural fibroids (OR 1.33, 95% CI 0.26 to 6.78; 45 participants; one study; very low-quality evidence), submucous fibroids (OR 1.27, 95% CI 0.27 to 5.97; 52 participants; one study; very low-quality evidence), intramural/subserous fibroids (OR 0.80, 95% CI 0.10 to 6.54; 31 participants; one study; very low-quality evidence) or intramural/submucous fibroids (OR 2.00, 95% CI 0.32 to 12.33; 42 participants; one study; very low-quality evidence). This study did not report on live birth, preterm delivery, ongoing pregnancy or caesarean section rate. Laparoscopic myomectomy versus myomectomy by laparotomy or mini-laparotomy Two studies compared laparoscopic myomectomy to myomectomy at laparotomy or mini-laparotomy. We are uncertain whether laparoscopic myomectomy compared to laparotomy or mini-laparotomy improves live birth rate (OR 0.80, 95% CI 0.42 to 1.50; 177 participants; two studies; I2 = 0%; very low-quality evidence), preterm delivery rate (OR 0.70, 95% CI 0.11 to 4.29; participants = 177; two studies; I2 = 0%, very low-quality evidence), clinical pregnancy rate (OR 0.96, 95% CI 0.52 to 1.78; 177 participants; two studies; I2 = 0%, very low-quality evidence), ongoing pregnancy rate (OR 1.61, 95% CI 0.26 to 10.04; 115 participants; one study; very low-quality evidence), miscarriage rate (OR 1.25, 95% CI 0.40 to 3.89; participants = 177; two studies; I2 = 0%, very low-quality evidence), or caesarean section rate (OR 0.69, 95% CI 0.34 to 1.39; participants = 177; two studies; I2 = 21%, very low-quality evidence). Monopolar resectoscope versus bipolar resectoscope One study evaluated the use of two electrosurgical systems during hysteroscopic myomectomy. We are uncertain whether bipolar resectoscope use compared to monopolar resectoscope use improves live birth/ongoing pregnancy rate (OR 0.86, 95% CI 0.30 to 2.50; 68 participants; one study, very low-quality evidence), clinical pregnancy rate (OR 0.88, 95% CI 0.33 to 2.36; 68 participants; one study; very low-quality evidence), or miscarriage rate (OR 1.00, 95% CI 0.19 to 5.34; participants = 68; one study; very low-quality evidence). This study did not report on preterm delivery or caesarean section rate. AUTHORS' CONCLUSIONS: There is limited evidence to determine the role of myomectomy for infertility in women with fibroids as only one trial compared myomectomy with no myomectomy. If the decision is made to have a myomectomy, the current evidence does not indicate a superior method (laparoscopy, laparotomy or different electrosurgical systems) to improve rates of live birth, preterm delivery, clinical pregnancy, ongoing pregnancy, miscarriage, or caesarean section. Furthermore, the existing evidence needs to be viewed with caution due to the small number of events, minimal number of studies and very low-quality evidence.


Assuntos
Infertilidade Feminina/cirurgia , Leiomiomatose/cirurgia , Miomectomia Uterina/métodos , Neoplasias Uterinas/cirurgia , Aborto Espontâneo/epidemiologia , Cesárea/estatística & dados numéricos , Feminino , Humanos , Infertilidade Feminina/etiologia , Leiomiomatose/complicações , Nascimento Vivo/epidemiologia , Gravidez , Taxa de Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto , Neoplasias Uterinas/complicações
3.
BJOG ; 127(2): 230-238, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31397072

RESUMO

Women with congenital absolute uterine factor infertility (AUFI) often need vaginal restoration to optimise sexual function. Given their lack of procreative ability, little consideration has previously been given to the resultant vaginal microbiome (VM). Uterine transplantation (UTx) now offers the opportunity to restore these women's reproductive potential. The structure of the VM is associated with clinical and reproductive implications that are intricately intertwined with the process of UTx. Consideration of how vaginal restoration methods impact VM is now warranted and assessment of the VM in future UTx procedures is essential to understand the interrelation of the VM and clinical and reproductive outcomes. TWEETABLE ABSTRACT: The vaginal microbiome has numerous implications for clinical and reproductive outcomes in the context of uterine transplantation.


Assuntos
Anormalidades Congênitas/cirurgia , Infertilidade Feminina/cirurgia , Microbiota/fisiologia , Transplante de Órgãos , Útero/transplante , Vagina/microbiologia , Feminino , Humanos , RNA Ribossômico 16S/fisiologia , Técnicas de Reprodução Assistida , Útero/anormalidades , Útero/microbiologia , Vagina/fisiopatologia
4.
BJOG ; 126(11): 1310-1319, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31410987

RESUMO

Uterine transplantation restores reproductive anatomy in women with absolute uterine factor infertility and allows the opportunity to conceive, experience gestation, and acquire motherhood. The number of cases being performed is increasing exponentially, with detailed outcomes from 45 cases, including nine live births, now available. In light of the data presented herein, including detailed surgical, immunosuppressive and obstetric outcomes, the feasibility of uterine transplantation is now difficult to refute. However, it is associated with significant risk with more than one-quarter of grafts removed because of complications, and one in ten donors suffering complications requiring surgical repair. TWEETABLE ABSTRACT: Uterine transplantation is feasible in women with uterine factor infertility, but is associated with significant risk of complication.


Assuntos
Sobrevivência de Enxerto/fisiologia , Imunossupressão/métodos , Infertilidade Feminina/cirurgia , Transplante de Órgãos , Doadores de Tecidos , Útero/transplante , Adulto , Feminino , Rejeição de Enxerto , Humanos , Nascimento Vivo , Pessoa de Meia-Idade , Transplante de Órgãos/métodos , Gravidez , Resultado do Tratamento , Adulto Jovem
5.
Fertil Steril ; 112(2): 183-196, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31352957

RESUMO

Before the modern era of in vitro fertilization, reproductive surgery to deal with pelvic disease was the key intervention in the management of infertility. A series of clinical observations and animal experiments led to the development of microsurgical principles, which were applicable to all forms of gynecologic surgery. The evolution of endoscopy permitted minimally invasive approaches to most pelvic pathology. Assisted reproductive techniques now have primacy in the management of infertility, but women deserve to have fertility-enhancing or fertility-sparing surgery performed by a surgeon with relevant training. Thus, we have an obligation to maintain formal training programs in reproductive surgery.


Assuntos
Fertilização In Vitro/métodos , Procedimentos Cirúrgicos em Ginecologia , Laparoscopia , Laparotomia , Endoscópios , Tubas Uterinas/cirurgia , Feminino , Fertilização In Vitro/instrumentação , Procedimentos Cirúrgicos em Ginecologia/instrumentação , Procedimentos Cirúrgicos em Ginecologia/métodos , Procedimentos Cirúrgicos em Ginecologia/tendências , Humanos , Infertilidade/cirurgia , Infertilidade Feminina/cirurgia , Laparoscopia/instrumentação , Laparoscopia/métodos , Laparoscopia/tendências , Laparotomia/instrumentação , Laparotomia/métodos , Laparotomia/tendências , Microcirurgia/métodos , Técnicas de Reprodução Assistida/tendências
6.
Fertil Steril ; 112(2): 203-210, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31352959

RESUMO

For humans, the uterus is their first home. Accurate evaluation and effective therapy are central to optimizing the conditions for implantation and sustained pregnancy. For macroscopic intracavitary disease, hysteroscopy remains the gold standard for diagnosis and treatment. We review the role of hysteroscopy before fertility therapies. We also address intracavitary pathologies and their relevance to procreative outcomes. Controversies in the literature are noted and clarified, and trends in the field of hysteroscopy are identified regarding how they will influence the future of reproductive care and women's health.


Assuntos
Histeroscopia , Infertilidade Feminina/etiologia , Infertilidade Feminina/cirurgia , Doenças Uterinas/complicações , Doenças Uterinas/cirurgia , Útero/cirurgia , Feminino , Humanos , Histeroscopia/métodos , Histeroscopia/tendências , Infertilidade Feminina/patologia , Gravidez , Fatores de Risco , Doenças Uterinas/patologia , Útero/diagnóstico por imagem , Útero/patologia
7.
Fertil Steril ; 112(2): 211-218, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31352960

RESUMO

Our article endeavors to be both a review of the recent past and a preview of the future of reproductive surgery. By reflecting on the rate of technological advancement over the past decade, we attempt to predict the trajectory of the next. We also delve into the changing nature and practical challenges of the practice of gynecologic surgery for the reproductive endocrinology and infertility subspecialist. We will explain how technological advances may alter our perception and expectations regarding the indications, timing and extent of surgical intervention in the infertile patient and in the patient seeking preservation of fertility. This review does not aim to be comprehensive, choosing instead to focus on those innovations that hold, in our view, true potential to shape the future of surgical practice. Ours is primarily a technology review. As such, it does not focus on novel surgical techniques, including uterine transplantation and ovarian tissue transplantation.


Assuntos
Competência Clínica , Procedimentos Cirúrgicos em Ginecologia , Infertilidade Feminina/cirurgia , Invenções/tendências , Procedimentos Cirúrgicos Robóticos/tendências , Competência Clínica/normas , Feminino , Procedimentos Cirúrgicos em Ginecologia/instrumentação , Procedimentos Cirúrgicos em Ginecologia/métodos , Procedimentos Cirúrgicos em Ginecologia/tendências , Humanos , Reprodução/fisiologia , Procedimentos Cirúrgicos Robóticos/métodos , Cirurgiões/normas , Cirurgiões/tendências , Cirurgia Assistida por Computador
8.
Fertil Steril ; 112(1): 1-2, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31277760

RESUMO

Uterus transplantation is the first available treatment for absolute uterine factor infertility. Live births have been reported after transplantation of uteri both from live and deceased donors. Although this novel infertility treatment is still at its experimental stage, with human attempts performed within clinical trials, there is a rapid development in the field. Up until June 2019 more than 60 human uterus transplantation attempts have been performed and the scientific data of the published cases will be reviewed in relation to surgery and outcome. The assisted reproductive technologies that are used before and after uterus transplantation have to be modified for this patient group. The special demands for in vitro fertilization in a patient with no uterus and with embryo transfer in a transplanted uterus will be discussed. Traditionally, uterus transplantation has been performed through laparotomy in both the donor and the recipient. There is now a move to introduce minimally invasive surgery in live donor surgery transplantation, and in the future this may also be applied to recipient surgery. There is a continuous debate whether live donor or deceased donor uterus is the organ source for optimal outcome. Ongoing studies and the general development of the uterus transplantation field will shed light on the pros and cons of each donor source.


Assuntos
Infertilidade Feminina/cirurgia , Doadores de Tecidos/provisão & distribução , Útero/transplante , Feminino , Fertilidade , Sobrevivência de Enxerto , Humanos , Infertilidade Feminina/diagnóstico , Infertilidade Feminina/fisiopatologia , Nascimento Vivo , Doadores Vivos/provisão & distribução , Gravidez , Taxa de Gravidez , Técnicas de Reprodução Assistida , Resultado do Tratamento
9.
Fertil Steril ; 112(1): 11-18, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31277761

RESUMO

Uterus transplantation (UTx) is the first available treatment for absolute uterine factor infertility, a condition due to absence of the uterus or presence of a non-functional uterus. The proof-of-concept of UTx as an infertility treatment for this group of patients occurred in 2014 in Sweden by the first birth after human UTx. That and subsequent cases of the Swedish trial were live-donor UTx procedures with laparotomy of both donor and recipient. Although results of the initial Swedish clinical UTx trial were very favorable in terms of take-home-baby rate, the drawback was the long duration (>10 h) of donor surgeries and associated long recovery periods. There exist three later publications, with uterus procurements from live donors by laparotomy with a range of surgical durations of 5.3 hours to 13 hours. Our collaborative Swedish-French team has initiated efforts to introduce minimal invasive surgery in one trial in Sweden and one in France. The principle of these UTx trials is to use modern concepts of robotic-assisted laparoscopy primarily in the live donor. There also exists a small number of published UTx procedures with donor surgery by partial conventional laparoscopy and one published case with total robotic-assisted laparoscopy procedure. This review discusses open versus minimal invasive surgery in relation to the accumulated knowledge in the field. Moreover, we propose some future directions for the development of this surgery in UTx.


Assuntos
Infertilidade Feminina/cirurgia , Laparoscopia , Laparotomia , Procedimentos Cirúrgicos Robóticos , Doadores de Tecidos/provisão & distribução , Útero/transplante , Feminino , Fertilidade , Sobrevivência de Enxerto , Humanos , Infertilidade Feminina/diagnóstico , Infertilidade Feminina/fisiopatologia , Laparoscopia/efeitos adversos , Laparotomia/efeitos adversos , Nascimento Vivo , Doadores Vivos/provisão & distribução , Gravidez , Taxa de Gravidez , Técnicas de Reprodução Assistida , Fatores de Risco , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Resultado do Tratamento
10.
Fertil Steril ; 112(1): 19-23, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31277762

RESUMO

The development of assisted reproductive technology (ART) through four decades has led to offer the ultimate treatment for nearly all forms of infertility. The only remaining factor of childlessness however that still eludes ART and its routine variants are the absolute uterine infertility factors, for which the only option is an experimental approach, uterus transplantation. Progresses has been made over the past few years, and more are underway for simplifying the process notably for simplifying the uterus extraction step performed in the uterus donor. Furthermore, as the technique is being better mastered, the original indications for uterus transplantation, the congenital or acquired absence of the uterus, are now widened to also include incurable uterine fibrosis, or Asherman's syndrome. The ART-related practicalities of uterus transplantation, ovarian stimulation and uterine priming are being discussed in the present review.


Assuntos
Infertilidade Feminina/cirurgia , Técnicas de Reprodução Assistida , Doadores de Tecidos/provisão & distribução , Útero/transplante , Feminino , Fertilidade , Sobrevivência de Enxerto , Humanos , Infertilidade Feminina/diagnóstico , Infertilidade Feminina/fisiopatologia , Nascimento Vivo , Doadores Vivos/provisão & distribução , Gravidez , Taxa de Gravidez , Técnicas de Reprodução Assistida/efeitos adversos , Fatores de Risco , Resultado do Tratamento
11.
Fertil Steril ; 112(1): 24-27, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31277763

RESUMO

Uterus transplantation to treat absolute uterine factor infertility is a rapidly evolving field still at its early clinical experimental stage. Most human uterus transplantation attempts and live births have been after transplantation with uteri from live donors, who, in most cases, are closely related to the recipient. However, successful transplant with live births after uterus transplantation from deceased donors has also been reported. This article discusses the pros and cons in relation to live and deceased donors for uterus transplantation.


Assuntos
Seleção do Doador , Infertilidade Feminina/cirurgia , Doadores Vivos/provisão & distribução , Doadores de Tecidos/provisão & distribução , Útero/transplante , Feminino , Fertilidade , Sobrevivência de Enxerto , Humanos , Infertilidade Feminina/diagnóstico , Infertilidade Feminina/fisiopatologia , Nascimento Vivo , Gravidez , Taxa de Gravidez , Técnicas de Reprodução Assistida , Fatores de Risco , Resultado do Tratamento
12.
Fertil Steril ; 112(1): 3-10, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31277765

RESUMO

Absolute uterine factor infertility, due to absence or non-function of the uterus, is one of the few major subgroups of infertility that has remained without any treatment. Uterus transplantation has now been proposed as treatment for this type of infertility. The first attempt of human uterus transplantation was in 2000. This was a live donor case, but due to suboptimal surgical solutions it resulted in a necrotic uterus being removed after 99 days. This first human case, although a failure, inspired several research groups around the globe to initiate animal-based studies to investigate uterus transplantation in relation to surgery, immunosuppression, rejection and pregnancy outcome. The research was carried out in several animal species and advanced the field substantially. In 2011, the second uterus transplantation attempt was performed, and this involved a deceased donor procedure. Although the case was surgically successful, with resumed menstruations, clinical pregnancy with live birth could not be achieved. The first clinical trial of uterus transplantation was initiated in Sweden in 2013 and involved nine live donor procedures. The world's first live birth was reported from that trial in September 2014 and this was followed by two more births within that trial in November 2014. Births after uterus transplantation has since been reported from Sweden and other centers in Europe, North America, Latin America, and Asia. Thirty human uterus transplantation procedures have been reported in the scientific literature so far but by our personal knowledge the double number of procedures have been performed. The published cases will be reviewed in detail, and we will also describe the pregnancies of the live births that have been published. A small number of graft failures have occurred. These may in part be linked to suboptimal selection of donors, specifically concerning the quality of the uterine arteries. Consequently, we will also address the issue of strategies for pre-surgical screening of donors.


Assuntos
Seleção do Doador , Infertilidade Feminina/cirurgia , Doadores de Tecidos/provisão & distribução , Útero/transplante , Adulto , Feminino , Fertilidade , Sobrevivência de Enxerto , Humanos , Infertilidade Feminina/diagnóstico , Infertilidade Feminina/fisiopatologia , Nascimento Vivo , Doadores Vivos/provisão & distribução , Pessoa de Meia-Idade , Gravidez , Taxa de Gravidez , Técnicas de Reprodução Assistida , Fatores de Risco , Resultado do Tratamento , Adulto Jovem
13.
Gynecol Obstet Invest ; 84(5): 512-518, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31311015

RESUMO

BACKGROUND: In the literature, there is no detailed analysis on the prediction factors for premalignancy/malignancy within endometrial polyps (EPs) in infertile patients. In this study, we aimed to determine the frequency of endometrial premalignancy/malignancy within EPs in infertile patients undergoing office hysteroscopic polypectomy and identify the factors that can potentially predict an endometrial premalignancy/malignancy within EPs. METHOD: A total of 957 infertile patients undergoing office hysteroscopy were diagnosed with EPs between February 2011 and August 2018. Patients were divided into 2 groups according to the pathological examination of EPs as benign (Group 1; n = 939) and premalignant/malignant (Group 2; n = 18). The medical records of all patients included in the study were reviewed retrospectively. RESULTS: In this cohort, prevalence of endometrial premalignancy/malignancy within EPs was 18/957 (1.88%). On univariate analysis, age, polyp size, diabetes, hypertension, and causes of infertility did not differ between the 2 groups. On multivariate analysis, diffuse polypoid appearance of the endometrial cavity on office hysteroscopy (hazard ratio [HR] 4.1; 95% CI 1.576-10.785), duration of infertility, (HR 4; 95% CI 1.279-12.562), and body mass index (HR 7.9; 95% CI 2.591-24.258) were found to be independent predictors of endometrial premalignancy/malignancy within polyps in infertile patients. CONCLUSION: When diffuse polypoid appearance of the endometrial cavity is detected in an infertile patient during office hysteroscopy, hysteroscopy-guided resection and endometrial curettage should be performed. The pathological specimen should be sent for histopathological evaluation to diagnose possible endometrial premalignancy/malignancy within polyps.


Assuntos
Neoplasias do Endométrio/diagnóstico , Infertilidade Feminina/patologia , Pólipos/patologia , Lesões Pré-Cancerosas/diagnóstico , Doenças Uterinas/patologia , Adulto , Índice de Massa Corporal , Neoplasias do Endométrio/complicações , Neoplasias do Endométrio/epidemiologia , Endométrio/patologia , Endométrio/cirurgia , Feminino , Humanos , Histeroscopia/estatística & dados numéricos , Infertilidade Feminina/etiologia , Infertilidade Feminina/cirurgia , Pessoa de Meia-Idade , Análise Multivariada , Pólipos/complicações , Pólipos/cirurgia , Lesões Pré-Cancerosas/complicações , Lesões Pré-Cancerosas/epidemiologia , Gravidez , Prevalência , Estudos Retrospectivos , Doenças Uterinas/complicações , Doenças Uterinas/cirurgia
14.
Artigo em Inglês | MEDLINE | ID: mdl-31279764

RESUMO

Ultrasound plays a key role in diagnosis and guidance in reproductive medicine and surgery. In the field of reproductive surgery, some of the interventions, especially intrauterine procedures, are regularly conducted without imaging guidance but instead performed based on clinical skills and experience alone. Operative real-time US provides concurrent visualisation of the structures, contents and planes and operating instruments and, therefore, has the potential to improve efficacy and safety of the operative interventions. Ultrasound should be used in our operating theatres more often to guide various intrauterine procedures to reduce the intra-operative risks and complications including uterine perforations and visceral injury. The use of ultrasound necessitates an additional assistant experienced in ultrasound in the theatre, but regular use of ultrasound improves the training opportunities of the trainees and clinicians.


Assuntos
Competência Clínica , Histeroscopia , Ultrassonografia , Feminino , Humanos , Infertilidade Feminina/cirurgia , Duração da Cirurgia
15.
Medicine (Baltimore) ; 98(30): e16623, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31348312

RESUMO

Different sizes of uterine septum between infertile women and patients with abortions may have a clinical relevance in reproductive performance after surgery. This study aimed to assess if the fecundity of women after surgical correction of the uterine septum is associated with septum size.A retrospective, single-center, cohort study was conducted in Peking Union Medical College Hospital using patients aged between 21 and 37 years. Hysteroscopic metroplasty was performed on 121 patients with a uterine septum. The septum size was assessed by ultrasonography and hysteroscopy. The subjects were divided into 3 groups: Group A consisted of 35 women with complete uterine septum (mean ± standard deviation (SD) age 28.29 ±â€Š3.53; group B consisted of 48 women with uterine septum >2.5 cm (mean ±â€ŠSD age 28.85 ±â€Š3.63); and group C consisted of 48 women with uterine septum ≤2.5 cm (mean ±â€ŠSD age 28.79 ±â€Š3.74). Age and body mass index (BMI) were not significantly different among the 3 groups.No serious hysteroscopic complications occurred. However, uterine septa were observed in 4 cases after surgery and 6 cases of intrauterine adhesions were observed after long-term follow-up. The abortion rate decreased, and term delivery rate increased significantly in the 3 groups after hysteroscopic metroplasty. The infertility rate was significantly lower in group C after surgery. However, no significant difference was observed in the infertility rate between groups A and B. The recurrent abortion rate was significantly lower in group A than in groups B and C before surgery. After surgery, the infertility rate was significantly higher in group A than in group B (28.57% and 10.53%, respectively; P = .048). After at least 12-months of follow-up, the pregnancy rate in group A was significantly lower than that in group C (71.43% and 89.47%, respectively; P = .048).Uterine septum resection improves obstetrical outcomes. After surgery, the infertility rate was significantly higher in patients with complete uterine septum than in those with a large partial uterine septum, and the pregnancy rate in patients with complete uterine septum was lower than that in the patients with a small partial uterine septum.


Assuntos
Fertilidade , Histeroscopia/métodos , Infertilidade Feminina/cirurgia , Doenças Uterinas/cirurgia , Adulto , Feminino , Humanos , Estudos Retrospectivos , Adulto Jovem
16.
Int J Gynaecol Obstet ; 146(2): 200-205, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31162639

RESUMO

OBJECTIVE: To determine the prevalence of Chlamydia trachomatis infection and the correlates of tubal pathology among Ghanaian women undergoing hysterosalpingography for suspected tubal factor infertility. METHODS: A cross-sectional study was conducted among 189 women with infertility who underwent hysterosalpingography at Korle Bu Teaching Hospital, Ghana, from September 1 to November 30, 2016. Demographic data; obstetric and gynecologic history; and hysterosalpingography findings were collected using a structured questionnaire. Endocervical swabs were tested for the presence of Chlamydia trachomatis using a rapid antigen-based diagnostic kit. Associations between the variables were assessed using bivariate analysis. RESULTS: Positive test results for Chlamydia trachomatis were recorded among 15 participants, giving an overall prevalence of 7.9% (95% confidence interval [CI] 4.1%-11.7%). In all, 67 (35.4%) participants had abnormal findings on hysterosalpingography, with 40 (21.2%) displaying bilateral tubal occlusion. The remaining 122 (64.6%) women had normal findings on hysterosalpingography. Eight participants with normal tubal appearance tested positive for Chlamydia trachomatis (prevalence 6.6%, 95% CI 2.2%-11.0%), whereas seven participants with abnormal tubal appearance tested positive (prevalence 10.4%, 95% CI 3.1%-17.7%; P=0.402). No associations were found between participant characteristics and tubal pathology. CONCLUSION: The prevalence of Chlamydia trachomatis did not differ by hysterosalpingography findings.


Assuntos
Infecções por Chlamydia/epidemiologia , Doenças das Tubas Uterinas/diagnóstico , Histerossalpingografia , Infertilidade Feminina/cirurgia , Adulto , Anticorpos Antibacterianos/sangue , Infecções por Chlamydia/diagnóstico , Chlamydia trachomatis/isolamento & purificação , Estudos Transversais , Feminino , Gana/epidemiologia , Humanos , Infertilidade Feminina/epidemiologia , Infertilidade Feminina/patologia , Gravidez , Prevalência
17.
BJOG ; 126(11): 1320-1326, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31215750

RESUMO

Absolute uterine factor infertility is the final hurdle for assisted reproductive treatments. Uterus transplant trials are happening worldwide; to advance the debate around uterine transplantation (UTx), this article considers selection criteria for clinical trials from a UK perspective and makes recommendations for future selection criteria for UTx treatment. Recommendations advanced include the use of donor eggs, access for single women and women in same-sex relationships, prohibiting participation of women who are already mothers, and a preference for deceased donors and bioengineered uteri. With UTx treatment on the horizon, it is important to proactively consider future selection criteria. TWEETABLE ABSTRACT: Review of UK selection criteria for clinical trials for uterus transplantation; recommendations for the future.


Assuntos
Imunossupressores/uso terapêutico , Infertilidade Feminina , Transplante de Órgãos/métodos , Seleção de Pacientes , Doadores de Tecidos , Obtenção de Tecidos e Órgãos/métodos , Útero/transplante , Adulto , Ensaios Clínicos como Assunto , Feminino , Humanos , Infertilidade Feminina/cirurgia , Transplante de Órgãos/ética , Seleção de Pacientes/ética , Suécia , Reino Unido , Adulto Jovem
18.
J Obstet Gynaecol Res ; 45(8): 1458-1465, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31062518

RESUMO

AIM: To describe our first clinical pregnancy following a uterus transplant from a brain-dead donor and to discuss current issues with deceased donor uterus transplantation as they relate to obstetrical success. METHODS: In August 2016, a 26-year-old woman with Mayer-Rokitansky-Küster-Hauser syndrome was the fourth person worldwide to receive a uterine transplant from a deceased donor and was the second in our trial. in vitro fertilization treatments using the long gonadotropin-releasing hormone agonist protocol preceded the transplantation procedure. Frozen embryo transfers were performed in months 12, 13, 16, 19 and 23 after transplant. RESULTS: Recovery of the uterus of a 24-year-old brain-dead nulliparous donor and the transplant procedure itself was uncomplicated. No abnormalities were revealed on Pap smears, which were performed every 6 months during the post-transplant period, and cervical biopsies showed no epithelial dysplasia. The fifth frozen embryo transfer resulted in a clinical pregnancy. Three weeks after embryo transfer, an intrauterine gestational sac containing an embryo with a heartbeat was detected. One week later, signs of a missed abortion were revealed by ultrasound. Two weeks later, spontaneous bleeding occurred, and an ultrasound examination performed a week later confirmed an empty uterine cavity. CONCLUSION: In light of present research, both deceased donor uterine procurement and transplantation surgeries are technically feasible; however, more experience is needed to determine the pregnancy success rate associated with this method. Thus, additional trials of deceased donor uterine transplantation should be performed in the future to continue research related to this promising concept for the treatment of absolute uterine factor infertility.


Assuntos
Transferência Embrionária , Infertilidade Feminina/terapia , Ductos Paramesonéfricos/anormalidades , Útero/transplante , Transtornos 46, XX do Desenvolvimento Sexual , Aborto Retido , Adulto , Morte Encefálica , Anormalidades Congênitas , Feminino , Humanos , Infertilidade Feminina/cirurgia , Ductos Paramesonéfricos/transplante , Gravidez , Doadores de Tecidos
19.
Eur J Obstet Gynecol Reprod Biol ; 238: 49-53, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31082744

RESUMO

OBJECTIVE: To compare the clinical characteristics of Asherman syndrome and the outcomes of hysteroscopic adhesiolysis in women after first or second-trimester termination of pregnancy (TOP). METHODS: This was a retrospective descriptive analysis of patients with moderate-to-severe intrauterine adhesiolysis (IUAs) after TOP and treated by hysteroscopic adhesiolysis and followed by "second-look" hysteroscopy 3 months later at The Beijing Obstetrics and Gynecology Hospital (China) between January 2013 and March 2016. The American Fertility Society (AFS) scoring system was used to evaluate the intrauterine adhesions. RESULTS: A total of 236 patients with 180 first-trimester TOP and 56 s-trimester TOP patients were included. The severe adhesion and amenorrhea rates during the second-trimester group (69.6% and 39.3%, respectively) were significantly higher than those in the first-trimester group (36.7% and 7.2%, respectively). AFS score reduction in the second-trimester group (6.2 ± 2.8) was significantly lower than in the first-trimester group (6.5 ± 2.5). The pregnancy rates in the second-trimester group (21.4%) were significantly lower than that in the first-trimester group (43.3%). The pregnancy rate of severe intrauterine adhesions in second-trimester TOP (10.3%) was significantly lower than in first-trimester TOP (40.9%). CONCLUSION: These findings suggested that second trimester TOP was associated with more severe intrauterine adhesion and a worse prognosis after hysteroscopic adhesiolysis in women with Asherman syndrome when compared to first-trimester TOP.


Assuntos
Aborto Induzido/efeitos adversos , Ginatresia/cirurgia , Histeroscopia/estatística & dados numéricos , Taxa de Gravidez , Adulto , Feminino , Ginatresia/etiologia , Ginatresia/patologia , Humanos , Infertilidade Feminina/etiologia , Infertilidade Feminina/cirurgia , Gravidez , Primeiro Trimestre da Gravidez , Segundo Trimestre da Gravidez , Estudos Retrospectivos , Índice de Gravidade de Doença , Útero/patologia
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