Endometrite crônica e infertilidade / Chronic endometritis and infertility

A endometrite crônica (EC) é uma doença que, apesar de ainda pouco investigada, tem sido associada a resultados reprodutivos desfavoráveis. Estudos têm mostrado que a EC pode prejudicar a receptividade endometrial, levando a falhas de implantação e perdas gestacionais recorrentes. Os métodos padronizados para diagnóstico incluem histeroscopia, histologia para pesquisa de plasmócitos e cultura endometrial para identificação de agentes bacterianos. O tratamento com antibióticos para EC parece melhorar as taxas de gestação e nascidos vivos em pacientes com falhas de implantação e perdas gestacionais recorrentes sem causa conhecida. Esta publicação tem por objetivo fazer uma revisão da etiologia, fisiopatologia, diagnóstico e tratamento da EC, seu impacto no microambiente endometrial e sua associação com infertilidade. Esta revisão narrativa da literatura atualizada sintetiza os achados encontrados em bases de dados computadorizadas.(AU)

Chronic endometritis (CE) is a poorly investigated disease, which has been related to adverse reproductive outcomes. Published studies have shown that CE can impair endometrial receptivity, which is associated with implantation failure and recurrent pregnancy loss. The standard tools for diagnosis include hysteroscopy, histology to identification of plasma cells and endometrial culture for identification of bacterial pathogens. Effective antibiotic treatment for CE seems to improve the pregnancy and live birth rates in patients with implantation failure and unexplained recurrent pregnancy loss. This paper intends to provide an overview of etiology, pathophysiology, diagnosis and treatment of CE, its impact on endometrial microenvironment and its association with infertility. This narrative review of the current literature synthesizes the findings retrieved from searches in computerized databases.(AU)

Effect of different laparoscopic methods on IVF-ET reproductive outcomes and ovarian reserve function in the treatment of hydrosalpinx / 中国实用妇科与产科杂志

OBJECTIVE: To investigate the effect of laparoscopic treatment for bilateral hydrosalpinx on ovarian reserve function and IVF-ET(in vitro fertilization and embryo transfer,IVF-ET)outcomes.METHODS: A retrospective analysis was performed in 84 patients with bilateral hydrosalpinx admitted to Shengjing Hospital Affiliated to China Medical University from January 2015 to January 2017.Group A underwent bilateral salpingectomy(21 cases)and group B underwent laparoscopic bilateral tubal proximal ligation distal ostomy(63 cases);group B1 included cases of tubal interstitial tubal ligation and distal ostomy(28 cases)and group B2 included cases of fallopian tube tubal ligation and distal ostomy(35 tubal ligation cases).RESULTS: There was no significant difference in anti-Mullerian hormone(AMH),follicle stimulating hormone(FSH),estradiol(E2),or FSH/luteinizing hormone(LH)levels between groups A and B(P>0.05),but the LH level of group A was higher than that of group B[(5.44±2.93)U/L vs.(3.20±1.40)U/L];this difference was statistically significant(P0.05).There was no significant difference in reproductive outcomes between groups B1 and B2(P>0.05).CONCLUSION: Compared with tubal ligation,salpingectomy can reduce ovarian reserve function to a certain extent;there is no significant difference in IVF-ET outcomes after tubal ligation at different locations.

Reproductive outcomes of fertility-sparing treatment for gynecologic malignancies / 中国实用妇科与产科杂志

Cervical cancer,endometrial cancer and ovarian cancer are common gynecologic malignancies.Recently,with the younger onset age and delay of childbearing,the fertility-sparing treatment has been increasingly used.In the fertility-sparing treatment for gynecologic malignancies,we should protect the fertility of patients without increasing tumor recurrence,which requires the multidisciplinary cooperation to develop individualized treatment strategy,provide optimal reproductive guidance and finally improve the reproductive outcomes.

Outcomes of GnRH Agonist and GnRH Antagonist Regimens for IVF in Women Aged up to 40.

Objective: To compare outcomes among good-prognosis patients undergoing in vitro fertilization and intracytoplasmic sperm injection followed by embryo transfer (IVF/ ICSI-ET) in GnRH-agonist (GnRH-a) and GnRH-antagonist (GnRH-ant) regimens. Methods: Retrospective analysis of 434 IVF/ICSI-ET cycles performed in a private center, in women aged up to 40: GnRH-a (n = 291) and GnRH-ant (n = 143). Pregestational, gestational and perinatal outcomes were evaluated. Statistical analysis was performed by unpaired t-test, Mann-Whitney test and Fisher’s exact test. Significance was set at p < 0.05. Results: GnRH-a regimen was associated with higher amounts of total oocytes (10.7 ± 5.7 vs 9.3 ± 5.7, p < 0.001), mature oocytes (8.2 ± 4,5 vs 6.8 ± 4.4, p < 0.001) and good quality embryos transferred (1.7 ± 0.8 vs 1.5 ± 0.9; p < 0.05). Rates of fertilization, embryo implantation and live births were also higher in GnRH-a (72.8%, 27.6% and 48.8%, respectively) compared to GnRH-ant (65.3%, 14.7% and 26.6%, respectively; p < 0.0001). There were no significant differences between rates of preterm delivery or low birth weight, comparing the two groups. Conclusion: Our results suggest that the long GnRH-a regimen is the one that offers the best reproductive outcomes among in women aged up to 40 undergoing IVF/ICSI-ET.

Decline in Child Marriage and Changes in Its Effect on Reproductive Outcomes in Bangladesh.

This paper explores the decline in child marriage and changes in its effect on reproductive outcomes of Bangladeshi women, using the 2007 Bangladesh Demographic and Health Survey data. Chi-square tests, negative binomial Poisson regression and binary logistic regression were performed in analyzing the data. Overall, 82% of women aged 20-49 years were married-off before 18 years of age, and 63% of the marriages took place before 16 years of age. The incidence of child marriage was significantly less among the young women aged 20-24 years compared to their older counterparts. Among others, women’s education appeared as the most significant single determinant of child marriage as well as decline in child marriage. Findings revealed that, after being adjusted for sociodemographic factors, child marriage compared to adult marriage appeared to be significantly associated with lower age at first birth (OR=0.81, 95% CI=76-0.86), higher fertility (IRR=1.45, 95% WCI=1.35-1.55), increased risk of child mortality (IRR=1.64, 95% WCI=1.44- 1.87), decreased risk of contraceptive-use before any childbirths (OR=0.56, 95% CI=0.50-0.63), higher risk of giving three or more childbirth (OR=3.94, 95% CI=3.38-4.58), elevated risk of unplanned pregnancies (OR=1.21, 95% CI=1.02-1.45), increased risk of pregnancy termination (OR=1.16, 95% CI=1.00-1.34), and higher risk of the use of any current contraceptive method (OR=1.20, 95% CI=1.06-1.35). Increased enforcement of existing policies is crucial for the prevention of child marriage. Special programmes should be undertaken to keep girls in school for longer period to raise the age of females at first marriage in Bangladesh and thereby reduce the adverse reproductive outcomes.

Effects of Hysteroscopic Septotomy on Pregnancy in Patients with History of Infertility or Recurrent Spontaneous Abortion / 대한불임학회지

OBJECTIVE: The aim of this study was to evaluate the influences of uterine septum and their elimination on the reproductive outcomes in women who have history of recurrent spontaneous abortion (RSA) and/or infertility. METHODS: The medical records of reproductive outcomes in patients who have had history of RSA and infertility who were diagnosed with uterine septum only by hysterosalpingogram (HSG) between January 2008 and December 2009 were retrospectively analyzed. The subjects who have had severe male factor, tubal factors, other uterine factors, endocrine abnormalities, peritoneal factors, and abnormal karyotyping among both partners were excluded. In 27 patients, confirmation of diagnosis by laparoscopy and elimination of uterine septum by trans-vaginal hysteroscopy was done. Seventeen patients were strongly suspected to uterine septum on HSG but tried to get pregnancy without any other procedure for evaluation and management of uterine anomaly. Age matched 42 patients who have history of RSA and/or infertility and diagnosed to normal HSG finding at same period were randomly selected as control. The medical records of reproductive outcomes were analyzed and compared between groups. RESULTS: The mean time of observation after diagnosis was 21.8 months (10 to 32). 55.6% (15/27) of patients in patients who received trans-vaginal hysteroscopic uterine septotomy were success to get pregnancies and was significantly higher than that of 17 patients who did not receive proper management (23.5%, 4/17, p<0.05). In control population, 40.5% (17/42) were success to pregnancies and the differences were not statistically significant compared to both two study groups. The live birth rate which was excluded pregnancy loss by abnormal fetal karyotyping and congenital anomaly were 75% (9/12) in treated septated uterus group and 84.6% (11/13) in control group each which have no statistically significant different. In patients with septated uterus who did not receive proper management showed lower delivery rate (50%, 2/4) than that of other groups but was not statistically significant. CONCLUSION: According to present data, women with a uterine septum have an increased chance of successful pregnancy with improved obstetric outcome after proper management of the uterine cavity. And these results were showed in patients with no regard to their reproductive history. But, in case of failed to receive proper management, uterine septum can affect not only pregnancy ongoing but successful pregnancy too.

Clinical characteristics of women with Mullerian anomaly: Twenty years of experience at Asan Medical Center / 대한산부인과학회지

OBJECTIVE: To investigate the clinical characteristics and reproductive outcomes of women with Mullerian anomalies. METHODS: One hundred and eighty-six patients were diagnosed with Mullerian anomalies at the Asan Medical Center from 1990 to 2009 and their clinical characteristics and reproductive outcomes were analyzed. Mullerian anomalies were categorized according to the classification by the American Fertility Society (1988). RESULTS: Mullerian anomaly was noticed in 1 in 1,326 patients (0.075%). Most cases were found in adulthood (84.9%) whereas only 15.1% cases in adolescent or pediatric period. More than 40% of cases were asymptomatic and found incidentally but others suffered from amenorrhea (12.4%), dysmenorrhea (10.8%), abnormal menstruation (10.2%), etc. Most common type of uterine anomalies was uterine didelphys (30.6%), followed by bicornuate uterus (19.4%), Mayer-Rokitansky-Kuster-Hauser syndrome (10.8%), septate uterus (9.1%) and unicornuate uterus (8.6%). On the reproductive outcomes of 251 pregnancies identified, spontaneous miscarriages and preterm labor were quite common (55.8%), and the overall live birth rate was 48.6%. When each anomaly was individually analyzed, the live birth rate was 60.0% in the arcuate uterus and 58.0% in the uterine didelphys. The unicornuate and bicornuate uterus presented a similar chance of having a living child (42.1%, 46.7%), while the septate uterus showed a relatively lower live birth rate (32.4%). CONCLUSION: Although most cases of Mullerian anomalies are diagnosed in adulthood, many patients may suffer from menstrual abnormalities, dysmenorrhea or recurrent miscarriages since adolescence. The reproductive outcomes of the arcuate uterus and uterine didelphys were better, while those of septate uterus were poor in our study.

Hysteroscopic management of intrauterine adhesion and their reproductive outcomes / 대한산부인과학회잡지

One hundred sixty three patients were hysteroscoped for various reasons at our department over 10 year period. Ninety eight patients out of 163 who were diagnosed and treated for their intrauterine adhesions(IUAs) by hysteroscopy were analysed retrospectively. Patients were classified as having mild, moderate or severe stage of IUAs according to American Fertility Society classification. Twenty nine patients(29.6%) had mild IUAs, 43 patients (43.9%) had moderate IUAs, and 26 patients(26.5%) were classified as having severe stage IUAs. The predisposing causal factors of IUAs were abortion, full-term delivery, H. mole, pelvic tuberculosis and myomectomy in order of frequency but in eight cases no cause was identified. After hysteroscopic surgery, although high rate(83.9%) of restoration of normal menstruation was attained but term pregnancy rate was only 53.3% and rather high rate (32%) of preterm or abortion were identified and those pregnancy outcomes were correlated with the stage of IUAs. Complications of surgery consisted of uterine or bladder perforation, pulmonary edema and hemorrhage.