Significant increased isolation of Escherichia coli in Iranian women with endometriosis: a case control - study.

BACKGROUND: The role of bacterial contamination in the development and progression of endometriosis lesions is currently a hot topic for gynecologists. In this study, we decided to compare the endometrial cultures of women affected by endometriosis with those of non-endometriotic women, focusing on specific microbial pathogens. MATERIAL AND METHOD: In this cross-sectional case-control study, 30 women with endometriosis in stages 4 of the disease whose endometriosis was confirmed based on clinical, ultrasound, and histopathological findings, and 30 women without endometriosis who were candidates for surgery due to benign uterine diseases with regular menstrual cycle, underwent endometrial biopsy with Novak Kort in sterile conditions before starting their operation, and the results of their endometrial culture were analyzed and compared. RESULTS: Results of the study indicate that there were no significant differences in terms of age, BMI, smoking, education level, place of residency, use of the intrauterine device, or vaginal douche, and age of menarche between the case and control groups. The only demographic difference observed was in parity, where the control group had a significantly higher parity than the case group (P = 0.001). Out of the 60 cultures, only 15 samples were positive in the endometriosis group, and E. coli was the most prevalent species, with 10 (33.3%) samples testing positive for it. Klebsiella spp. and Enterobacteria spp. were also detected in 3 (10.0%) and 2 (6.7%) samples, respectively. The comparison between the two groups showed that only E. coli had a significant association with the presence of endometriosis (P = 0.001). There was no significant relationship between the location of endometriosis in the pelvic cavity and culture results. It was observed that parity among the E. coli negative group was significantly higher compared to the E. coli positive group (P < 0.001). CONCLUSION: Based on The high occurrence of E. coli in women with endometriosis, along with its potential involvement in the progression and/or recurrence of this condition, the researchers propose that treating women with endometriosis and recurrent IVF failure, as well as those with endometriosis recurrence after surgical treatment, with suitable antibiotics and repeated culture until the culture becomes negative, could be beneficial.

Evaluation of endometrioma size effect on ovarian reserve, embryo quality and pregnancy outcome after in vitro fertilization cycle; a cross-sectional study.

INTRODUCTION: Investigation of endometrioma size and its laterality on the quality of the embryo in patients with endometrioma compared to healthy subjects. MATERIALS AND METHODS: In this retrospective and cross-sectional study, 70 patients with unilateral and bilateral endometrioma were recruited and compared with 70 age-matched infertile patients as the control group in terms of AMH before ovum pick-up, embryo quality as well as pregnancy outcome. Additionally, in the case group, we divided both unilateral (n = 32) and bilateral endometrioma patients (n = 38) into three groups based on the size of endometrioma. (1-3 cm, 3-6 cm, 6-10 cm) RESULTS: There was no difference in terms of age, BMI, parity, and age of menarche between the case and control groups. Moreover, no significant difference was observed in the baseline level of AMH between the case 2.96 ± 2.72 ng/dl (0.21-11.3) and control 2.73 ± 2.39 (0.21-12.8) groups. (P = 0.59) There was also no significant difference concerning AMH level between unilateral 3.58 ± 3.20 ng/dl (0.21-12.8) and bilateral endometrioma 2.45 ± 2.14 (0.21 - 0.20) groups. In terms of the quality and number of embryos, there was no significant difference between the case and control groups. (P = 0.30) Although the AMH level decreased with the increase in endometrioma size, this difference was not statistically significant. (P = 0.07) There was no significant difference in terms of the embryo quality between the groups based on the size of endometrioma. (P = 0.77) In addition, no significant difference was observed between the case and control groups in the terms of birth weight and pregnancy complications, such as premature delivery, cesarean section rate, neonatal respiratory distress, jaundice, as well as hospitalization rate. Head circumference of the newborns was higher in the endometrioma group while their Apgar score was lower in the case compared to the control group. CONCLUSION: The presence of endometrioma by itself does not affect the main result of IVF procedures, including the number and quality of embryos and pregnancy outcome. Thus, IVF and embryo preservation and even pregnancy before surgery seem to be reasonable for endometriotic patients.

Successful laparoscopic sigmoid transposition for cervicovaginal agenesis in the presence of a functioning uterus: A case series.

OBJECTIVE: This study investigated the long-term outcomes of laparascopic sigmoid cervicovaginoplasty in patients with congenital cervicovaginal atresia with a functioning uterus. METHODS: In this case series study, seven patients with cervicovaginal atresia with a functioning uterus underwent laparoscopic sigmoid cervicovaginoplasty surgery between 2016 and 2020. Mean follow-up duration was 25.9 months (2-48 months). All of the patients had regular menstrual cycles. The average length of the vagina was 8.9 cm (7.6-10.5 cm). In one patient, proximal stenosis of neovagina was observed 12 months after surgery. RESULTS: The mean age and body mass index of the patients were 18 years (12-27 years) and 19.7 (17.6-22.4), respectively. The average time period between the initiation of disease symptoms and the operation was 52.28 months (2-156 months). There were no postoperative short-term complications. We did not perform hysterectomy in our patients. None of our patients complained of signs of low anterior resection syndrome. Two patients had sexual activities without dyspareunia, postcoital bleeding, or malodorous vaginal discharge. CONCLUSION: Sigmoid cervicovaginoplasty is a safe and effective procedure with satisfactory long-term outcomes. This surgery eliminates the psychological burden of hysterectomy in these patients. Through preserving the uterus, patients may have a chance of possible future pregnancy if abdominal cerclage is performed.

The effect of vasopressin injection on ovarian reserve in patients with ovarian endometrioma: a randomized controlled trial.

RESEARCH QUESTION: Does injecting vasopressin into the mesovarium during endometrioma cystectomy further preserve postoperative ovarian reserve by reducing intraoperative bleeding and electrocoagulation points? DESIGN: Randomized controlled trial conducted between March 2016 and March 2020. One hundred and twenty patients with unilateral and unilobulated endometrioma were included and divided into two groups: group 1 (n = 60) comprised all patients with ovarian cystectomy after vasopressin injection in the mesovarium space; group 2 included the controls. In both groups, the anti-Müllerian hormone (AMH) concentration was examined before surgery and 3, 6 and 12 months after surgery. In both groups, the number of bipolar cauterization points and the amount of bleeding during cystectomy as well as the pain symptoms related to endometriosis and pregnancy rate were further assessed and compared. RESULTS: Compared with the vassopressin group, the controls had significantly higher haemostasis points and bleeding (P = 0.0001). No significant difference was found between the two groups in serum AMH concentration at 3, 6 and 12 months after surgery. A significant reduction in pain symptoms was reported in both groups 6 months after surgery (P = 0.0001). No significant difference was found between the two groups in spontaneous pregnancy, miscarriage rate and pregnancy time after surgery. CONCLUSION: Despite the reduction in the amount of bleeding and electrocoagulation points in the vasopressin group, ovarian reserve had a similar downward trend in both groups, which is attributed to the nature of these cysts.

The success of various endometrioma treatments in infertility: A systematic review and meta-analysis of prospective studies.

BACKGROUND: Endometriosis is seen in 0.5%-5% of fertile and 25%-40% of infertile women. To investigate this conflict between gynecologists that ovarian endometriomas should be removed or not before making any decision about pregnancy among infertile women, the authors decided to carry out a systematic review and meta-analysis to compare the effect of various available therapeutic methods and notice the impact of these options on women's pregnancy rate. METHODS: This review is based on PRISMA recommendations with an electronic search using the following databases: PubMed, Scopus, Google scholar, etc, from 2000 to 2018, in the English language. The studies compare pregnancy rate based on four different treatment types of OMAs between infertile women: (surgery + ART, surgery + spontaneous pregnancy, aspiration ± sclerotherapy + ART, and ART alone). MAIN FINDINGS: At least eight prospective studies were included, in which 553 infertile women were compared in terms of treatment methods of OMAs before trying to become pregnant. CONCLUSION: Treatments are usually based on the patient's clinical condition and must be individual, with the purpose of relieving pain, improving fertility, or both. The authors do not have not any significant difference between our four groups of study; however, the success of surgical procedure compared to other methods was higher and the success of ART alone was the least.