Endometrial Ablation: Past, Present, and Future Part II.

Endometrial ablation (EA) is the most commonly performed surgical procedure for the management of abnormal uterine bleeding unresponsive to medical therapy. In well-selected subjects, EA provides a safe, inexpensive, and convenient alternative to hysterectomy with a rapid return to normal function. The first generation of EA techniques were introduced in 1886 by Professor Sneguireff of Moscow. He was the first to apply super-heated steam to the uterine cavity to vaporize the endometrial basalis. This method-known as atmocausis-was refined by Ludwig Pincus of Danzig in 1895, and he went on to perform over 800 procedures. As the 20th century brought forth other energy sources-electricity, X-ray, radium, and even cryogenics-they were each used, in turn, to accomplish endometrial ablation. In 1981, Dr. Milton Goldrath successfully performed EA by co-locating a neodymium-doped yttrium aluminum garnet (Nd:YAG) laser with a rod-lens hysteroscope to achieve photovaporization of the endometrium. The accomplishment of EA under direct visualization defined the second generation of EA. The challenges and risks of second-generation technology, however, was soon apparent, and though this practice continues today, it appears to be confined to a relatively small number of devoted and highly-skilled sub-specialists. The late 1990s saw increasing interest in safe, affordable, and easily-mastered EA technology. The result was a return to blind technology but modified with a variety of features that brought unprecedented safety to EA, even permitting its selected in-office application. This third generation of EA techniques and devices has propelled the growth of EA in the 21st century. Although much has been accomplished in the quest for safe, affordable, convenient, and easily-mastered EA, the future requires refinement of patient selection criteria, management strategies for late-onset endometrial ablation failures (LOEAFs), as well as minimally invasive methods for reducing them.

Situación actual de la técnica time lapse en el laboratorio / Current status of time-lapse systems in the laboratory

El uso de los sistemas time lapse está cada vez más extendido en los laboratorios, se ha demostrado su utilidad a la hora de seleccionar mejor los embriones en combinación con la morfología, que hasta hoy era el método utilizado para realizar esta selección. Aunque existen autores que no están muy de acuerdo con esta afirmación, hay una gran mayoría que coincide en que la monitorización continua de los embriones ofrece una información relevante a la hora de elegir los mejores embriones de un cultivo. Durante los últimos años han surgido estudios avalando el uso de esta técnica, así se ha descrito que se puede conseguir elevar las tasas de embarazo y apostar con más fuerza por la transferencia de embrión único. Todo lo descrito en la literatura habla de resultados con patrones de división y los distintos estudios que validan esos modelos, pero ninguno nombra en profundidad las especificaciones propias de cada sistema, por tanto, el objetivo de este estudio ha sido el intentar resaltar las diferencias existentes entre las plataformas que se pueden encontrar en el mercado e indicar el futuro de cada una de ellas

The use of time-lapse systems is increasingly widespread in laboratories, it has proved useful in the selection of the best embryos when combined with their morphology, the traditional method used until now. Although there are some authors that disagree with this statement, a large majority agrees that the continuous monitorization of the embryos offers relevant information at the time of choosing the best embryos within a culture. In recent years there have been studies that support the use of this technique, and have proven that higher pregnancy rates can be achieved with its use, placing more emphasis on single embryo transfer. Everything published in the literature describes the results of with division patterns and the various studies that validate those models, but none provide an in-depth description of their specifications, thus the aim of this study was to highlight the differences between each of the platforms found on the market and indicate the predicted future of each of them