Estimation of the prevalence of uterine infertility and its different causes in France according to data from a literature review.

INTRODUCTION: Uterine infertility (UI) is defined as the complete absence of a uterus (absolute uterine infertility or AUI) or the presence of a non functional uterus (non-absolute uterine infertility or NAUI). The exact prevalence of uterine infertility is currently unknown. Our aim was to assess the number of French women concerned by Uterine Infertility according to a recent literature review. MATERIALS AND METHODS: We have previously conducted a systematic review of the literature on UI and its various causes in the world. Based on these study and demographic data of 2022 from INSEE (Institut National de la Statistique et des Études Économiques), we attempted to estimate the number of women under 40 years of age in France affected by potential UI using direct standardization. RESULTS AND DISCUSSION: Based on the estimation from INSEE data, approximately 2066 women of childbearing age would have MRKH syndrome in France, 380 the Androgen Insensitivity Syndrome and 3700 had an haemostasis hysterectomy in France. We did not find data on the prevalence of hysterectomies before the age of 40 in France. For the following pathologies: uterine malformations, radiation uterus, synechiae, myomas and adenomyosis there was a huge amount of missing data, which does not allow us to estimate the number of potentially infertile patients. CONCLUSION: Prevalence of UI is poorly known. UI probably concerns several thousand patients in France. The creation of a UI registry would make enable to assess the number of patients potentially eligible for adoption, uterus transplantation or even surrogacy.

Coincidence of uterine malformations and endometriosis: a clinically relevant problem?

INTRODUCTION: It is suspected that uterine malformations and endometriosis have a high coincidence. Furthermore, it is expected that obstructive uterine malformations are significantly higher affected than non-obstructive malformations. The correlation between endometriosis and uterine malformations may be due to increased retrograde menstruation, which would explain a higher coincidence of obstructive malformations and endometriosis [14]. METHODS: This retrospective study investigates whether patients with uterine malformations have a higher prevalence of endometriosis. The study includes patients with uterine malformations who were admitted to our hospital in the period from 01.12.2014 to 30.11.2019. RESULTS: 279 cases were analysed. 263 (94.2%) patients had a non-obstructive uterine malformation, 12 (4.3%) patients had an obstructive uterine malformation and 4 (1.4%) patients had uterine agenesia/hypoplasia. 209 (74.9%) patients had histologically confirmed endometriosis (peritoneal, ovarian or deep infiltrating) and 70 (25.1%) had no endometriosis. In 27 cases, deep infiltrating endometriosis (ENZIAN ABC) was detected additionally to peritoneal and ovarian endometriosis. CONCLUSION: The study shows a high prevalence of endometriosis in women with uterine malformations. For this reason, endometriosis should always be specifically sought in uterine malformations.

Correção histeroscópica de útero septado completo / Hysteroscopic correction of complete septate uterus

As anomalias congênitas do trato genital feminino são condições relativamente comuns que podem levar com frequência a problemas reprodutivos. Atualmente, a abordagem cirúrgica da maioria das malformações uterinas tem sido realizada por via endoscópica, tendo a histeroscopia, com sua segurança e baixa invasividade, substituído a correção cirúrgica por via abdominal, praticamente em desuso. Com o advento da cirurgia histeroscópica, a realização de metroplastia se tornou um procedimento simples, com ótimos resultados reprodutivos. O caso clínico apresentado relata o resultado de uma correção cirúrgica endoscópica de uma malformação uterina pouco comum: útero septado completo. A dificuldade cirúrgica na abordagem da doença está na presença de dupla vagina e, sobretudo, na presença de dois colos uterinos que implicam a utilização de estratégias endoscópicas especiais para superar os obstáculos. Os autores detalham sua experiência com esse tipo de metroplastia. Uma boa prática endoscópica aliada a modernas técnicas de imagem permitem, também nesses casos, uma completa restituição da integridade da cavidade uterina, melhorando o potencial reprodutivo dessas pacientes.(AU)

Congenital malformations of the female genital tract are relatively common conditions that can often lead to reproductive problems. Currently, the surgical approach to most uterine malformations has been performed endoscopically, and hysteroscopy, with its safety and low invasiveness, has been replacing abdominal surgical correction, practically in disuse. With the advent of hysteroscopic surgery, the realization of metroplasty became a simple procedure, with excellent reproductive results. The clinical case presented, reports the result of an endoscopic surgical correction of an uncommon uterine malformation: complete septate uterus. The surgical difficulty in approaching the disease is in the presence of double vagina, and, especially, in the presence of two uterine cervix that imply the use of special endoscopic strategies to overcome obstacles. The authors detail their experience with this type of metroplasty. A good endoscopic experience combined with modern imaging techniques also allows in these cases a complete restoration of the integrity of the uterine cavity, improving the reproductive potential of these patients.(AU)