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Mohan, Abhinav Amarnath, Gaurav O. Sharma, and Pankaj J. Banode. "Fallopian Tube Recanalization (F.T.R): application of Interventional Radiology (I.R) post hysterosalpingography in management of female infertility at rural hospital." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 7, no. 8 (July 26, 2018): 3074. http://dx.doi.org/10.18203/2320-1770.ijrcog20182968.
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Background: Infertility is defined as inability to conceive even after 1 year of unprotected intercourse. Tubal blockage is one of the common causes of primary as well as secondary infertility in females. Fallopian tube recanalization (FTR) an interventional radiological procedure is one of the most promising, effective, minimally invasive and cost-effective technique in patients having infertility owing to tubal blockage. The aim is to study the cause, hysterosalpingography findings, and outcome of fallopian tube recanalization by interventional radiological procedure in patients with tubal-blockage presenting with infertility.Methods: This was a prospective observational study of women with primary or secondary infertility presenting to interventional radiology department. The patients either had already undergone hysterosalpingography (HSG) or came for HSG. Fallopian tube recanalization was done as per institutional protocol. Hysterosalpingography abnormalities, outcome and complications of fallopian tube recanalization procedure were studied.Results: In this study of 87 patients unilateral or bilateral tubal blockages were seen in 16 and 24 patients respectively. Majority of the patients had Segment I proximal block. Bilateral recanalization could be successfully done in 12 patients (24 tubes) with bilateral Proximal Tubal Blockage (PTO). Unilateral recanalization was possible in 12 patients (tubes) with unilateral proximal block and 8 tubes with bilateral proximal tubal block. 10 tubes with PTO could not be recanalized. 5 cases diagnosed with bilateral Distal Tubal Block (DTO), recanalization was not attempted and were referred for appropriate gynecological management. Minor complications were noted in 8 patients while no major procedure related complications were observed.Conclusions: Fallopian tube recanalization (by interventional radiology procedure) in patients with fallopian tube blockage diagnosed on HSG is found to be cost effective, minimally invasive and have low complication rate. It is associated with excellent outcome in terms of technical success and improved conception rate.
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Vala1, K. B., G. B. Solanki, D. T. Fefar, D. Borakhatariya, and R. J. Raval. "Abattoir Survey of Genital Abnormalities in Jaffrabadi Buffaloes." INDIAN JOURNAL OF VETERINARY SCIENCES AND BIOTECHNOLOGY 15, no. 01 (July 7, 2019): 61–64. http://dx.doi.org/10.21887/ijvsbt.15.1.14.
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The present study was conducted to address the prevalence and type of pathological conditions in genitalia of 100 culled Jaffrabadi buffaloes (Bubalus bubalis). Out of 100 reproductive tracts examined, 24 were normal and 76 had gross abnormalities. Among the 184 affections observed, either single or multiple, the cervical affections were found to be the maximum 84 (45.65%) followed by uterus50 (27.17%), ovary and bursa 29 (15.76%), fallopian tube 16 (8.70%) and vagina 5 (2.71%). Out of 50 uterii examined for the histological lesions, endometritis was observed to the extent of 72 % (36 genitalia). Based on histopathological findings, uterine lesions were classified as an acute (13.89%, n = 5), subacute (19.45%, n = 7) and chronic (66.67%, n = 24) endometritis. Among the oviducts, 16 (8.70%) tubal affections were noticed to be of salpingitis. Of these, mild (+), moderate (++) and severe (+++) degree of salpingitis was found in 3 (18.75%), 4 (25.00%) and 9 (56.25%) fallopian tubes, respectively. Biometrically, right side ovary, fallopian tube as well as uterine horn were found to be larger than the respective left organs. The study concluded that about half of the culled Jaffrabadi buffaloes haveacquired cervical affections, therefore it is recommended that care should be taken while doing AI or clinical handling of the female genitalia, which can adversely affect the fertility status of animals.
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Bhattarai, Manoj, and Sita Pokhrel Ghimire. "Hysterosalpingographic Evaluation of Uterus and Fallopian Tubes of Infertile Women." Journal of Nobel Medical College 6, no. 1 (August 22, 2017): 63–71. http://dx.doi.org/10.3126/jonmc.v6i1.18089.
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Background: Hysterosalpingography (HSG) is a routinely performed radiological investigation for evaluation of uterine cavity morphology and fallopian tube patency in infertile women. This study was undertaken to describe patterns of HSG findings and to assess any significant difference in uterine and fallopian tube findings in women with primary and secondary infertility in eastern part of Nepal.Material and Methods: Hospital based cross sectional descriptive study was conducted by retrospectively analyzing HSG records of 216 infertile women (both primary and secondary infertility) done from April 2014 to August 2016. Radiological findings in uterus and fallopian tubes were recorded and analyzed. Association between two categorical variables was examined by Chi-square test.Results: Majority of infertile women (53.2%) had primary infertility. Abnormal HSG was seen in 44.9% infertile women and higher in secondary infertility (57.4%) than with primary infertility (33.9%) (OR = 2.63, 95% CI = 1.51 – 4.57, P value = 0.001). Tubal abnormality was common than uterine abnormality (36.1% versus 8.8%, P value= 0.001). Tubal abnormalities were higher in women with secondary infertility than with primary infertility (52.5% versus 21.7%), whereas uterine abnormalities were common with primary infertility compared to secondary infertility (12.2% versus 5.0%) (P value= 0.001).Conclusion: Abnormal HSG was more associated with secondary infertility. Infertility was significantly associated with tubal abnormality than with uterine abnormality. Tubal abnormalities are common in women with secondary infertility whereas uterine abnormalities are common in women with primary infertility and are statistically significant.Journal of Nobel Medical CollegeVolume 6, Number 1, Issue 10 (January-June, 2017), Page: 63-71
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Agarwal, Mukta, Hemali H. Sinha, and Anamika. "Congenital absence of a part of the fallopian tube: a case report." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 6, no. 1 (December 20, 2016): 320. http://dx.doi.org/10.18203/2320-1770.ijrcog20164686.
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Congenital malformations of female genital tract are frequently seen in Gynaecological clinics, incidence being upto 5-6% in cases of infertility. Most of these anomalies are related to uterus and vagina, abnormalities related to ovaries and fallopian tubes are of rare occurrence and the exact incidence of these anomalies are not known, only a few incidental case reports are available in literature. Here, we present a rare case report of absent mid- tubal segment of fallopian tube in a patient of infertility.
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Jimah, Bashiru Babatunde, Philip Gorleku, and Anthony Baffour Appiah. "Hysterosalpingography Findings and Jimah Ratio of the Uterine Cavity in Women with Infertility in Central Region, Ghana." Radiology Research and Practice 2020 (December 14, 2020): 1–7. http://dx.doi.org/10.1155/2020/6697653.
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Background. Infertility affects from 1.3% to 25.7% of couples worldwide and, especially, from 14.5% to 16.4% in Africa. Hysterosalpingography (HSG) is a diagnostic modality that is considered both common and efficient. It is used to investigate abnormalities of the uterine cavity and fallopian tubes. This study assessed the spectrum of findings on HSG among women with infertility in the Central Region (Ghana). Methods. We conducted a prospective cross-sectional study to examine 203 infertile women undergoing HSG work-up at the Cape Coast Teaching Hospital. The exclusion criteria were acute infection of the vagina or cervix and active vaginal bleeding or pregnancy. Data were entered with Microsoft Excel and analyzed using SPSS version 21. Results. A total of 203 women were enrolled, and eighty-five (41.87%) of the women had at least one or more abnormalities. The mean age was 32.9 years with majority of the women within 30–39 years (61.08%). More than half (50.74%) of the women presented with secondary infertility, while age of women ( p = 0.004 ) and duration of infertility (0.034) were found to be in association with the type of infertility. Uterine findings were predominantly capacious uterine cavity (45.1%) and uterine fibroids (33.3%), while fallopian tube findings included bilateral blockage (24.2%), right unilateral proximal blockage (17.7%), loculated spillage (16.1%), and left unilateral proximal blockage (16.1%). The range of normal uterine cavity size, measured as ratio (Jimah ratio) of intercornual diameter to interiliac diameter was 0.2–0.45, with a mean of 0.36. Conclusion. Secondary infertility was the commonest indication for HSG in the study, and a significant proportion of infertile women had abnormalities. Abnormalities were higher in the fallopian tubes than the uterus, while capacious uterine cavity, uterine fibroid, and bilaterally blocked tubes were the top three abnormalities found.
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Chene, Gautier, Sarah Urvoas, Stéphanie Moret, Béatrice Nadaud, Annie Buenerd, Philippe Chabert, Georges Mellier, and Gery Lamblin. "Opportunistic Salpingectomy at the Time of Benign Laparoscopic Hysterectomy: Assessment of Possible Complications and Histopathological p53-Signatures." Geburtshilfe und Frauenheilkunde 78, no. 06 (June 2018): 605–11. http://dx.doi.org/10.1055/a-0611-5167.
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Abstract Introduction The aim of this study is to assess the prevalence of tubal histopathological abnormalities (serous tubal intraepithelial carcinoma STIC and p53 signatures) and the prevalence of perioperative and postoperative complications related to opportunistic laparoscopic salpingectomy in a low risk population. Materials and Methods In this observational prospective cohort, prophylactic bilateral salpingectomy during benign laparoscopic hysterectomy was systematically performed in 100 consecutive women. Peri- and postoperative complications were registered. Duration of salpingectomy and post-salpingectomy blood loss were also measured. Histopathological and immunohistochemical analysis with anti-p53 antibody were performed on the whole fallopian tubes according to a specific and validated protocol. Results Laparoscopic salpingectomy was always possible without any peri- or postoperative complication attributable to the salpingectomy itself. The mean duration was 428 seconds (354 – 596) and the blood loss was 9 cm3 (2 – 15). Using histopathological and immunohistochemical assessment with anti-p53 antibody on 199 fallopian tubes (99 bilateral salpingectomies and one unilateral salpingectomy because of previous salpingectomy for ectopic pregnancy), there was a prevalence of 5.52% (11/199) of p53 signatures. No STIC were observed and no associated cancer. Conclusions Laparoscopic salpingectomy is both feasible and innocuous during benign hysterectomy. Meticulous histopathologic examination of the tubes may reveal specific abnormalities.
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Sharma, Devesh, and Anjali Vinocha. "Benign Ovarian Cysts with Raised CA-125 Levels: Do We Need to Evaluate the Fallopian Tubes?" Journal of Laboratory Physicians 12, no. 04 (December 2020): 276–80. http://dx.doi.org/10.1055/s-0040-1722547.
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Abstract Objectives It is not clearly known whether some benign (simple) ovarian cysts can convert into cancerous cysts. Size of cyst and wall abnormalities do predict the potentiality of malignancy. Not many studies have been done to explore the malignant potential of large-sized (> 5 cm) unilocular ovarian cysts without wall abnormalities. This study evaluated the correlation between ultrasonographic size of benign ovarian cysts and carbohydrate antigen 125 (CA-125) levels. Methodology Sixty (60) premenopausal women were recruited for the study preoperatively, based on transvaginal ultrasound (TVUS) findings present in the case record sheet received along with the CA-125 sample in the biochemistry laboratories. Those cases with elevated CA-125 levels were selected, where patients had unilocular ovarian cysts without wall abnormalities. CA-125 was done using ECLIA methodology (Cobas e411, Germany). Statistical correlation was calculated between the ovarian cyst size and CA-125 levels using Spearman’s Rho coefficient. Results Mean age group of subjects were 29.7 ± 7.3 years and mean value of CA-125 (normal < 35 IU/mL) was found to be increased: 118.0 ± 147.1 IU/mL so was the mean diameter of cysts (cut off ≤ 5 cm): 48.6 ± 59.8 cm. No correlation was found between CA-125 levels and volume of ovarian cyst (r = 0.005, p = 0.680) for all subjects. Conclusions The lack of correlation between size of ovarian cysts and CA-125 levels provides a hint that the ovarian cyst epithelium does not directly express CA-125 and it may come from sites like the fallopian tube. Thus, raised level of CA-125 in benign ovarian cyst should be followed-up more closely, demanding assessment of fallopian tubes for early diagnosis of ovarian cancer. Also, algorithms can be explored to include size of ovarian cyst and CA 125 levels to predict ovarian cancer.
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Santhalia, Pranav Kumar, MK Gupta, D. Uprety, K. Ahmad, S. Ansari, N. Agrawal, and RK Rauniyar. "Role of Radiographic Hysterosalpingography in Infertility in Eastern Nepal." Nepalese Journal of Radiology 3, no. 1 (October 6, 2013): 59–66. http://dx.doi.org/10.3126/njr.v3i1.8810.
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Background: Hysterosalpingography (HSG) is the radiographic technique for evaluation of uterine cavity and fallopian tubes. It still remains the best imaging procedure for fallopian tubes despite the advent of newer modalities and is used primarily for the evaluation of female infertility.1,2 The purpose of the study was to assess the uterine and tubal abnormalities detected on radiographic HSG as causative factors of infertility and to describe their imaging features. Methods: This prospective cross sectional study was conducted at the Department of Radiodiagnosis and Imaging, BPKIHS, Dharan. Forty-four patients with infertility (both primary and secondary) referred for HSG were included. HSG was performed using non-ionic contrast medium under image intensifier fluoroscopic control during the follicular phase of menstrual cycle. Radiographic films were obtained and analyzed. Results: Out of the total 44 patient, 26 (59.0%) had primary infertility while 18 (41.0%) had secondary infertility. Tubal abnormalities were seen in 28 (63.6%) and uterine abnormalities in 2 (4.6%) patients. The most common tubal abnormality detected on HSG was tubal block (50.0%). Unilateral and bilateral tubal blocks were equally distributed (50.0% each). Proximal tubal block was observed in 8 (36.4%) and distal in 13 (59.1%) patients. Fifteen (34.1%) patients had hydrosalpinx. Conclusion: HSG is easy, safe, and cost-effective and plays vital role in the evaluation of female with infertility. The most common structural cause of female infertility found as per this study was tubal block. Nepalese Journal of Radiology / Vol.3 / No.1 / Issue 4 / Jan-June, 2013 / 59-66 DOI: http://dx.doi.org/10.3126/njr.v3i1.8810
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Fanny, Mohamed, Edele Aka, Perel Konan, Luc Olou, Abdoul K. Koffi, Stephane Adjoussou, Konan Seni, Apollinaire Horo, and Mamourou Kone. "African experience of hysterosalpingography abnormalities tubes management by laparoscopy in infertile women." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 8, no. 11 (October 23, 2019): 4271. http://dx.doi.org/10.18203/2320-1770.ijrcog20194842.
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Background: Infertility affects about 80 million people worldwide and one in ten couples. The objective of this study was to report our experience of the contribution of laparoscopy in the diagnostic and prognostic approach of fallopian tubes pathology in infertile women in sub-Saharan Africa.Methods: We conducted a retrospective study in the Gynecology and Obstetrics unit of Yopougon Teaching Hospital over a 2-year period (January 1, 2017 to December 31, 2018) which included 49 cases of tubo-peritoneal infertility diagnosed by hysterosalpingography (HSG) then laparoscopy procedure.Results: The average age was 33 years old. 30.6 % were single. 75% had secondary infertility. 59.2% had a medical history of abortion. Pelvic Inflammatory Disease and pelvic surgery accounted 84.2% and 49 respectively. Laparoscopy showed a predominance of distal tubal damage (66.6%) whose 47% hydrosalpinx. Bilateral tubal patency was demonstrated in 77.5% of our patients during laparoscopy procedure. We observed a sensitivity, a specificity, and a concordance laparoscopy / HSG of 63.6%, 80% 63.1% respectively. Laparoscopy also allowed therapeutic procedures such as adhesiolysis or tubal plasty in 22 patients (44.89% of our cases). At the end of laparoscopy procedure, 35 patients (71.42%) were turned towards IVF.Conclusions: Laparoscopy allows an assessment of tubal abnormalities revealed by hysterosalpingography and the fertility prognostic as well as better therapeutic approach in management of tubal infertility.
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Baygazakov, A. T. "Laparoscopic techniques and anti-adhesion barrier means in the women treatment with abnormalities of the fallopian tubes." Endoskopicheskaya khirurgiya 21, no. 5 (2015): 33. http://dx.doi.org/10.17116/endoskop201521533-35.
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Zafarani, Fatemeh, Firouzeh Ghaffari, Firoozeh Ahmadi, Malek Soleimani Mehranjani, and Golam Shahrzad. "Hysterosalpingography in the assessment of proximal tubal pathology: a review of congenital and acquired abnormalities." British Journal of Radiology 94, no. 1122 (June 1, 2021): 20201386. http://dx.doi.org/10.1259/bjr.20201386.
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Tubal and peritoneal disease are the main causes of infertility. Tubal pathology can be either congenital malformation or acquired, proximal or distal, unilateral or bilateral and transient or permanent. Several imaging methods such as laparoscopy, fluoroscopy, saline infusion sonography, and hysterosalpingography (HSG) have been used in the assessment of tubal and peritoneal pathology. Although laparoscopy is the modality of choice for investigating tubal patency and pelvic structure in many infertility centers, HSG is usually the initial diagnostic method for infertility workup because of its ease of performance, accuracy, and minimal risk of complications. This method provides useful information about size, contour, and anatomy of the inner surface of the fallopian tubes and is the gold standard for evaluation of tubal lumen. Tubal and peritubal pathology show various imaging manifestations on HSG. This review illustrates the radiographic features of congenital and acquired structural abnormalities of the proximal tubal pathology and along with etiology of proximal obstruction or occlusion will be described.
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Dubbewar, Avinash, and Saumen Kanti Nath. "Observational study of HSG with laparoscopic correlation in infertility patients." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 7, no. 5 (April 28, 2018): 1903. http://dx.doi.org/10.18203/2320-1770.ijrcog20181926.
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Background: Uterine abnormalities contribute to 10% of infertility cases and 50% of women with recurrent early pregnancy loss whereas fallopian tube abnormalities contribute to 20% of such cases.Methods: Total 61 patients of infertility and subfertility undergoing evaluation and treatment at our centre were selected for HSG. Total 25 patients from this group have undergone diagnostic laparoscopy, their findings were correlated with HSG findings retrospectively.Results: All the patients in the study group were either primary or secondary infertility patients. Of the 61 patients of infertility, 49 were in primary infertility group and 12 were in secondary infertility group. The age of patients was between 23 and 35 years. The average duration of primary infertility was 5 years and secondary infertility was 3.5years. Total 61 patients underwent HSG, 42(68.8%) patients had normal findings and 19(31.14%) patients had abnormal findings. In abnormal findings 4(6.55%) were Mullerian abnormalities and 15(24.59%) were either unilateral or bilateral tubal block. Total 25 patients underwent diagnostic laparoscopy out of 61 patients. The sensitivity of HSG was 90% and specificity was 60 % with positive predictive value of 60% and negative predictive value of 90% as compared to diagnostic laparoscopy. Tubal block was defined as any form of tubal occlusion detected at HSG and finally confirmed on laparoscopy. In our laparoscopy findings, peri-adnexal adhesions were found in 5 (20%) of the blocked tubes on laparoscopy. Endometriosis was detected in 1 (4%) of the blocked tubes and suspected intra-tubal block in 2 (8%).Pelvic inflammatory disease was found to contribute in 3 (12%).Conclusions: HSG demonstrates high sensitivity in our study. So, it should be used as the initial investigation for identifying uterine abnormality and tubal patency. As the specificity is less, we suggest that laparoscopy is necessary to recognize those cases of tubal block, which were unrecognized or wrongly recognized on HSG. In addition, the patients who were found to have tubal block on HSG, laparoscopy helps in finding the cause of infertility like existence of peritubal adhesions and endometriosis that can guide appropriate therapy.
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Ventskivs’ka, Iryna, and Oleksandra Zahorodnia. "Female Factors of Infertility in a Couple." Health of Man, no. 2 (June 30, 2021): 8–13. http://dx.doi.org/10.30841/2307-5090.2.2021.237516.
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The problem of infertility is relevant to the whole world, that is explaned both by the prevalence (at least 50 million couples on the planet are diagnosed) and by the enormous medical, ecoomic, social and psychological significance. Another important aspect of infertility is the heterogeneity of its causes – about 40% of infertile marriages are caused by the female factor, 35% – male, 20% – a combination of male and female factors and 5% – have no identified factor. In 2019, the American Collegue of Obstetricians and Gynecologists updated the guidelines for the timing and scope of examinations of infertile couples. In particular, if a woman is 35–40 years old, examination and elimination of the probable factor of infertility should be started after 6 months of non-pregnancy, and in the case of age older than 40 years – immediately after the couple’s accost. The expected tactics should not be used if the patient has oligo- or amenorrhea, known uterine and fallopian tube abnormalities, grade III or IV severity of endometriosis, and the couple has known male infertility factors. Ovulation disorders as a factor of infertility include hypothalamic syndrome, polycystic ovary syndrome, premature ovarian failure and hyperprolactinemia, which differ in the content of gonadotropic hormones and ovarian hormones. The adhesion process of the pelvic organs, which restricts the transport of sperm and fertilized egg through the fallopian tubes, is a consequence of endometriosis and inflammatory diseases caused mainly by sexually transmitted pathogens. Endometriosis, in addition to the formation of adhesions in the pelvic cavity, which is characteristic of stage III and IV of the disease, is also a factor in infertility due to elevated concentrations of prostaglandins and proinflammatory cytokines, failed endometrial reciprocity. Among the uterus abnormalities in the violation of fertility are the uterine membrane, leiomyoma with submucosal localization of the node and uterine synechiae. As part of a comprehensive examination of patients with infertility, it is necessary to take into account the study of thyroid function.
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Mukherjee, Soma, Sanghamita R., and Nandita Bhartiya. "Ovarian maldescent: a case report and discussion." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 9, no. 5 (April 28, 2020): 2164. http://dx.doi.org/10.18203/2320-1770.ijrcog20201826.
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Undescended ovary or ovarian maldescent is a rare condition usually associated with mullerian malformation and typically found in case of infertility during their workup. Embryologically, the ovarian development from the genital ridge is totally different from the paramesonephric duct which forms the uterus and fallopian tubes. Still the ovarian maldescent has strong association with mullerian abnormalities, especially with unicornuate uterus. Therefore, supporting the hypothesis that abnormal migration could affect their normal fusion. In strong correlation of ovarian maldescent with mullerian abnormality here we report case of a patient presented to infertility clinic with unicornuate uterus with unilateral renal agenesis diagnosed to have unilateral undescended ovary with conclusion that the accurate diagnosis is important and radiological effort should be made to locate the undescended ovary if the ovary could not be found in normal location especially when associated with mullerian abnormality.
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Begum, Nurjahan, Fawzia Hussain, Farzana Deeba, Shaheen Ara Anwary, Parveen Sultana, and Jesmin Banu. "Evaluation of tubal and peritoneal factors in chlamydia positive infertile women by laparoscope." Journal of Shaheed Suhrawardy Medical College 7, no. 2 (March 7, 2017): 54–58. http://dx.doi.org/10.3329/jssmc.v7i2.31442.
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Background: Abnormalities or damage to the fallopian tube interferes with fertility and is responsible for abnormal implantation (eg, ectopic pregnancy). Obstruction of the distal end of the fallopian tubes results in accumulation of the normally secreted tubal fluid, creating distention of the tube with subsequent damage of the epithelial cilia (hydrosalpinx). Genital Chlamydia trachomatis infection has a worldwide distribution6 and is now recognized as the single most common cause of tubal peritoneal damage. The study explores the relationship between serum chlamydia antibody titres (CATs) and detection of tubal damage in infertile women.Objective: To Evaluation of tubal and peritonial factors in chlamydia positive infertile women by laparoscope.Methodology: The tubal status and pelvic findings in 138 women underwent laparoscopy for infertility were related to CAT, which was measured using the whole-cell inclusion immunofluorescence test. RESULTS: A total of 138 infertile women who underwent laparoscopic investigation for infertility were identified and they were divided in two groups, on the bsis of presence is absence Chlamydia positive (n=69) and Chlamydia Negative (n=69). Demographic status were almost similar between two groups, however service holder was found significantly higher in Chlamydia positive group (17 vs. 7). Tubal block was found in 44(63.7%) in Chlamydia positive and 37(53.6%) in Chlamydia negative. The difference was statistically significant (p<0.01) between two groups. Site of block & hydrosalpinges was almost similar between two groups. POD was completely obliterated in 10(14.5%) in Chlamydia positive and 3(4.3%) in Chlamydia negative. The difference was statistically significant (p<0.05) between two groups.Conclusion: Chlamydia serology is useful mainly as a screening test for the likelihood of tubal damage in infertile women and may facilitate decisions on which women should proceed with further investigations without delay.J Shaheed Suhrawardy Med Coll, December 2015, Vol.7(2); 54-58
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Heis, Mwaffaq, Zouhair Amarin, Alaa Ibrahim, Nael Obeidat, Basil Obeidat, and MA'MOON AL-Omari. "Uterine and tubal anatomical abnormalities in infertile women: diagnosis with routine hysterosalpingography prior to selective laparoscopy." South African Journal of Radiology 15, no. 4 (December 7, 2011): 120. http://dx.doi.org/10.4102/sajr.v15i4.354.
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Objective: To assess the findings and usefulness of hysterosalpingography as a routine investigation in the fertility workup prior to selective laparoscopy.
Design: Descriptive retrospective study.
Setting: A university hospital in the north of Jordan.
Subjects: All hysterosalpingographies performed in the period between 1st January and 31 December 2008.
Outcome measures: Detection of uterine and fallopian tube abnormalities and their correlation with laparoscopic findings.
Results: During the study period, 281 infertile women underwent hysterosalpingography with no post procedural complications. The mean (SD) age was 31.5 (5.91) years. Mean (SD) duration of infertility was 4 (3.44) years. Infertility was reported as primary and secondary by 119 (42.3 %) and 162 (57.6 %), respectively. Altogether 281 patients and 562 tubes were examined. Of those, 402 were patent and 160 occluded. There was only one woman in whom peritubal adhesions were diagnosed. Because of hysterosalpingographically diagnosed tubal occlusion, 46 women (16.4 %) were referred for laparoscopy. Eight (17.3%) of them were treated with unilateral salpingectomy and 28 (60.8%) with bilateral salpingectomy. Salpingolysis was performed for 7 (15.2%) women, and 3 (6.7%) women had untreatable adhesions. The concordance was 71.7%. The sensitivity of HSG was 80%, the specificity 50%, the negative predictive value 61% and the positive predictive value 71%. Of the total of 281 women, 30 (10.7%) conceived within 1 - 11 months after the hysterosalpingography.
Conclusions: The very high abnormal predictive value of hysterosalpingography in the diagnosis of tubal occlusion suggests that this procedure could be performed as a screening examination.
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Duan, Na, Xiao Chen, Yanyun Yin, Zhongqiu Wang, and Rong Chen. "Comparison between magnetic resonance hysterosalpingography and conventional hysterosalpingography: direct visualization of the fallopian tubes using a novel MRI contrast agent mixture." Acta Radiologica 61, no. 7 (November 4, 2019): 1001–7. http://dx.doi.org/10.1177/0284185119883712.
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Background Magnetic resonance hysterosalpingography (MR-HSG) is a promising technique in the work-up of female infertility. Few existing MR-HSG studies focus on the comparison between MR-HSG with gold standard examination. Purpose To compare the diagnostic value of MR-HSG with conventional HSG in patients receiving both exams in one day. Material and Methods This study included 33 infertile women who completed pelvic MR scanning, HSG, and MR-HSG in that order. A traditional HSG contrast agent (iohexol) and a magnetic resonance imaging (MRI) contrast agent (1 mL gadopentetate dimeglumine (Gd-DTPA) blended with 100 mL iohexol) were used to achieve image enhancement. Inter-observer and inter-modality agreements of HSG and MR-HSG exams were assessed. The results were calculated by using the kappa test. Three radiologists who were blinded to the clinical data independently reviewed the MR images. Extratubal abnormalities were analyzed. Results A total of 62 fallopian tubes of 33 women were included in the study. MR-HSG imaging findings to depict tubal patency were similar to these of HSG (AUC 0.911, sensitivity 0.821, specificity 1.000, positive predictive values 1.000, and negative predictive values 0.872). Pairwise inter-observer agreement among three observers and inter-modality agreement of the diagnosis were excellent (mean kappa 0.863 and 0.835, respectively). In addition, 29 extratubal abnormalities in 21 patients were found on pelvic MR scanning. Conclusion MR-HSG and HSG demonstrated similar results in assessing tubal patency. Because it offers the comprehensive assessment of female pelvic structures, and avoids ionizing radiation, MR-HSG may be used as an alternative imaging technique for evaluation of female infertility.
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Albal, Manisha, Prasad Y. Bansod, and Mahendra Chauhan. "Neovagina creation using sigmoid colon in vaginal agenesis: a case report and review of literature." International Surgery Journal 7, no. 3 (February 26, 2020): 904. http://dx.doi.org/10.18203/2349-2902.isj20200843.
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Mullerian duct anomalies are rare and can present with abnormalities in upper vagina, cervix, uterus, and fallopian tubes. The exact incidence of cervicovaginal agenesis is unknown and there are very few cases recorded in the literature. Authors report a 12-year-old girl referred from gynaecologist with chronic cyclical abdominal pain with underdeveloped, geniatilia and developed secondary sexual characters. Radiological investigations showed hypoplastic cervix with hematometra and left hemato salpinx. A definitive repair with creation of a neovagina using a sigmoid colon segment was performed in a single stage. Many techniques are described for reconstruction of cervicovaginal canal. Use of colon in creation of a neovagina is described by authors. Here we report a case of complete vaginal agenesis presenting with Hematometra-Hematosalpinx where a neovagina was created using a segment of sigmoid colon. Single staged surgery for neovagina creation using segment of sigmoid colon offers a promising and safe alternative for cervicovaginal agenesis.
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V., Sitalakshmi, and Alpana Bansal. "Role of transvaginal sonography in gynecological diagnosis at a tertiary care hospital." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 6, no. 7 (June 24, 2017): 2910. http://dx.doi.org/10.18203/2320-1770.ijrcog20172905.
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Background: Transvaginal sonography (TVS) is very useful to assess the abnormalities in the anatomical structure of the uterus as well as endometrium. Not only this, it is capable of finding out any abnormalities of ovary, fallopian tubes, cervical structures as well as myometrium. The objective of the study was the role of transvaginal sonography in gynecological diagnosis at a tertiary care hospital.Methods: Present hospital based prospective study was carried out among 31 randomly selected eligible patients as per inclusion and exclusion criteria of the study for a period of one year at Department of Obstetrics and Gynecology of S. V. Medical College, Tirupati. All ethical guidelines were followed. A pre-designed and semi structured pre-tested questionnaire was prepared for entry of patient data.Results: Transvaginal sonography was more accurate in terms of evaluation of both tubes. Overall diagnostic accuracy of transvaginal sonography was 90.9%. It was found that the accuracy of clinical diagnosis was 100% in comparison to diagnosis by scan. In five cases, the clinical diagnosis of infertility was made as ovarian cyst and in all those cases it was confirmed. In three cases, the clinical diagnosis of infertility was made as fibroids and in all those cases it was confirmed. It was found that in cases of ectopic pregnancy, copper T missing loop and missed abortion, the clinical diagnosis was 100% accurate in comparison to scan diagnosis. Only in case of pelvic inflammatory disease, the accuracy of clinical diagnosis was 66% in comparison to scan diagnosis.Conclusions: Despite the few disadvantages of transvaginal sonography in measuring large pelvic masses, the smallest details of the masses yield valuable preoperative information. The more accurate delineation of internal echo characteristics scores the benefit over transvaginal sonography has its rightful place in gynecological practice has diagnostic and minimally invasive therapeutic tool.
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Esipova, I., I. Krasnova, and N. Kalmykova. "M029 THE ROLE OF 3-DIMENSIONAL SONOHYSTEROGRAPHY FOR DETECTION OF UTERINE CAVITY ABNORMALITIES AND PATHOLOGY OF THE FALLOPIAN TUBES IN PATIENTS WITH INFERTILITY." International Journal of Gynecology & Obstetrics 119 (October 2012): S540. http://dx.doi.org/10.1016/s0020-7292(12)61223-5.
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Itanyi, Ukamaka D., and Hadijat O. Oluseyi. "Spectrum of hysterosalpingographic findings among women presenting with infertility in Abuja, Nigeria’s capital." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 6, no. 4 (March 30, 2017): 1583. http://dx.doi.org/10.18203/2320-1770.ijrcog20171433.
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Background: Hysterosalpingography HSG provides the outline of the endometrial canal and fallopian tubes and is an invaluable imaging modality in the investigative management of infertility especially in resource challenged environments. The objective of the study was to review the hysterosalpingographic (HSG) findings in women investigated for infertility in Abuja, Nigeria’s capital.Methods: This is a descriptive review of retrospective radiologic reports of 219 patients who underwent HSG as part of infertility investigation over a three-year period (2013-2015) in University of Abuja teaching Hospital.Results: A total of 219 reports were reviewed with age range of 20-53years (mean 33.9 ±5.7 2SD) years. Majority were between the ages of 26-37 years (n=102, 33.6%). Secondary infertility was the indication in 172 (78.5%) and primary infertility in 47 (21.5%). Majority of the women (n=149, 68%) had hysterosalpingographic abnormalities with Tuboperitoneal pathology as the prevalent finding in 112 (75.2%) of the cases either as a single pathology or coexisting with intrauterine abnormality. The most common endometrial cavity abnormality was uterine Fibroid seen in 53, (35.6%) women.Conclusions: Hysterosalpingography remains very important in the investigation of infertility in our center with tuboperitoneal pathology as the major contributor to female infertility.
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Hager, Marlene, Johannes Ott, Christian Göbl, Iris Holzer, Rudolf Seemann, Christine Kurz, and John Preston Parry. "Detection of hysteroscopic fluid in the pouch of Douglas: a prospective cohort study about the predictability of bilateral tubal occlusion." Archives of Gynecology and Obstetrics 304, no. 4 (February 24, 2021): 1073–80. http://dx.doi.org/10.1007/s00404-021-05993-0.
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Abstract Purpose To determine whether an increase in cul de sac (CDS) fluid after hysteroscopy is predictive of tubal patency. Methods In a prospective clinical cohort study, 115 subfertile women undergoing laparoscopic and hysteroscopic surgery at the Medical University of Vienna were invited to participate. The primary outcome was determining whether an increase in fluid in the pouch of Douglas was reflective of unilateral or bilateral tubal patency. Vaginal sonography before and after hysteroscopy was performed to detect fluid in the pouch of Douglas, directly followed by laparoscopy with chromopertubation. Results Laparoscopic chromopertubation revealed bilateral Fallopian tube occlusion in 28 women (24.3%). Twenty-seven/40 patients (67.5%) with no fluid shift had bilateral occlusion during the consecutive laparoscopy (p < 0.001). One/75 patients (1.3%) showing a fluid shift had bilateral occlusion (sensitivity of a present fluid shift for uni- or bilateral patency 85.1%, 95% CI: 81.7–99.9, specificity: 96.4%, 95% CI: 75.8–91.8). Intracavitary abnormalities (odds ratio, OR, 0.038; p = 0.030) and adhesions covering one or both tubes (OR 0.076; p = 0.041) increased the risk for a false abnormal result, i.e., uni- or bilateral tubal patency despite the lack of a fluid shift. Conclusion When CDS fluid does not change after hysteroscopy, this is a sensitive test for tubal occlusion and further testing may be warranted. However, if there is an increase in CDS fluid after hysteroscopy, particularly for a patient without fluid present prior, this is both sensitive and specific for unilateral or bilateral tubal patency.
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Khan, Masuda Islam, Suha Jesmin, Jesmin Jerin, Shahana Shermin, and TA Chowdhury. "Hysterosalpingography in Infertility." Delta Medical College Journal 2, no. 1 (January 29, 2014): 9–12. http://dx.doi.org/10.3329/dmcj.v2i1.17790.
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Background: Infertility is a common medical problem. It can be due to problems in either partner, or both. Ovulatory dysfunction, tubal and peritoneal factors comprise the majority of female factor for infertility. Hysterosalpingography (HSG) plays an important role in the evaluation of abnormalities related to the uterus and fallopian tubes. Objective: The aim of this study was to evaluate the hysterosalpingographic findings of women with infertility in our setting. Materials and method: This cross sectional study was carried out in the infertility centre at BIRDEM, Dhaka, Bangladesh during the period of September 2002 to February 2003. Out of 100 infertile patients 50 infertile women of reproductive age (21-40 years) indicated for HSG were enrolled in this study. Results: Sixty percent patients had secondary infertility. Majority of the subjects of both primary and secondary infertility (55% and 60%) were in 26-30 years age group. On HSG any sort of uterine pathology was found in 10% cases and unilateral and bilateral tubal block were present in 24% and 20% cases respectively. Conclusion: Hysterosalpingography, a safe, less invasive procedure, has an important role in diagnosing uterine and tubal factors of infertility. DOI: http://dx.doi.org/10.3329/dmcj.v2i1.17790 Delta Med Col J. Jan 2014; 2(1): 9-12
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Daniel, Guerrier, and Morcel Karine. "Partial SHOX duplications associated with various cases of congenital uterovaginal aplasia (MRKH syndrome): A tangible evidence but a puzzling mechanism." Journal of Genetic Medicine and Gene Therapy 4, no. 1 (March 24, 2021): 001–8. http://dx.doi.org/10.29328/journal.jgmgt.1001006.
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The Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is the most severe form of congenital malformation of the inner female reproductive tract. It is diagnosed as such when the uterus, the upper vagina and optionally the Fallopian tubes are absent. It accounts for approximately 1 in 5000 live-born females and has been classified in two subtypes: type 1 in the presence of isolated uterovaginal aplasia and type 2 when associated in various combinations with extragenital malformations of the kidneys, skeleton, heart and auditory system. Most cases of MRKH syndrome are sporadic, although a significant number of many familial cases have been reported to date. Despite numerous studies, the genetics of the syndrome remains largely unknown and appears to be heterogeneous: chromosomal abnormalities and some candidate gene variants appear to be associated with a few cases; others have been suggested but not yet confirmed. To date, mainly the GREB1L gene appears to be a serious candidate. Among the remaining hypotheses, the controversial contribution of partial duplications of the SHOX gene is still puzzling, as the deficiency of this gene is a major cause of skeletal adysplasia syndromes. We have attempted to resolve this controversy in a study of 60 MRKH cases. Our results tend to show that SHOX duplications can be the origin of a genetic mechanism responsible for MRKH syndrome.
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Reddy, Gurram Swetha, and Gandavaram Jyothi. "Hysterosalpingogram in evaluation of primary and secondary infertility: a two year study at a tertiary care hospital of South India." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 8, no. 6 (May 28, 2019): 2202. http://dx.doi.org/10.18203/2320-1770.ijrcog20192164.
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Background: Infertility globally is a raising threat and problem associated with significant social and psychological problem. Infertility currently affects about 10 to 14 percent of the Indian population, with higher rates in urban areas where one out of six couples is impacted. Patency of the tubes, structure of uterus and cervix can be visualized by hysterosalpingogram which is a simple safer inexpensive investigation of choice in cases of infertility. Objective of this study was to study the role of hysterosalpingography (HSG) in cases of primary and secondary infertility and to observe the structural abnormalities of cervix, uterus and fallopian tubes.Methods: A two year prospective study was conducted on cases of primary and secondary infertility attending the OPD of infertility clinic. HSG was performed on the subjects included in study and findings were noted. Analysis was done by Microsoft excel spread sheet.Results: A total of 286 cases with 11.19% of primary infertility and 88.81% of secondary infertility evaluated by HSG. Mean age of the study group was 35.16±2.8 years. 74.83% had abnormal findings, with 20.28% having normal uterine cavity with uterine filling defect being the common abnormality. Two congenital anomalies of uterus were noted. Tubal occlusion was seen in 8.39% right and 9.09% left cases. Hydrosalpinx was observed in 7.69% of right and 9.79% of left cases.Conclusions: To conclude, women presenting with infertility should be evaluated for tubal pathology. The tubal pathologies like occlusion or hydrosalpinx may be due to infections or post surgical sequelae. HSG remains one of the diagnostic backbone in infertility even availability of new modalities.
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Vilchis, Felipe, Lizette Mares, Bertha Chávez, Arcadio Paredes, and Luis Ramos. "Late-onset vanishing testis-like syndrome in a 38,XX/38,XY agonadic pig (Sus scrofa)." Reproduction, Fertility and Development 32, no. 3 (2020): 284. http://dx.doi.org/10.1071/rd18514.
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Here we describe the case of a pig with intersex traits including ambiguous external genitalia, sex chromosome abnormalities and a late-onset vanishing testis-like syndrome. It was identified shortly after birth by presenting a predominantly female phenotype with two large scrotal masses resembling testes. The karyotype is 38,XX (53%)/38,XY (47%). Sex steroid levels were undetectable at 1 and 7 months old, whereas circulating cortisol levels were typical. DNA studies excluded gene alterations in sex-determining region Y (SRY), dosage-sensitive sex reversal-congenital adrenal hypoplasia critical region on the X chromosome protein 1 (DAX1), SRY-related high mobility group-box gene 9 (SOX9), nuclear receptor subfamily 5, group a, member 1 (NR5A1), nuclear receptor subfamily 3, group c, member 4 (NR3C4) and steroid 5-alpha-reductase 2 (SRD5A2). At 8 months of age the XX/XY pig evinced delayed growth; however, the most striking phenotypic change was that the testes-like structures completely vanished in a 2–3-week period. The internal genitalia were found to consist of a portion of a vagina and urethra. No fallopian tubes, uterus or remnants of Wolffian derivatives were observed. More importantly, no testes, ovaries, ovotestis or gonadal streaks could be identified. The XX/XY sex chromosome dosage and/or overexpression of the DAX1 gene on the X chromosome in the presence of a wild-type SRY gene may have caused this predominantly female phenotype. This specimen represents an atypical case of 38,XX/38,XY chimeric, ovotesticular disorder of sex development associated with agonadism.
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Steenbeek, Miranda P., Johan Bulten, Marc P. L. M. Snijders, Marike Lombaers, Jeanine Hendriks, Michiel van den Brand, Arjan A. Kraayenbrink, et al. "Fallopian tube abnormalities in uterine serous carcinoma." Gynecologic Oncology 158, no. 2 (August 2020): 339–46. http://dx.doi.org/10.1016/j.ygyno.2020.04.707.
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Bartels, Chantal, Andrea J. DiLuigi, and Christopher M. Morosky. "Fallopian Tube Abnormalities and Associated Surgical Interventions." Postgraduate Obstetrics & Gynecology 35, no. 22 (November 2015): 1–7. http://dx.doi.org/10.1097/01.pgo.0000473622.90713.2a.
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Shrotri, Tejashri, and Meenakshi Ahuja. "Bilateral absence of fallopian tube segments: an uncommon condition." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 8, no. 1 (December 26, 2018): 335. http://dx.doi.org/10.18203/2320-1770.ijrcog20185449.
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Congenital abnormalities of fallopian tube are rare among the abnormalities of female urogenital system. Bilateral absence of fallopian tube segments is an extremely uncommon condition. The authors report one such rare case diagnosed during diagnostic laparoscopy during evaluation of infertility. On one side, it was completely absent; while on the other side, it was partially absent simulating a formal tubal ligation. To the best of authors knowledge, this is an extremely unusual condition with very few reports available in literature.
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Bellal, Amulya Reddy, Puneet Shirbur, and Geetha R.G. "Mayer-Rokitansky-Kuster-Hauser Syndrome - A Detailed Study of Nine Cases." Journal of Evidence Based Medicine and Healthcare 7, no. 43 (October 26, 2020): 2479–84. http://dx.doi.org/10.18410/jebmh/2020/513.
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BACKGROUND Mayer-Rokitansky-Küster-Hauser Syndrome or MRKH Syndrome is a rare condition and is the second most common cause of primary amenorrhea, comprising of vaginal atresia (upper two thirds), rudimentary uterus, normal fallopian tubes, ovaries, broad and round ligaments. The spectrum of uterine anomalies (hypoplasia or duplication) include a partial lumen to a bicornuate or septate uterus with obstruction (unilateral or bilateral). The incidence is 1 in 4500 - 5000 female live births, presenting with primary amenorrhoea. The secondary sexual characteristics, external genitalia, ovaries and karyotype are normal. There are two types - the first type is the isolated form and the second type also termed as MURCS association [Müllerian duct aplasia, renal dysplasia-agenesis, hydronephrosis, horseshoe kidney and cervicothoracic anomalies such as fused vertebrae, scoliosis etc.]. Initial assessment with ultrasound scan of abdomen and pelvis followed by MRI study of the abdomen and pelvis are the imaging modalities of choice. METHODS This is a case series of 9 female patients who had presented to the Department of Obstetrics & Gynaecology and the Department of Radiodiagnosis from July 2019 to June 2020, aged between 15 and 20 years with a chief complaint of anxiety due to primary amenorrhoea. Following a thorough clinical, gynaecological and biochemical evaluation (levels of FSH, LH and 17 beta oestradiol), radiological examination (ultrasound and MRI - abdomen and pelvis) was conducted. RESULTS In our study, out of a total of nine cases, six cases were MRKH Type I and three were MRKH Type 2. All the nine cases presented with primary amenorrhoea, normal secondary sexual characteristics (except one case with ectopic atrophic ovaries) and normal external genitalia. Available hormonal profile was unremarkable. Uterus was not palpable on PV and per speculum examination. Along with the above features, when features of only hypoplastic / infantile / rudimentary / absent uterus with hypoplastic / absent upper two thirds of vagina, normal pelvic ovaries or ectopic inguinal ovaries was present, a diagnosis of MRKH Type–I was given. With additional features of renal abnormalities or skeletal system abnormalities, a diagnosis of MRKH Type–II was given. CONCLUSIONS MRKH syndrome is a condition caused due to the failure of fusion of Müllerian duct derivatives. It affects 1 in 4500 - 5000 female live births. It is a class I Mullerian duct anomaly including vaginal atresia, uterine anomalies & malformations of the upper urinary tract. There are two types in this. USG and MRI of the abdomen and pelvis are helpful in imaging this condition. KEYWORDS MRKH Syndrome, Ultrasound, MRI, MURCS Association
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Castro, Eduardo, Linden Morales, Riyam Zreik, and Ludvik R. Donner. "A Focus of Differentiated Myeloid Sarcoma in a Ligation Specimen of the Fallopian Tube: No Evidence of Hematologic Abnormality in 18 Years of Follow-up Despite Absence of Treatment." International Journal of Surgical Pathology 28, no. 1 (July 25, 2019): 99–101. http://dx.doi.org/10.1177/1066896919864167.
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A 0.2-cm intramural focus composed predominantly of myelocytes and metamyelocytes, many CD3+, CD43+ T-lymphocytes, scanty CD20+ B-lymphocytes, rare mast cells, but no eosinophils or myeloblasts was incidentally found in a ligation specimen of the left fallopian tube. The myeloid cells were positive for chloroacetate esterase, myeloperoxidase, myeloid marker BM2, and CD43, and they were negative for CD30, CD34, CD117, ERG, and TDT. The findings in the left fallopian tube were consistent with the diagnosis of differentiated myeloid sarcoma. The right fallopian tube was normal. No hematologic abnormalities were found elsewhere in the body. Curiously, the patient remains free of any hematologic abnormality for 18 years despite absence of treatment.
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Healy, N. A., S. O. Hynes, J. Bruzzi, S. Curran, M. O'Leary, and K. J. Sweeney. "Asymptomatic Primary Fallopian Tube Cancer: An Unusual Cause of Axillary Lymphadenopathy." Case Reports in Obstetrics and Gynecology 2011 (2011): 1–6. http://dx.doi.org/10.1155/2011/402127.
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Primary Fallopian tube malignancy is considered a rare disease and is often mistaken histologically and clinically for ovarian cancer. The etiology is poorly understood, and it typically presents at an advanced disease stage, as symptoms are often absent in the initial period. As a result, primary fallopian tube cancer is generally associated with a poor prognosis. We present the case of a 45-year-old female who presents with a 5-day history of left axillary swelling and a normal breast examination. Mammogram and biopsy of a lesion in the left breast revealed a fibroadenoma but no other abnormalities. Initial sampling of the axillary node was suspicious for a primary breast malignancy, but histology of the excised node refuted this. PET-CT showed an area of high uptake in the right pelvis, and a laparoscopy identified a tumor of the left fallopian tube which was subsequently excised and confirmed as a serous adenocarcinoma.
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Aribon, Pamela Ann T., Leslie Daphne R. Kawaji, Freyja Diana A. Ramos, and Monica Therese B. Cating-Cabral. "Pituitary Stalk Interruption Syndrome in a 40-Year-Old Female With Absent Uterus and Ovaries." Journal of the Endocrine Society 5, Supplement_1 (May 1, 2021): A601—A602. http://dx.doi.org/10.1210/jendso/bvab048.1226.
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Abstract Background: A patient with multiple pituitary hormone deficiencies due to a rare congenital pituitary defect also presented with an absent uterus and ovaries. Coexisting Müllerian agenesis was suspected, however hormone replacement unraveled a different story. Case Presentation: A 40-year-old female presented with generalized body weakness and euvolemic hyponatremia. She also had cold intolerance, constipation, primary amenorrhea and dyspareunia. As a child, she was worked up for short stature but was lost to follow up. Physical examination showed Tanner stage 1 breast and pubic hair, and absence of axillary hair. She had no facial anomalies, visual abnormalities or anosmia. Hormone panel was consistent with panhypopituitarism: ACTH 5.69 pg/mL (<46 pg/mL), cortisol 1.9 ug/dL (4.30-22.40 μg/dL), TSH 3.375 uIU/mL (0.55-4.78 uIU/mL), FT4 0.51 ng/dL (0.55-4.78 uIU/mL), FT3 1.79 pg/mL (2.30-4.20 pg/mL), LH <0.07 mIU/mL (1.9-12.5 mIU/mL), FSH 0.95 mIU/mL (2.5-10.2 mIU/mL) and IGF-1 40.8 ng/dL (109-284 ng/mL). Bone age was delayed (16-year-old) but with most ossification centers fused. Pituitary MRI showed hypoplastic anterior pituitary, ectopic posterior pituitary and absent pituitary stalk suggestive of Pituitary Stalk Interruption Syndrome (PSIS). Low estradiol 19.35 pg/mL (19.5-144.2 pg/mL) in the setting of low LH and FSH was compatible with hypogonadotrophic hypogonadism. She had female-range serum testosterone level <0.007 ng/mL (0.1209-0.5946 ng/mL) and karyotype of 46XX. Transvaginal ultrasound revealed a blind vaginal pouch with absent uterus, fallopian tubes and ovaries; hence Müllerian agenesis was also considered. Hormonal replacement with prednisone, levothyroxine and conjugated equine estrogen was started. Secondary osteoporosis was treated with alendronate, calcium and vitamin D on top of estrogen therapy. Six months after initiation of estrogen, there was appearance of a small anteverted uterus and atrophic right ovary. Müllerian agenesis was ruled out and hypogonadotropic hypogonadism was proved to be the cause of the initial absence of the uterus and ovaries on imaging. Conclusion: Increased awareness of PSIS is important since early and accurate diagnosis is crucial for timely initiation of hormone replacement. This case also demonstrates the need for reassessment after hormonal replacement in patients with severe estrogen deficiency and apparent Müllerian agenesis.
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Maherunnessa, TA Chowdhury, Samsad Jahan, Nurunnahar Begum, Samina Sultana, and Umme Rumman. "Laparoscopic Evaluation of Pelvic Organs In Case of Infertility." BIRDEM Medical Journal 3, no. 2 (December 1, 2013): 90–93. http://dx.doi.org/10.3329/birdem.v3i2.17212.
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Objective: Evaluation of pelvic organs by laparoscopy in infertile patient. Background: Despite of absence of any known risk factor for infertility various studies indicate that there may be abnormalities in pelvic organ in about two-third of the cases, as evidenced by laparoscopic study. Present study was done to have an idea about the problem in a group of patients reporting to specialised centre. Materials and Methods: It was a prospective study which was undertaken in Gynaecology and Obstetric Department at BIRDEM during the period of January 2001 to December 2001. Results: The study group comprised 100 cases of infertile patients of age between 20 to 40 years. Sixty seven percent patients had primary infertility and 33% patients had secondary infertility. Size and shape of uterus was normal in 76% cases and bicornuate uterus was found in 2% cases. Right ovary was normal in 51%patient and left ovary was normal in 53%. Polycystic changes of right ovary were observed in 23% and of left ovary in 22% cases . Right fallopian tube was normal in 71% and left fallopian tube was normal in 69% cases. Patency of right fallopian tube was found in 89%and patency of left fallopian tube was found in 90%. Eleven percent patients were found to have peritubal adhesion on right side and 10% on left side. Pouch of Douglas was found to be normal in 69% cases and 9% cases had adhesion with obliteration. Conclusion: Laparoscopy is an important tool for diagnosing anatomical and pathological abnormalities of internal genital organs which plays a major role in infertility management. For treating infertility, we should give appropriate importance on laparoscopic evaluation of pelvic organs. Birdem Med J 2013; 3(2): 90-93 DOI: http://dx.doi.org/10.3329/birdem.v3i2.17212
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Bardi, Georgia, Tatjana Sukhikh, Nikos Pandis, Berit Hølund, and Sverre Heim. "Complex karyotypic abnormalities in a primary carcinoma of the fallopian tube." Genes, Chromosomes and Cancer 10, no. 3 (July 1994): 207–9. http://dx.doi.org/10.1002/gcc.2870100310.
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Ahmed, Polly, T. A. Chowdhury, and Kaniz Mahmud. "Laparoscopic evaluation of pelvic organ in case of subfertility." International Journal of Reproduction, Contraception, Obstetrics and Gynecology 10, no. 8 (July 26, 2021): 2955. http://dx.doi.org/10.18203/2320-1770.ijrcog20212940.
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Background: Globally subfertility affects 10-15% of couple. All these people need proper evaluation and treatment. Now a days laparoscopy considered as a gold standard procedure for evaluation of pelvic organ. The aim of this study was to find out the different causes of female factor infertility with the help of laparoscopy.Methods: This retrospective study was conducted in infertility clinic of BIRDEM hospital, Dhaka, Bangladesh during the period of May, 2007 to October 2007. The study group comprised 100 cases of infertile patients.Results: In this study, among 100 patients 68% had primary and 32% had secondary infertility. In laparoscopy majority (55.0%) had normal ovary, 20.0% had cystic change with thick capsule in right ovary and 22% had in left ovary, 7.0% had endometriosis, 8.0% had adhesion, 10.0% had simple cyst in right ovary and 8% had in left ovary and rest could not be visualized. 79.4% right and 77.9% left fallopian tube patent in primary subfertility cases and 56.3% right and 59.4% left tube normal in secondary subfertility cases. Both fallopian tube patent in 62%, unilateral block 21% and bilateral block in 17% cases in this study peritoneum was normal in 78% cases, 8% cases there was endometriosis and 14% cases there was adhesion of fallopian tube with the ovary, adhesion of uterus with intestine and also with bladder.Conclusions: Laparoscopy is an important tool for diagnosing anatomical and pathological abnormalities of pelvic organ which has a major role in subfertility management.
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Turan, Arzu, Halil Aslan, Nese Colcimen, Fatma Beyazal Celiker, and Meryem Demirtas. "The assessment of endometrial pathology and tubal patency of infertile patients: MR-HSG and X-ray HSG." International Journal of Research in Medical Sciences 5, no. 12 (November 25, 2017): 5135. http://dx.doi.org/10.18203/2320-6012.ijrms20175432.
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Background: Infertility is an important disorder for the pairs. Genetic, endocrine disorders or structural genital abnormalities can be cause. The cause of infertility can be determined with careful.Methods: Although it can be reported that ultrasound with saline solution or contrast enhanced hystero salpingo-sonography is the best method to evaluate the uterine cavity and Fallopian tube patency, conventional hysterosalpingography (X-ray-HSG) remains the most commonly used procedure for imaging the uterine cavity and the fallopian tube patency in the evaluation of female infertility. But ionizing radiation to genital organs is the most important problem for X-ray-HSG.Results: For this reason, they are still working on new methods to investigate female infertility as an alternative to X-ray HSGMRI is a favorite method because of excellent image characterization for the female genitals.Conclusions: In this study, the diagnostic performance of MR-HSG was compared with X-ray-HSG which was accepted as a gold standard for detection of tubal patency and pathology of the endometrial cavity.
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Mahdy, E. A. "Pathological studies on fallopian tube in relation to uterine lesions and ovarian abnormalities." Journal of Veterinary Medical Research 20, no. 1 (March 1, 2010): 69–75. http://dx.doi.org/10.21608/jvmr.2020.77582.
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Izhar, R., S. Tahir, and F. Mansuri. "O332 COMPARISON OF SALINE HYSTEROSONOGRAPHY & HYSTEROSALPINGOGRAM IN ASSESSMENT OF FALLOPIAN TUBE PATENCY & INTRAUTERINE ABNORMALITIES IN INFERTILITY ASSESSMENT." International Journal of Gynecology & Obstetrics 119 (October 2012): S377—S378. http://dx.doi.org/10.1016/s0020-7292(12)60762-0.
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Zheng, Xingbang, Xiaoming Yu, Togas Tulandi, Yaron Gil, He Cai, Hongjing Han, and Jing Guan. "THE PREVALENCE OF SUBTLE DISTAL FALLOPIAN TUBE ABNORMALITIES AND THE RELATIONSHIP WITH ENDOMETRIOSIS IN INFERTILITY PATIENTS:A PROSPECTIVE COHORT STUDY." Fertility and Sterility 114, no. 3 (September 2020): e474. http://dx.doi.org/10.1016/j.fertnstert.2020.08.1364.
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Mobini, Gholam Reza, Abbas Karimi, Abolfazl Akbari, and Forouzan Rahmani. "Evaluation of Teratogenic Activity of Antiepileptic Drug Lamotrigine in Mouse Fetuses." Folia Medica 61, no. 1 (March 1, 2019): 84–89. http://dx.doi.org/10.2478/folmed-2018-0058.
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Abstract Background: Use of antiepileptic drugs during pregnancy can be associated with an increased risk of teratogenicity as well as congenital abnormalities. However, there are numerous discrepancies to determine whether lamotrigine, as an antiepileptic drug, can significantly induce malformation in newborn infants or not. Thus, the purpose of the study was to evaluate the teratogenic effects of lamotrigine on mouse fetuses. Materials and methods: In the present study, 21 pregnant mice were assigned to four groups. Groups 1 and 2 (controls) received mock treatment and ethanol 20%, respectively. Groups 3 and 4 (treatment) were intraperitoneally administered with 25 and 75 mg/kg lamotrigine for three days, respectively. The treatment protocol was performed within the gestational days of 9-18 in all groups. On gestational day 18, 117 fetuses were taken out of the fallopian tube of studied mice and then examined for any anomalies (vertebral, limbs and cranial), followed by a measurement of their height and weight. Results: The results revealed that, in the treated groups, the weight and the height had significantly decreased (p<0.01) and also various anomalies were evident. Moreover, as the dose of lamotrigine increased, the decrease in the weight and the height and rising trend in anomalies were intensified. Conclusion: According to the findings, lamotrigine (LTG) could be considered as a risk factor for the development of the anomalies examined.
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Fuehrer, Neil E., Gary L. Keeney, Rhett P. Ketterling, Ryan A. Knudson, and Debra A. Bell. "ALK-1 Protein Expression and ALK Gene Rearrangements Aid in the Diagnosis of Inflammatory Myofibroblastic Tumors of the Female Genital Tract." Archives of Pathology & Laboratory Medicine 136, no. 6 (June 1, 2012): 623–26. http://dx.doi.org/10.5858/arpa.2011-0341-oa.
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Context.—Inflammatory myofibroblastic tumor is a predominantly benign, spindle cell, mesenchymal neoplasm with myxoid areas that occurs rarely in the female genital tract and may be confused with other spindle cell lesions, particularly leiomyosarcoma. Objective.—To investigate the utility of detecting anaplastic lymphoma kinase-1 protein expression and ALK gene rearrangements in the diagnosis of inflammatory myofibroblastic tumors in the female genital tract. Design.—Eight inflammatory myofibroblastic tumors arising in the female genital tract and seen in consultation (from 2004 to 2011) were reviewed. Immunohistochemistry for anaplastic lymphoma kinase-1 and fluorescence in-situ hybridization studies for ALK gene rearrangements were performed. Results.—The anatomic sites included myometrium (4 cases) and endometrium, fallopian tube, cervix, and a cervical polyp (1 each), with a patient age range from 25 to 52 years. Histologic features ranged from bland spindle cells to striking cytologic atypia, embedded in a prominent myxoid background. Anaplastic lymphoma kinase-1 immunohistochemistry was positive in 7 cases. Fluorescence in-situ hybridization studies detected ALK gene rearrangements in 5 cases. Five cases had both immunopositivity and fluorescence in-situ hybridization abnormalities, 2 cases had immunopositivity only, and 1 case was negative by both methods. Conclusions.—This is the first report, to our knowledge, of ALK gene rearrangements in inflammatory myofibroblastic tumors in the female genital tract. If a myxoid background is appreciated in a spindle cell lesion of the female genital tract, especially if inflammatory cells are present, anaplastic lymphoma kinase-1 staining along with fluorescence in situ hybridization studies, for ALK gene rearrangements, may aid in distinguishing inflammatory myofibroblastic tumors from their malignant mimics.
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Sales, Elizabeth, Richard T. Penson, Laura A. Sullivan, Darrell R. Borger, Carolyn N. Krasner, Annekathryn Goodman, Marcela G. del Carmen, et al. "A snapshot of potentially personalized care: Molecular diagnostics in gynecologic cancer." Journal of Clinical Oncology 30, no. 15_suppl (May 20, 2012): 5029. http://dx.doi.org/10.1200/jco.2012.30.15_suppl.5029.
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5029 Background: Genetic abnormalities underlie the development of cancer. It has been proposed that tumors be recategorized by gene mutation such as BRAF in LG serous, TP53 in HG serous, and PIK3CA in clear cell and endometrioid tumors. These targets potentially represent an opportunity for personalizing cancer therapy. Methods: Gynecologic Oncology patients at the MGH Cancer Center can have their tumor genotyped for a panel of mutations by SNaPshot, a validated, CLIA approved assay developed by MGH that uses DNA from FFPE tissue to interrogate 160 site-specific mutations across 15 genes (AKT1, APC, BRAF, CTNNB1, EGFR, ERBB2, IDH1, KIT, KRAS, MAP2K1, NOTCH1, NRAS, PIK3CA, PTEN, TP53). At present SNaPshot has no validated endpoints in GYN Cancers but may help identify a useful clinical trial. Results: Between 5/17/10 and 10/17/11, 125 patients consented to SNaPshot genotyping. Patients had a median age of 59 (24-78) yrs. Tumors were ovarian 70(56%), uterine clear, UPSC, or MMMT 16(13%), uterine endometrioid 10(8%), fallopian tube 8(6%), PPC 7(6%), cervical 6(5%), uterine sarcomas (3), ACUP (2), vulvovaginal (2), metastatic (1). A mutation was identified in 41(33%), with 9 of these (23%) having 2 or 3 (n=2) mutations. In the 85 ovarian, FT, and PPC cancers 33% were +ve, but 50% were in TP53. The low mutation rate for TP53 is likely explained by copy number abnormalities (Amplification). 50% of the 10 uterine tumors were +ve, with 3 of those 5 having multiple mutations in the PIK3CA pathway, while 69% of the non-endometrioid uterine tumors had mutations. Only 20% of the vulvo-vaginal and Cx tumors had mutations, both PIK3CA. 19% of the purely serous tumors (n=58) had TP53 mutations, and 37% of the purely clear/endometrioid tumors (n=19) had mutations in PIK3CA, PTEN or AKT. Certain rare tumors did not have identifiable mutations: granulosa cell tumors (2), ovarian small cell (2). 5 pts with a PIK3CA mutation were enrolled on a clinical trial (2 phase II, 3 phase I, 3 uterine, 1 ovary, 1 cervix). Conclusions: SNaPshot can identify potentially important therapeutic targets. However, the incidence of "drugable" targets in ovarian cancer is low, and <5% subjects eventually were treated on a relevant clinical trial.
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Blank, S. V., J. P. Curtin, N. A. Goldman, C. D. Runowicz, J. L. Speyer, A. D. Tiersten, J. Dancey, S. Wadler, and F. M. Muggia. "Report of first-stage accrual for NCI 5886, a phase II study of erlotinib, carboplatin and paclitaxel as first-line treatment of ovarian cancer." Journal of Clinical Oncology 24, no. 18_suppl (June 20, 2006): 5076. http://dx.doi.org/10.1200/jco.2006.24.18_suppl.5076.
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5076 Background: Abnormalities in the EGFR pathway are thought to play a major role in the dysregulated growth of ovarian and related epithelial cancers. The purpose of this study is to determine whether the addition of erlotinib (erl) to the standard first line regimen of paclitaxel (T) and carboplatin (CB) encourages pathologic complete response (pCR) in patients (pts) with ovarian (OC), fallopian tube (FTC) or primary peritoneal (PPC) cancers. Tolerability and toxicity data have been previously reported (ASCO 2005). Correlative studies of EGFR and related pathways are being performed, but data is insufficient currently for presentation. Methods: Pts with a histologic diagnosis of OC, FTC or PPC Stage III or IV with either optimal (≤ 1 cm) or suboptimal residual disease within 12 weeks of initial surgery were eligible for enrollment. Pts received T (175 mg/m2) and CB (AUC 6) every 21 days, along with erl (150 mg) by mouth, daily, continuously, for a planned 6 cycles, after which pts underwent surgical reassessment to determine pCR. Data were analyzed as two parallel phase II trials in the strata of Stage III optimal (Op) and Stage III suboptimal/Stage IV (S). Both trials followed Simon’s two-stage design, with planned first stage sample sizes of 28 (Op) and 19 (S). Early stopping rules applied for ≤ 11 pCR in Op pts, and ≤3 responses in S pts. Results: Since June 2003, 47 pts have been accrued, 29 Op and 18 S. In the Op stratum, 19 second looks (SL) were performed: 10 negative, revealing pCR, and 9 positive. Two patients elected not to have SL. Six Op pts discontinued treatment prior to completion, and four pts in this group continue treatment. In the S stratum, 7 pts were treated neoadjuvantly, and 1 pt is Stage IV. Surgical reassessment was performed in 5 of the 18 S pts, all of whom had dramatic responses, but not pCR. One pt’s disease did not respond enough to the regimen to warrant surgical reassessment. One pt was ineligible, 8 discontinued treatment, and 3 continue treatment. Conclusions: First stage accrual goals have been met, and demonstrate enough activity of erl, T and Cb in OC, FTC and PPC to proceed with second stage accrual. In the S cohort, criteria for proceeding with the study are being reassessed to account for early dropouts and neoadjuvant treatment. No significant financial relationships to disclose.
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Vincze, Márió Attila, Gábor Németh, and Tibor Novák. "Torquálódott méhfüggelék laparoszkópos ellátása a 32. terhességi héten." Orvosi Hetilap 162, no. 35 (August 29, 2021): 1418–21. http://dx.doi.org/10.1556/650.2021.32165.
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Összefoglaló. Terhességben az élettani és anatómiai változások miatt bizonyos patológiás szervi eltérések nem specifikus tünettannal járhatnak. A várandósság alatt fellépő hasi panaszok esetén lényeges felállítani a gyors és pontos diagnózist, a minél korábbi adekvát terápia érdekében. A klinikai tünetek hátterében többek között állhatnak szülészeti betegségek, illetve appendicitis, megnagyobbodott ovariumcysta, nephrolithiasis vagy diverticulitis is. Esetismertetésünkben egy 32 hetes gravida ellátását prezentáljuk, aki jobb alhasi panaszok miatt jelentkezett a Szegedi Tudományegyetem Szülészeti és Nőgyógyászati Klinikáján. A magzati paraméterek megfelelőek voltak. A klinikai vizsgálatok appendicitis gyanúját vetették fel, mely miatt laparoszkópia történt. Torquálódott jobb oldali tuba uterina miatt jobb oldali salpingectomiát végeztünk, az appendix kóros elváltozása nem igazolódott. Magzati, illetve anyai szövődmény a posztoperatív szakban nem volt. A további terhesgondozás során szövődményt nem észleltünk, majd a betöltött 40. terhességi héten hüvelyi úton egészséges újszülött született. A méhfüggelék megcsavarodásának operatív megoldása laparoszkópos úton alkalmazható módszernek tekinthető terhességben is. Az adnexcsavarodás ritka sürgősségi nőgyógyászati kórképnek számít, bár szakirodalmi adatok alapján az adnexum torsiójának rizikója fokozott lehet a terhesség korai szakaszában, kiváltképp asszisztált reprodukciós technikák alkalmazása esetén. Várandósság alatt hirtelen jelentkező alhasi panaszok esetén az anamnesztikus adatok tükrében, a klinikai vizsgálatok során szükséges az adnextorsio lehetőségére is gondolni. Orv Hetil. 2021; 162(35): 1418–1421. Summary. Due to physiological and anatomical changes in pregnancy, certain pathological organ abnormalities may be associated with non-specific symptoms. In the case of abdominal complaints during pregnancy, it is important to make a quick and accurate diagnosis to apply an early adequate therapy. The cause of the clinical symptoms can be obstetrical diseases, appendicitis, large ovarial cyst, rarely nephrolithiasis or diverticulitis. Through our case study, we present the treatment of a 32-week gravida. Examination of the pregnant patient occured at the Department of Obstetrics and Gynecology of the University of Szeged due to right lower abdominal pain. The fetal parameters were satisfactory. We assumed appendicitis, so after proper preparation laparoscopy was performed. Salpingectomy was performed because of torqued right fallopian tube and no pathological changes were detected on the appendix. In the postoperative period, there were no fetal or maternal complications. During further care of pregnancy, there were no complications and a healthy newborn was born by vaginal delivery at the 40th week of gestation. The operative procedure of adnexal rotation by laparoscopy can be considered as an applicable method even in pregnancy. Adnexal torsion is a rare emergency gynecological disease, although literature data suggest an increased risk in early pregnancy, especially in the case of assisted reproductive technology. In the case of sudden abdominal pain during pregnancy, in the light of anamnestic data, it is recommended to consider the possibility of adnexal torsion, too. Orv Hetil. 2021; 162(35): 1418–1421.
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Winer, Ira Seth, Anthony Frank Shields, Oladapo O. Yeku, Joyce F. Liu, Mary Jane Peterman, Suk Young Yoo, Israel Lowy, N. Alice Yama-Dang, Priscila Hermont Goncalves, and Glenn Kroog. "A phase I/II, multicenter, open-label study of REGN5668 (mucin [MUC]16 x CD28 bispecific antibody [bsAb]) with cemiplimab (programmed death [PD]-1 Ab) or REGN4018 (MUC16 x CD3 bsAb) in recurrent ovarian cancer (rOVCA)." Journal of Clinical Oncology 39, no. 15_suppl (May 20, 2021): TPS5602. http://dx.doi.org/10.1200/jco.2021.39.15_suppl.tps5602.
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TPS5602 Background: There is a high unmet need in rOVCA treatment, with 14,000 deaths/year in the US and a 30%‒40% 5-year overall survival rate in patients (pts) with advanced disease. REGN5668 and REGN4018 are human IgG4-based bsAbs that bridge ovarian MUC16+ tumor cells to CD28 and CD3, respectively, on T-cells to stimulate cytotoxicity. Cemiplimab is a human monoclonal Ab that blocks PD-1 binding to PD-ligand(L)1 and PD-L2. REGN5668 demonstrated increased preclinical anti-tumor activity with PD-1 inhibition or REGN4018 relative to each monotherapy. A Phase I/II study of REGN4018 alone or with cemiplimab is ongoing. Methods: This first-in-human study (NCT04590326) will assess safety, tolerability, pharmacokinetics, and preliminary anti-tumor activity of REGN5668 with cemiplimab (Module 1) or REGN4018 (Module 2) in pts with rOVCA. Key inclusion criteria include histologically confirmed diagnosis of advanced epithelial ovarian (except carcinosarcoma), fallopian tube, or primary peritoneal cancer; serum CA-125 level ≥2x upper normal limit; ≥1 prior-line of platinum-based therapy; prior treatment with or intolerance to available standard-of-care therapy. Exclusion criteria include recent biologic therapy ( < 5 half-lives or 28 days, whichever is longer, except < 3 half-lives for bevacizumab or other nonimmunomodulatory Abs with half-lives > 7 days); approved conventional therapy (except biologics or immunotherapy) < 3 weeks (wks) or investigational agents < 4 wks prior to first study dose; and anti–PD-L1 therapy < 5 half-lives prior to first study dose. This two-phase study includes dose escalation (a 4+3 design modified from 3+3) and expansion phases. In Module 1, ≤84 pts will receive 3–4 wks of REGN5668 monotherapy lead-in at assigned intravenous (IV) weekly (QW) dose levels, followed by REGN5668 QW combined with cemiplimab IV every 3 wks. In Module 2, ≤106 pts will receive 4–5 wks of REGN4018 QW IV lead-in, followed by REGN4018 full QW dose combined with REGN5668 at initial and full assigned QW doses. In expansion, REGN5668+cemiplimab and REGN5668+REGN4018 combination regimens will each recruit 20 pts in stage 1 and 30 pts in stage 2 using a Simon two-stage design. In escalation, primary endpoints are dose-limiting toxicities, serious and treatment-emergent adverse events (TEAEs), deaths, laboratory abnormalities (Grade ≥3), concentrations of REGN5668 in serum alone and in each combination regimen; key secondary endpoint is objective response rate (ORR) per Response Evaluation Criteria in Solid Tumors (RECIST) 1.1. In expansion, primary endpoint is ORR by RECIST 1.1 for each combination; key secondary endpoints are TEAEs, serious AEs, deaths. Key exploratory endpoints are correlation between clinical efficacy endpoints and baseline protein expression levels of MUC16 and PD-L1. Clinical trial information: NCT04590326.
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Khan, Khaleque N., Akira Fujishita, Takashi Suematsu, Kanae Ogawa, Akemi Koshiba, Taisuke Mori, Kyoko Itoh, et al. "An axonemal alteration in apical endometria of human adenomyosis." Human Reproduction 36, no. 6 (April 23, 2021): 1574–89. http://dx.doi.org/10.1093/humrep/deab090.
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Abstract STUDY QUESTION Is there any change in the distribution of microvilli and microtubules in the apical endometria of women with adenomyosis? SUMMARY ANSWER We observed microvilli damage in the apical endometria and an axonemal alteration characterized by abnormal distribution of longitudinal bundles of microtubules within microvilli in women with adenomyosis. WHAT IS KNOWN ALREADY Human adenomyosis has a negative impact on female fertility. Abnormal utero-tubal sperm transport, tissue inflammation and toxic effect of chemical mediators have been proposed as contributing factors. Inflammation-induced damage of mucosal cilia in the Fallopian tube has been reported. However, information on inflammation-induced damage of microvilli on the apical endometrial cells and its core bundles of microtubules in adenomyosis remains unknown. STUDY DESIGN, SIZE, DURATION This is a prospective cohort study with subjects undergoing laparoscopic surgery or hysterectomy for clinical indication and evaluations of endometrial biopsy samples in two academic university hospitals. During the period between March 2015 and December 2018, endometrial biopsy samples were prospectively collected from 15 control women and 45 women with adenomyosis for immunohistochemical analysis and a separate cohort of 10 control women with cervical intraepithelial neoplasia Grade 3 (CIN3) and 20 women with adenomyosis for analysis by immunohistochemistry and transmission electron microscopy (TEM). PARTICIPANTS/MATERIALS, SETTING, METHODS For immunohistochemical study, endometrial biopsy samples were prospectively collected from 15 control women with fibroids, 25 women with focal adenomyosis and 20 women with diffuse adenomyosis after surgery. The diagnosis of fibroid and adenomyosis was made clinically by transvaginal ultrasonography and magnetic resonance imaging and confirmed by histology. Immunohistochemical analysis was performed retrospectively using antibody against CD68 (marker of macrophages) in endometrial biopsy specimens of women with and without adenomyosis. TEM was performed with the apical endometria collected from a separate cohort of 10 control women with CIN3 and 20 women with focal and diffuse adenomyosis for the identification of any change in the distribution of microvilli and longitudinal bundles of microtubules within microvilli. MAIN RESULTS AND ROLE OF CHANCE Comparing to control endometria and contralateral side, tissue infiltration of macrophages (Mφ) in the endometria was significantly higher on the ipsilateral side of focal adenomyosis (P = 0.02 and P = 0.03, respectively) and anterior/posterior walls of diffuse adenomyosis (P = 0.01 for both). In a subgroup analysis of patients with focal adenomyosis with and without symptoms, the endometria of symptomatic women displayed a tendency of higher Mφ infiltration on the ipsilateral side than in asymptomatic women (P = 0.07). Comparing to contralateral side endometria of symptomatic women, Mφ infiltration was significantly higher in the endometria of symptomatic women collected from the ipsilateral side of focal adenomyosis (P = 0.03). We found a significantly less tissue infiltration of Mφ in the endometria of women with CIN3 than that in endometria of women with focal adenomyosis. TEM analysis showed that number of microvilli in the endometria was significantly decreased on the ipsilateral side (P = 0.003) comparing to that on the contralateral side of focal adenomyosis. The Chi-squared test indicated that cases with abnormal (disruption in the normal arrangement of 9 peripheral pairs + 1 central pair) microtubules (MT) were significantly higher in women with adenomyosis than in cases with normal patterns (P = 0.0016). While contralateral side displayed significantly less abnormal MT (P = 0.0002), ipsilateral side of focal adenomyosis showed significantly higher abnormal MT (P = 0.0164) comparing to normal patterns. Cases with symptomatic adenomyosis showed significantly higher abnormal MT than normal MT (P = 0.0004). An axonemal alteration characterized by abnormal structural distribution of microtubules within microvilli in the apical endometria in response to endometrial inflammation may be involved in adverse reproductive outcome in women with adenomyosis. LIMITATIONS, REASONS FOR CAUTION The average age of women in this study was high that may be associated with overall decline in fertility regardless of the presence or absence of adenomyosis or endometriosis. We collected endometrial biopsy samples from two completely separate cohorts of women for analysis by immunohiostochemistry and TEM. We need future follow-up study with increased sample size and from the same patients to precisely clarify the mechanistic link between axonemal alteration and negative fertility outcome. WIDER IMPLICATIONS OF THE FINDINGS Our current findings may have some biological implication to better understand the endometrial epithelial biology and pathology in women with adenomyosis and may open the avenue for future study in other reproductive diseases. The ultra-structural abnormalities of microvilli and microtubules in the apical endometria in response to tissue inflammatory reaction may clarify the possible association between negative fertility outcome and adenomyosis. Our findings may be clinically useful during counseling with symptomatic patients with adenomyosis desiring pregnancy. STUDY FUNDING/COMPETING INTEREST (S) This work was supported by Grants-in-Aid for Scientific Research from the Ministry of Education, Sports, Culture, Science and Technology of Japan. There is no conflict of interest related to this study. TRIAL REGISTRATION NUMBER N/A.
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Levens, Eric D., and Alan H. DeCherney. "Ectopic Pregnancy and Spontaneous Abortion." DeckerMed Medicine, October 11, 2019. http://dx.doi.org/10.2310/im.1219.
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Ectopic pregnancy, the implantation of an embryo outside the endometrial cavity, is the leading cause of morbidity and mortality in the first trimester. The embryo may be implanted in the fallopian tubes, ovaries, abdomen, or cervix, with the fallopian tubes being the site of implantation in 95% of cases. If left untreated, ectopic pregnancy can result in rupture of the fallopian tube, which can lead to hemorrhagic shock and death. The signs and symptoms of ectopic pregnancy and diagnosis and treatment are detailed in the chapter. Spontaneous abortion, defined as a natural termination of a pregnancy before 20 weeks’ gestation, occurs in almost 30% of known pregnancies and an estimated 50% of all conceptions. Causes include genetic, environmental, endocrine, and immunologic factors; anatomic abnormalities; antiphospholipid syndrome; and polycystic ovary syndrome. This review contains 6 figures, 7 tables, and 42 references. Keywords: Ectopic pregnancy, miscarriage, spontaneous abortion, early pregnancy loss, vaginal spotting
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Levens, Eric D., and Alan H. DeCherney. "Ectopic Pregnancy and Spontaneous Abortion." DeckerMed Family Medicine, October 11, 2019. http://dx.doi.org/10.2310/fm.1219.
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Ectopic pregnancy, the implantation of an embryo outside the endometrial cavity, is the leading cause of morbidity and mortality in the first trimester. The embryo may be implanted in the fallopian tubes, ovaries, abdomen, or cervix, with the fallopian tubes being the site of implantation in 95% of cases. If left untreated, ectopic pregnancy can result in rupture of the fallopian tube, which can lead to hemorrhagic shock and death. The signs and symptoms of ectopic pregnancy and diagnosis and treatment are detailed in the chapter. Spontaneous abortion, defined as a natural termination of a pregnancy before 20 weeks’ gestation, occurs in almost 30% of known pregnancies and an estimated 50% of all conceptions. Causes include genetic, environmental, endocrine, and immunologic factors; anatomic abnormalities; antiphospholipid syndrome; and polycystic ovary syndrome. This review contains 6 figures, 7 tables, and 42 references. Keywords: Ectopic pregnancy, miscarriage, spontaneous abortion, early pregnancy loss, vaginal spotting
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Pranavi, Vamanagunta, and Kurapati Sai Anusha. "MAYER-ROKITANSKY-KUSTER-HAUSER (MRKH) SYNDROME: A CASE REPORT." GLOBAL JOURNAL FOR RESEARCH ANALYSIS, October 15, 2020, 44–45. http://dx.doi.org/10.36106/gjra/3601596.
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Mayer-Rokitansky-Kuster-Hauser syndrome is an uncommon condition, with an incidence of 1 in 4000- 5000 female births and is the second most frequent cause of primary amenorrhea after gonadal dysgenesis .The reproductive abnormalities of MRKH syndrome are due to incomplete development of the Müllerian duct which develops into the uterus, fallopian tubes, cervix, and the upper part of the vagina. The cause of the abnormal development of the Müllerian duct in affected individuals is unknown. This abnormality is characterized by congenital aplasia/hypoplasia of the uterus and the upper part (2/3) of vagina, in young women presenting otherwise with normal endocrine status. It may include absence or hypoplasia of the uterus and fallopian tubes. The patients present with normal secondary sexual characteristics, as the functional ovaries are present, but menstruation is absent .