Myomectomy: rational management of the perioperative period and long-term treatment outcomes

2020 ◽  
Vol 19 (4) ◽  
pp. 39-48
Author(s):  
N.M. Podzolkova ◽  
◽  
V.V. Korennaya ◽  
R.E. Kuznetsov ◽  
О.Yu. Ignatchenko ◽  
...  
Keyword(s):  
Assisted Reproductive Technologies ◽  
Uterine Fibroids ◽  
Reproductive Technologies ◽  
Endometrial Receptivity ◽  
Surgical Approaches ◽  
Control Group ◽  
Childbearing Age ◽  
Arterial Perfusion ◽  
Number Of Patients ◽  
Long Term Treatment

Objective – to study the influence of various surgical approaches on the outcomes of myomectomy and to determine the optimal strategy of postoperative management of patients of childbearing age with uterine fibroids. Patients and methods. A retrospective study included 145 patients who had uterine fibroids with a total increase of 480–560 cm3, with the intramural component not less than 55% of the total volume. Patients of group 1 (n = 62) underwent classical laparoscopic myomectomy. Patients of group 2 (n = 48) had surgery supplemented by temporary reduction of arterial perfusion by temporary clipping of the uterine or internal iliac arteries. Robot-assisted myomectomy was performed in 34 patients of group 3. The comparison group comprised 54 women with uterine fibroids of the same sizes who did not undergo operative treatment, and the control group consisted of 36 healthy women. Results. After myomectomy, the progesterone/oestradiol receptor ratio in the endometrium increased from 1.8 to 4.6 and from 1.6 to 2.7 in patients who suffered from primary or secondary infertility before surgery. After surgery, the expression of НОХА-10 became higher in the epithelium and pinopodes of patients of both groups. But the positive response of the stromal cells was obtained only in women who had pregnancies before surgery. The expression of the proto-oncogene bcl-2 after myomectomy decreased in patients of all groups in both the stroma and epithelium, but it was more pronounced in women with primary infertility. Changes in the endometrium occur irrespective of the type of operative intervention. Taking into account the fact that temporary cessation of arterial perfusion in the uterus does not worsen endometrial receptivity but allows a 5-fold reduction of intraoperative blood loss, this technique might be regarded as one of the most effective for prevention of intra- and postoperative complications. The incidence of pregnancy following myomectomy was 84.7% among women who planned conception, whereas among women with myoma it was only 18.9%. The number of pregnancies after assisted reproductive technologies amounted to 19.4% of the total number of patients. Conclusion. Surgical treatment of uterine fibroids makes it possible to improve a reproductive prognosis and achieve a pregnancy in 85% of cases, which, among other factors, is due to improvement of endometrial receptivity. Key words: pregnancy, contraception, uterine fibroid, myomectomy, reproductive outcomes, endometrial receptivity

The efficacy of assisted reproductive technologies in patients with uterine fibroids (review)

GYNECOLOGY ◽  
2015 ◽  
pp. 60-64
Author(s):  
N.M. Podzolkova ◽  
◽  
Yu.A. Koloda ◽  
V.V. Korennaya ◽  
K.N. Kayibkhanova ◽  
...  
Keyword(s):  
Assisted Reproductive Technologies ◽  
Uterine Fibroids ◽  
Reproductive Technologies

Mechanism of the adverse effect of hyaluronidase used for oocyte denudation on early development of bovine embryos

Zygote ◽  
2021 ◽  
pp. 1-5
Author(s):  
Shiori Ashibe ◽  
Kanade Irisawa ◽  
Ken Yokawa ◽  
Yoshikazu Nagao
Keyword(s):  
Treatment Group ◽  
Assisted Reproductive Technologies ◽  
Cumulus Cells ◽  
Reproductive Technologies ◽  
Control Group ◽  
Free Calcium ◽  
Parthenogenetic Development ◽  
Early Embryos ◽  
Bovine Oocytes

Summary Hyaluronidase is widely used in animal and human assisted reproductive technologies (ARTs) to remove cumulus cells around oocytes. However, adverse effects of hyaluronidase treatment, such as increased rates of degeneration and parthenogenesis, have been found after treatment of human and mouse oocytes. Currently, the mechanism(s) of the detrimental effects are unclear. The present study was initiated to identify the mechanism of adverse responses to hyaluronidase treatment in bovine oocytes and early embryos. Cumulus cells were removed from cumulus–oocyte complexes (COCs) with or without hyaluronidase and the oocytes were subjected to intracytoplasmic sperm injection (ICSI) or in vitro fertilization (IVF). Significantly lower rates of blastocyst formation were obtained in the hyaluronidase treatment group after ICSI (22.4%) and IVF (21.2%) compared with the non-hyaluronidase control groups: 36.1% after ICSI and 30.4% after IVF. Next, we examined the effect of hyaluronidase on parthenogenetic development rates and on the cytoplasmic levels of free calcium ions (Ca2+), reactive oxygen species (ROS) and reduced glutathione (GSH). No differences in parthenogenesis rates were found between treated and untreated groups. Ca2+ levels in oocytes from the hyaluronidase treatment group indicated using mean fluorescence intensity were significantly higher (68.8 ± 5.3) compared with in the control group (45.0 ± 2.5). No differences were found in the levels of ROS or GSH between the treated and untreated groups. We conclude that hyaluronidase might trigger an increase in Ca2+ levels in oocytes, resulting in a decreased potential for normal embryonic development.

scholarly journals Endometrial receptivity: the molecularmechanisms regulation of implantation

2013 ◽  
Vol 62 (2) ◽  
pp. 63-74 ◽  
Author(s):  
Yuliya Sergeyevna Krylova ◽  
Igor Moiseyevich Kvetnoy ◽  
Eduard Karpovich Aylamazyan
Keyword(s):  
Parameter Estimation ◽  
Molecular Mechanisms ◽  
Assisted Reproductive Technologies ◽  
Reproductive Technologies ◽  
Signaling Molecules ◽  
Endometrial Receptivity

Presents current views on endometrial receptivity and the molecular mechanisms regulation of implantation. Examines the signaling molecules as potential markers of parameter estimation window of implantation in assisted reproductive technologies.

198 Comparison of invitro production of bison and cattle embryos and effect of L-carnitine during maturation of bison oocytes

2020 ◽  
Vol 32 (2) ◽  
pp. 227
Author(s):  
A. R. Moawad ◽  
H. Benham ◽  
J. P. Barfield
Keyword(s):  
Assisted Reproductive Technologies ◽  
Cell Mass ◽  
Reproductive Technologies ◽  
T Test ◽  
Control Group ◽  
Chi Square ◽  
Important Species ◽  
Developmental Potential ◽  
Cell Numbers ◽  
Frozen Semen

Bison are an important species in North America, both economically and culturally. Although assisted reproductive technologies have been applied to preserve the genetic diversity of bison, development of these technologies remains limited for this species. The objective of the present study was to compare success rates of oocyte maturation, fertilization, and embryo development invitro in bison versus cattle (experiment 1). Cumulus-oocyte complexes obtained from abattoir-derived cattle and bison ovaries were matured, fertilized with frozen semen, and cultured invitro using standard procedures (De La Torre-Sanchez et al. 2006 Reprod. Fertil. Dev. 18, 585-596). At least three replicates were repeated for each experimental group. Oocyte recovery rate was lower in bison than in cattle (4.3; 2797/699 vs. 6.7; 4138/677, oocyte/ovary; P<0.01, t-test). Nuclear maturation (oocytes at MII, 23h post-IVM) and fertilization rates (oocytes with 2 pronuclei 18h post-insemination; p.i.) evaluated by Hoechst stain were lower (P<0.01, chi-square) for bison (65.1%; 56/86 and 32.7%; 18/55, respectively) than for cattle (88.3%; 83/94 and 70.9%; 39/55, respectively). Polyspermy tended to be higher in bison than in cattle (12.7% vs. 3.6%, P=0.08). The percentages of 2-cell embryos tended to be lower in bison than in cattle (13.5% vs. 25.0%, P>0.05) at 24h p.i. but by 30h p.i., this difference increased (33.7% vs. 67.0%, P<0.01, chi-square). Cleavage (Day 3) and blastocyst (Day 7) rates were lower (P<0.01, chi-square) for bison (58.2%; 280/481 and 14.6%; 70/481, respectively) than for cattle (90.8%; 405/446 and 22.9%; 102/446, respectively). Total cell number (74.9±4.8 vs.114.2±5.8), trophectoderm cell numbers (57.9±4.6 vs. 89.2±4.8) and inner cell mass cell numbers (16.9±2.3 vs. 25±1.9) as determined by Hoechst and propidium iodide were all lower (P<0.01, t-test) in bison than in cattle blastocysts. To improve oocyte competence in bison, we evaluated effects of L-carnitine (LC) supplementation during IVM on developmental potential of bison oocytes (experiment 2). Cumulus-oocyte complexes were matured in IVM medium supplemented with 0, 0.15, 0.3, 0.6, or 1.2mgmL−1 LC. No differences were observed in cleavage rates of control (0mgmL−1 LC) and LC-treated groups (values ranged from 60.0 to 66.4%). Interestingly, a dose-dependent increase in blastocyst development was found with the lowest value recorded in control group (10.4%; 14/134) and the highest value in the 1.2mgmL−1 LC supplemented group (22.2%; 23/105; P<0.01, chi-square, n=4). Adding 1.2mgmL−1 LC to the IVM medium improved the percentage of hatching blastocysts compared with the control. In conclusion, bison oocytes exhibited lower invitro maturation, fertilization, and developmental rates compared with cattle oocytes using our system, and bison embryos were delayed in the timing of first cleavage. L-Carnitine supplementation during IVM of bison oocytes improved the preimplantation development and quality of invitro-produced blastocysts.

Effectiveness and outcomes of embryo cryopreservation programs in assisted reproductive technologies

2014 ◽  
Vol 63 (4) ◽  
pp. 39-46 ◽  
Author(s):  
Yana Nikolayevna Kravchuk ◽  
Alla Stanislavovna Kalugina ◽  
Olga Vladimirovna Bystrova ◽  
Svetlana Aleksandrovna Shlykova
Keyword(s):  
Embryo Transfer ◽  
Assisted Reproductive Technologies ◽  
Negative Impact ◽  
Perinatal Outcomes ◽  
Reproductive Technologies ◽  
Embryo Cryopreservation ◽  
Control Group ◽  
Fresh Embryo Transfer ◽  
Art Programs ◽  
Thawed Embryo Transfer

Background. Embryo cryopreservation is an essential part of ART programs today. In recent years vitrification method is used increasingly widely. Purposes and tasks. To compare the effectiveness of ART programs using vitrified and fresh embryos, as well as different endometrial preparation regimes for frozen\thawed embryo transfer (modified natural cycle (MNC) and the preparatory hormone therapy(PHT)). To analyze the course of pregnancy and perinatal outcomes after vitrified embryo transfer. Materials and methods. We prospectively assessed the ART programs effectiveness and perinatal outcomes in 153 patients (I group), who underwent vitrified embryo transfer in 2011-2013 year. To prepare the endometrium for thawed embryo transfer in 83 patients PHT (Ia subgroup) and MNC in 70 patients (Ib subgroup) were used. Control group consisted of 70 patients, who underwent fresh embryo transfer. Results. The clinical pregnancy rate, birth rate and “take home baby” rate were not significantly different between the I (47,5 %; 30,9 %; 30,9 %) and II (53,0 %; 34,9 %; 32,5 %) groups, and between Ia (48,3 %; 28,4 %; 28,4 %) and IIb (46,6 %; 34,1 %; 34,1 %) subgroups. Complications during pregnancy and delivery, birthweight, length, Apgar score, congenital malformation rate did not differ significantly after vitrified and fresh embryo transfer. Conclusion. Vitrification is an effective method to achieve clinical results, comparable to native cycles. Application of PHT and MNC results in similar clinical outcomes. Transfer Vitrified embryo transfer does not have a negative impact on obstetric and perinatal outcomes when compared with native cycles.

scholarly journals Using Uterine Biophysical Profile as a Predictor of Endometrial Receptivity and Pregnancy in Stimulated IUI Cycles

2020 ◽  
Vol 9 (2) ◽  
Author(s):  
Rawaa Saad Hasan Abunayla ◽  
◽  
Lubna Amer Al-Anbari ◽  
Muayad S, Abood ◽  
Huda A. R. Hussaini ◽  
...  
Keyword(s):  
Pregnancy Outcome ◽  
Pulsatility Index ◽  
Uterine Artery ◽  
Assisted Reproductive Technologies ◽  
Intrauterine Insemination ◽  
Reproductive Technologies ◽  
Endometrial Receptivity ◽  
Infertile Women ◽  
Biophysical Profile ◽  
The Mean

Implantation failure and disorders of endometrial receptivity represent an essential cause of infertility; multiple parameters were needed to predict the uterine receptivity understanding that no sole parameter could predict the same. A score was termed as (Uterine Biophysical Profile) could be utilized as a predictor of endometrial receptivity. To evaluate the predictive potential of Uterine biophysical profile of both endometrial receptivity and pregnancy outcome in infertile women undergoing Intrauterine Insemination (IUI). The current cross-sectional study was conducted in the High Institute for Infertility Diagnosis and Assisted Reproductive Technologies in Al Nahrain University, Baghdad, Iraq from the 1st of Oct. 2018 till 1st of May 2019 involving seventy women of infertile couples with the same inclusion and exclusion criteria. Uterine biophysical profile was evaluated using a doppler ultrasound examination and then a score was calculated and correlated to pregnancy outcome. The mean Uterine Artery Pulsatility Index (UAPI) was significantly lower in women with positive pregnancy in comparison to women with negative pregnancy, 2.10±0.19 versus 2.47±0.65, respectively (P=0.032). Moreover, no women with Pulsatility Index (PI) score (0) succeeded to get pregnant and the higher the score, the higher the rate of pregnancy (P=0.006). Furthermore, Spearman correlation showed significant positive correlation between positive pregnancy outcome and UAPI (r=0.365; P=0.002). The mean total score was significantly higher for pregnant women than in women with negative pregnancy, 18.27±1.33 versus 16.35±2.47, respectively (P=0.005). The cutoff value was >17 with an acceptable accuracy level of 74.2. The sensitivity of that cutoff vale was 80 % and the specificity was 65.5%. Uterine artery pulsatility index and total uterine biophysical score are the principal predictors of positive pregnancy outcomes in infertile women undergoing IUI.

scholarly journals Efficiency evaluation of the improved treatment and prevention complex in pregnant women after assisted reproductive technologies

2021 ◽  
pp. 26-31
Author(s):  
V.O. Beniuk ◽  
L.M. Vygivska ◽  
I.V. Maidannyk ◽  
T.V. Kovaliuk ◽  
O.O. Chorna ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Assisted Reproductive Technologies ◽  
First Trimester ◽  
Reproductive Technologies ◽  
Control Group ◽  
Significant Difference ◽  
Β Hcg ◽  
Arginine Aspartate ◽  
Micronized Progesterone

Study objective: to determine the role and effectiveness of the proposed therapeutic and preventive complex and psychoemotional correction of hormonal disorders in the pregnancy dynamics after assisted reproductive technologies (ART) to improve the antenatal observation and prevention of obstetric and perinatal complications.Materials and methods. The study included 299 pregnant women: the main group included 249 women whose pregnancy occurred as an ART result; the control group included 50 pregnant women with spontaneous pregnancy. Therapeutic and prophylactic complex for pregnant women after ART included: micronized progesterone, magnesium oxide, folic acid, L-arginine aspartate, ω3-polyunsaturated fatty acids and long-term psychological correction on the eve of the ART program, at 8–10, 16–18 and 28–30 weeks of pregnancy. Results. There was a significant increase in the β-chorionic gonadotropin (β-hCG) level in women of the study groups in the first trimester of pregnancy against the background of the proposed treatment. Mean β-HCG value at 7–8 weeks of gestation in the subgroup IA exceeded the subgroup IB by 37% (p <0.05), in subgroup IIA it exceeded the subgroup IIB by 33% (p <0.05). The mean β-hCG value in subgroups IIIA and IIIB did not have a significant difference in the dynamics of the first trimester compared with the control group and among themselves (p >0.05).Mean progesterone value at 7–8 weeks of gestation in subgroup IA increased by 38% in comparison with pregnant women who received the conventional treatment complex (p <0.05), in subgroup IIA it was 73% higher than in subgroup IIB (p <0.05). There was no significant difference in the progesterone level in subgroups IIIA and IIIB in the dynamics of the first trimester.The average cortisol value at 23–24 weeks of pregnancy in subgroup IA decreased by 42% (p <0.05), in pregnant women with endocrine infertility against the background of the proposed treatment complex it was 62% less than in subgroup IIB (p <0.05). The average cortisol level in women with a male factor of infertility was 63% lower than in subgroup IIIB against the background of the proposed complex (p <0.05).Conclusion. Advanced therapy with micronized progesterone in combination with magnesium saturation, L-arginine aspartate, folic acid, ω-3 polyunsaturated fatty acids, as well as long-term psychoemotional correction is appropriate and effective compared to conventional therapy for pregnant women.

Morphological features of the state of fetoplacental complex in women with early preterm birth after assisted reproductive technologies

2016 ◽  
pp. 79-81
Author(s):  
A.S. Mandrykova ◽  
Keyword(s):  
Preterm Birth ◽  
Preterm Delivery ◽  
Assisted Reproductive Technologies ◽  
Reproductive Technologies ◽  
Main Group ◽  
Fetal Membranes ◽  
Control Group ◽  
Premature Rupture ◽  
Fetoplacental Complex ◽  
Early Preterm Birth

The objective: the study of morphofunctional changes of the fetoplacental complex at 28–33 weeks of gestation in women with early preterm delivery after the application of ART. Patients and methods. We have examined 130 patients whose pregnancy occurred after the use of ART. This is the woman who gave birth at 28–33 weeks of gestation. Of these, 80 women had early premature births in the background premature rupture of fetal membranes, 50 – patients with early preterm delivery and timely rupture of fetal membranes (control group 2). The main group included 4 groups of 20 women with regard to the duration of anhydrous interval: 1.1 – anhydrous interval 5–6 hours (main group 1); 1.2 – anhydrous span 24 hours; 1.3 – anhydrous interval 45–48 hours; 1.4 – anhydrous period 5 days after PRFM. Results. Thus, the results of the research indicate that the main cause of early preterm birth in women after using ART are structural dezorhanization changes of collagen fibers of the connective tissue amnion and chorionic which lead to the appearance of microscopic defects – delamination its surface, causing premature rupture of fetal membranes the launch stage localized focal immediate type hypersensitivity reactions and restructuring epithelial cell membranes. Neutrophil macrophage properties in this case reduced and programmed to perform a cycle of incomplete phagocytosis, which increases the synthesis of inflammatory cytokines in the area of rupture of fetal membranes. Сonclusion. Reduced activity of neutrophils increases the effect of abuse and cytokine balance in favor predictor of early spontaneous labor at 28-33 weeks of gestation. Key words: morphological changes of the fetoplacental complex, early preterm birth, expectant tactics of childbirth.

scholarly journals Infertility and reproductive disorders: impact of hormonal and inflammatory mechanisms on pregnancy outcome

2015 ◽  
Vol 22 (1) ◽  
pp. 104-115 ◽  
Author(s):  
Silvia Vannuccini ◽  
Vicki L. Clifton ◽  
Ian S. Fraser ◽  
Hugh S. Taylor ◽  
Hilary Critchley ◽  
...  
Keyword(s):  
Pregnancy Outcome ◽  
Pregnancy Outcomes ◽  
Assisted Reproductive Technologies ◽  
Negative Impact ◽  
Polycystic Ovary ◽  
Reproductive Technologies ◽  
Obstetric Complications ◽  
Reproductive Disorders ◽  
Childbearing Age ◽  
Increased Risk

Abstract BACKGROUND Reproductive disorders and infertility are associated with the risk of obstetric complications and have a negative impact on pregnancy outcome. Affected patients often require assisted reproductive technologies (ART) to conceive, and advanced maternal age is a further confounding factor. The challenge is to dissect causation, correlation and confounders in determining how infertility and reproductive disorders individually or together predispose women to poor pregnancy outcomes. METHODS The published literature, to June 2015, was searched using PubMed, summarizing all evidences concerning the perinatal outcome of women with infertility and reproductive disorders and the potential mechanisms that may influence poor pregnancy outcome. RESULTS Reproductive disorders (endometriosis, adenomyosis, polycystic ovary syndrome and uterine fibroids) and unexplained infertility share inflammatory pathways, hormonal aberrations, decidual senescence and vascular abnormalities that may impair pregnancy success through common mechanisms. Either in combination or alone, these disorders results in an increased risk of preterm birth, fetal growth restriction, placental pathologies and hypertensive disorders. Systemic hormonal aberrations, and inflammatory and metabolic factors acting on endometrium, myometrium, cervix and placenta are all associated with an aberrant milieu during implantation and pregnancy, thus contributing to the genesis of obstetric complications. Some of these features have been also described in placentas from ART. CONCLUSIONS Reproductive disorders are common in women of childbearing age and rarely occur in isolation. Inflammatory, endocrine and metabolic mechanisms associated with these disorders are responsible for an increased incidence of obstetric complications. These patients should be recognized as ‘high risk’ for poor pregnancy outcomes and monitored with specialized follow-up. There is a real need for development of evidence-based recommendations about clinical management and specific obstetric care pathways for the introduction of prompt preventative care measures.

Possibility of elimination of pathogen from Babesia infected animals by means of embryo transfer

2014 ◽  
Vol 11 (2) ◽  
pp. 36-42
Author(s):  
P Erdenetogtokh ◽  
S Ganbat ◽  
Hiroshi Suzuki
Keyword(s):  
Embryo Transfer ◽  
Assisted Reproductive Technologies ◽  
Morphological Characteristics ◽  
Reproductive Technologies ◽  
Development Stage ◽  
Babesia Microti ◽  
Control Group ◽  
Mice Model ◽  
Economic Sectors

Babesia infections occur mainly in animals, and are transmitted by ticks. The severity of the diseases varies considerably depending on the species of Babesia involved as well as the immune response of the infected animal. In Mongolia infection produced by Babesia parasites is widely spread, provoking severe damage to the agricultural and economic sectors. Currently, strategies to control and prevent the infection are inefficient. Indeed, the necessity to look for suitable and accessible strategies to obtain animals free from the infection is needed. Currently, assisted reproductive technologies (ART) are used for the improvement of productivity in livestock. Moreover, embryo transfer seams to be useful approach to obtain clean embryos obtained from infected animals. Therefore, by using a mice model (ICR) infected with Babesia microti, an alternative method to obtain animals free from infection was examined. ICR mice at 8 weeks old were challenged with 0.2 ml of 1x107 IRBC/ml by i.p injection. After infection, superovulation was induced and then embryos were obtained and washed. Then, their development stage along with their morphological characteristics were monitored. In vitro embryos obtained from uninfected mice were used as a control group. The results indicate that the infection does not have any influence on pre-implantation embryonic development and morphological characteristics. Thus, we suggest that embryos obtained from infected animals might be useful for embryo transfer in order to improve productivity of livestock and reduce the risk of congenital infection. In summary, ART such as embryo transfer might be an useful technique in countries where Babesiosis is an endemic disease. DOI: http://dx.doi.org/10.5564/mjas.v11i2.214 Mongolian Journal of Agricultural Sciences Vol.11(2) 2013 pp.36-42

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