scholarly journals New approach for T-shaped uterus: Metroplasty with resection of lateral fibromuscular tissue using a 15 Fr miniresectoscope. A step-by-step technique.

2021 ◽  
Vol 13 (1) ◽  
pp. 67-71
Author(s):  
U. Catena ◽  
R. Campo ◽  
G. Bolomini ◽  
M.C. Moruzzi ◽  
V. Verdecchia ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Recurrent Miscarriage ◽  
Three Dimensional ◽  
Uterine Cavity ◽  
In Vitro Fertilisation ◽  
Step Method ◽  
New Approach ◽  
Uterine Malformation ◽  
New Surgical Technique

T-shaped uterus is a congenital uterine malformation (CUM), only recently defined by the ESGE ESHRE classification as Class U1a. The uterus is characterised by a narrow uterine cavity due to thickened lateral walls with a correlation 2/3 uterine corpus and 1/3 cervix (Grimbizis et al, 2013). Although the significance of this dysmorphic malformation on reproductive performance has been questioned, recent studies reported significant improvement of life birth rates after surgical correction in patients with failed in-vitro fertilisation (IVF) or recurrent miscarriage (Ferro et al, 2018; Di Spiezio Sardo et al, 2020; Alonso Pacheco et al. 2019). The classical surgical technique to treat a T-shaped uterus is by performing a sidewall incision with the micro scissor or bipolar needle, resulting in a triangular cavity. In this video article, we describe a new surgical technique with a step-by-step method combining three-dimensional ultrasound (3D-US) and hysteroscopic metroplasty in an office setting, using a 15 Fr office resectoscope (Karl Storz, Tuttlingen, Germany), to treat a T-shaped uterus by resecting the lateral fibromuscular tissue of the uterine walls. No complications occurred and the postoperative hysteroscopy showed a triangular and symmetrical uterine cavity without any adhesions.

scholarly journals Menstrual flow as a non-invasive source of endometrial organoids

2021 ◽  
Vol 4 (1) ◽  
Author(s):  
Tereza Cindrova-Davies ◽  
Xiaohui Zhao ◽  
Kay Elder ◽  
Carolyn J. P. Jones ◽  
Ashley Moffett ◽  
...  
Keyword(s):  
Early Pregnancy ◽  
Recurrent Miscarriage ◽  
Milk Proteins ◽  
Receptor Expression ◽  
In Vitro Fertilisation ◽  
Non Invasive ◽  
Menstrual Flow ◽  
Pregnancy Hormones

AbstractAssessment of the endometrium often necessitates a biopsy, which currently involves an invasive, transcervical procedure. Here, we present an alternative technique based on deriving organoids from menstrual flow. We demonstrate that organoids can be derived from gland fragments recovered from menstrual flow. To confirm they faithfully reflect the in vivo state we compared organoids derived from paired scratch biopsies and ensuing menstrual flow from patients undergoing in vitro fertilisation (IVF). We demonstrate that the two sets of organoids share the same transcriptome signature, derivation efficiency and proliferation rate. Furthermore, they respond similarly to sex steroids and early-pregnancy hormones, with changes in morphology, receptor expression, and production of ‘uterine milk’ proteins that mimic those during the late-secretory phase and early pregnancy. This technique has wide-ranging impact for non-invasive investigation and personalised approaches to treatment of common gynaecological conditions, such as endometriosis, and reproductive disorders, including failed implantation after IVF and recurrent miscarriage.

scholarly journals Investigation and management of subfertility

2019 ◽  
Vol 72 (9) ◽  
pp. 579-587 ◽  
Author(s):  
Layla Thurston ◽  
Ali Abbara ◽  
Waljit S Dhillo
Keyword(s):  
Polycystic Ovary ◽  
Uterine Cavity ◽  
Antral Follicle ◽  
Antral Follicle Count ◽  
Semen Parameters ◽  
In Vitro Fertilisation ◽  
Expert Assessment ◽  
Serum Progesterone ◽  
Tubal Patency

Subfertility affects one in seven couples and is defined as the inability to conceive after 1 year of regular unprotected intercourse. This article describes the initial clinical evaluation and investigation to guide diagnosis and management. The primary assessment of subfertility is to establish the presence of ovulation, normal uterine cavity and patent fallopian tubes in women, and normal semen parameters in men. Ovulation is supported by a history of regular menstrual cycles (21–35 days) and confirmed by a serum progesterone >30 nmol/L during the luteal phase of the menstrual cycle. Common causes of anovulation include polycystic ovary syndrome (PCOS), hypothalamic amenorrhoea (HA) and premature ovarian insufficiency (POI). Tubal patency is assessed by hysterosalpingography, hystero-contrast sonography, or more invasively by laparoscopy and dye test. The presence of clinical or biochemical hyperandrogenism, serum gonadotrophins (luteinising hormone/follicle stimulating hormone) / oestradiol, pelvic ultrasound to assess ovarian morphology / antral follicle count, can help establish the cause of anovulation. Ovulation can be restored in women with PCOS using letrozole (an aromatase inhibitor), clomifene citrate (an oestrogen antagonist) or exogenous gonadotrophin administration. If available, pulsatile gonadotrophin releasing hormone therapy is the preferred option for restoring ovulation in HA. Spermatogenesis can be induced in men with hypogonadotrophic hypogonadism with exogenous gonadotrophins. Unexplained subfertility can be treated with in vitro fertilisation after 2 years of trying to conceive. Involuntary childlessness is associated with significant psychological morbidity; hence, expert assessment and prompt treatment are necessary to support such couples.

scholarly journals In vitro fertilisation in patients with variant treatment for uterine fi broids (A Review)

2020 ◽  
Vol 27 (5) ◽  
pp. 114-127
Author(s):  
Z. U. Archegova ◽  
N. K. Kasum-zade ◽  
R. I. Shalina
Keyword(s):  
Reproductive Medicine ◽  
Uterine Artery ◽  
Negative Impact ◽  
Uterine Cavity ◽  
Reproductive Age ◽  
Uterine Artery Embolisation ◽  
Venous Stasis ◽  
In Vitro Fertilisation ◽  
The Impact

Background. Uterine fi broids is a highly prevalent gynaecological disease affecting 30–35% of reproductive age women and twice as many beyond this age, according to various sources. Uterine fi broids are diagnosed in 25–27% of infertile women. According to the American Society of Reproductive Medicine, this disease causes infertility in 2–3% of the cases.Objectives. A prognostic assessment of recovering fertility after treatment for uterine fi broids, outlining a comprehensive strategy for successful in vitro fertilisation after variant organ-preserving treatment for uterine fi broids.Мethods. Publication records were mined in the PubMed, Elibrary, Web of science and Cyberleninca databases under the search depth of 7 years. The query terms were: uterine fi broids, in vitro fertilisation, myomectomy, uterine artery embolisation, myomectomy and pregnancy, uterine artery embolisation and pregnancy, uterine fi broids and in vitro fertilisation.Results. We analysed 105 records and selected 32 for review. Many sources suggest that the putative pathogenetic mechanisms of a reduced in vitro fertilisation success in uterine fi broids comprise: abnormal circulation and receptor apparatus; abnormal uterine blood fl ow, venous stasis, vascular changes; local infl ammation; abnormal endometrial morphology, distortions of the uterine cavity with submucosal and large interstitial fi broids, continuity between endometrium and myometrium, subendometrial thickening; local nodal oestrogen/progesterone imbalance. Clinical data on the impact of uterine fi broids in assisted reproductive technology trials are multitude but ambiguous. Submucosal and intramural fi broids distorting the uterine cavity are commonly considered for resection due to their signifi cant negative impact on the pregnancy success rate with assisted reproductive strategies.Conclusion. Uterine fi broids pose an acute persistent challenge in gynaecology and reproductive medicine aggravated by the lack of a unifi ed strategy for patient management and reproductive life planning. Various aspects of the uterine blood fl ow diagnosis, treatment for uterine fi broids, pregravid preparation, long-term management of in vitro fertilisation protocols and pregnancy in this pathology require further detailed studies.

Improved Understanding of Stent Malapposition Using Virtual Bench Testing

2011 ◽  
Vol 6 (2) ◽  
pp. 106 ◽  
Author(s):  
Peter Mortier ◽  
Heleen MM van Beusekom ◽  
Matthieu De Beule ◽  
Ilona Krabbendam-Peters ◽  
Benjamin Van Der Smissen ◽  
...  
Keyword(s):  
Imaging Techniques ◽  
Average Distance ◽  
Three Dimensional ◽  
Proximal Part ◽  
New Approach ◽  
Incomplete Stent Apposition ◽  
Bifurcation Stenting ◽  
Silicone Model ◽  
Bench Testing

Intravascular imaging techniques such as optical coherence tomography (OCT) and intravascular ultrasound (IVUS) are often used to assess strut apposition, but only provide limited insight into the three-dimensional appositioning behaviour of stents. Recently, a new approach has been introduced to study the phenomenon of incomplete stent apposition (ISA) based on finite element simulations. In this study, we employed this virtual strut apposition assessment technique in the setting of coronary bifurcation stenting and compared simulated strut–artery distances of two stent designs with actual measurements based on OCT imaging using a silicone model. Stenting of the main branch leads to malapposed struts in the proximal part and the average strut–artery distance in that region for the Integrity stent is 126 μm based on the simulation and 117±14 μm based on the OCT analysis. For the Multi-Link 8 stent, this average distance is 150 μm and 174±7 µm for the simulation and thein vitroOCT measurements respectively. In conclusion, the virtual assessment of strut appositioning results in similar strut–artery distances when compared with measurements based on OCT-visualisedin vitrostent deployments and could be used to optimise devices and procedures.

Intracranial Longitudinal Splitting of Facial Nerve: A New Approach for Hemifacial Spasm

1993 ◽  
Vol 102 (2) ◽  
pp. 108-109 ◽  
Author(s):  
Zhong Fan
Keyword(s):  
Surgical Technique ◽  
Facial Nerve ◽  
Hemifacial Spasm ◽  
Cerebellopontine Angle ◽  
Facial Paresis ◽  
New Approach ◽  
Longitudinal Splitting ◽  
Aberrant Artery ◽  
New Surgical Technique

A new surgical technique for the treatment of hemifacial spasm consisting of longitudinal splitting of the facial nerve in the cerebellopontine angle is described. Thirty-three cases have been treated with good results. Follow-up of 20 cases for 1 year or more showed no recurrence or facial paresis. One case required a second operation. The novelty of this approach lies in its effectiveness in relieving the symptoms without running the risk of overmanipulating the aberrant artery.

scholarly journals National Survey Highlights the Urgent Need for Standardisation of Embryo Transfer Techniques in the UK

2021 ◽  
Vol 10 (13) ◽  
pp. 2839
Author(s):  
Lewis Nancarrow ◽  
Nicola Tempest ◽  
Andrew J. Drakeley ◽  
Roy Homburg ◽  
Richard Russell ◽  
...  
Keyword(s):  
Embryo Transfer ◽  
Good Practice ◽  
Uterine Cavity ◽  
In Vitro Fertilisation ◽  
Success Rates ◽  
Electronic Survey ◽  
Wide Range ◽  
The Uk ◽  
Survey Responses

Embryo transfer (ET) is one of the vital steps in the in vitro fertilisation (IVF) process, yet there is wide variation in ET technique throughout the UK, without a nationally approved standardised approach. The aim of this study was to gain contemporaneous information regarding the current clinical ET practice in the UK. Method: A 38-question electronic survey was distributed to the 79 UK Human Fertilisation and Embryology Authority (HFEA) registered clinics performing ETs. Results: In total, 59% (47/79) of units responded, 83% (39/47) performing ultrasound-guided transfers, with 42% (20/47) of units using a tenaculum; 22% (10/45) would proceed with transfer regardless of fluid in the endometrial cavity. In 91% (43/47) of units, embryos were deposited in the upper/middle portion of the uterine cavity, but interpretation of this area ranged from 0.5 to >2 cm from the fundus, with 68% (32/47) allowing patients to mobilise immediately after transfer. In 60% (27/45) of clinics, success rates were based on clinical pregnancy rates (CPR). Conclusion: Within the UK there is a wide range of variability in ET techniques, with >70% of discordance in survey-responses between clinics. Whilst there are areas of good practice, some disadvantageous techniques continue to persist. This survey emphasises the importance of developing a standardised, evidence-based approach to improve ET success rates.

scholarly journals Three-Dimensional Biofabrication Models of Endometriosis and the Endometriotic Microenvironment

2020 ◽  
Author(s):  
Jillian R. H. Wendel ◽  
Xiyin Wang ◽  
Lester J. Smith ◽  
Shannon M. Hawkins
Keyword(s):  
Cell Line ◽  
Three Dimensional ◽  
Uterine Cavity ◽  
Building Blocks ◽  
Cell Types ◽  
In Vitro Models ◽  
Inflammatory Factors ◽  
Biologically Relevant ◽  
Increased Risk

Endometriosis occurs when endometrial-like tissue grows outside the uterine cavity, leading to pelvic pain, infertility, and increased risk of ovarian cancer. The present study describes the optimization and characterization of cellular spheroids as building blocks for Kenzan scaffold-free method biofabrication and proof-of-concept models of endometriosis and the endometriotic microenvironment. The spheroid building blocks must be a specific diameter (~500 m), compact, round, and smooth to withstand Kenzan biofabrication. Under optimized spheroid conditions for biofabrication, the endometriotic epithelial-like cell line, 12Z, expressed high levels of estrogen-related genes and secreted high amounts of endometriotic inflammatory factors that were independent of TNF stimulation. Heterotypic spheroids, composed of 12Z and T-HESC, an immortalized endometrial stromal cell line, self-assembled into a biologically relevant pattern, consisting of epithelial cells on the outside of the spheroids and stromal cells in the core. 12Z spheroids were biofabricated into large three-dimensional constructs alone, with HEYA8 spheroids, or as heterotypic spheroids with T-HESC. These three-dimensional biofabricated constructs containing multiple monotypic or heterotypic spheroids represent the first scaffold-free biofabricated in vitro models of endometriosis and the endometriotic microenvironment. These efficient and innovative models will allow us to study the complex interactions of multiple cell types within a biologically relevant microenvironment.

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