scholarly journals Management of endometriosis-related infertility: Considerations and treatment options

2020 ◽  
Vol 47 (1) ◽  
pp. 1-11 ◽  
Author(s):  
Dayong Lee ◽  
Seul Ki Kim ◽  
Jung Ryeol Lee ◽  
Byung Chul Jee
Keyword(s):  
Surgical Treatment ◽  
Ovarian Reserve ◽  
Intrauterine Insemination ◽  
Treatment Options ◽  
Oocyte Retrieval ◽  
Reproductive Age ◽  
Treatment Modalities ◽  
Inflammatory Reactions ◽  
Risk Of Cancer

Endometriosis is a common inflammatory disease in women of reproductive age and is one of the major causes of infertility. Endometriosis causes a sustained reduction of ovarian reserve through both physical mechanisms and inflammatory reactions, which result in the production of reactive oxygen species and tissue fibrosis. The severity of endometriosis is related to ovarian reserve. With regard to infertility treatment, medical therapy as a neoadjuvant or adjuvant to surgical therapy has no definite beneficial effect. Surgical treatment of endometriosis can lead to ovarian injury during the resection of endometriotic tissue, which leads to the deterioration of ovarian reserve. To overcome this disadvantage, a multistep technique has been proposed to minimize the reduction of ovarian reserve. When considering surgical treatment of endometriosis in patients experiencing infertility, it should be kept in mind that ovarian reserve can be reduced both due to endometriosis itself and by the process of removing endometriosis. In cases of mild- to moderate-stage endometriosis, intrauterine insemination with ovarian stimulation after surgical treatment may increase the likelihood of pregnancy. In cases of severe endometriosis, the characteristics of the patient should be considered in a multidisciplinary manner to determine the prioritization of treatment modalities, including surgical treatment and assisted reproduction methods such as <i>in vitro</i> fertilization. The risk of cancer, complications after pregnancy, and infection during oocyte retrieval should also be considered when making treatment decisions.

scholarly journals Recent trends in managing abnormal uterine bleeding

2021 ◽  
Vol 10 (4) ◽  
pp. 1742
Author(s):  
Shruthi Ananthula ◽  
Ushadevi Gopalan ◽  
Sivan Kumar Kumarapillai
Keyword(s):  
Surgical Treatment ◽  
Treatment Options ◽  
Abnormal Uterine Bleeding ◽  
Uterine Bleeding ◽  
Reproductive Age ◽  
Treatment Modalities ◽  
Major Surgery ◽  
High Morbidity ◽  
Management Options ◽  
Mesh Terms

Abnormal uterine bleeding is one of the most common problems among women of reproductive age. It is an important health care problem and may cause physiological as well as psycological stress impairing the quality of life. The aim of this review was to present various management options for women suffering from menorrhagia. An extensive electronic literature search was done using search engines like PubMed and Google scholar using the mesh terms/ key words like “abnormal uterine bleeding, menorrhagia, medical management, hysterectomy” to identify trials and reviews on management of abnormal uterine bleeding. Various pharmacological and surgical treatment options are available, among medical therapy Tranexamic acid being most effective. Second-generation endometrial ablation techniques are effective and safe alternatives compared to first-generation devices. Hysterectomy should be considered as a last resort in management of AUB as this major surgery is associated with high morbidity and mortality rates. Thus role of clinician is to counsel every women and provide full information regarding both medical as well as surgical treatment modalities available and facilitate them in making an appropriate choice.

scholarly journals INFLUENCE OF SURGICAL INTERVENTION ON PATIENTS WITH OVARIAN APOPLEXY IN THE ASPECT OF OVARIAN RESERVE PRESERVATION

World Science ◽  
2019 ◽  
Vol 2 (5(45)) ◽  
pp. 7-10
Author(s):  
O. M. Ishchak
Keyword(s):  
Surgical Treatment ◽  
Ovarian Reserve ◽  
Antral Follicle ◽  
Disease Recurrence ◽  
Reproductive Age ◽  
Hemodynamic Parameters ◽  
Bipolar Coagulation ◽  
Study Results ◽  
Duration Of Surgery ◽  
First Time

Ovarian apoplexy is the women’s disease of reproductive age, 75% of which are under the age of 30 years old, about 30% undergo surgery, and 40-62% of them are subjected to repeated surgeries because of disease recurrence [3, 10]. Goal of study: improvement of surgical treatment of the patients with ovarian apoplexy for maximal preservation of ovarian reserve.Materials and methods. A total of 120 women were included in the study. These include 55 patients with ovarian apoplexy, who underwent laparoscopic surgery for the first time. These patients were included in the prospective study and divided into two groups, depending on the hemostasis method used during the surgery. Group 1 included 30 patients with hemostasis, which was carried out using bipolar coagulation, group 2 included 25 patients, whose bleeding from the ovary was stopped by applying sutures. In each group, the patients were selected with the “blind” method. The study included patients with stable hemodynamic parameters before surgery and duration of hospitalization of not more than 24 hours. The comparison group consisted of 45 patients with laparoscopic confirmation of pain form of the ovarian apoplexy, who underwent conservative treatment. Study results and their discussion. Patients with ovarian apoplexy with stable hemodynamic parameters should undergo surgery using laparoscopic access, which allows to clarify the diagnosis, stop bleeding, prevent development of sexually transmitted infections and carry out surgical correction of the associated pathological processes of the internal genital organs. Stop of bleeding at the patients with ovarian apoplexy with bipolar electrosurgery is faster (shorter duration of surgery by 13 minutes), but this leads to more significant decrease in ovarian reserve (Anti-Mullerian hormone (AMH) by 30%, antral follicle count (AFC) by 10%) than use of hemostatic sutures (AMH by 22%, PAF by 8%) (p <0.05). In order to maximize the maintenance of the ovarian reserve at surgeries by women with ovarian apoplexy, it is always better to carry out hemostasis by enucleating the cyst capsule within healthy tissues and saturation with absorbable synthetic areactive sutures on the ovarian wound following by intracorporal knot tying. Regardless of the hemostasis, used during surgical treatment of ovarian apoplexy by patients of the age of 36 years old and older, there is a greater decrease in ovarian reserve (AMH by 30%, AFC by 20%) than at patients whose age is less than 35 years old (AMH by 20%, AFC by 12%) (p <0.05). By patients with implemented fertility function regardless of age and by all patients under the age of 35, undergoing surgery because of ovarian apoplexy for the first time, bipolar coagulation is permissible to stop bleeding. At implementation of bipolar hemostasis of patients with ovarian apoplexy, point coagulation of bleeding vessels should be performed, avoiding damage to surrounding tissues.

scholarly journals Stem Cells as a Resource for Treatment of Infertility-related Diseases

2019 ◽  
Vol 19 (8) ◽  
pp. 539-546
Author(s):  
Jing Wang ◽  
Chi Liu ◽  
Masayuki Fujino ◽  
Guoqing Tong ◽  
Qinxiu Zhang ◽  
...  
Keyword(s):  
Stem Cells ◽  
Stem Cell ◽  
In Vitro Fertilization ◽  
Cell Therapy ◽  
Reproductive Medicine ◽  
Intrauterine Insemination ◽  
Reproductive Age ◽  
Vitro Fertilization ◽  
Undifferentiated Cells

Worldwide, infertility affects 8-12% of couples of reproductive age and has become a common problem. There are many ways to treat infertility, including medication, intrauterine insemination, and in vitro fertilization. In recent years, stem-cell therapy has raised new hope in the field of reproductive disability management. Stem cells are self-renewing, self-replicating undifferentiated cells that are capable of producing specialized cells under appropriate conditions. They exist throughout a human’s embryo, fetal, and adult stages and can proliferate into different cells. While many issues remain to be addressed concerning stem cells, stem cells have undeniably opened up new ways to treat infertility. In this review, we describe past, present, and future strategies for the use of stem cells in reproductive medicine.

scholarly journals Endometriosis Associated Infertility: A Critical Review and Analysis on Etiopathogenesis and Therapeutic Approaches

Medicina ◽  
2020 ◽  
Vol 56 (9) ◽  
pp. 460
Author(s):  
Lidia Filip ◽  
Florentina Duică ◽  
Alina Prădatu ◽  
Dragoș Crețoiu ◽  
Nicolae Suciu ◽  
...  
Keyword(s):  
Intrauterine Insemination ◽  
Imaging Techniques ◽  
Treatment Options ◽  
Follicular Development ◽  
Future Research ◽  
Genetic Profile ◽  
Vitro Fertilization ◽  
Emerging Therapies ◽  
Treatment Alternatives

Endometriosis represents a frequently diagnosed gynecological affliction in the reproductive timespan of women, defined by symptoms ranging from pelvic pain to infertility. A complex interplay between the genetic profile, hormonal activity, menstrual cyclicity, inflammation status, and immunological factors define the phenotypic presentation of endometriosis. To date, imaging techniques represent the gold standard in diagnosing endometriosis, of which transvaginal ultrasonography and magnetic resonance imaging bring the most value to the diagnostic step. Current medical treatment options for endometriosis-associated infertility focus on either stimulating the follicular development and ovulation or on inhibiting the growth and development of endometriotic lesions. Techniques of assisted reproduction consisting of superovulation with in vitro fertilization or intrauterine insemination represent effective treatment alternatives that improve fertility in patients suffering from endometriosis. Emerging therapies such as the usage of antioxidant molecules and stem cells still need future research to prove the therapeutic efficacy in this pathology.

The effect of endometrioma on ovarian reserve

2017 ◽  
Vol 86 (3) ◽  
pp. 237
Author(s):  
Małgorzata Agnieszka Szczepańska ◽  
Paweł P. Jagodziński ◽  
Ewa Wender‑Ożegowska
Keyword(s):  
Ovarian Reserve ◽  
Antral Follicle ◽  
Antral Follicle Count ◽  
Reproductive Age ◽  
In Vitro Fertilisation ◽  
Current State ◽  
Ovarian Endometrioma ◽  
State Of Research ◽  
Ovarian Endometriomas

An ovarian endometrioma is a very common form of endometriosis in women of reproductive age. This review presents the current state of research on ovarian reserve in women with ovarian endometriomas. Endometrioma can negatively affect ovarian markers: the anti‑Müllerian hormone (AMH), antral follicle count (AFC) and in vitro fertilisation (IVF) results. Decisions on the surgical treatment of endometrial cysts should be carefully thought through, especially in women who have not given birth.

scholarly journals Hyperactivation of dormant primordial follicles in ovarian endometrioma patients

Reproduction ◽  
2020 ◽  
Vol 160 (6) ◽  
pp. R145-R153
Author(s):  
Sachiko Matsuzaki ◽  
Michael W Pankhurst
Keyword(s):  
Surgical Treatment ◽  
Ovarian Reserve ◽  
Severe Pain ◽  
Primordial Follicle ◽  
Primordial Follicles ◽  
Relative Contribution ◽  
Ovarian Endometrioma ◽  
Main Factor ◽  
Surgical Injury

Serum anti-Müllerian hormone (AMH) levels decrease after surgical treatment of ovarian endometrioma. This is the main reason that surgery for ovarian endometrioma endometriosis is not recommended before in vitro fertilization, unless the patient has severe pain or suspected malignant cysts. Furthermore, it has been suggested that ovarian endometrioma itself damages ovarian reserve. This raises two important challenges: (1) determining how to prevent surgical damage to the ovarian reserve in women with ovarian endometrioma and severe pain requiring surgical treatment and (2) deciding the best treatment for women with ovarian endometrioma without pain, who do not wish to conceive immediately. The mechanisms underlying the decline in ovarian reserve are potentially induced by both ovarian endometrioma and surgical injury but the relative contribution of each process has not been determined. Data obtained from various animal models and human studies suggest that hyperactivation of dormant primordial follicles caused by the local microenvironment of ovarian endometrioma (mechanical and/or chemical cues) is the main factor responsible for the decreased primordial follicle numbers in women with ovarian endometrioma. However, surgical injury also induces hyperactivation of dormant primordial follicles, which may further reduce ovarian reserve after removal of the endometriosis. Although further studies are required to elucidate the mechanisms underlying diminished ovarian reserve in women with ovarian endometrioma, the available data strongly suggests the need to prevent/minimize hyperactivation of dormant primordial follicles, regardless of whether surgery is performed, for better clinical management of ovarian endometrioma.

Surgical Treatment of Retinal Branch Venous Occlusion and Related Complications

2019 ◽  
pp. 129-133
Keyword(s):  
Surgical Treatment ◽  
Vision Loss ◽  
Treatment Options ◽  
Vitreous Hemorrhage ◽  
Venous Occlusion ◽  
Treatment Modalities ◽  
Venous Outflow ◽  
Vein Occlusion ◽  
Retinal Vascular Disease ◽  
Macular Ischemia

Branch retinal vein occlusion (BRVO) is the second most common cause of the retinal vascular disease after diabetic retinopathy. Vision loss from BRVO may be associated with multiple causes, including macular edema, macular ischemia, foveal hemorrhage, vitreous hemorrhage, epiretinal membrane, and retinal detachment. To date, no proven effective treatment has been shown in randomized studies. Several treatment modalities have been used in order to reestablish the venous outflow of the retina as well as for the treatment of complications. In this review, we aimed to discuss the surgical treatment approaches in the treatment of BRVO, in which some of these treatment options were already abandoned.

scholarly journals Selective Inhibition of Prostaglandin E2 Receptors EP2 and EP4 Induces Apoptosis of Human Endometriotic Cells through Suppression of ERK1/2, AKT, NFκB and β-CATENIN Pathways and Activation of Intrinsic Apoptotic Mechanisms

2009 ◽  
Vol 94 (7) ◽  
pp. 2673-2673
Author(s):  
Sakhila K. Banu ◽  
JeHoon Lee ◽  
V. O. Speights ◽  
Anna Starzinski-Powitz ◽  
Joe A. Arosh
Keyword(s):  
Prostaglandin E2 ◽  
Treatment Options ◽  
Uterine Cavity ◽  
Selective Inhibition ◽  
Current Treatment ◽  
Reproductive Age ◽  
Treatment Modalities ◽  
Migration And Invasion ◽  
Antiapoptotic Proteins ◽  
Apoptotic Pathways

Endometriosis is a benign chronic gynecological disease of reproductive age women characterized by the presence of functional endometrial tissues outside the uterine cavity. It is an estrogen-dependent disease. Current treatment modalities to inhibit biosynthesis and actions of estrogen compromise menstruation, pregnancy, reproductive health of women, and fail to prevent reoccurrence of disease. There is a critical need to identify new specific signaling modules for non-estrogen targeted therapies for endometriosis. In our previous study, we reported that selective inhibition of cyclooxygenase-2 prevented survival, migration and invasion of human endometriotic epithelial and stromal cells which was due to decreased PGE2 production. In this study, we determined mechanisms through which prostaglandin E2 (PGE2) promoted survival of human endometriotic cells. Results of the present study indicate that: (i) PGE2 promotes survival of human endometriotic cells through EP2 and EP4 receptors by activating ERK1/2, AKT, NFκB, and β-catenin signaling pathways; (ii) selective inhibition of EP2 and EP4 suppresses these cell survival pathways and augments interactions between proapoptotic proteins (Bax and Bad) and antiapoptotic proteins (Bcl-2/Bcl-XL), facilitates the release of cytochrome C and thus activates caspase-3/PARP-mediated intrinsic apoptotic pathways; and (iii) these PGE2 signaling components are more abundantly expressed in ectopic endometriosis tissues compared to eutopic endometrial tissues during the menstrual cycle in women. These novel findings may provide an important molecular framework for further evaluation of selective inhibition of EP2 and EP4 as potential therapy, including non-estrogen target, to expand the spectrum of currently available treatment options for endometriosis in women.

Therapeutic potential of stem cells in lung disease: progress and pitfalls

2007 ◽  
Vol 114 (2) ◽  
pp. 99-108 ◽  
Author(s):  
Michael R. Loebinger ◽  
Susana Aguilar ◽  
Sam M. Janes
Keyword(s):  
Stem Cells ◽  
Lung Disease ◽  
Therapeutic Potential ◽  
Treatment Options ◽  
Lung Parenchyma ◽  
Treatment Modalities ◽  
In Vivo Experiments ◽  
Wide Range

There has been increasing excitement over the last few years with the suggestion that exogenous stem cells may offer new treatment options for a wide range of diseases. Within respiratory medicine, these cells have been shown to have the ability to differentiate and function as both airway and lung parenchyma epithelial cells in both in vitro and increasingly in vivo experiments. The hypothesis is that these cells may actively seek out damaged tissue to assist in the local repair, and the hope is that their use will open up new cellular and genetic treatment modalities. Such is the promise of these cells that they are being rushed from the benchside to the bedside with the commencement of early clinical trials. However, important questions over their use remain and the field is presently littered with controversy and uncertainty. This review evaluates the progress made and the pitfalls encountered to date, and critically assesses the evidence for the use of stem cells in lung disease.

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