Correlation of Bladder Wall Endometriosis Histological Location, To Infertility Patients’ Clinical Characteristics and Severity of Peritoneal Endometriosis

Study question: What is the correlation of bladder wall endometriosis histological location, to the severity of peritoneal endometriosis in infertility patients? Summary answer: Secondary infertility, back pain, micturition problems, history of ectopic pregnancy and number of abortions can probably be considered as high-risk factors for bladder wall endometriosis for infertility patients. What is known already: Bladder and/or ureter endometriosis occur in 70–85% among patients with deep infiltrating endometriosis. The knowledge regarding the bladder wall involvement with endometriosis in association to peritoneal endometriosis and infertility patients’ clinical characteristics is limited. Study design, size, duration: Retrospective, longitudinal cohort, Sixty-six, primary and secondary infertility patients, collection of surgical and clinical data between 2010 to 2018. Participants/materials, setting, and methods: An experienced histopathologist on endometriosis was asked to review all the patients’ histopathological results. The histopathological reported findings were reviewed prior to the study to reassure the bladder wall depth of endometriosis involvement. The operation and tissue macroscopic description reports before processing were also reviewed. Attention was paid for possible discrepancies or missed important data that could influence the histopathological results. In cases where results were equivocal, the paraffin blocks were available for additional sections for reassuring the diagnosis. An extra effort was made to meticulously observe and identify the involvement of the bladder serosa, muscularis and mucosa with endometriotic cells and glands. Main results and the role of chance: Primary infertility was the indication for the current laparoscopic surgeries in 32 out of 66 (48.5%) patients and secondary infertility for the rest of the group. The highest incidence of bladder endometriosis (BE) was detected on the serosa of 12 patients and in the detrusor muscle (DM) of 11 cases. Bladder serosa endometriosis (BSE) was significantly more prominent among patients with history of ectopic pregnancy (p=0.004) and among patients with secondary infertility (p=0.029). Destrusor muscle endometriosis (DME) was significantly more frequent (p=0.012) in patients with increasing number of abortions. DME highest rates of 37.7% were observed among the severe spread of abdominal endometriosis as compared to 19% of the cases with bladder serosa endometriosis. No statistically significant difference found between serosa and detrusor muscle endometriosis involvement, when compared to severity and spread of endometriosis within the abdominal cavity. Back pain was most prominent with statistical significant difference (p=0.007) in 8 patients with BSE + DME as compared with other groups of patients (4 BSE, 3 DME and 3 BME+DME patients). Among 30 cases with an ovarian endometrioma detected by TVU, DME was diagnosed in 13 patients, in serosa of 10, and in serosa and DM of 6 patients. Statistical analysis was performed using Pearson chi-square, Fisher’s exact tests and the Kruskal-Wallis test by STATA version 15 SE (StataCorp. 2017). Limitations, reasons for caution: This is a cohort retrospective study. There is a possibility that other areas with endometriosis were also involved in the BW other than those diagnosed and treated. The mixture of patients with primary and secondary infertility could also affect the results, although statistical analysis did not show any significance in BWE, clinical symptoms and surgical findings. BE is rarely an isolated condition, and other forms of endometriosis are frequently concomitant Wider implications of the findings: Detrusor muscle endometriosis involvement was in 68% and bladder serosa in 32% of all cases with bladder endometriosis and infertility investigated. The severity of the peritoneal endometriosis can probably direct to meticulous intraoperative investigation for bladder endometriosis.

The Efficacy and Safety of Letrozole or Anastrozole in The Treatment of Specific Male Infertility Patients: Meta-Analysis and Systematic Review

Background: Letrozole (LE) or anastrozole (AZ) is clinically beneficial in male infertility patients with a low testosterone-estradiol ratio (T/E2). Many scholars believe it has the potential to become one of the effective drugs to treat male infertility. But some relevant research results are different or even the opposite. Study Question: The purpose of this report is to evaluate the efficacy and safety of letrozole or anastrozole in the treatment of specific male infertility patients. Data Sources: We performed a comprehensive literature search using PubMed, Embase, Cochrane, CNKI, VIP, CBM, and Wanfang Date through August 2021 for all studies.Study Design: We conducted a systematic review with meta- analysis of the all available literature reporting sperm conventional parameters, gonadotropin and testosterone levels, and/or the pregnancy rate. Results: The total of 10 studies involving 280 patients were included. LE or AZ administration increased significantly sperm concentration, total sperm count, and serum luteinizing hormone, follicle-stimulating hormone, testosterone levels and T / E2 compared with baseline values, but E2 levels were significantly reduced. In contrast, LE or AZ did not have any significant effect on sperm concentration and motility and pregnancy rate, but improved total sperm count, sperm morphology, compared to the control group, which included studies done with Selective estrogen receptor modulators (SEMR) or testosterone undecanoate (TU). Conclusion: LE or AZ may be effective in the treatment of low T / E2 male infertility, perhaps better than other anti-estrogen or exogenous testosterone supplementation. In addition, we should pay special attention to the changes of E2 during treatment.

Appraisal of Experimental Methods to Manage Menopause and Infertility: Intraovarian Platelet-Rich Plasma vs. Condensed Platelet-Derived Cytokines

The first published description of intraovarian platelet-rich plasma (PRP) appeared in mid-2016, when a new experimental technique was successfully used in adult human ovaries to correct the reduced fertility potential accompanying advanced maternal age. Considering the potential therapeutic scope of intraovarian PRP would likely cover both menopause and infertility, the mainstream response has ranged from skeptical disbelief to welcome astonishment. Indeed, reports of intraovarian PRP leading to restored menses in menopause (as an alternative to conventional hormone replacement therapy) and healthy term livebirths for infertility patients (from IVF or as unassisted conceptions) continue to draw notice. Yet, any proper criticism of ovarian PRP applications will be difficult to rebut given the heterogenous patient screening, varied sample preparations, wide differences in platelet incubation and activation protocols, surgical/anesthesia techniques, and delivery methods. Notwithstanding these aspects, no adverse events have thus far been reported and ovarian PRP appears well tolerated by patients. Here, early studies guiding the transition of ‘ovarian rejuvenation’ from experimental to clinical are outlined, with mechanisms to explain results observed in both veterinary and human ovarian PRP research. Current and future challenges for intraovarian cytokine treatment are also discussed.

Reoperation rates for recurrence of fibroids after abdominal myomectomy in women with large uterus

Background The population of women undergoing abdominal myomectomy for symptomatic large fibroid uterus is unique. We seek to characterize the timing, risk factors as well as the presenting symptoms which led patients to undergo repeat surgery in this patient population. Methods and findings We followed 592 patients who underwent an abdominal myomectomy from March 1998 to June 2010 at St. Vincent’s Catholic Medical Center and presented later during the study period with a recurrence of symptoms attributable to a reemergence of fibroids and who chose to undergo repeat surgical management. Twelve percent of patients exhibited symptoms of fibroid uterus which led to reoperation within the study period. The mean age at repeat surgery was 44.1 ± 0.6 years old (n = 69) and the mean time between operations was 7.9 ± 0.3 years. Presentation was variable but included bleeding, pain and infertility. Patients presented for surgery with a significantly smaller sized uterus than at their initial surgery. Timing between surgeries correlated with age at initial surgery and uterine size but race, number of fibroids, aggregate weight of fibroids removed, operative time or blood loss at the initial surgery did not correlate. Data is suggestive that intraperitoneal triamcinolone may reduce reoperation rates but not timing of recurrence. Conclusion These results may help in counseling patients, particularly younger women, on the risks of fibroid recurrence necessitating repeat surgery. Further research is necessary to assess if triamcinolone can alter fibroid reurrence in patients who undergo uterus sparing procedures.

Comparative characteristics of patients with infertility when applying melatonin in complex preparation for assisted reproductive technologies

Оbjective of the study was to conduct a retrospective comparative characterization of patients with infertility who took or did not take melatonin with assisted reproductive technologies (ART).Materials and methods. In our study, we examined 89 women. The first (control) group included 13 healthy women oocyte donors who got pregnant on their own and gave birth to their own healthy children, the second group - 33 patients with infertility, who took 3 mg of the preparation "Vita-melatonin" produced by "Kyiv Vitamin Plant" at the same time before bedtime, two weeks before and during ovulation stimulation, the third group - 43 patients with infertility who did not take melatonin preparation before and during ovulation stimulation. There were no women who worked night shifts among the patients. Medical documentation of women of the control group and those with infertility, data of gynecological, ultrasound examination, hormones blood were analyzed. Ultrasound examination of the pelvic organs was performed on all patients with the device "Mindray DC-80 X-Insight", and measurements were performed using a transvaginal sensor. The thickness and structure of the endometrium were evaluated, and the number of antral follicles (NAF) ranging in size from 2 to 10 mm was counted in each ovary. All patients were tested for serum levels of the anti-mullerian hormone (AMG), follicle-stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), prolactin (PRL), progesterone (P), thyroid-stimulating hormone (TSH), triiodothyronine (T4).Results. The average age of women in the first (control) group was 27.08 ± 12.38 years, the second (taking melatonin) - 33.12 ± 8.18 years, the third (not taking melatonin) - 30.95 ± 7.07 years > 0.05), i. e. the age of the patients of the examined groups was equal. It should be noted that in the studied patients of both groups, the occurrence of primary infertility exceeded secondary infertility 2.7 times in the second group (p < 0.05) and 1.7 times in the third (p < 0.05). Infertility factors such as reduced ovarian reserve, habitual miscarriage and infertility of unknown origin were more common in patients of the second group, and endometriosis, tubal factor and male factor in the third, although the difference was not significant. The available extragenital pathology did not differ in the patients of the examined groups. The number of antral follicles was significantly higher in both ovaries of women in the control group compared with patients of the second and third groups. While the thickness of the endometrium did not differ significantly in groups, although in women of the control group it was slightly less. Regarding the study of hormonal status, it should be noted that we did not find a significant difference in the levels of hormones in the blood of women we examined. Exceptionally, there was a significant difference (p < 0.001) in progesterone content between the second (0.62 ± 0.052 nmol/l) and third (181.63 ± 13.87 nmol/l) groups. Also, the patients of the third group had significantly (p < 0.05) higher levels of FSH in blood (8.25 ± 0.63 mUn/ml) compared with the control group (4.93 ± 0.69 mUn/ml).Conclusions. The examined women in the control group, as well as infertility patients who received melatonin two weeks before the expected menstruation and during ovulation stimulation, and infertility patients who did not receive this preparation in similar programs, did not differ in age, occurrence of primary and secondary infertility, the factor that led to infertility, concomitant extragenital pathology, ovarian reserve and hormone levels of the reproductive panel. That is, they were equal in our study.

Appraisal of Experimental Methods to Manage Menopause and Infertility: Intraovarian Platelet-Rich Plasma vs. Condensed Platelet-Derived Cytokines

The first published description of intraovarian platelet-rich plasma (PRP) appeared in mid-2016, when a new experimental technique was successfully used in adult human ovaries to correct the reduced fertility potential accompanying advanced maternal age. Considering the potential therapeutic scope of intraovarian activated PRP and/or condensed platelet cytokines would likely cover both menopause treatment and infertility, the mainstream response has ranged from skeptical disbelief to welcome astonishment. Indeed, reports of restored menses in menopause (as an alternative to conventional hormone replacement therapy) and healthy term livebirths for infertility patients (either with IVF or as unassisted conceptions) after intraovarian PRP injection continue to draw notice. Yet any proper criticism of ovarian PRP applications will be difficult to rebut given the heterogenous patient screening, varied sample preparations, wide differences in platelet incubation and activation protocols, surgical/anesthesia techniques, and delivery methods. Notwithstanding these features, no adverse events have been reported thus far and ovarian PRP appears well tolerated by patients. Here, early research guiding the transition of &lsquo;ovarian rejuvenation&rsquo; from experimental to clinical is outlined. Likely mechanisms are presented to explain results observed in both veterinary and human ovarian PRP research. Current and future challenges for intraovarian cytokine treatment are also discussed.

Metabolomics Analysis Discovers Estrogen Altering Cell Proliferation via the Pentose Phosphate Pathway in Infertility Patient Endometria

Estrogen therapy is widely used as a supplementary treatment after hysteroscopy for female infertility patients owing to its protective function that improves endometrial regeneration and menstruation, inhibits recurrent adhesions, and improves subsequent conception rate. The endometrial protective function of such estrogen administration pre-surgery is still controversial. In the current study, 12 infertility patients were enrolled, who were treated with estrogen before hysteroscopy surgery. Using cutting-edge metabolomic analysis, we observed alterations in the pentose phosphate pathway (PPP) intermediates of the patient’s endometrial tissues. Furthermore, using Ishikawa endometrial cells, we validated our clinical discovery and identified estrogen–ESR–G6PD–PPP axial function, which promotes estrogen-induced cell proliferation.

The Role of Diagnostic Laparoscopy in the Unexplained Infertility Cases

Purpose: The study examines how useful laparoscopy is in finalizing the diagnosis of unexplained infertility. Materials: The study included 50 women with 1 year or 2 years of infertility, who had a regular marital life with unprotected intercourse for more than a year, normal husband's semen analysis, normal ovulation by folliculometry, normal hormonal profile, and normal hysterosalpingogram at the department of Obstetrics and Gynecology at Aswan University Hospital from January to December 2019. Methods: This is a cross-sectional observational study involving 50 women who underwent diagnostic laparoscopy after investigations and imaging failed to reveal the cause of infertility. During the procedure, the pelvis was inspected for any pathology, including the uterus, fallopian tubes, round ligaments, ureterovesical pouch, uterosacral ligaments, Douglas pouch, and ovarian fossae. Results: Diagnostic laparoscopy helped uncover abnormal pathologies such as endometriosis, adhesions, and tubal pathologies in 30 women (60%) of the 50 included in the study, whereas no abnormality was detected in the remaining 20 (40%). Conclusion: Laparoscopy is not only a crucial diagnostic technique in infertility patients, but it can also help with treatment selections. Conducting laparoscopy in cases of unexplained infertility is linked to both peritubular adhesions and pelvic endometriosis. These pelvic disorders might not be appropriately detected or treated without laparoscopy, and hysterosalpingography and basic imaging such as pelvic ultrasonography are frequently ignored.