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Jiang J, Pan Y, Yu J, Zhang Y, Yang Y, Xu H, Sun F. Laparoscopic adenomyomectomy combined with levonorgestrel-releasing intrauterine system is effective for long-term management of adenomyosis. BMC Womens Health 2024; 24:28. [PMID: 38191409 PMCID: PMC10775492 DOI: 10.1186/s12905-023-02795-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 11/20/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUD Laparoscopic adenomyomectomy combined with intraoperative placement of levonorgestrel-releasing intrauterine device (LNG-IUS) is a novel conservative surgical procedure for adenomyosis. Our study aimed to compare the efficacy of surgery with or without intraoperative placement of LNG-IUS treatment in adenomyosis. METHODS We retrospectively reviewed the medical records of adenomyosis patients who received laparoscopic adenomyomectomy from January 2014 to April 2020, finally including 70 patients undergoing surgery-LNG-IUS as group A and 69 patients undegoing surgery only as group B. Risk factors for three-year relapse were analyzed using Cox's multivariate proportional hazard analysis. RESULTS Visual analog scale and Mansfield-Voda-Jorgensen Menstrual Bleeding Scale scores of group A at 3, 6, 12, 24, and 36 months were significantly lower than those of group B at the corresponding points (P < .001 for both scales). Individuals in both groups showed statistically significant symptom relief. The recurrence rate in group A was significantly lower than that in group B at 36 months after the surgery (2.94% vs. 32.84%, P < .001). A cox proportional hazard model showed that relapse was significantly associated with coexisting ovarian endometriosis (adjusted hazard ratio [aHR], 2.94; 95% confidence interval [CI], 1.33-7.02, P = .015). Patients who received surgery-LNG-IUS had a lower risk of recurrence than those with surgery-alone (aHR, 0.07; 95% CI, 0.016-0.31, P < .001). CONCLUSIONS Conservative surgery with intraoperative placement of LNG-IUS is effective and well-accepted for long-term therapy with a lower recurrence rate for adenomyosis. Coexistent ovarian endometriosis is a major factor for adenomyosis relapse.
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Affiliation(s)
- Jilan Jiang
- Department of Gynecology & Obstetrics, International Peace Maternity & Child Health Hospital, Shanghai Jiao Tong University School of Medicine, No.910 Hengshan Road, Xuhui District, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
- Shanghai Municipal Key Clinical Speciality, Shanghai, China
| | - Yilian Pan
- Department of Gynecology & Obstetrics, International Peace Maternity & Child Health Hospital, Shanghai Jiao Tong University School of Medicine, No.910 Hengshan Road, Xuhui District, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
- Shanghai Municipal Key Clinical Speciality, Shanghai, China
| | - Jin Yu
- Department of Gynecology & Obstetrics, International Peace Maternity & Child Health Hospital, Shanghai Jiao Tong University School of Medicine, No.910 Hengshan Road, Xuhui District, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
- Shanghai Municipal Key Clinical Speciality, Shanghai, China
| | - Ye Zhang
- Department of Gynecology & Obstetrics, International Peace Maternity & Child Health Hospital, Shanghai Jiao Tong University School of Medicine, No.910 Hengshan Road, Xuhui District, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
- Shanghai Municipal Key Clinical Speciality, Shanghai, China
| | - Yeping Yang
- Department of Gynecology & Obstetrics, International Peace Maternity & Child Health Hospital, Shanghai Jiao Tong University School of Medicine, No.910 Hengshan Road, Xuhui District, Shanghai, China
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China
- Shanghai Municipal Key Clinical Speciality, Shanghai, China
| | - Hong Xu
- Department of Gynecology & Obstetrics, International Peace Maternity & Child Health Hospital, Shanghai Jiao Tong University School of Medicine, No.910 Hengshan Road, Xuhui District, Shanghai, China.
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China.
- Shanghai Municipal Key Clinical Speciality, Shanghai, China.
| | - Feng Sun
- Department of Gynecology & Obstetrics, International Peace Maternity & Child Health Hospital, Shanghai Jiao Tong University School of Medicine, No.910 Hengshan Road, Xuhui District, Shanghai, China.
- Shanghai Key Laboratory of Embryo Original Diseases, Shanghai, China.
- Shanghai Municipal Key Clinical Speciality, Shanghai, China.
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2
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Wang PH, Yang ST, Lee WL. Both adjuvant and maintenance therapies are needed in women with symptomatic adenomyosis after uterus-sparing treatment. Taiwan J Obstet Gynecol 2023; 62:489-491. [PMID: 37407180 DOI: 10.1016/j.tjog.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/10/2023] [Indexed: 07/07/2023] Open
Affiliation(s)
- Peng-Hui Wang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Female Cancer Foundation, Taipei, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.
| | - Szu-Ting Yang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Female Cancer Foundation, Taipei, Taiwan
| | - Wen-Ling Lee
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Medicine, Cheng-Hsin General Hospital, Taipei, Taiwan
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3
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Lee WL, Yang ST, Wang PH. Letter to the editor: Adjuvant or maintenance therapy may be needed in adenomyosis patients after uterus-sparing surgery. Int J Gynaecol Obstet 2023; 160:1054-1055. [PMID: 36700453 DOI: 10.1002/ijgo.14678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 01/13/2023] [Indexed: 01/27/2023]
Affiliation(s)
- Wen-Ling Lee
- Department of Medicine, Cheng-Hsin General Hospital, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Szu-Ting Yang
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Peng-Hui Wang
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan.,The Female Cancer Foundation, Taipei, Taiwan.,Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
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4
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Comparison of Clinical and Reproductive Outcomes between Adenomyomectomy and Myomectomy. J Minim Invasive Gynecol 2021; 29:392-400. [PMID: 34670164 DOI: 10.1016/j.jmig.2021.10.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 10/06/2021] [Accepted: 10/08/2021] [Indexed: 01/10/2023]
Abstract
STUDY OBJECTIVE Women with adenomyosis may show a lower pregnancy rate and a higher miscarriage rate than healthy women. There is also a general agreement that leiomyomas, either submucosal or intramural, negatively affect fertility, when compared with women without myomas. Some of these women may benefit from adenomyomectomy, however this cytoreductive procedure is considered invasive and technically challenging especially in severe diffuse cases. The study aimed to compare the clinical and reproductive outcomes of patients who underwent adenomyomectomy with those of patients who underwent intramural myomectomy. DESIGN A retrospective study. SETTING Department of Obstetrics & Gynecology, Center of Gynecological Endoscopy and Minimally Invasive surgery, First Faculty of Medicine, General University Hospital in Prague. PATIENTS A total of 55 women who underwent surgical resection of uterine adenomyosis and 55 patients who underwent myomectomy for intramural uterine myomas were included in this study. All study participants wished to retain and possibly improve their reproductive potential. INTERVENTIONS Between 2004 and 2019, 110 women underwent laparoscopic or open uterus-sparing surgery for clinically significant uterine adenomyosis (group A) or myomas (group B), respectively. MEASUREMENTS AND MAIN RESULTS Two groups of women who underwent different fertility-saving procedures were compared. Although all women entering the study had declared their wish to conceive, only 28 patients in group A (group A1) and 24 women in group B (group B1) finally aimed toward pregnancy. The mean age and follow-up period was 35.0 years and 76.81 months, respectively, in group A and 34.8 years and 72.5 months, respectively, in group B. The pregnancy and delivery rates were 75.0% and 46.4%, respectively, in group A1 vs 96.0% and 70.8%, respectively, in group B1, with no significant differences between the 2 groups. The open surgical approach was significantly more frequently employed in group A (47.3% vs 16.4%; p <.01). CONCLUSION In this study, women who underwent surgery involving the uterine muscularity, including myomectomy or adenomyomectomy, had comparable reproductive outcomes, with no significant differences.
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5
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Higgins C, Fernandes H, Da Silva Costa F, Martins WP, Vollenhoven B, Healey M. The impact of adenomyosis on IVF outcomes: a prospective cohort study. Hum Reprod Open 2021; 2021:hoab015. [PMID: 33898760 PMCID: PMC8054136 DOI: 10.1093/hropen/hoab015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2020] [Revised: 01/27/2021] [Indexed: 01/05/2023] Open
Abstract
STUDY QUESTION Does the presence of adenomyosis in women treated with IVF alter IVF outcomes? SUMMARY ANSWER Adenomyosis does not significantly alter IVF outcomes when adjusted for confounding factors including maternal age and smoking status. WHAT IS KNOWN ALREADY Studies evaluating adenomyosis and its impact on infertility, particularly when focusing on IVF, remain controversial. Many studies report that adenomyosis has a detrimental effect on IVF outcomes, however age is strongly related with both the prevalence of adenomyosis and worse reproductive outcomes. STUDY DESIGN, SIZE, DURATION A prospective cohort study of women undergoing 4002 IVF cycles who had undergone a screening ultrasound assessing features of adenomyosis from 1 January 2016 to 31 March 2018 at a multi-site private fertility clinic. Of these women, 1228 fulfilled the inclusion criteria and commenced an IVF cycle, with a subset of 715 women undergoing an embryo transfer (ET). Women were defined as having adenomyosis if there was sonographic evidence of adenomyosis on ultrasound as per the Morphological Uterus Sonographic Assessment criteria, and were then compared to women without. PARTICIPANTS/MATERIALS, SETTING, METHODS All women at a private multi-site IVF clinic who underwent a standardised ultrasound to identify features of adenomyosis and also commenced an IVF cycle were assessed for their outcomes. These included clinical pregnancy (defined as the presence of a gestational sac on ultrasound at 7 weeks’ gestation), clinical pregnancy loss, number of cancelled cycles, number of useful embryos for transfer or freezing and live birth rates. As a secondary aim, initiated stimulation cycles and those that had an ET were analysed separately to determine when an effect of adenomyosis on IVF might occur: during stimulation or transfer. MAIN RESULTS AND THE ROLE OF CHANCE When adjusting for confounders, women with and without sonographic features of adenomyosis had no significant differences in most of their IVF outcomes including live birth rates. LIMITATIONS, REASONS FOR CAUTION Adenomyosis had a detrimental impact on IVF outcomes prior to adjusting for confounding factors. No allowance was made for the possibility that confounding factors may merely reduce the effect size of adenomyosis on IVF outcomes. Second, despite a power calculation, the study was underpowered as not all fresh cycles led to an ET. WIDER IMPLICATIONS OF THE FINDINGS This is one of the largest studies to evaluate adenomyosis and IVF outcomes, while also importantly adjusting for confounding factors. The results suggest that adenomyosis does not have the detrimental impact on IVF that has previously been suggested, possibly reducing the importance of screening for and treating this entity. STUDY FUNDING/COMPETING INTEREST(S) The study received no external funding. The authors declare no conflicts of interest. TRIAL REGISTRATION NUMBER ACTRN12617000796381.
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Affiliation(s)
- Chloe Higgins
- Women's and Newborn Programme, Monash Health, Clayton, VIC, Australia
| | - Hugo Fernandes
- Newlife IVF, Box Hill, VIC, Australia.,Royal Women's Hospital, Parkville, VIC, Australia
| | - Fabricio Da Silva Costa
- Department Obstetrics & Gynaecology, Monash University, Clayton, VIC, Australia.,Department of Gynecology and Obstetrics, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Wellington P Martins
- Department of Reproductive Medicine, SEMEAR fertilidade, Ribeirão Preto, São Paulo, Brazil
| | - Beverley Vollenhoven
- Women's and Newborn Programme, Monash Health, Clayton, VIC, Australia.,Department Obstetrics & Gynaecology, Monash University, Clayton, VIC, Australia.,Monash IVF, Clayton, VIC, Australia
| | - Martin Healey
- Newlife IVF, Box Hill, VIC, Australia.,Royal Women's Hospital, Parkville, VIC, Australia.,Department Obstetrics & Gynaecology, University of Melbourne, Parkville, VIC, Australia
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Li Q, Yuan M, Li N, Zhen Q, Chen C, Wang G. The efficacy of medical treatment for adenomyosis after adenomyomectomy. J Obstet Gynaecol Res 2020; 46:2092-2099. [PMID: 32725682 DOI: 10.1111/jog.14376] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 05/27/2020] [Accepted: 06/13/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Qiuju Li
- Department of Obstetrics and Gynecology Qilu Hospital of Shandong University Jinan China
| | - Ming Yuan
- Department of Obstetrics and Gynecology Qilu Hospital of Shandong University Jinan China
| | - Ni Li
- Department of Obstetrics and Gynecology Qilu Hospital of Shandong University Jinan China
| | - Qianwei Zhen
- Department of Obstetrics and Gynecology Qilu Hospital of Shandong University Jinan China
| | - Chang Chen
- Department of Obstetrics and Gynecology Qilu Hospital of Shandong University Jinan China
| | - Guoyun Wang
- Department of Obstetrics and Gynecology Qilu Hospital of Shandong University Jinan China
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7
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Wang PH, Chen CP, Kuo TC. Outstanding research paper awards of the 2018 Taiwanese Journal of Obstetrics and Gynecology. Taiwan J Obstet Gynecol 2019. [DOI: 10.1016/j.tjog.2019.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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8
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Vannuccini S, Luisi S, Tosti C, Sorbi F, Petraglia F. Role of medical therapy in the management of uterine adenomyosis. Fertil Steril 2018; 109:398-405. [PMID: 29566852 DOI: 10.1016/j.fertnstert.2018.01.013] [Citation(s) in RCA: 129] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 01/08/2018] [Accepted: 01/09/2018] [Indexed: 12/19/2022]
Abstract
Adenomyosis is a benign uterine condition affecting women at various ages with different symptoms. The management of these patients is still controversial. Few clinical studies focusing on medical or surgical treatment for adenomyosis have been performed. No drug is currently labelled for adenomyosis and there are no specific guidelines to follow for the best management. Anyhow, medical treatments are effective in improving symptoms (pain, abnormal uterine bleeding and infertility). The rationale for using medical treatment is based on the pathogenetic mechanisms of adenomyosis: sex steroid hormones aberrations, impaired apoptosis, and increased inflammation. Several nonhormonal (i.e., nonsteroidal anti-inflammatory drugs) and hormonal treatments (i.e., progestins, oral contraceptives, gonadotropin-releasing hormone analogues) are currently used off-label to control pain symptoms and abnormal uterine bleeding in adenomyosis. Gonadotropin-releasing hormone analogues are indicated before fertility treatments to improve the chances of pregnancy in infertile women with adenomyosis. An antiproliferative and anti-inflammatory effect of progestins, such as dienogest, danazol and norethindrone acetate, suggests their use in medical management of adenomyosis mainly to control pain symptoms. On the other hand, the intrauterine device releasing levonorgestrel resulted is extremely effective in resolving abnormal uterine bleeding and reducing uterine volume in a long-term management plan. Based on new findings on pathogenetic mechanisms, new drugs are under development for the treatment of adenomyosis, such as selective progesterone receptor modulators, aromatase inhibitors, valproic acid, and anti-platelets therapy.
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Affiliation(s)
- Silvia Vannuccini
- Department of Health Sciences, University of Florence, Obstetrics and Gynecology, Careggi University Hospital, Florence, Italy
| | - Stefano Luisi
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Claudia Tosti
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Flavia Sorbi
- Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Obstetrics and Gynecology, Careggi University Hospital, Florence, Italy
| | - Felice Petraglia
- Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Obstetrics and Gynecology, Careggi University Hospital, Florence, Italy.
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9
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Liu CH, Chang WH, Liu WM, Wang PH. Serous carcinoma arising from adenomyosis. Taiwan J Obstet Gynecol 2018; 56:706-707. [PMID: 29037565 DOI: 10.1016/j.tjog.2017.08.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- Chia-Hao Liu
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Obstetrics and Gynecology, National Yang-Ming University, Taipei, Taiwan
| | - Wen-Hsun Chang
- Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Nursing, National Yang-Ming University, Taipei, Taiwan
| | - Wei-Min Liu
- Department of Obstetrics and Gynecology, Taipei Medical University Hospital, Taipei, Taiwan; Department of Obstetrics and Gynecology, Taipei Medical University, Taipei, Taiwan
| | - Peng-Hui Wang
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Obstetrics and Gynecology, National Yang-Ming University, Taipei, Taiwan; Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.
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10
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Tan J, Moriarty S, Taskin O, Allaire C, Williams C, Yong P, Bedaiwy MA. Reproductive Outcomes after Fertility-Sparing Surgery for Focal and Diffuse Adenomyosis: A Systematic Review. J Minim Invasive Gynecol 2018; 25:608-621. [DOI: 10.1016/j.jmig.2017.12.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 12/02/2017] [Accepted: 12/23/2017] [Indexed: 01/10/2023]
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11
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Soave I, Wenger JM, Pluchino N, Marci R. Treatment options and reproductive outcome for adenomyosis-associated infertility. Curr Med Res Opin 2018; 34:839-849. [PMID: 29046066 DOI: 10.1080/03007995.2017.1393404] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE Adenomyosis is a benign gynecological disease mostly diagnosed in the forth and fifth decades. The recent improvement of the diagnostic tools and a better understanding of the pathology allowed clinicians to postulate a possible relationship between adenomyosis and infertility and to diagnose it in younger asymptomatic women during infertility work-up. Purpose of this article is to review the different theories regarding the possible correlation between adenomyosis and infertility and to discuss the treatment options and the final reproductive outcome after the treatment. MATERIALS AND METHODS We search Pubmed for articles published in the English language with the use of the following MeSH search terms: "adenomyosis" combined with "treatment" and "fertility outcome" with the restriction to the human species. A manual search of review articles and cross-references completed the search. All selected articles were assessed for study design, patients characteristic, diagnosis of adenomyosis, type of treatment, post-treatment rates of conception, full-term pregnancy and completeness of information of the data sets. RESULTS Limited data are available concerning the efficacy of the different treatment options of adenomyosis on fertility outcome and the only ones published are retrospective evaluations or small case series. CONCLUSIONS Adenomyosis represents a common gynecological disorder with a negative impact on fertility. However, it remains challenging to establish if adenomyosis is the only cause of the infertility or not, because patients, in both case and control groups, may be affected by concomitant endometriosis. Further studies are required to determine the reason of implantation failure in women with adenomyosis and the impact of adenomyosis on infertile women with or without endometriosis.
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Affiliation(s)
- Ilaria Soave
- a Department of Morphology, Surgery and Experimental Medicine , University of Ferrara , Ferrara , Italy
| | - Jean-Marie Wenger
- b Division of Obstetrics and Gynecology , University Hospital of Geneva , Geneva , Switzerland
| | - Nicola Pluchino
- b Division of Obstetrics and Gynecology , University Hospital of Geneva , Geneva , Switzerland
| | - Roberto Marci
- a Department of Morphology, Surgery and Experimental Medicine , University of Ferrara , Ferrara , Italy
- b Division of Obstetrics and Gynecology , University Hospital of Geneva , Geneva , Switzerland
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12
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Liang E, Brown B, Rachinsky M. A clinical audit on the efficacy and safety of uterine artery embolisation for symptomatic adenomyosis: Results in 117 women. Aust N Z J Obstet Gynaecol 2018; 58:454-459. [PMID: 29344938 DOI: 10.1111/ajo.12767] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2017] [Accepted: 12/03/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Uterine artery embolisation (UAE) is a possible uterine-sparing treatment option for women with unsuccessful conservative management for adenomyosis-related heavy menstrual bleeding (HMB) and dysmenorrhoea. AIM To conduct a clinical audit on the efficacy and safety of UAE for symptomatic adenomyosis. MATERIALS AND METHODS Retrospective review of 309 women who underwent UAE identified 117 women with magnetic resonance imaging features of adenomyosis (junctional zone thickness ≥ 12 mm). Overall success and HMB control were rated by women. Visual analogue scale (VAS) pain score, Uterine Fibroid Symptom and health-related Quality of Life (UFS-QoL) symptoms score and quality of life score were also used to measure outcome. RESULTS One hundred and fifteen women (98%) were available for outcome evaluation. The mean follow-up was 22.5 months. Overall clinical success was achieved in 102/115 (89%) women; HMB control was achieved in 91/104 (88%); dysmenorrhea relief was achieved in 94/104 (90%), with VAS reduction of 6.13 (P < 0.001), Mean symptoms score was reduced from 58 to 17 at 12 months (P < 0.001) and QoL score increased from 42 to 88 at 12 months (P < 0.001). Hysterectomy was performed on six (5%) women. There were three (3%) mild groin haematomatas and three (3%) mild subacute complications (one possible endometritis, two urinary tract infections; all responded to oral antibiotics). Two women had unintended pregnancies which were complicated. CONCLUSIONS In this clinical audit UAE was found to be an effective uterine-sparing option for women who had unsuccessful conservative treatments for adenomyosis-related HMB and dysmenorrhoea. There were no major complications. Two women had unintended pregnancies that were complicated.
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Affiliation(s)
- Eisen Liang
- Department of Radiology, Sydney Adventist Hospital Clinical School, University of Sydney, Wahroonga, New South Wales, Australia
| | - Bevan Brown
- Department of Obstetrics and Gynaecology, Sydney Adventist Hospital Clinical School, University of Sydney, Wahroonga, New South Wales, Australia
| | - Maxim Rachinsky
- Sydney Adventist Hospital Clinical School, University of Sydney, Wahroonga, New South Wales, Australia
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13
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Dasrilsyah RA, Shan LP, Kwang NB, Shafiee MN, Omar MH. Spontaneous conception following GnRHa and progestogen therapy in adenomyosis. Horm Mol Biol Clin Investig 2017; 27:77-9. [PMID: 26812802 DOI: 10.1515/hmbci-2015-0061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Accepted: 12/17/2015] [Indexed: 12/25/2022]
Abstract
Adenomyosis is a common gynaecological disorder that is associated with infertility and miscarriage. We report a case of adenomyosis presented with urinary retention and infertility. The patient successfully conceived spontaneously following GnRHa followed by progestogen therapy. This treatment option might provide a synergistic effect in improving fertility and pregnancy outcome for women with adenomyosis. This modality has no potential surgical risk; it minimises the long-term side effects of GnRHa and also provides luteal support.
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Abstract
Until recently, adenomyosis has been associated with multiparity, not impaired fertility. Currently, adenomyosis is diagnosed with increasing frequency in infertile patients since women delay their first pregnancy until their late 30s or early 40s. Although an association between adenomyosis and infertility has not been fully established, based on the available information, recent studies suggested that adenomyosis has a negative impact on female fertility. Several uncontrolled studies with limited data also suggested that treatment of adenomyosis may improve fertility. This article discusses (i) the hypothesis and epidemiology of adenomyosis, (ii) diagnostic techniques, (iii) clinical evidence of correlation between adenomyosis and infertility, (iv) proposed mechanism of infertility in women with adenomyosis, (v) different treatment strategies and reproductive outcomes, and (vi) assisted reproductive technology outcome in women with adenomyosis.
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15
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Effectiveness of treatment for infertility using clinical investigation of laparoscopy cytoreductive surgery combined with gestrinone in adenomyosis. ACTA ACUST UNITED AC 2016. [DOI: 10.1007/s10397-016-0966-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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16
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Xu RF, Zhang J, Han ZY, Zhang BS, Liu H, Li XM, Ge HL, Dong XJ. Variables associated with vaginal discharge after ultrasound-guided percutaneous microwave ablation for adenomyosis. Int J Hyperthermia 2016; 32:504-10. [DOI: 10.3109/02656736.2016.1150523] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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17
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Tsui KH, Lee FK, Seow KM, Chang WC, Wang JW, Chen SU, Chao HT, Yen MS, Wang PH. Conservative surgical treatment of adenomyosis to improve fertility: Controversial values, indications, complications, and pregnancy outcomes. Taiwan J Obstet Gynecol 2015; 54:635-40. [DOI: 10.1016/j.tjog.2015.05.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2015] [Indexed: 01/03/2023] Open
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18
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Galliano D, Bellver J, Díaz-García C, Simón C, Pellicer A. ART and uterine pathology: how relevant is the maternal side for implantation? Hum Reprod Update 2014; 21:13-38. [PMID: 25155826 DOI: 10.1093/humupd/dmu047] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Assisted reproduction technology (ART) has become a standard treatment for infertile couples. Increased success rates obtained over the years have resulted primarily from improved embryo quality, but implantation rates still remain lower than expected. The uterus, an important player in implantation, has been frequently neglected. While a number of uterine pathologies have been associated with decreased natural fertility, less information exists regarding the impact of these pathologies in ART. This report reviews the evidence to help clinicians advise ART patients. METHODS An electronic search of PubMed and EMBASE was performed to identify articles in the English, French or Spanish language published until May 2014 which addressed uterine pathology and ART. Data from natural conception were used only in the absence of data from ART. Studies were classified in decreasing categories: RCTs, prospective controlled trials, prospective non-controlled trials, retrospective studies and experimental studies. Studies included in lower categories were only used if insufficient evidence was available. Pooled data were obtained from systematic reviews with meta-analyses when available. The summary of the evidence for the different outcomes and the degree of the recommendation for interventions were based on the GRADE (Grading of Recommendations Assessment, Development and Evaluation) statement recommendations. RESULTS There is strong evidence that surrogacy is effective for uterine agenesia. For the remaining pathologies, however, there is very little evidence that the established treatments improve outcomes, or that these pathologies have a negative effect on ART. In the presence of an apparently normal uterus, assessing endometrial receptivity (ER) is the goal; however diagnostic tests are still under development. CONCLUSIONS The real effect of different uterine/endometrial integrity pathologies on ART is not known. Moreover, currently proposed treatments are not based on solid evidence, and little can be done to assess ER in normal or abnormal conditions. No strong recommendations can be given based on the published experience, bringing an urgent need for well-designed studies. In this context, we propose algorithms to study the uterus in ART.
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Affiliation(s)
- Daniela Galliano
- Department of Reproduction, Instituto Valenciano de Infertilidad, Barcelona 08017, Spain
| | - José Bellver
- Department of Reproduction, Instituto Valenciano de Infertilidad (IVI), Valencia 46015, Spain
| | - César Díaz-García
- Woman's Health Department, Hospital Politécnico y Universitario La Fe, Valencia 46026, Spain
| | - Carlos Simón
- Department of Reproduction, Instituto Valenciano de Infertilidad (IVI), Valencia 46015, Spain IVI Foundation, Valencia 46015, Spain
| | - Antonio Pellicer
- Department of Reproduction, Instituto Valenciano de Infertilidad (IVI), Valencia 46015, Spain Woman's Health Department, Hospital Politécnico y Universitario La Fe, Valencia 46026, Spain IVI Foundation, Valencia 46015, Spain
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Tsui KH, Lee WL, Seow KM, Yang LW, Wang SY, Wang PH, Chang CL, Yen MS, Cheng JT, Chen CP. Effect of gonadotropin-releasing hormone agonist on ES-2 ovarian cancer cells. Taiwan J Obstet Gynecol 2014; 53:35-42. [PMID: 24767644 DOI: 10.1016/j.tjog.2013.05.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2013] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE Gonadotropin-releasing hormone (GnRH) receptor is found in the ovarian tissue, including epithelial ovarian cancer (EOC), suggesting that GnRH agonists may have direct action on EOC. MATERIALS AND METHODS Ovarian clear cell cancer (ES-2) cells were treated with low-dose GnRH agonist with/without low-dose paclitaxel (1 μM D-Lys(6) with/without 0.5 μM or 1.0 μM paclitaxel). Growth and behavior of ES-2 cells were evaluated. RESULTS Use of either D-Lys(6) or paclitaxel or a combination of the two did not affect the morphology and growth pattern of ES-2 cells. However, ability of migration and invasion of ES-2 cells was significantly decreased in either use of D-Lys(6) or paclitaxel and more apparent with the combination. Type I GnRH receptor expression of ES-2 was not altered significantly by the combination. CONCLUSION GnRH agonist might modify the ES-2 ovarian cancer cells, and its role might be independent, additional or synergistic, suggesting the potential role of the use of GnRH agonist in the management of clear cell type of the ovarian cancer. However, the results of this study were derived using ES-2 ovarian cancer cells, and might not be valid in other cell types of ovarian cancers.
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Affiliation(s)
- Kuan-Hao Tsui
- Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan; Department of Biological Science, National Sun Yat-Sen University, Kaohsiung, Taiwan; Department of Obstetrics and Gynecology, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Wen-Ling Lee
- Department of Obstetrics and Gynecology, National Yang-Ming University School of Medicine, Taipei, Taiwan; Department of Medicine, Cheng-Hsin General Hospital, Taipei, Taiwan; Department of Nursing, Oriental Institute of Technology, New Taipei City, Taiwan
| | - Kok-Min Seow
- Department of Obstetrics and Gynecology, National Yang-Ming University School of Medicine, Taipei, Taiwan; Department of Obstetrics and Gynecology, Shih Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Lin-Wei Yang
- Department of Obstetrics and Gynecology, National Yang-Ming University School of Medicine, Taipei, Taiwan; Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shih-Yi Wang
- Department of Obstetrics and Gynecology, National Yang-Ming University School of Medicine, Taipei, Taiwan; Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Peng-Hui Wang
- Department of Obstetrics and Gynecology, National Yang-Ming University School of Medicine, Taipei, Taiwan; Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan; Immunology Center, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Medical Research, China Medical University Hospital, Taichung, Taiwan.
| | - Chi-Lun Chang
- Department of Obstetrics and Gynecology, National Yang-Ming University School of Medicine, Taipei, Taiwan; Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ming-Shyen Yen
- Department of Obstetrics and Gynecology, National Yang-Ming University School of Medicine, Taipei, Taiwan; Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jiin-Tsuey Cheng
- Department of Biological Science, National Sun Yat-Sen University, Kaohsiung, Taiwan
| | - Chih-Ping Chen
- Department of Obstetrics and Gynecology, National Yang-Ming University School of Medicine, Taipei, Taiwan; Department of Obstetrics and Gynecology, Mackay Memorial Hospital, Taipei, Taiwan; Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
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Uterine-sparing surgery for adenomyosis and/or adenomyoma. Taiwan J Obstet Gynecol 2014; 53:3-7. [DOI: 10.1016/j.tjog.2014.01.001] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2014] [Indexed: 11/18/2022] Open
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Grimbizis GF, Mikos T, Tarlatzis B. Uterus-sparing operative treatment for adenomyosis. Fertil Steril 2014; 101:472-87. [DOI: 10.1016/j.fertnstert.2013.10.025] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Revised: 10/15/2013] [Accepted: 10/15/2013] [Indexed: 10/26/2022]
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Chang WH, Wang KC, Lee NR, Huang N, Su WH, Chao HT, Yen MS, Fuh JL, Wang PH. Reproductive performance of severely symptomatic women with uterine adenomyoma who wanted preservation of the uterus and underwent combined surgical–medical treatment. Taiwan J Obstet Gynecol 2013; 52:39-45. [DOI: 10.1016/j.tjog.2013.01.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/14/2012] [Indexed: 12/23/2022] Open
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Long-term follow-up of severely symptomatic women with adenomyoma treated with combination therapy. Taiwan J Obstet Gynecol 2013; 52:85-9. [DOI: 10.1016/j.tjog.2012.12.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/03/2012] [Indexed: 11/18/2022] Open
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Louis LS, Manzo E, Barsoum EM, Al-Samarrai M. A case report of a successful live birth following IVF preceded by fertility sparing surgery for a large adenomyomata. J OBSTET GYNAECOL 2012; 32:496-7. [PMID: 22663334 DOI: 10.3109/01443615.2012.680935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- L S Louis
- Department of Surgery and Cancer, Imperial College London, London, UK.
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Fertility outcome of infertile women with adenomyosis treated with the combination of a conservative microsurgical technique and GnRH agonist: Long-term follow-up in a series of nine patients. Taiwan J Obstet Gynecol 2012; 51:212-6. [DOI: 10.1016/j.tjog.2012.04.008] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/03/2012] [Indexed: 11/19/2022] Open
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Louis L, Saso S, Chatterjee J, Barsoum E, Al-Samarrai M. Adenomyosis and infertility. Reprod Biomed Online 2012; 24:586; author reply 587. [DOI: 10.1016/j.rbmo.2012.02.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Accepted: 02/09/2012] [Indexed: 12/01/2022]
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Maheshwari A, Gurunath S, Fatima F, Bhattacharya S. Adenomyosis and subfertility: a systematic review of prevalence, diagnosis, treatment and fertility outcomes. Hum Reprod Update 2012; 18:374-92. [DOI: 10.1093/humupd/dms006] [Citation(s) in RCA: 151] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Ballester M, d'Argent EM, Morcel K, Belaisch-Allart J, Nisolle M, Darai E. Cumulative pregnancy rate after ICSI-IVF in patients with colorectal endometriosis: results of a multicentre study. Hum Reprod 2012; 27:1043-9. [DOI: 10.1093/humrep/des012] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
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Sunkara SK, Khan KS. Adenomyosis and female fertility: A critical review of the evidence. J OBSTET GYNAECOL 2012; 32:113-6. [DOI: 10.3109/01443615.2011.624208] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
Classically, the diagnosis of adenomyosis has only been possible on a hysterectomy specimen, usually in women in their late fourth and fifth decades, and, therefore, evaluating any relationship with infertility was simply not possible. As a consequence, to this day, no epidemiologic data exists linking adenomyosis to a state of subfertility. Today, new imaging techniques have enabled a noninvasive diagnosis at a much earlier time and a number of single-case or small series reports have appeared showing that medical, surgical, or combined treatment can restore fertility in women with adenomyosis, an indirect proof of an association. At the functional level, several anomalies found in the so-called junctional zone, or inner myometrium, in adenomyosis patients have been shown to be associated with poor reproductive performance, mainly through perturbed uterine peristalsis. Additional evidence for an association comes from experimental data: in baboons, adenomyosis is associated with lifelong primary infertility, as well as to endometriosis. Finally, indirect proof comes from studies of the eutopic and ectopic endometrium in women with adenomyosis proving the existence of an altered endometrial function and receptivity. In conclusion, sufficient indirect proof exists linking adenomyosis to infertility to warrant systematic clinical studies.
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Al Jama FE. Management of adenomyosis in subfertile women and pregnancy outcome. Oman Med J 2011; 26:178-81. [PMID: 22043411 DOI: 10.5001/omj.2011.43] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Accepted: 04/12/2011] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES To assess the outcome of treatment with only gonadotropin releasing hormone agonists (Gn-RHa) versus combined conservative surgery and Gn-RHa therapy in the management of sub-fertile patients with symptomatic uterine adenomyosis. METHODS A retrospective study of the two treatment modalities allocated to 40 sub-fertile patients with pathology-proven adenomyosis over a period of eight years was undertaken at the Obstetrics and Gynecology department, King Fahad Hospital, Dammam University, Saudi Arabia. Twenty-two patients (Group A) were treated with Gn-RHa alone, and 18 patients (Group B) received combined conservative surgery with Gn-RHa therapy. After completion of six courses of Gn-RHa injections, there was a 3-year follow up period for all patients. Treatment outcome included relief of symptoms, pregnancy rate and successful deliveries, which were compared between the two groups. RESULTS The patients in group A were younger in age, had lower CA-125 levels and shorter infertile years than Group B. Three (13.6%) spontaneous pregnancies resulted upto 18 months of stopping Gn-RHa in group A, while 8 (44.4%) pregnancies resulted upto 36 months in group B patients, which was statistically significant (p=0.0393). Term delivery occurred normally in one (4.5%) Group A patient, while 6 (33.3%) patients in Group B had cesarean section at term (p=0.0328). CONCLUSION Combined conservative surgery and Gn-RHa may provide effective symptom relief, better reproductive performance in subfertile patients with uterine adenomyosis and longer period of pregnancy prospects after treatment than patients who recieved Gn-RHa alone. Due to the nature of this study, a well conducted randomized trial is needed in the future to assess the benefits of the two treatment modalities.
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Affiliation(s)
- Fathia E Al Jama
- Department of Obstetrics and Gynecology, College of Medicine, Dammam University, and Consultant, King Fahad Hospital, Al Khobar, Saudi Arabia
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Campo S, Campo V, Benagiano G. Adenomyosis and infertility. Reprod Biomed Online 2011; 24:35-46. [PMID: 22116070 DOI: 10.1016/j.rbmo.2011.10.003] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Revised: 09/30/2011] [Accepted: 10/04/2011] [Indexed: 12/19/2022]
Abstract
Today an accurate diagnosis of adenomyosis can be made thanks to progress in imaging techniques: sonography and magnetic resonance imaging (MRI). This has made it possible to clinically correlate the presence of adenomyosis to infertility. At the same time, a series of pathogenetic hypotheses have been presented to explain this correlation. First, the identification of the myometrial junctional zone (JZ) and of its disruption and thickening has been linked to poor reproductive performance mainly through perturbed uterine peristalsis, a phenomenon that originates exclusively from the JZ in the nonpregnant uterus. In addition, a number of biochemical and functional alterations in both eutopic and heterotopic endometrium in women with adenomyosis have now been found to lead to lower receptivity, indicated by the presence of 'implantation marker' defects. In these patients there is also an altered decidualization and abnormal concentrations of intrauterine free radicals. All these abnormalities in the endometrial environment seem to contribute to subfertility. Several attempts have been made to restore fertility in adenomyosis patients, the oldest being gonadotrophin-releasing hormone agonists coupled to conservative surgery. Also, uterine artery embolization and MRI-assisted high-intensity focused ultrasound ablation have been tried with some degree of success.
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Affiliation(s)
- Sebastiano Campo
- Institute of Obstetrics and Gynaecology, Catholic University of Sacred Heart, Rome, Italy
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The effect of adenomyosis on in vitro fertilisation and intra-cytoplasmic sperm injection treatment outcome. Eur J Obstet Gynecol Reprod Biol 2011; 158:229-34. [DOI: 10.1016/j.ejogrb.2011.04.030] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2010] [Revised: 03/11/2011] [Accepted: 04/30/2011] [Indexed: 11/20/2022]
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Nishida M, Takano K, Arai Y, Ozone H, Ichikawa R. Conservative surgical management for diffuse uterine adenomyosis. Fertil Steril 2010; 94:715-9. [DOI: 10.1016/j.fertnstert.2009.03.046] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2008] [Revised: 03/07/2009] [Accepted: 03/10/2009] [Indexed: 11/25/2022]
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Wang PH, Su WH, Sheu BC, Liu WM. Adenomyosis and Its Variance: Adenomyoma and Female Fertility. Taiwan J Obstet Gynecol 2009; 48:232-8. [DOI: 10.1016/s1028-4559(09)60295-3] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Wang PH, Liu WM, Fuh JL, Cheng MH, Chao HT. Comparison of surgery alone and combined surgical-medical treatment in the management of symptomatic uterine adenomyoma. Fertil Steril 2009; 92:876-885. [DOI: 10.1016/j.fertnstert.2008.07.1744] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2008] [Revised: 06/04/2008] [Accepted: 07/23/2008] [Indexed: 11/25/2022]
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Wang PH, Fuh JL, Chao HT, Liu WM, Cheng MH, Chao KC. Is the surgical approach beneficial to subfertile women with symptomatic extensive adenomyosis? J Obstet Gynaecol Res 2009; 35:495-502. [DOI: 10.1111/j.1447-0756.2008.00951.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Moreira L, Carvalho E, Caldas-Bussiere M. Aspectos histopatológicos da adenomiose em úteros bovinos nas diferentes fases do ciclo estral. ARQ BRAS MED VET ZOO 2007. [DOI: 10.1590/s0102-09352007000500002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Relacionaram-se as características da adenomiose com as fases do ciclo estral em 61 peças de úteros de bovinos colhidas em matadouros. A adenomiose foi classificada em superficial e profunda. A fase do ciclo estral foi estimada pela morfologia, pela coloração e pela vascularização do corpo lúteo e presença ou não de folículos ovarianos maiores que 8mm. Os animais que estavam em anestro (n=11) apresentaram a menor ocorrência de adenomiose (8,2%), e os que estavam na fase lútea média (n=21), a maior (31,0%). Nas fases lútea inicial (n=13) e folicular (n=16) as ocorrências foram semelhantes, 18,0 e 22,9%, respectivamente. A maior porcentagem de adenomiose profunda ocorreu nas fases lútea inicial e média, 45,0 e 47,4%, respectivamente, e durante o anestro e a fase folicular foram de 20,0 e 14,3%, respectivamente. Os resultados sugerem que a fase do ciclo estral influencia na ocorrência de adenomiose e no grau de infiltração miometrial das glândulas endometriais.
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Wang JH, He XH, Wu RJ, Xu XR. Clinicopathologic characteristics of uterine adenomyoma in pregnant women. Fertil Steril 2007; 88:172-5. [PMID: 17336979 DOI: 10.1016/j.fertnstert.2006.11.083] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2006] [Revised: 11/01/2006] [Accepted: 11/16/2006] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To study the clinicopathologic characteristics and the treatment means of pregnant women with uterine adenomyoma. DESIGN Retrospective, consecutive, controlled study. SETTING University hospital for obstetrics and gynecology. PATIENT(S) Eighteen pregnant women with uterine adenomyoma. INTERVENTION(S) Data collection and statistical analysis. MAIN OUTCOME MEASURE(S) Eighteen pregnant women with uterine adenomyoma were diagnosed by excision of adenomyoma tissue during cesarean section and histopathology. The 18 subjects were retrospectively divided into treatment group (achieving this pregnancy by treatment; 10 cases) and control group (having no difficulty conceiving; 8 cases). The clinicopathologic characteristics and treatment means of the patients were analyzed retrospectively. RESULT(S) The mean volume of uterine adenomyoma in the treatment group was larger than that of the control group. The methods of treating women with uterine adenomyoma-associated infertility include GnRH agonist (GnRH-a: 6 cases), GnRH-a and IVF and embryo transfer (3 cases), and traditional Chinese medicines (1 case). CONCLUSION(S) Severe uterine adenomyoma correlate with infertility in women of childbearing age. GnRH-a is effective in treating women with uterine adenomyoma-associated infertility.
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Affiliation(s)
- Jian-Hua Wang
- Department of Obstetrics and Gynecology, Women's Hospital, The School of Medicine, Zhejiang University, Hangzhou, Zhejiang, People's Republic of China.
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Levgur M. Therapeutic options for adenomyosis: a review. Arch Gynecol Obstet 2006; 276:1-15. [PMID: 17186255 DOI: 10.1007/s00404-006-0299-8] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2006] [Accepted: 11/22/2006] [Indexed: 12/29/2022]
Abstract
BACKGROUND To review the literature on various therapeutic modalities for uterine adenomyosis. METHODS Reviews, case-controlled studies and reports from November 1949 until August 2006 written in English or summarized in English abstracts retrieved from Medline and Pubmed using the key words: adenomyosis and adenomyosis therapy. RESULTS Symptoms of adenomyosis may be alleviated by antiprostaglandins, sex hormones, danazol and GnRH analogs. Minor surgical procedures for therapy include endomyometrial ablation, laparoscopic myometrial electrocoagulation and adenomyoma excision. Patient's age and symptoms, desired fertility, site and extent of lesion and surgeon's skills should be considered in choosing the appropriate procedure. Endomyometrial ablation is effective for lesions deeper than the endometrial-myometrial junction whereas the efficacy of hysteroscopic ablation is limited to foci 2-3 mm deep. Focal and diffuse disease may be managed by laparoscopic electrocoagulation or myometrial excision with preservation of fertility but risk of recurrence exists. Uterine artery embolization assumingly invokes infarction and necrosis. Encouraging results reported in some cases warrant expanding its use for more experience. Hysterectomy is the ultimate solution for women with deep myometrial involvement or if future fertility is not desired. CONCLUSIONS Various therapeutic options for adenomyosis, including few minimally invasive procedures became available in the last two decades but need evaluation and improvement.
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Affiliation(s)
- Michael Levgur
- Department of Obstetrics and Gynecology, Maimonides Medical Center, 967 48th street, Brooklyn, NY, USA.
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Wang CJ, Yuen LT, Chang SD, Lee CL, Soong YK. Use of laparoscopic cytoreductive surgery to treat infertile women with localized adenomyosis. Fertil Steril 2006; 86:462.e5-8. [PMID: 16806205 DOI: 10.1016/j.fertnstert.2005.12.066] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2005] [Revised: 12/26/2005] [Accepted: 12/26/2005] [Indexed: 11/20/2022]
Abstract
OBJECTIVE We report on two infertile women with localized adenomyosis who had successful pregnancies after treatment with laparoscopic cytoreductive surgery. DESIGN Case report. SETTING Tertiary care university hospital. PATIENT(S) Two infertile women with localized adenomyosis. INTERVENTION(S) Laparoscopic excision of adenomyotic lesion with/without subsequent hypoestrogenic agent was performed. MAIN OUTCOME MEASURE(S) Pregnancy. RESULT(S) Hypoestrogenic agent with danazol was administered 3 months immediately after surgery in one woman. Both women conceived spontaneously at 30 and 21 months after surgery, respectively. The pregnancies were uneventful, and healthy infants were delivered via cesarean section at term. CONCLUSION(S) Laparoscopic cytoreductive surgery can be an alternative treatment to the use of hypoestrogenic agents or hysterectomy in women with localized adenomyosis, especially for those who want to maintain their fertility and achieve successful pregnancies. Patients may wait up to 21 months after surgery until a pregnancy occurs.
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Affiliation(s)
- Chin-Jung Wang
- Department of Obstetrics and Gynecology, Division of Gynecologic Endoscopy, Chang Gung Memorial Hospital, Kwei-Shan Tao-Yuan, Taiwan
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Abstract
Adenomyosis of the uterus is a common condition amongst women in their reproductive years. It is defined as the presence of heterotopic endometrial glands and stroma in the myometrium with adjacent smooth muscle hyperplasia. The common presenting symptoms are painful and heavy periods and infertility, although many women are asymptomatic. Adenomyosis is thought to affect 1% of women and is typically diagnosed in the 4th and 5th decades of life. The aetiology is unclear, and until recently a diagnosis was made only after invasive and destructive surgery. With the advent of improved imaging of the pelvic organs, and in particular magnetic resonance imaging, the diagnosis of adenomyosis is being made more frequently. Unfortunately, because the disease has been infrequently diagnosed prior to hysterectomy, there are few well-designed studies of medical or surgical management. Management with hormonal treatment that aims to reduce the proliferation of endometrial cells is promising, but there is a paucity of well-designed studies to guide treatment. Hysterectomy or use of the levonorgestrel intrauterine system (LNG-IUS) remains the mainstay of treatment.
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Affiliation(s)
- Cynthia Farquhar
- Department of Obstetrics and Gynaecology, National Womens' Health at Auckland, City Hospital, University of Auckland, Private Bag 92019, Auckland, New Zealand.
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Wada SI, Kudo M, Minakami H. Spontaneous uterine rupture of a twin pregnancy after a laparoscopic adenomyomectomy: A case report. J Minim Invasive Gynecol 2006; 13:166-8. [PMID: 16527723 DOI: 10.1016/j.jmig.2005.12.002] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2005] [Revised: 12/07/2005] [Accepted: 12/13/2005] [Indexed: 11/29/2022]
Abstract
Adenomyomectomy is a treatment option to preserve fertility and reduce symptoms associated with adenomyosis. Although this procedure is reasonably expected to increase the risk of uterine rupture during pregnancy, reports on this issue are scarce. We recently encountered a 33-year-old nulliparous woman with a twin pregnancy who experienced a spontaneous uterine rupture at 30 weeks' gestation. This patient was the first to conceive after undergoing laparoscopic adenomyomectomy at our institution. Her pregnancy was established with in vitro fertilization-embryo transfer 12 months after laparoscopic adenomyomectomy. The uterine rupture was heralded by a sudden onset of severe abdominal pain while she was receiving intravenous ritodrine. This case reinforces that pregnancy after adenomyomectomy should be closely monitored with respect to uterine rupture.
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Affiliation(s)
- Shin-ichiro Wada
- Department of Obstetrics and Gynecology, School of Medicine, Hokkaido University, Sapporo, Japan.
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Cheng MH, Yu BKJ, Chang SP, Wang PH. A randomized, parallel, comparative study of the efficacy and safety of nafarelin versus danazol in the treatment of endometriosis in Taiwan. J Chin Med Assoc 2005; 68:307-14. [PMID: 16038370 DOI: 10.1016/s1726-4901(09)70166-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the efficacy and safety of nafarelin, a gonadotropin-releasing hormone (GnRH) analogue, versus danazol in the treatment of women with endometriosis in Taiwan. METHODS Fifty-nine women with laparoscopically and pathologically confirmed endometriosis were randomized to receive nafarelin or danazol for 180 days. Efficacy was assessed from mean changes in laparoscopy score (LS) and total symptom severity score (TSSS). Adverse events (AEs) and laboratory parameters, including hematology, hepatic function, blood pressure, and lipid levels, were monitored for safety evaluations. RESULTS All demographic and baseline factors, except body weight, were comparable between the 2 treatment groups. Both nafarelin and danazol satisfactorily resolved pelvic tenderness, induration, pelvic pain, dysmenorrhea and dyspareunia. No significant differences were noted in efficacy endpoints between nafarelin and danazol regarding LS and TSSS at 90 and 180 days of treatment. No significant difference was observed between the 2 groups regarding the overall incidence of AEs, except for laboratory-related AEs. However, nafarelin tended to have less impact than danazol on aspartate transaminase and alanine transaminase, and nafarelin was better tolerated than danazol regarding changes in lipid profiles. Both treatments had little or no effect on hematologic parameters. CONCLUSION Nafarelin and danazol demonstrated similar clinical efficacy, but nafarelin was associated with fewer laboratory changes and a stable lipid profile, relative to danazol. Moreover, intranasally administered nafarelin is noninvasive, and may be a more comfortable and safer alternative to slow-release injectable GnRH agonists. Based on this study, we suggest that nafarelin, like other GnRH analogues, may be a treatment of choice for Taiwanese women with endometriosis. However, direct comparative studies of nafarelin with slow-release injectable GnRH agonists are now required.
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Affiliation(s)
- Ming-Huei Cheng
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, Taipei, Taiwan, R.O.C
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Abstract
PURPOSE OF REVIEW This review is timely and relevant for several reasons. The incidence of adenomyosis begins to rise from the mid-thirties. Moreover, more women are delaying their first pregnancy until later in their thirties or forties, and consequently adenomyosis is encountered more frequently in the fertility clinic during diagnostic work-up. Furthermore, it is difficult to diagnose adenomyosis before surgery, because there are no pathognomonic signs, symptoms or physical findings. Finally, reference data are very limited. RECENT FINDINGS This review refers to adenomyosis of the uterus as a factor in female infertility. The clinical presentation of adenomyosis uteri is also reviewed, as well as animal and human studies concerning the effect of adenomyosis in female infertility. Different treatment options are discussed, especially those referring to patients who wish to maintain their fecundity. SUMMARY Uterine adenomyosis remains a fairly frequent and debilitating disease that will be encountered with increasing incidence in the infertile female population. While spectacular advances have been made in recent years in the non-invasive diagnosis of the condition, non-surgical treatment options for infertile patients with adenomyosis arise but need to be confirmed in larger series.
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Affiliation(s)
- Ioannis M Matalliotakis
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, Connecticut 06520-8063, USA.
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Yen MS, Yang TS, Yu KJ, Wang PH. Comments on Laparoscopic Excision of Myometrial Adenomyomas in Patients with Adenomyosis Uteri and Main Symptoms of Severe Dysmenorrhea and Hypermenorrhea. ACTA ACUST UNITED AC 2004; 11:441; author reply 442. [PMID: 15559362 DOI: 10.1016/s1074-3804(05)60068-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Shimizu Y, Fukuda J, Kumasawa Y, Tanaka T. Pregnancy complicated by adenomyosis resulted in miscarriage in three cases of in vitro fertilization-embryo transfer. Reprod Med Biol 2004; 3:95-98. [PMID: 29699187 DOI: 10.1111/j.1447-0578.2004.00057.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Three women with adenomyosis conceived by in vitro fertilization-embryo transfer (IVF-ET), but miscarried in the second trimester. The uterus in each case was inflamed post-partum and one patient underwent total abdominal hysterectomy as treatment for the severe inflammation. Although the mechanism of the miscarriages is unclear, these cases strongly suggest that it is related to the inflammation of the myometrium associated with adenomyosis, and that such pregnancies have a high risk of not continuing to term. Preventing inflammation could result in a live birth. (Reprod Med Biol 2004; 3: 95-98).
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Affiliation(s)
- Yasushi Shimizu
- Division of Obstetrics and Gynecology, Department of Reproductive and Development Medicine, Akita University School of Medicine, Akita, Japan
| | - Jun Fukuda
- Division of Obstetrics and Gynecology, Department of Reproductive and Development Medicine, Akita University School of Medicine, Akita, Japan
| | - Yukiyo Kumasawa
- Division of Obstetrics and Gynecology, Department of Reproductive and Development Medicine, Akita University School of Medicine, Akita, Japan
| | - Toshinobu Tanaka
- Division of Obstetrics and Gynecology, Department of Reproductive and Development Medicine, Akita University School of Medicine, Akita, Japan
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Chen YJ, Wang PH, Yuan CC, Wu YC, Liu WM. Early pregnancy uninterrupted by laparoscopic bipolar coagulation of uterine vessels. THE JOURNAL OF THE AMERICAN ASSOCIATION OF GYNECOLOGIC LAPAROSCOPISTS 2002; 9:79-83. [PMID: 11821611 DOI: 10.1016/s1074-3804(05)60109-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Laparoscopic bipolar coagulation of uterine vessels (LBCUV) is reported to treat clinically symptomatic myomas that caused severe menorrhagia, but the viability of pregnancy after operation is unknown. A woman with clinically diagnosed uterine myomas, possibly with adenomyosis, had unexpected early pregnancy diagnosed at the time of LBCUV. The procedure resulted in improvement of menorrhagia to normal menstruation and reductions in the volume of both uterus and myomas. The intrauterine pregnancy was terminated at the woman's request. Pregnancy may be possible after LBCUV, although none has been reported.
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Affiliation(s)
- Yi-Jen Chen
- Department of Obstetrics and Gynecology, Veterans General Hospital-Taipei, 201, Section 2, Shin-Pai Road, Taipei 11217, Taiwan
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