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Cai H, Mol B, Gordts S, Wang H, Shi J. Elective single versus double blastocyst-stage embryo transfer in women aged 36 years or older: a retrospective cohort study. HUM FERTIL 2023; 26:1185-1194. [PMID: 36719262 DOI: 10.1080/14647273.2022.2153348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 08/29/2022] [Indexed: 02/01/2023]
Abstract
We evaluated if elective single-blastocyst transfer (eSBT) could be adopted in women aged 36 or older. In this retrospective cohort, women aged ≥36 years received IVF ovarian stimulation cycles and had ≥ two blastocysts. A total of 240 women underwent eSBT and 189 double-blastocyst transfer (DBT) in the first transfer cycle. The subsequent frozen-thawed embryo transfer cycles were a combination of single- and double- blastocyst transfers. Analysis was stratified for patients in age groups 36-37, 38-39 and ≥40, considering the quality of the blastocyst transferred. The cumulative live birth rates (cLBR) were 74.2% (178/240) versus 63.0% (119/189) after eSBT versus DBT, respectively (aOR: 1.09 (0.68, 1.75)). Time to live birth did not vary significantly between the two groups (HR: 0.85 (0.68, 1.08)). The total number of children born was 194 after eSBT (162 singletons and 16 pairs of twins) versus 154 (84 singletons and 35 twins) after DBT. The odds ratios for preterm birth (0.37 (0.21-0.64)), and low birth weight (0.31 (0.16, 0.60)) were all lower in eSBT. In women aged ≥36 years, cLBR following single- versus double- blastocyst transfer was comparable while the odds of multiple live births and adverse perinatal outcomes were reduced.
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Affiliation(s)
- He Cai
- Assisted Reproduction Center, Northwest Women's and Children's Hospital, Xi'an, People's Republic of China
| | - Ben Mol
- Medicine Department, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Parkville, Victoria, Australia
- Pregnancy Research Centre, Department of Maternal-Fetal Medicine, Royal Women's Hospital, Parkville, Victoria, Australia
| | - Stephan Gordts
- Leuven Institute for Fertility & Embryology, Leuven, Belgium
| | - Hui Wang
- Assisted Reproduction Center, Northwest Women's and Children's Hospital, Xi'an, People's Republic of China
| | - Juanzi Shi
- Assisted Reproduction Center, Northwest Women's and Children's Hospital, Xi'an, People's Republic of China
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Gordts S, Grimbizis G, Tanos V, Koninckx P, Campo R. Junctional zone thickening: an endo-myometrial unit disorder. Facts Views Vis Obgyn 2023; 15:309-316. [PMID: 38128089 PMCID: PMC10832651 DOI: 10.52054/fvvo.15.4.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023] Open
Abstract
Adenomyosis is a disease defined by histopathology, mostly of hysterectomy specimens, and classification is challenged by the disagreement of the histologic definition. With the introduction of Magnetic Resonance Imaging (MRI) and two- and three-dimensional ultrasound, the diagnosis of adenomyosis became a clinical entity. In MRI and US, adenomyosis ranges from thickening of the inner myometrium or junctional zone to nodular, cystic, or diffuse lesions involving the entire uterine wall, up to a well-circumscribed adenomyoma or a polypoid adenomyoma. The absence of an accepted classification and the vague and inconsistent terminology hamper basic and clinical research. The sub-endometrial halo seen at US and MRI is a distinct entity, differing from the outer myometrium by its increased nuclear density and vascular structure. The endometrium and the sub-endometrial muscularis or archimetra are of Müllarian origin, while the outer myometrium is non-Mullerian mesenchymal. The junctional zone (JZ) is important for uterine contractions, conception, implantation, and placentation. Thickening of the JZ can be considered inner myometrium adenomyosis, with or without endometrial invasion. Changes in the JZ should be considered a different entity than myometrial clinically associated with impaired conception, implantation, abnormal uterine bleeding, pelvic pain and obstetrical outcome. Pathology of the basal endometrium and JZ is a separate entity and should be identified as an endo-myometrial unit disorder (EMUD).
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Pados G, Gordts S, Sorrentino F, Nisolle M, Nappi L, Daniilidis A. Adenomyosis and Infertility: A Literature Review. Medicina (Kaunas) 2023; 59:1551. [PMID: 37763670 PMCID: PMC10534714 DOI: 10.3390/medicina59091551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 09/29/2023]
Abstract
Background and Objectives: Adenomyosis (the presence of ectopic endometrial glands and stroma below the endometrial-myometrial junction) is a benign condition which is increasingly diagnosed in younger women suffering from infertility. The aim of this narrative review was to study the pathophysiology and prevalence of adenomyosis, the mechanisms causing infertility, treatment options, and reproductive outcomes in infertile women suffering from adenomyosis. Materials and Methods: A literature search for suitable articles published in the English language was performed using PubMed from January 1970 to July 2022. Results: The literature search retrieved 50 articles that met the purpose of this review and summarized the most recent findings regarding the accuracy of diagnostic methods, pathophysiology, and the prevalence of adenomyosis and optimal strategies for the treatment of infertile women with adenomyosis. Conclusions: Adenomyosis is a common gynecological disorder, affecting women of reproductive age. It negatively affects in vitro fertilization, pregnancy and the live birth rate, as well as increases the risk of miscarriage. With the advent of non-invasive diagnoses with MRI and TVUS, the role of adenomyosis in infertility has been better recognized. Overall, more randomized controlled trials (RCTs) are needed to provide strong data on the accuracy of diagnostic methods, the pathophysiology and the prevalence of adenomyosis, the fertility outcomes of patients and the optimal strategy for the treatment.
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Affiliation(s)
- George Pados
- 1st Department of Obstetrics and Gynaecology, Papageorgiou General Hospital, School of Medicine, Aristotle University of Thessaloniki, 54643 Thessaloniki, Greece;
| | | | - Felice Sorrentino
- Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynecology, University of Foggia, 71121 Foggia, Italy;
| | - Michelle Nisolle
- Department of Obstetrics and Gynecology, Hospital de La Citadelle, University of Liege, 4000 Liege, Belgium;
| | - Luigi Nappi
- Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynecology, University of Foggia, 71121 Foggia, Italy;
| | - Angelos Daniilidis
- 1st Department of Obstetrics and Gynaecology, Papageorgiou General Hospital, School of Medicine, Aristotle University of Thessaloniki, 54643 Thessaloniki, Greece;
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Koninckx PR, Ussia A, Gordts S, Keckstein J, Saridogan E, Malzoni M, Stepanian A, Setubal A, Adamyan L, Wattiez A. The 10 "Cardinal Sins" in the Clinical Diagnosis and Treatment of Endometriosis: A Bayesian Approach. J Clin Med 2023; 12:4547. [PMID: 37445589 DOI: 10.3390/jcm12134547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/04/2023] [Accepted: 07/06/2023] [Indexed: 07/15/2023] Open
Abstract
Evidence-based data for endometriosis management are limited. Experiments are excluded without adequate animal models. Data are limited to symptomatic women and occasional observations. Hormonal medical therapy cannot be blinded if recognised by the patient. Randomised controlled trials are not realistic for surgery, since endometriosis is a variable disease with low numbers. Each diagnosis and treatment is an experiment with an outcome, and experience is the means by which Bayesian updating, according to the past, takes place. If the experiences of many are similar, this holds more value than an opinion. The combined experience of a group of endometriosis surgeons was used to discuss problems in managing endometriosis. Considering endometriosis as several genetically/epigenetically different diseases is important for medical therapy. Imaging cannot exclude endometriosis, and diagnostic accuracy is limited for superficial lesions, deep lesions, and cystic corpora lutea. Surgery should not be avoided for emotional reasons. Shifting infertility treatment to IVF without considering fertility surgery is questionable. The concept of complete excision should be reconsidered. Surgeons should introduce quality control, and teaching should move to explain why this occurs. The perception of information has a personal bias. These are the major problems involved in managing endometriosis, as identified by the combined experience of the authors, who are endometriosis surgeons.
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Affiliation(s)
- Philippe R Koninckx
- Department of OBGYN, Faculty of Medicine, Katholieke University Leuven, 3000 Leuven, Belgium
- Department of OBGYN, Faculty of Medicine, University of Oxford, Oxford OX1 2JD, UK
- Department of OBGYN, Faculty of Medicine, University Cattolica, del Sacro Cuore, 00168 Rome, Italy
- Department of OBGYN, Faculty of Medicine, Moscow State University, 119991 Moscow, Russia
- Latifa Hospital, Dubai 9115, United Arab Emirates
| | - Anastasia Ussia
- Department of OBGYN, Gemelli Hospitals, Università Cattolica, 00168 Rome, Italy
| | | | - Jörg Keckstein
- Endometriosis Centre, Dres. Keckstein, 9500 Villach, Austria
- Faculty of Medicine, University Ulm, 89081 Ulm, Germany
| | - Ertan Saridogan
- Elizabeth Garrett Anderson Institute for Women's Health, University College London, London SW7 2BX, UK
| | | | - Assia Stepanian
- Academia of Women's Health and Endoscopic Surgery, Atlanta, GA 30328, USA
| | - Antonio Setubal
- Department of Ob/Gyn and MIGS, Hospital da Luz Lisbon, 1500-650 Lisboa, Portugal
| | - Leila Adamyan
- Department of Operative Gynecology, Federal State Budget Institution V. I. Kulakov, Research Centre for Obstetrics, Gynecology, and Perinatology, Ministry of Health of the Russian Federation, 117198 Moscow, Russia
- Department of Reproductive Medicine and Surgery, Moscow State University of Medicine and Dentistry, 127473 Moscow, Russia
| | - Arnaud Wattiez
- Latifa Hospital, Dubai 9115, United Arab Emirates
- Department of Obstetrics and Gynaecology, University of Strasbourg, 67081 Strasbourg, France
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Gordts S, Deprest J. Obituary for Professor Ivo Brosens. Facts Views Vis Obgyn 2023. [DOI: 10.52054/fvvo.15.1.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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Gordts S, Puttemans P, Segaert I, Valkenburg M, Schutyser V, Campo R, Gordts S. Diagnosis and treatment of early-stage endometriosis by
Transvaginal Hydro laparoscopy. Facts Views Vis Obgyn 2023; 15:45-52. [PMID: 37010334 PMCID: PMC10392117 DOI: 10.52054/fvvo.15.1.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023] Open
Abstract
Background: Transvaginal Hydro Laparoscopy (THL) is known as a minimal invasive procedure allowing endoscopic exploration of the female pelvis.
Objective: To evaluate the possibilities of the THL as a tool for early diagnosis and treatment of minimal endometriosis.
Materials and methods: A retrospective study of a consecutive series of 2288 patients referred for fertility problems to a tertiary centre for reproductive medicine was undertaken. Mean duration of infertility was 23.6 months (SD ±11-48), mean age of patients was 31.25 (SD± 3.8y). With normal findings at clinical and ultrasound examination patients underwent, as part of their fertility exploration, a THL.
Main outcome measures: Evaluation of feasibility, identified pathology and pregnancy rate.
Results: Endometriosis was diagnosed in 365 patients (16%); the localisation was higher on the left side (n=237) than on the right side (n=169). Small endometriomas, with diameters between 0.5 and 2 cm, were present in 24.3% (right side in 31, left side 48 and bilateral 10). These early lesions were characterised by the presence of active endometrial like cells and a pronounced neo-angiogenesis. Destruction of the endometriotic lesions with bipolar energy resulted in an in vivo pregnancy rate (spontaneous/IUI) of 43.8% (CPR after 8 months: spontaneous 57.7%; IUI/AID 29.7%).
Conclusion: THL allowed in a minimally invasive way an accurate diagnosis of the early stages of peritoneal and ovarian endometriosis with the possibility of offering treatment with minimal damage.
What is new? This is the largest series reporting the usefulness of THL for the diagnosis and treatment of peritoneal and ovarian endometriosis in patients without obviously visible preoperative pelvic pathology.
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Koninckx PR, Ussia A, Gordts S. Letter to the Editor. Facts Views Vis Obgyn 2022; 14:357. [PMID: 36724431 PMCID: PMC10364334 DOI: 10.52054/fvvo.14.4.052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
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Gianaroli L, Veiga A, Gordts S, Ebner T, Woodward B, Plas C, van Groesen W, Sgargi S, Kovačič B. ESHRE certification of ART centres for good laboratory and clinical practice. Hum Reprod Open 2022; 2022:hoac040. [PMID: 36196081 PMCID: PMC9494398 DOI: 10.1093/hropen/hoac040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Indexed: 11/13/2022] Open
Abstract
Abstract
STUDY QUESTION
Three years after the start of the ESHRE ART Centre Certification (ARTCC) programme, what is the current state of the system, in terms of the interest expressed in it and experiences during assessment of ART services?
SUMMARY ANSWER
As of 1st December 2021, 25 European ART centres have been involved in the various stages of certification and the most common recommendations from inspectors were the need for documented training, verification of competencies for all staff members, verification of laboratory and clinical performance indicators, implementation of a quality management system and avoidance of overusing ICSI and add-ons.
WHAT IS KNOWN ALREADY
European Union (EU) legislation has included ART activities in the EU Tissue and Cells Directives (EUTCDs). Following inspections by national EUTCD authorities, many details regarding documentation, laboratory environment, handling of reproductive cells and tissues, traceability, coding and patient testing have become standardized. However, the EUTCDs do not cover all ART-specific aspects. For this reason, the ARTCC was established to focus on peculiar areas, including relevant staff qualifications, training, continuing professional development, workload, equipment suitability, (non)-evidence-based laboratory and clinical methods used, treatment approaches according to ESHRE guidelines, recommendations and laboratory and clinical key performance indicators.
STUDY DESIGN, SIZE, DURATION
The paper reviews the state of the art of the ESHRE certification of ART centres for good clinical and laboratory practice over an initial 3-year period of operation, including the number of ART centres involved in the different stages of certification and the most common recommendations by inspectors.
PARTICIPANTS/MATERIALS, SETTING, METHODS
In 2016, the ARTCC working group began to establish a new ESHRE ARTCC programme. Since then, the working group has organised four preparatory courses and appointed 37 inspectors (19 clinicians, 17 embryologists and one paramedical). A tool to verify compliance with ESHRE recommendations for good laboratory and clinical practice was developed. The ARTCC has been open for applications since September 2018. In Step 1, the applicant enters basic information about the ART centre, staff and ART activities into the application platform. After review and approval, the applicant is given the opportunity to enter Step 2 and provide detailed online checklists on general, laboratory, clinical services and clinical outcomes. Two inspectors (one clinician and one embryologist) independently evaluate the submitted checklists. The condition to proceed to evaluation is a positive mean score (at least 66%) from each of the four checklists. In Step 3, a live site visit [or virtual owing to the coronavirus disease 2019 (COVID-19) pandemic] is organised and the inspectors prepare a final report with appropriate recommendations. The application may be rejected at any time if the criteria required to advance to the next stage are not met. The ARTCC programme is currently available for European countries listed in ESHRE internal rules, available on the ESHRE website. The certificate is valid for 3 years, after which an application for renewal can be submitted.
MAIN RESULTS AND THE ROLE OF CHANCE
Over a 3-year period (until 1st December 2021), 63 ART centres from 25 countries started applying through an online platform. So far, 38 applications did not progress owing to lack of completion of the initial application within a 1-year period or because applications came from non-European countries. Of the remaining 25 applications, eight centres have been inspected and seven centres have been certified. The most common recommendations given by inspectors to assessed centres were the need for documented training, verification of competencies, skills and continuing professional development for all staff members, verification of laboratory and clinical performance indicators and implementation of a quality management system. The inspectors identified some recurring areas of medically assisted reproduction that deviate from good practice: the overuse of ICSI, preimplantation genetic testing for aneuploidies, freeze-all and other add-ons. They often reported that the clinical outcomes could not be objectively assessed because of non-inclusion of the started cycles or the frequent use of freeze-all cycles.
LIMITATIONS, REASONS FOR CAUTION
No major modifications have been made to the application platform and checklists since the early stages of the certification programme. However, in this short time, quite a few changes in clinical practice have occurred, especially concerning the more frequent use of the “freeze-all” strategy. As a result, problems arose in the evaluation of clinical outcomes. In addition, because of the COVID-19 pandemic, site visits were substituted by the implementation of virtual visits. While this enabled the certification programme to continue, it is possible that certain critical details that would have been noticed during a traditional site visit may have been overlooked.
WIDER IMPLICATIONS OF THE FINDINGS
Regular monitoring of the observations of ARTCC inspectors and analysis of their reports is certainly useful to harmonise inspectors’ criteria in the assessment process and to identify chronic deficiencies in clinical and laboratory practice. Nonconformities can be addressed by ESHRE through guidelines and recommendations, as well as through discussion with EU institutions and competent authorities.
STUDY FUNDING/COMPETING INTEREST(S)
The ARTCC programme was developed and funded by ESHRE, covering expenses associated with the meetings. The Steering Committee members who are the authors of this paper did not receive payments for the completion of this study. The inspectors were remunerated for their work with an honorarium. The authors have no conflicts of interest to declare.
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Affiliation(s)
| | - Anna Veiga
- Reproductive Medicine Service, Dexeus Mujer, Hospital Universitari Dexeus/Institut d'Investigació Biomèdica de Bellvitge, IDIBELL, Barcelona Stem Cell Bank, Regenerative Medicine Programme , Barcelona, Spain
| | | | - Thomas Ebner
- Kepler Universitätsklinikum Department of Gynecology, Obstetrics, and Gynecological Endocrinology, , Linz, Austria
| | | | | | | | | | - Borut Kovačič
- University Medical Centre Maribor Department of Reproductive Medicine and Gynecological Endocrinology, , Maribor, Slovenia
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Koninckx PR, Ussia A, Wattiez A, Adamyan L, Martin DC, Gordts S. The severity and frequency distribution of endometriosis subtypes at different ages: a model to understand the natural history of endometriosis based on single centre/single surgeon data. Facts Views Vis Obgyn 2021; 13:209-219. [PMID: 34555875 PMCID: PMC8823267 DOI: 10.52054/fvvo.13.3.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Background and Objective to study the natural history of endometriosis. Materials and methods the analysis of all women (n=2086) undergoing laparoscopy for pelvic pain and endometriosis between 1988 and 2011 at University Hospital Gasthuisberg. Main outcome measures the severity of subtle, typical, cystic and deep endometriosis in adult women, with or without a pregnancy, as estimated by their pelvic area and their volume. Results the number of women undergoing a laparoscopy increased up to 28 years of age and decreased thereafter. Between 24 and 44 years, the severity and relative frequencies of subtle, typical, cystic and deep lesions did not vary significantly. The number of women younger than 20 years was too small to ascertain the impression of less severe lesions. The severity of endometriosis lesions was not less in women with 1 or more previous pregnancies or with previous surgery. There was no bias over time since the type and severity of endometriosis lesions remained constant between 1988 and 2011. Conclusions severity of endometriosis does not increase between 24 and 44 years of age, suggesting that growth is limited by intrinsic or extrinsic factors. Severity was not lower in women with a previous pregnancy. What is new considering the time needed for lesions to become symptomatic together with the diagnostic delay, the decreasing number of laparoscopies after age 28 is compatible with a progressively declining risk of initiating endometriosis lesions after menarche, the remaining women being progessively less susceptible.
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Cai H, Mol BW, Gordts S, Wang H, Shi J. P–774 Clinical effectiveness of elective single versus double blastocyst transfer in women aged 36 years or older. Hum Reprod 2021. [DOI: 10.1093/humrep/deab130.773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Study question
If the elective single-blastocyst transfer (eSBT) strategy can be applied to women aged 36 or older.
Summary answer
In women ≥36 years old with at least two blastocysts, eSBT increased cumulative livebirth rate (LBR) while minimizing twins compared with double blastocyst transfer (DBT). What is known already: In young women with a good prognosis, eSBT policy is an accepted strategy to maintain LBR while decreasing multiple gestation. However, in many areas of the world DBT is still applied in older women.
Study design, size, duration
We performed a retrospective cohort study of 429 women aged ≥36 years or older who received IVF ovarian stimulation cycles between Jan 2015 and Oct 2018 and who had at least two blastocysts. Women were followed up until Oct 2020 for their fertility outcomes including cumulative live birth and multiple pregnancies. The study was performed at the Northwest Women and Children’s Hospital, Xi’an, China.
Participants/materials, setting, methods
Out of 429 women, 240 underwent a fresh cycle of eSBT and 189 DBT. The subsequent frozen-thawed embryo transfer cycles were a combination of single- and double- blastocyst transfers, more commonly the latter. Analysis was stratified for patients in age groups 36–37, 38–39 and ≥40 and quality of the blastocyst transferred, as graded by morphological examination. Outcomes were the LBR in the fresh cycle, cumulative LBR and multiple rate after fresh and frozen embryo transfers.
Main results and the role of chance
The cumulative LBR was 74.2% (178/240) for eSBT versus 63.0% (119/189) for DBT (OR = 1.69, 95%CI 1.12–2.56), irrespective of female age. The multiple rate was 9% (16/178) after eSBT versus 29.4% (35/119) after DBT (P- value < .001). The total number of children born was 194 after eSBT versus 154 after DBT. Stratified by female age, the cumulative LBRs in women aged 36–37 (78.9 vs 70.5%), 38–39 (68.9 and 61.1%) and ≥ 40 years (59.3 and 47.5%), were higher after eSBT compared with DBT, however, the differences did not reach statistical significance in each subgroups. LBRs in the fresh cycles were comparable for patients with eSBT compared with DBT (52.1% vs. 52.4%, OR = 0.99, 95%CI 0.68–1.45). In women < 40 years, DBT resulted in a small non-significant increase in LBR in the fresh transfer (63.2% vs. 61.2%, 95%CI=0.64–1.85, 36–37 years; 48.1% vs. 41.0%, 95%CI=0.64–2.80, 38–39 years) at the expense of a marked increase in twinning rate (0–5.4% vs. 31.7–34.6%). For women ≥40 years, no significant differences were observed in the LBR (37.0% vs 45%, 95%CI 0.47–4.07) or twinning rate (0 vs 7.7%) between eSBT and DBT group. The findings persisted with and without accounting for quality of the blastocyst transferred.
Limitations, reasons for caution
This study is limited by its observational character.
Wider implications of the findings: In women ≥36 years with two blastocysts, eSBT should be the preferred treatment which maximizes the cumulative LBR for a decrease in the rate of multiple pregnancies.
Trial registration number
Not applicable
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Affiliation(s)
- H Cai
- Northwest Women’s and Children’s Hospital, Assisted Reproduction Center, Xi’an, China
| | - B W Mol
- Monash Medical Centre- Monash University, Obstetrics and Gynaecology, Melbourne, Australia
| | - S Gordts
- Leuven Institute for Fertility & Embryology, Fertility & Embryology, Leuven, Belgium
| | - H Wang
- Northwest Women’s and Children’s Hospital, Assisted Reproduction Center, Xi’an, China
| | - J Shi
- Northwest Women’s and Children’s Hospital, Assisted Reproduction Center, Xi’an, China
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Abstract
Abstract text
Endoscopic management of the unexplained infertility, what does it add?
Stephan Gordts
stephan.gordts@lifeexpertcentre.be
Unexplained infertility “strictu sensu” is not a diagnosis, but a description of a status where no causal factor is identified in a couple trying to conceive for at least one year. The more parameters are assessed, the more likely to identify an etiology, the less likely becomes “unexplained” infertility. Limiting the fertility exploration to indirect visualization techniques like ultrasound, HSG or HycoSy involves the risk of missing existing pathologies.
Uterus
Uterine volumetric abnormalities can be detected by indirect techniques, but information is lacking on the visualization of the endometrium in case of chronic endometritis and the presence of endometrial defects and hypervascularization areas as seen in patients with adenomyosis.
Tubo-ovarian
Even with the increased accuracy of indirect visualization techniques, lesions of minimal endometriosis and tubo-ovarian adhesions are not detected (Table). Tubal normality constitutes not only normal tubal patency but also normal tubal function. The importance of subtle tubal lesions is underestimated. Hydatid of Morgagni are detected in 38.1% in patients with infertility versus only in 16,7% in fertile women (Gupta et al. JMIG 2017).Removal of these lesions resulted in a spontaneous pregnancy rate of 58.7% versus 20.6 in the non-treated group (Rasheed et al. EJOG Repr. 2011).
Endometriosis
In a series of 107 patients with unexplained infertility and 3 failed IVF cycles (Agni Pantou et al. J. Clin. Med. 2019)laparoscopy revealed the presence of endometriosis in 57.97%, peri-adnexal adhesions in 23.3% and was normal in 18.69%. Also, in a group of patients with 3 failed IVF cycles and unexplained infertility (Xiaoming Yu et al.Medicine 2019) laparoscopy showed endometriosis in 57.7%, tubal abnormalities in 31.1% and adhesions in 33.3%. Laparoscopic correction of these pathologies did not only result in a spontaneous pregnancy rate of 35% but resulted also in a higher pregnancy rate after IVF compared to the non-treated control group.
Unexplained infertility hides frequently undiagnosed endometriosis. Endometrial BCL6 levels, a proto-oncogene where overexpression is associated with increased cellular proliferation and progesterone resistance, are increased in patients with endometriosis. In case of elevated BCL6 in patients with unexplained infertility, laparoscopy confirmed the presence of endometriosis in 93.8% (Evans-Hoeker et al. 2016). Abnormal BCL6 expression in a population with unexplained infertility reduced the chance of having a successful IVF treatment in 74% of the population (Almquist et al. Fertil Steril 2017).
Transvaginal Hydro Laparoscopy
Direct endoscopic visualization remains important but due to the invasiveness, diagnostic standard laparoscopy is frequently postponed or omitted in the exploration of the infertile patient. The technique of transvaginal hydro-laparoscopy allows in a minimal invasive way the inspection of the pelvis. In a consecutive series of 2288 patients without obvious pelvic pathology, findings were normal in 49.3%, endometriosis was diagnosed in 15.9% and tubal pathology in 14.5% of the patients (Gordts et al. FVV 2021). The rate of failed access was 1% and the complication rate 0.74%. Causing a minimal ovarian trauma, treatment of these early endometriotic lesions resulted in a spontaneous pregnancy rate of 73.2%.
Conclusion
The inappropriate use of “unexplained infertility” by omitting the diagnostic endoscopy in the exploration of the infertile patient, can hide undiagnosed and treatable pathology, jeopardizing possibilities for patients for a spontaneous conception and can be responsible for reduced pregnancy rates after IVF.
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Affiliation(s)
- S Gordts
- LIFE, Life Expert Centre, Leuven, Belgium
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Gordts S, Gordts S, Puttemans P, Segaert I, Valkenburg M, Campo R. Systematic use of transvaginal hydrolaparoscopy as a minimally invasive procedure in the exploration of the infertile patient: results and reflections. Facts Views Vis Obgyn 2021; 13:131-140. [PMID: 34184842 PMCID: PMC8291988 DOI: 10.52054/fvvo.13.2.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background The aim of this study was to evaluate the added value of transvaginal hydrolaparoscopy (THL) in the investigation of the infertile patient. Methods A retrospective cohort study, based on records from 01/09/2006 to 30/12/2019 was undertaken in a tertiary care infertility centre. THL was performed in 2288 patients. These were patients who were referred for endoscopic exploration of the female pelvis as part of their infertility investigation. In 374 patients with clomiphene- resistant polycystic ovary syndrome (PCOS), ovarian capsule drilling was also performed. The outcome objectives of this study included the evaluation of the added diagnostic value of THL as well as the feasibility and safety of the visual inspection of the female pelvis using this technique. Results Of the 2288 procedures failed access to the pouch of Douglas occurred in in 23 patients (1%). The complication rate was 0.74%, due to bowel perforations (n= 13) and bleeding (n= 4) requiring laparoscopy. All bowel perforations were treated conservatively, with 6 days of antibiotics, and no further complications occurred. Findings were normal in 49.8% of patients. Endometriosis was diagnosed in 366 patients (15.9%); adhesions were present in 144 patients. Conclusions THL is a minimally invasive procedure, with a low complication and failure rate, providing an accurate visual exploration of the female pelvis in a one-day hospital setting. When indicated, minimally invasive surgery is possible in the early stages of endometriosis and for ovarian capsule drilling in patients with clomiphene- resistant PCOS.
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13
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Alonso Pacheco L, Ata B, Bettocchi S, Campo R, Carugno J, Checa MA, de Angelis C, Di Spiezio Sardo A, Donnez J, Farrugia M, Ferro J, Franchini M, Garzon S, Gianaroli L, Gergolet M, Gubbini G, Gordts S, Grimbizis G, Haimovich S, Laganà AS, Li TC, Mencaglia L, Rienzi L, Saravelos S, Soares SR, Tanos V, Ubeda A, Ubaldi FM, Van Herendael B, Vereczkey A, Vitagliano A, Vitale SG, Zullo F. Septate uterus and reproductive outcomes: let's get serious about this. Hum Reprod 2021; 35:2627-2629. [PMID: 32968815 DOI: 10.1093/humrep/deaa230] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Bariş Ata
- Endoscopy Unit, Centro Gutenberg, Málaga, Spain
| | | | - Rudi Campo
- Department of Obstetrics and Gynecology, Koç University School of Medicine, Istanbul, Turkey
| | - Jose Carugno
- Inter-Departmental Project Unit of "Minimal-Invasive Gynecological Surgery", Integrated Department of Medicine (D.I.M.), University "Aldo Moro", Policlinico of Bari, Italy
| | - Miguel Angel Checa
- Inter-Departmental Project Unit of "Minimal-Invasive Gynecological Surgery", Integrated Department of Medicine (D.I.M.), University "Aldo Moro", Policlinico of Bari, Italy
| | | | | | - Jacques Donnez
- Université Catholique de Louvain, Brussels, Belgium.,Société de Recherche pour l'Infertilité (SRI), Brussels, Belgium
| | | | - Jaime Ferro
- Instituto Valenciano Infertilidad (IVI) Valencia, Valencia, Spain
| | - Mario Franchini
- Demetra Infertility Center and Villa Cherubini Clinic, Firenze, Italy
| | - Simone Garzon
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | | | | | | | - Stephan Gordts
- Inter-Departmental Project Unit of "Minimal-Invasive Gynecological Surgery", Integrated Department of Medicine (D.I.M.), University "Aldo Moro", Policlinico of Bari, Italy
| | - Grigoris Grimbizis
- Head 1st Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Sergio Haimovich
- Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, The Rappaport Faculty of Medicine, Technion, Israel
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - T C Li
- Department of Obstetrics & Gynaecology, Chinese University of Hong Kong
| | - Luca Mencaglia
- Unit of Phisiopatology of Reproduction USL South Est, Tuscany, Italy
| | - Laura Rienzi
- GENERA, Centre for Reproductive Medicine, Clinica Valle Giulia, Rome, Italy
| | | | | | - Vasilis Tanos
- Aretaeio Hospital and St Georges Medical School, Nicosia University, Nicosia, Cyprus
| | - Alicia Ubeda
- Department of Obstetrics and Gynecology, Institut Universitari Dexeus, Barcelona, Spain
| | - Filippo M Ubaldi
- GENERA, Centre for Reproductive Medicine, Clinica Valle Giulia, Rome, Italy
| | - Bruno Van Herendael
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy.,Stuivenberg General Hospital, Ziekenhuis Netwerk Antwerpen (ZNA), Antwerp, Belgium
| | | | - Amerigo Vitagliano
- Unit of Gynaecology and Obstetrics, Department of Women and Children's Health, University of Padua, Padua, Italy
| | - Salvatore Giovanni Vitale
- Obstetrics and Gynecology Unit, Department of General Surgery and Medical Surgical Specialties, University of Catania, Catania, Italy
| | - Fulvio Zullo
- Department of Neuroscience, Reproductive Science and Dentistry, School of Medicine, University of Naples Federico II, Naples, Italy
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14
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Chapron C, Vannuccini S, Santulli P, Abrão MS, Carmona F, Fraser IS, Gordts S, Guo SW, Just PA, Noël JC, Pistofidis G, Van den Bosch T, Petraglia F. Diagnosing adenomyosis: an integrated clinical and imaging approach. Hum Reprod Update 2020; 26:392-411. [PMID: 32097456 DOI: 10.1093/humupd/dmz049] [Citation(s) in RCA: 157] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 11/20/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Adenomyosis is a benign uterine disorder where endometrial glands and stroma are pathologically demonstrated within the uterine myometrium. The pathogenesis involves sex steroid hormone abnormalities, inflammation, fibrosis and neuroangiogenesis, even though the proposed mechanisms are not fully understood. For many years, adenomyosis has been considered a histopathological diagnosis made after hysterectomy, classically performed in perimenopausal women with abnormal uterine bleeding (AUB) or pelvic pain. Until recently, adenomyosis was a clinically neglected condition. Nowadays, adenomyosis may also be diagnosed by non-invasive techniques, because of imaging advancements. Thus, a new epidemiological scenario has developed with an increasing number of women of reproductive age with ultrasound (US) or magnetic resonance imaging (MRI) diagnosis of adenomyosis. This condition is associated with a wide variety of symptoms (pelvic pain, AUB and/or infertility), but it is also recognised that some women are asymptomatic. Furthermore, adenomyosis often coexists with other gynecological comorbidities, such as endometriosis and uterine fibroids, and the diagnostic criteria are still not universally agreed. Therefore, the diagnostic process for adenomyosis is challenging. OBJECTIVE AND RATIONALE We present a comprehensive review on the diagnostic criteria of adenomyosis, including clinical signs and symptoms, ultrasound and MRI features and histopathological aspects of adenomyotic lesions. We also briefly summarise the relevant theories on adenomyosis pathogenesis, in order to provide the pathophysiological background to understand the different phenotypes and clinical presentation. The review highlights the controversies of multiple existing criteria, summarising all of the available evidences on adenomyosis diagnosis. The review aims also to underline the future perspective for diagnosis, stressing the importance of an integrated clinical and imaging approach, in order to identify this gynecological disease, so often underdiagnosed. SEARCH METHODS PubMed and Google Scholar were searched for all original and review articles related to diagnosis of adenomyosis published in English until October 2018. OUTCOMES The challenge in diagnosing adenomyosis starts with the controversies in the available pathogenic theories. The difficulties in understanding the way the disease arises and progresses have an impact also on the specific diagnostic criteria to use for a correct identification. Currently, the diagnosis of adenomyosis may be performed by non-invasive methods and the clinical signs and symptoms, despite their heterogeneity and poor specificity, may guide the clinician for a suspicion of the disease. Imaging techniques, including 2D and 3D US as well as MRI, allow the proper identification of the different phenotypes of adenomyosis (diffuse and/or focal). From a histological point of view, if the diagnosis of diffuse adenomyosis is straightforward, in more limited disease, the diagnosis has poor inter-observer reproducibility, leading to extreme variations in the prevalence of disease. Therefore, an integrated non-invasive diagnostic approach, considering risk factors profile, clinical symptoms, clinical examination and imaging, is proposed to adequately identify and characterise adenomyosis. WIDER IMPLICATIONS The development of the diagnostic tools allows the physicians to make an accurate diagnosis of adenomyosis by means of non-invasive techniques, representing a major breakthrough, in the light of the clinical consequences of this disease. Furthermore, this technological improvement will open a new epidemiological scenario, identifying different groups of women, with a dissimilar clinical and/or imaging phenotypes of adenomyosis, and this should be object of future research.
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Affiliation(s)
- Charles Chapron
- Department of Gynecology Obstetrics II and Reproductive Medicine, Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France.,Department "Development, Reproduction and Cancer", Institut Cochin, INSERM U1016 (Doctor Vaiman), Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Department "Development, Reproduction and Cancer", Institut Cochin, INSERM U1016 (Professor Batteux), Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Silvia Vannuccini
- Department of Gynecology Obstetrics II and Reproductive Medicine, Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France.,Department of Obstetrics and Gynecology, Careggi University Hospital, Largo Brambilla 3, 50134, Florence, Italy.,Department of Neuroscience, Psychology, Pharmacology and Child Health (NEUROFARBA), University of Florence, Florence, Italy.,Department of Molecular and Developmental Medicine, University of Siena, viale Mario Bracci, 16, 53100, Siena, Italy
| | - Pietro Santulli
- Department of Gynecology Obstetrics II and Reproductive Medicine, Université Paris Descartes, Sorbonne Paris Cité, Faculté de Médecine, Assistance Publique - Hôpitaux de Paris (AP-HP), Hôpital Universitaire Paris Centre (HUPC), Centre Hospitalier Universitaire (CHU) Cochin, Paris, France.,Department "Development, Reproduction and Cancer", Institut Cochin, INSERM U1016 (Doctor Vaiman), Université Paris Descartes, Sorbonne Paris Cité, Paris, France.,Department "Development, Reproduction and Cancer", Institut Cochin, INSERM U1016 (Professor Batteux), Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Mauricio S Abrão
- Endometriosis Section, Gynecologic Division, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil.,Gynecologic Division, BP-A Beneficencia Portuguesa de Sao Paulo, Sao Paulo, Brazil
| | - Francisco Carmona
- Department of Gynecology, Institut Clinic of Gynecology, Obstetrics and Neonatology, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Ian S Fraser
- School of Women's and Children's Health, Royal Hospital for Women, University of New South Wales, Randwick, NSW, Australia
| | - Stephan Gordts
- Leuven Institute for Fertility & Embryology, Schipvaartstraat 4, 3000 Leuven, Belgium
| | - Sun-Wei Guo
- Department of Biochemistry, Shanghai Obstetrics and Gynecology Hospital, Fudan University, Shanghai, China.,Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China
| | - Pierre-Alexandre Just
- Faculté de Médecine, Hôpitaux Universitaires Paris Centre (AP-HP), Hôpital Cochin, Service de pathologie, CAncer Research for PErsonalized Medicine (CARPEM), Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Jean-Christophe Noël
- Department of Pathology, Erasme University Hospital/Curepath, Free University of Brussels (ULB), Brussels, Belgium
| | - George Pistofidis
- Department of Gynecologic Endoscopy, Lefkos Stavros Hospital, Athens, Greece
| | - Thierry Van den Bosch
- Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium
| | - Felice Petraglia
- Department of Experimental, Clinical and Biomedical Sciences, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
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15
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Cai H, Mol BW, Gordts S, Wang H, Wang T, Li N, Shi J. Early and late pregnancy loss in women with polycystic ovary syndrome undergoing IVF/ICSI treatment: a retrospective cohort analysis of 21 820 pregnancies. BJOG 2020; 128:1160-1169. [PMID: 33142019 DOI: 10.1111/1471-0528.16590] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To examine early and late pregnancy loss in women with and without polycystic ovary syndrome (PCOS) undergoing IVF/ICSI transfers. DESIGN Retrospective cohort study. SETTING Reproductive medicine centre at a tertiary hospital. POPULATION We studied women with a positive β-human chorionic gonadotropin (β-hCG) after in vitro fertilisation/intra-cytoplasmic sperm injection (IVF/ICSI) treatment from May 2014 to April 2019. METHODS Odds ratios (OR) for early (≤13 weeks) and late (>13 weeks) pregnancy loss were calculated among women with and without PCOS for plurality of the pregnancy with adjustment for confounding factors. MAIN OUTCOME MEASURES Early pregnancy loss (EPL) and late pregnancy loss (LPL). RESULTS From 21 820 women identified with a positive β-hCG, 2357 (10.8%) women had PCOS, and 19 463 (89.2%) women did not. EPL occurred in 16.6% (391) of women with PCOS versus 18.3% (3565) in women with non-PCOS (OR 0.89, 95% CI 0.79-0.99, P = 0.04). After adjustment for age and other confounders, the rate of EPL was not statistically significantly associated with PCOS status (adjusted OR [aOR] 0.91, 95% CI 0.80-1.05). Women with PCOS demonstrated a higher rate of LPL (6.4% in PCOS versus 3.6% in non-PCOS, OR 1.81, 95% CI 1.48-2.21, P < 0.001). In multivariable analysis, the potential impact of PCOS was less strong (aOR 1.38, 95% CI 0.96-1.98), with BMI and maternal comorbidities also associated with LPL (aOR 1.08, 95% CI 1.04-1.1 and aOR 2.07, 95% CI 1.43-3.00, respectively). CONCLUSIONS Polycystic ovary syndrome was not independently associated with EPL. There was an increased risk of LPL but this difference was not statistically significant. TWEETABLE ABSTRACT Polycystic ovary syndrome women are at increased risk of late pregnancy loss, partly driven by elevated BMI and maternal comorbidities.
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Affiliation(s)
- He Cai
- Assisted Reproduction Centre, Northwest Women and Children's Hospital, Xi'an, China
| | - B W Mol
- Department of Obstetrics and Gynaecology, Monash Medical Centre, Monash University, Melbourne, Victoria, Australia
| | - S Gordts
- Leuven Institute for Fertility & Embryology, Leuven, Belgium
| | - H Wang
- Assisted Reproduction Centre, Northwest Women and Children's Hospital, Xi'an, China
| | - T Wang
- Assisted Reproduction Centre, Northwest Women and Children's Hospital, Xi'an, China
| | - N Li
- Assisted Reproduction Centre, Northwest Women and Children's Hospital, Xi'an, China
| | - J Shi
- Assisted Reproduction Centre, Northwest Women and Children's Hospital, Xi'an, China
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16
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Mikos T, Gordts S, Grimbizis GF. Current knowledge about the management of congenital cervical malformations: a literature review. Fertil Steril 2020; 113:723-732. [PMID: 32228875 DOI: 10.1016/j.fertnstert.2020.02.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 02/16/2020] [Accepted: 02/17/2020] [Indexed: 11/30/2022]
Abstract
The prevalence of congenital cervical agenesis or dysgenesis ranges from 1/80,000 to 1/100,000, and in about 50% of these cases it coexists with congenital vaginal agenesis. This narrative review summarizes the contemporary knowledge in the field of conservative surgical restoration of the reproductive tract. The management of congenital cervical malformations aims to [1] provide relief from the obstructive symptoms, [2] establish normal sexual function, and [3] preserve the uterus for future fertility. In cases of cervical agenesis and vaginal aplasia, the surgical approach involves the creation of neovagina, the creation of neocervix, and then subsequent restoration of the continuity of the genital tract. In cases where vagina is not congenitally absent, the surgical approach involves either a direct uterovaginal anastomosis or initial creation of neocervix and then subsequent restoration of the continuity of the genital tract. The neocervix can be surgically created with small intestinal submucosa, split-thickness skin graft, full-thickness skin graft, peritoneal flap, or vaginal mucosa lined with a polytetrafluoroethylene graft. Most of the published cases report long-term menstruation and sporadic pregnancies. Conservative surgery of cervical congenital malformations could serve as a first-line treatment. Sexual function and menstruation are established in the majority of patients. Extirpatory surgery may be preserved for surgical failures after initial restoration of the continuity of uterus-cervix-vagina or in cases with more complex anatomy.
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Affiliation(s)
- Themistoklis Mikos
- 1st Department of Obstetrics and Gynecology, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki Greece.
| | | | - Grigoris F Grimbizis
- 1st Department of Obstetrics and Gynecology, Papageorgiou General Hospital, Aristotle University of Thessaloniki, Thessaloniki Greece
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17
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Daniilidis A, Nisolle M, Papandreou P, Gordts S, Krentel H, Pados G. A European survey on treatment of hydrosalpinges in infertile women on behalf of the European Society for Gynaecological Endoscopy (ESGE) Special Interest Group (SIG) on Reproductive Surgery. Facts Views Vis Obgyn 2020; 12:241-244. [PMID: 33123698 PMCID: PMC7580267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
A questionnaire-based survey was conducted among members of the European Society for Gynaecological Endoscopy (ESGE), with the aim of increasing awareness of the diagnosis and surgical treatment of tubal disease as an alternative to in-vitro fertiliszation (IVF). Seventeen participants (34%) occasionally used a test for prediction of the ovarian reserve before surgery, and the most commonly used test was anti-mullerian hormone assay (39/50; (80%). Laparoscopy was the preferred method for staging tubal disease (43/50; 86%).Thirty-seven (76%) participants always performed salpingectomy or tubal occlusion before the first IVF attempt. Thirty (60%) of the gynaecological surgeons considered the outcome with tubal surgery and IVF to be similar in mild tubal disease, whereas for severe disease, 31/50 (62%) felt that surgery had worse outcome. Among other factors to be considered in choosing a strategy for treating infertility, 20/50 (40%) of respondents listed the stage of disease. The findings of this survey suggest that first-line treatment for women younger than 35 years old with minor tubal pathology, is tubal surgery. IVF appears to be offered if there are other infertility factors, if the patient is >38 years old and if moderate to severe tubal disease is present.
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Affiliation(s)
- A Daniilidis
- 2nd Dept. OB-GYN, ‘Hippokratio’ General Hospital, Aristotle University of Thessaloniki, Greece
| | - M Nisolle
- OB-GYN clinic, Citadelle hospital. Liege, Belgium
| | - P Papandreou
- 2nd Dept. OB-GYN, ‘Hippokratio’ General Hospital, Aristotle University of Thessaloniki, Greece
| | - S Gordts
- Life Expert Centre, Leuven, Belgium
| | - H Krentel
- OB-GYN clinic, Bethesda Hospital, Duisburg, Germany
| | - G Pados
- 1st Dept. OB-GYN, “Papageorgiou” General Hospital, Aristotle University of Thessaloniki and Centre for Endoscopic Surgery “Diavalkaniko” Hospital, Thessaloniki, Greece
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18
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Pados G, Daniilidis A, Keckstein J, Papandreou P, Gordts S. A European survey on the conservative surgical management of endometriotic cysts on behalf of the European Society for Gynaecological Endoscopy (ESGE) Special Interest Group (SIG) on Endometriosis. Facts Views Vis Obgyn 2020; 12:105-108. [PMID: 32832924 PMCID: PMC7431198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
The mainstay of endometrioma management, when treatment is required, is surgical. Although laparoscopy is considered to be the gold standard for endometriosis surgery, there is no clarity on the preferred laparoscopic technique, which may depend on whether the primary goalis treatment of infertility or pelvic pain, prevention of recurrence or preservation of ovarian reserve. The aim of this survey to assess the surgical practice of the members of the European Society for Gynaecological Endoscopy (ESGE) on the conservative management of endometiotic cysts in women of reproductive age. The current survey showed that practice for the conservative management of endometriotic cysts was that laparoscopy accounted for 84.9% of the cases, expectant management for 12.1%, and laparotomy for 3%. The preferred surgical approach was cystectomy in 69% of the cases, while the parameters that determined the preferred surgical method were the diameter of the cyst (62%) and the bilaterality or non-location (53%). The type of energy used was in most cases bipolar (83%), 71.4% of surgeons did not reconstitute the ovary and 41% of responses included the administration of adhesion barrier agents. The primary surgical end-point was ovarian reserve (50%), which was tested preoperatively in 51.8%, mainly with an anti-mullerian hormone. In case of an incidentally deep-infiltrating endometriosis, 55.4% of the responses included concomitant treatment thereof, while 71% of the participants considered that a "pelvic surgeon", who could more effectively treat co- existing pelvic and intestinal disease, should be the ideal one to effectively manage endometriosis. The majority of participants (74%) in this survey consider that there is insufficient scientific evidence regarding the conservative management of endometriotic cysts. The treatment of ovarian endometrioma should be individualised, taking into consideration not only the relief of symptoms, pregnancy rates or recurrence rates, but also ovarian function and reserve after surgery.
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Affiliation(s)
- G Pados
- 1st Dept. OB-GYN, "Papageorgiou" General Hospital, Aristotle University of Thessaloniki and Centre for Endoscopic Surgery "Diavalkaniko" Hospital, Thessaloniki, Greece
| | - A Daniilidis
- 2nd Dept. OB-GYN, 'Hippokratio' General Hospital, Aristotle University of Thessaloniki, Greece
| | - J Keckstein
- Landeskrankenanstalten-Betriebsgesellschaft (KABEG) and Landeskrankenhaus Villach, Abteilung fur Gynakologie und Geburtshilfe, Villach, Austria
| | - P Papandreou
- 2nd Dept. OB-GYN, 'Hippokratio' General Hospital, Aristotle University of Thessaloniki, Greece
| | - S Gordts
- Life Expert Centre, Leuven, Belgium
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19
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Cai H, Gordts S, Sun J, Meng B, Shi J. Reproductive outcomes with donor sperm in couples with severe male-factor infertility after intracytoplasmic sperm injection failures. J Assist Reprod Genet 2020; 37:1883-1893. [PMID: 32440933 DOI: 10.1007/s10815-020-01828-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 05/13/2020] [Indexed: 10/24/2022] Open
Abstract
PURPOSE To evaluate reproductive outcomes of artificial insemination and IVF with donor sperm (AID or IVF-D) for male-factor couples with a history of unsuccessful ICSI attempt. METHODS This retrospective cohort includes couples with severe male-factor infertility who failed ICSI treatment, and subsequently underwent semen donation treatment. We report the following outcomes: (1) live birth rates in AID and IVF-D treatment for couples with severe male infertility factors and prior ICSI failures; (2) paternal impact on embryo development of the same oocyte cohort; (3) prognostic factors in obtaining a live birth with donor semen. RESULTS Of 92 women with failed ICSI cycles (26 with multiple attempts), 45 couples underwent AID treatment. Live birth rate per cycle of AID was 18.9%. Fifty-three patients underwent IVF-D including 6 couples who previously did not conceive with AID. Embryological outcomes including fertilization, viable cleavage embryos, and blastocyst formation rates were significantly lower in ICSI cycles with partner sperm compared with IVF-D (P < 0.01). Logistic regression analysis showed that female age and the severity of spermatogenetic disorder are prognostic factors in obtaining a live birth with donated sperm. CONCLUSION Couples with severe male infertility factor (azoospermia or extreme oligoasthenospermia) and a history of unsuccessful ICSI cycles benefit from treating with donor sperm. ICSI fertilization, embryo viability, and progression of the embryo to the blastocyst stage are significantly deteriorated by semen parameters. The prognostic factors identified may help couples plan their treatment and prepare for their parenthood journey.
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Affiliation(s)
- He Cai
- Assisted Reproduction Center, Northwest Women's and Children's Hospital Affiliated to Xi'an Jiaotong University, 73#, Houzaimen North Street, Xi'an, People's Republic of China
| | - Stephan Gordts
- Leuven Institute for Fertility & Embryology, Schipvaartstraat 4, 3000, Leuven, Belgium
| | - Jianhua Sun
- Assisted Reproduction Center, Northwest Women's and Children's Hospital Affiliated to Xi'an Jiaotong University, 73#, Houzaimen North Street, Xi'an, People's Republic of China
| | - Bin Meng
- Assisted Reproduction Center, Northwest Women's and Children's Hospital Affiliated to Xi'an Jiaotong University, 73#, Houzaimen North Street, Xi'an, People's Republic of China
| | - Juanzi Shi
- Assisted Reproduction Center, Northwest Women's and Children's Hospital Affiliated to Xi'an Jiaotong University, 73#, Houzaimen North Street, Xi'an, People's Republic of China.
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20
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Habiba M, Gordts S, Bazot M, Brosens I, Benagiano G. Exploring the challenges for a new classification of adenomyosis. Reprod Biomed Online 2020; 40:569-581. [PMID: 32173239 DOI: 10.1016/j.rbmo.2020.01.017] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 01/14/2020] [Accepted: 01/20/2020] [Indexed: 01/06/2023]
Abstract
The availability of non-invasive diagnostic tests is an important factor in the renewed interest in adenomyosis, as the disease can now be more accurately mapped in the uterus without a need for hysterectomy. An agreed system for classifying and reporting the condition will enhance our understanding of the disease and is envisaged to enable comparison of research studies and treatment outcomes. In this review, we assess previous and more recent attempts at producing a taxonomy, especially in view of the latest proposal for subdivision of adenomyosis into an internal and an external variant. In this context, we also explore the uncertainties linked to classifying involvement of the uterovesical pouch, the pouch of Douglas and lesions in the outer myometrium. Two opposing hypotheses are forwarded to explain the pathogenesis of these variants, namely that disease localized in these areas originates from an invasion by uterine adenomyosis of peritoneal organs; alternatively, that lesions present in the outer myometrium originate from peritoneal endometriosis. At the root of debates around these opposing theories of pathogenesis is fragmentary evidence. Because of the limitations of currently available evidence, and until this issue is resolved, broad agreement on a hypothesis to underpin any proposed classification is unlikely.
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Affiliation(s)
- Marwan Habiba
- Department of Health Sciences University of Leicester and University Hospitals of Leicester, Leicester Royal Infirmary, Leicester, LE1 5WW, UK.
| | | | - Marc Bazot
- Department of Radiology, Tenon Hospital, Assistance Publique des Hôpitaux de Paris, Université Sorbonne Université Paris, France & Groupe de Recherche Clinique GRC6-UPMC, Centre Expert en Endométriose (C3E), AP-HP, 75020 Paris, France
| | - Ivo Brosens
- Faculty of Medicine, Catholic University of Leuven, Herestraat 49, 3001 Leuven, Belgium
| | - Giuseppe Benagiano
- Department of Maternal & Child Health, Gynecology and Urology, Sapienza, University of Rome, 00185 Rome, Italy
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Gordts S, Campo R. Modern approaches to surgical management of endometrioma. Best Pract Res Clin Obstet Gynaecol 2019; 59:48-55. [PMID: 30709745 DOI: 10.1016/j.bpobgyn.2018.12.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Revised: 12/29/2018] [Accepted: 12/31/2018] [Indexed: 11/17/2022]
Abstract
Formation of the ovarian endometrioma consists of implantation, invagination of the ovarian cortex, and adhesion formation. Progression is characterized by repeated injury and repair with degenerative changes. Already with a partially deprived ovarian reserve, resulting from the disease, surgical treatment carries a potential risk of further follicular deprivation. Surgery should therefore be performed with microsurgical precision by experienced hands. Early treatment can possibly prevent further progression. The adverse impact on ovarian reserve of the ablative approach has to be balanced against a lower recurrence rate of a cystectomy. Adapted surgical approaches like a two-step approach or a combination of excisional and ablative surgery has to be considered in case of a large endometrioma. Further studies on the possibility and advantages of sclerotherapy are warranted. Fertility preservation by cryopreservation of ovarian cortex should be part of the informed consent with the patient.
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Affiliation(s)
- S Gordts
- Leuven Institute for Fertility & Embryology, Schipvaartstraat 4, 3000 Leuven, Belgium.
| | - R Campo
- Leuven Institute for Fertility & Embryology, Schipvaartstraat 4, 3000 Leuven, Belgium
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Gordts S, Grimbizis G, Campo R. Symptoms and classification of uterine adenomyosis, including the place of hysteroscopy in diagnosis. Fertil Steril 2018; 109:380-388.e1. [PMID: 29566850 DOI: 10.1016/j.fertnstert.2018.01.006] [Citation(s) in RCA: 97] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 01/03/2018] [Accepted: 01/05/2018] [Indexed: 12/28/2022]
Abstract
Where histology used the presence of glands and/or stroma in the myometrium as pathognomonic for adenomyosis, imaging uses the appearance of the myometrium, the presence of striations, related to the presence of endometrial tissue within the myometrium, the presence of intramyometrial cystic structures and the size and asymmetry of the uterus to identify adenomyosis. Preliminary reports show a good correlation between the features detected by imaging and the histological findings. Symptoms associated with adenomyosis are abnormal uterine bleeding, pelvic pain (dysmenorrhea, chronic pelvic pain, dyspareunia), and impaired reproduction. However a high incidence of existing comorbidity like fibroids and endometriosis makes it difficult to attribute a specific pathognomonic symptom to adenomyosis. Heterogeneity in the reported pregnancy rates after assisted reproduction is due to the use of different ovarian stimulation protocols and absence of a correct description of the adenomyotic pathology. Current efforts to classify the disease contributed a lot in elucidated the potential characteristics that a classification system should be relied on. The need for a comprehensive, user friendly, and clear categorization of adenomyosis including the pattern, location, histological variants, and the myometrial zone seems to be an urgent need. With the uterus as a possible unifying link between adenomyosis and endometriosis, exploration of the uterus should not only be restricted to the hysteroscopic exploration of the uterine cavity but in a fusion with ultrasound.
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Affiliation(s)
- Stephan Gordts
- Leuven Institute for Fertility & Embryology, Leuven, Belgium; Life Expert Centre, Schipvaartstraat 4, Leuven, Belgium.
| | - Grigoris Grimbizis
- 1st Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Rudi Campo
- Leuven Institute for Fertility & Embryology, Leuven, Belgium; Life Expert Centre, Schipvaartstraat 4, Leuven, Belgium
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Campo R, Santangelo F, Gordts S, Di Cesare C, Van Kerrebroeck H, De Angelis MC, Di Spiezio Sardo A. Outpatient hysteroscopy. Facts Views Vis Obgyn 2018; 10:115-122. [PMID: 31191845 PMCID: PMC6548410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Modern hysteroscopy represents a copernical revolution for the diagnosis and treatment of uterine pathology. Traditionally hysteroscopy was performed in a conventional operation room under general anaesthesia (in-patient hysteroscopy). Recent advances in technology and techniques made hysteroscopy less painful and invasive allowing it to be performed in an ambulatory setting (outpatient hysteroscopy). The so called "see & treat hysteroscopy", has reduced the distinction between diagnostic and operative procedure, thus, introducing the concept of a single procedure in which the operative part is perfectly integrated within the diagnostic work-up. The "digital hysteroscopic clinic" (DHC) on the other hand combines ultrasound with hysteroscopy, ideal for a one stop diagnostic procedure and surgical approach, outlasting laparoscopy with ultrasound, for increased surgical performance in outpatient settings. The aim of this paper is to describe the "state of the art" in an outpatient hysteroscopy setting.
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Affiliation(s)
- R Campo
- European Academy of Gynaecological Surgery, Diestsevest, 43, 3000 Leuven Belgium.,Department of Obstetrics and Gynecology, ZOL Hospitals, Schiepse Bos 6, 3600 Genk, Belgium,Life Expert Centre, Schipvaart straat 4, 3000 Leuven Belgium
| | - F Santangelo
- Unit of Obstetrics and Gynecology, University of Federico II, Naples, Italy, 80131
| | - S Gordts
- Life Expert Centre, Schipvaart straat 4, 3000 Leuven Belgium
| | - C Di Cesare
- Catholic University of Sacred Heart, Department of Obstetrics and Gynecology , Fondazione Policlinico Universitario Agostino Gemelli, Rome, Italy
| | - H Van Kerrebroeck
- Department of Obstetrics and Gynecology, ZOL Hospitals, Schiepse Bos 6, 3600 Genk, Belgium
| | - MC De Angelis
- Unit of Obstetrics and Gynecology, University of Federico II, Naples, Italy, 80131
| | - A Di Spiezio Sardo
- European Academy of Gynaecological Surgery, Diestsevest, 43, 3000 Leuven Belgium.,Unit of Obstetrics and Gynecology, University of Federico II, Naples, Italy, 80131
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Tanos V, Berry KE, Seikkula J, Abi Raad E, Stavroulis A, Sleiman Z, Campo R, Gordts S. The management of polyps in female reproductive organs. Int J Surg 2017; 43:7-16. [DOI: 10.1016/j.ijsu.2017.05.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 05/02/2017] [Indexed: 02/07/2023]
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Gordts S, Campo R, Bogers JP, Tanos V, Segaert I, Valkenburg M, Puttemans P, Gordts S. Transvaginal laparoscopy: A minimally invasive approach to obtain brush cytology of the Fallopian tube. Eur J Obstet Gynecol Reprod Biol 2017; 212:80-84. [PMID: 28342394 DOI: 10.1016/j.ejogrb.2017.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 02/14/2017] [Accepted: 03/01/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate in a prospective pilot study the feasibility of cytobrushing of the fimbrial end using a transvaginal endoscopic access. STUDY DESIGN Prospective feasibility study. The procedure was performed in a consecutive series of 15 infertile women referred for a transvaginal laparoscopy as part of their fertility investigation. Tubal cells were collected using a 5Fr cytobrush. Cytology and immunocytochemistry was done. RESULTS In all patients enough cell material was obtained for analysis, without traumatizing the fimbrial end. Specimens showed the presence of a sufficient amount of cells enabling standard cytologic examinations and immunocytochemistry (Ki 67, p53). CONCLUSION Fimbrial cytobrushing using the transvaginal approach is an easy and minimally invasive procedure. The easy accessibility of the fimbrial end and the distal ampullary part at TVL allows an accurate collection of tubal epithelial cells. In view of the recent data reporting the Fallopian tube and more specifically the fimbrial end as a possible origin of ovarian carcinoma, further research is needed to evaluate the potential of this technique as a possible screening method for patients at risk for ovarian cancer.
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Affiliation(s)
- Stephan Gordts
- Life Expert Centre, Schipvaartstraat 4, 3000 Leuven, Belgium.
| | - Rudi Campo
- Life Expert Centre, Schipvaartstraat 4, 3000 Leuven, Belgium
| | - J P Bogers
- Department Histology & Cytology, AML, Antwerp, Belgium
| | - Vasilis Tanos
- Department of Gynecological Oncology, Evagelistria Medical Center, Nicosia, Cyprus
| | - Isabelle Segaert
- Unit Reproductive Medicine, Heilig Hart Hospital, Naamsestraat 105, 3000 Leuven, Belgium
| | - Marion Valkenburg
- Life Expert Centre, Schipvaartstraat 4, 3000 Leuven, Belgium; Unit Reproductive Medicine, Heilig Hart Hospital, Naamsestraat 105, 3000 Leuven, Belgium
| | - Patrick Puttemans
- Unit Reproductive Medicine, Heilig Hart Hospital, Naamsestraat 105, 3000 Leuven, Belgium
| | - Sylvie Gordts
- Unit Reproductive Medicine, Heilig Hart Hospital, Naamsestraat 105, 3000 Leuven, Belgium
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Abstract
INTRODUCTION Treatment of ovarian endometriomas is commonly achieved through laparoscopic surgery and this can be effective in eliminating the disease, although a majority of recent trials documented an adverse effect of surgery on ovarian reserve markers. With the advancement in imaging techniques, ovarian endometriomas are increasingly diagnosed at an earlier stage when the endometrioma may be smaller, less fibrotic and more responsive to medical treatment, making an evaluation of medical options critically important. AREAS COVERED The review focuses on currently utilized pharmacologic therapies for endometrioma (oral contraceptives, the levonorgestrel-releasing IUS, the hormone-releasing subdermal implant, Implanon); experimental and future treatments are also mentioned (GnRH antagonists, progesterone receptor modulators, antioestrogens, newer subdermal implants and intracystic administration of pharmacologic agents). Finally, the usefulness of post-operative adjuvant medical treatments is discussed Expert opinion: Today, reliable, non-invasive diagnostic procedures of an ovarian endometrioma are available and should be utilized to identify its presence and type of pathology. In a young patient, classic medical therapies such as oral contraceptives and synthetic progestins should be tried first to alleviate symptoms. Only when these regimens fail, should a minimally invasive surgery be envisaged. Following endoscopic surgery, adjuvant medical treatment may reduce recurrence of both symptoms and the lesion.
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Affiliation(s)
- Giuseppe Benagiano
- a Department of Gynaecology, Obstetrics and Urology , Sapienza University of Rome , Rome , Italy
| | - Sun-Wei Guo
- b Department of Gynecology, Shanghai Obstetrics and Gynecology Hospital , Fudan University , Shanghai , People's Republic of China
| | - Paola Bianchi
- c Department of Surgical and Medical Sciences and Traslational Medicine, Sant'Andrea Hospital, Faculty of Medicine and Psychology , Sapienza University of Rome , Rome , Italy
| | | | - Stephan Gordts
- d Leuven Institute for Fertility and Embryology , Leuven , Belgium
| | - Felice Petraglia
- e Department of Molecular and Developmental Medicine, Obstetrics and Gynecology , University of Siena , Siena , Italy
| | - Ivo Brosens
- f Department of Obstetrics and Gynaecology , Catholic University of Leuven , Leuven , Belgium
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El-Toukhy T, Campo R, Khalaf Y, Tabanelli C, Gianaroli L, Gordts SS, Gordts S, Mestdagh G, Mardesic T, Voboril J, Marchino GL, Benedetto C, Al-Shawaf T, Sabatini L, Seed PT, Gergolet M, Grimbizis G, Harb H, Coomarasamy A. Hysteroscopy in recurrent in-vitro fertilisation failure (TROPHY): a multicentre, randomised controlled trial. Lancet 2016; 387:2614-2621. [PMID: 27132053 DOI: 10.1016/s0140-6736(16)00258-0] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND The success rate of in-vitro fertilisation (IVF) remains low and many women undergo multiple treatment cycles. A previous meta-analysis suggested hysteroscopy could improve outcomes in women who have had recurrent implantation failure; however, studies were of poor quality and a definitive randomised trial was needed. In the TROPHY trial we aimed to assess whether hysteroscopy improves the livebirth rate following IVF treatment in women with recurrent failure of implantation. METHODS We did a multicentre, randomised controlled trial in eight hospitals in the UK, Belgium, Italy, and the Czech Republic. We recruited women younger than 38 years who had normal ultrasound of the uterine cavity and history of two to four unsuccessful IVF cycles. We used an independent web-based trial management system to randomly assign (1:1) women to receive outpatient hysteroscopy (hysteroscopy group) or no hysteroscopy (control group) in the month before starting a treatment cycle of IVF (with or without intracytoplasmic sperm injection). A computer-based algorithm minimised for key prognostic variables: age, body-mass index, basal follicle-stimulating hormone concentration, and the number of previous failed IVF cycles. The order of group assignment was masked to the researchers at the time of recruitment and randomisation. Embryologists involved in the embryo transfer were masked to group allocation, but physicians doing the procedure knew of group assignment and had hysteroscopy findings accessible. Participants were not masked to their group assignment. The primary outcome was the livebirth rate (proportion of women who had a live baby beyond 24 weeks of gestation) in the intention-to-treat population. The trial was registered with the ISRCTN Registry, ISRCTN35859078. FINDINGS Between Jan 1, 2010, and Dec 31, 2013, we randomly assigned 350 women to the hysteroscopy group and 352 women to the control group. 102 (29%) of women in the hysteroscopy group had a livebirth after IVF compared with 102 (29%) women in the control group (risk ratio 1·0, 95% CI 0·79-1·25; p=0·96). No hysteroscopy-related adverse events were reported. INTERPRETATION Outpatient hysteroscopy before IVF in women with a normal ultrasound of the uterine cavity and a history of unsuccessful IVF treatment cycles does not improve the livebirth rate. Further research into the effectiveness of surgical correction of specific uterine cavity abnormalities before IVF is warranted. FUNDING European Society of Human Reproduction and Embryology, European Society for Gynaecological Endoscopy.
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Affiliation(s)
- Tarek El-Toukhy
- Assisted Conception Unit, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK.
| | - Rudi Campo
- Ziekenhuis Oost Limburg, Assisted Conception Unit, Genk, Belgium
| | - Yacoub Khalaf
- Assisted Conception Unit, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK
| | | | | | - Sylvie S Gordts
- Leuven Institute for Fertility and Embryology, Tiensevest, Leuven, Belgium
| | - Stephan Gordts
- Leuven Institute for Fertility and Embryology, Tiensevest, Leuven, Belgium
| | - Greet Mestdagh
- Ziekenhuis Oost Limburg, Assisted Conception Unit, Genk, Belgium
| | - Tonko Mardesic
- The Sanatorium Pronatal, Assisted Conception Unit, Prague, Czech Republic
| | - Jan Voboril
- The Sanatorium Pronatal, Assisted Conception Unit, Prague, Czech Republic
| | - Gian L Marchino
- Obstetrics and Gynaecology Department, University of Turin, Torino, Italy
| | - Chiara Benedetto
- Obstetrics and Gynaecology Department, University of Turin, Torino, Italy
| | - Talha Al-Shawaf
- Centre for Reproductive Medicine, Barts Health NHS Trust, London, UK
| | - Luca Sabatini
- Centre for Reproductive Medicine, Barts Health NHS Trust, London, UK
| | - Paul T Seed
- Division of Women's Health, Women's Health Academic Centre, King's College London and King's Health Partners, St Thomas' Hospital, London, UK
| | - Marco Gergolet
- Reproductive Surgery Special Interest Group, European Society of Human Reproduction and Embryology, Brussels, Belgium
| | - Grigoris Grimbizis
- First Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, Greece
| | - Hoda Harb
- Institute of Metabolism and Systems Research and Tommy's National Centre for Miscarriage Care and Research, University of Birmingham, Birmingham, UK
| | - Arri Coomarasamy
- Institute of Metabolism and Systems Research and Tommy's National Centre for Miscarriage Care and Research, University of Birmingham, Birmingham, UK
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Benagiano G, Petraglia F, Gordts S, Brosens I. A new approach to the management of ovarian endometrioma to prevent tissue damage and recurrence. Reprod Biomed Online 2016; 32:556-62. [DOI: 10.1016/j.rbmo.2016.03.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2015] [Revised: 03/01/2016] [Accepted: 03/02/2016] [Indexed: 01/08/2023]
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Affiliation(s)
- Ivo Brosens
- Leuven Institute for Fertility and Embryology, Leuven, Belgium
| | - Caroline E. Gargett
- The Ritchie Centre, Hudson Institute of Medical Research and Department of Obstetrics and Gynaecology Monash University, Clayton, Australia
| | - Sun-Wei Guo
- Department of Gynecology, Shanghai Obstetrics and Gynecology Hospital, Fudan University, Shanghai, People’s Republic of China
| | | | - Stephan Gordts
- Leuven Institute for Fertility and Embryology, Leuven, Belgium
| | - Jan J. Brosens
- Division of Biomedical Sciences, Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Giuseppe Benagiano
- Department of Gynaecology, Obstetrics and Urology, “Sapienza” University, Rome, Italy
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Brosens I, Gordts S, Habiba M, Benagiano G. Uterine Cystic Adenomyosis: A Disease of Younger Women. J Pediatr Adolesc Gynecol 2015; 28:420-6. [PMID: 26049940 DOI: 10.1016/j.jpag.2014.05.008] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Revised: 05/19/2014] [Accepted: 05/19/2014] [Indexed: 01/02/2023]
Abstract
PURPOSE OF REVIEW We adopted a life-cycle approach to further our understanding of the natural history of the cystic forms of uterine adenomyosis first described by Cullen in 1908. SEARCH STRATEGY Scopus and PubMed were searched for all terms referring to cystic variant of adenomyosis or adenomyoma. References found in major publications were also included in the review. MAIN FINDINGS With the introduction of non-invasive imaging techniques, a number of cases of cystic variants of adenomyosis have been reported. Progressive, severe, medication-resistant dysmenorrhea is the main clinical feature but delay in diagnosis remains problematic. The life-cycle approach demonstrates that cystic adenomyosis is more relevant to adolescent and young adulthood. Congenital müllerian and wolffian cysts and the uterus-like masses are more frequent in women >30 years of age. The latter is frequently located outside the uterus and may represent a form of endometriosis rather than adenomyosis. Differential diagnosis includes ovarian cysts and congenital uterine anomalies. Menstruation suppression with continuous oral contraceptive pill with ultrasonographic monitoring of cyst regression may prove successful in the young woman, but surgical excision using minimally invasive endoscopy is highly effective. The various terms used in literature to describe these lesions cause considerable confusion. Here we propose a classification into 3 subtypes and standardized reporting criteria to enable comparison. CONCLUSIONS Endometrial lined myometrial cysts are almost specific to adolescent and young women. We propose a new classification system.
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Affiliation(s)
- Ivo Brosens
- Catholic University of Leuven, Leuven, Belgium.
| | - Stephan Gordts
- Leuven Institute for Fertility and Embryology, Leuven, Belgium
| | - Marwan Habiba
- Reproductive Sciences Section, University of Leicester and University Hospitals of Leicester, Leicester, UK
| | - Giuseppe Benagiano
- Department of Gynecology, Obstetrics and Urology, Sapienza University, Rome, Italy
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Grimbizis GF, Di Spiezio Sardo A, Saravelos SH, Gordts S, Exacoustos C, Van Schoubroeck D, Bermejo C, Amso NN, Nargund G, Timmerman D, Athanasiadis A, Brucker S, De Angelis C, Gergolet M, Li TC, Tanos V, Tarlatzis B, Farquharson R, Gianaroli L, Campo R. The Thessaloniki ESHRE/ESGE consensus on diagnosis of female genital anomalies. Hum Reprod 2015; 31:2-7. [PMID: 26537921 DOI: 10.1093/humrep/dev264] [Citation(s) in RCA: 98] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 09/14/2015] [Indexed: 11/15/2022] Open
Abstract
STUDY QUESTION What is the recommended diagnostic work-up of female genital anomalies according to the European Society of Human Reproduction and Embryology (ESHRE)/European Society for Gynaecological Endoscopy (ESGE) system? SUMMARY ANSWER The ESHRE/ESGE consensus for the diagnosis of female genital anomalies is presented. WHAT IS KNOWN ALREADY Accurate diagnosis of congenital anomalies still remains a clinical challenge because of the drawbacks of the previous classification systems and the non-systematic use of diagnostic methods with varying accuracy, some of them quite inaccurate. Currently, a wide range of non-invasive diagnostic procedures are available enriching the opportunity to accurately detect the anatomical status of the female genital tract, as well as a new objective and comprehensive classification system with well-described classes and sub-classes. STUDY DESIGN, SIZE, DURATION The ESHRE/ESGE CONgenital UTerine Anomalies (CONUTA) Working Group established an initiative with the goal of developing a consensus for the diagnosis of female genital anomalies. The CONUTA working group and imaging experts in the field have been appointed to run the project. PARTICIPANTS/MATERIALS, SETTING, METHODS The consensus is developed based on: (i) evaluation of the currently available diagnostic methods and, more specifically, of their characteristics with the use of the experts panel consensus method and of their diagnostic accuracy by performing a systematic review of evidence and (ii) consensus for the definition of where and how to measure uterine wall thickness and the recommendations for the diagnostic work-up of female genital anomalies, based on the results of the previous evaluation procedure, with the use of the experts panel consensus method. MAIN RESULTS AND THE ROLE OF CHANCE Uterine wall thickness is defined as the distance between the interostial line and external uterine profile at the midcoronal plane of the uterus; alternatively, if a coronal plane is not available, the mean anterior and posterior uterine wall thickness at the longitudinal plane could be used. Gynecological examination and two-dimensional ultrasound (2D US) are recommended for the evaluation of asymptomatic women. Three-dimensional (3D) US is recommended for the diagnosis of female genital anomalies in 'symptomatic' patients belonging to high risk groups for the presence of a female genital anomaly and in any asymptomatic woman suspected to have an anomaly from routine evaluation. Magnetic resonance imaging (MRI) and endoscopic evaluation are recommended for the subgroup of patients with suspected complex anomalies or in diagnostic dilemmas. Adolescents with symptoms suggestive for the presence of a female genital anomaly should be thoroughly evaluated with 2D US, 3D US, MRI and endoscopically. LIMITATIONS, REASONS FOR CAUTION The various diagnostic methods should always be used in the proper way and evaluated by experts to avoid mis-, over- and underdiagnosis. WIDER IMPLICATIONS OF THE FINDINGS The role of a combined US examination and outpatient hysteroscopy should be prospectively evaluated. It is a challenge for further research, based on diagnosis, to objectively evaluate the clinical consequences related to various degrees of uterine deformity. STUDY FUNDING/COMPETING INTERESTS None.
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Affiliation(s)
- Grigoris F Grimbizis
- Congenital Uterine Anomalies (CONUTA) common ESHRE/ESGE Working Group and invited Experts, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Attilio Di Spiezio Sardo
- Congenital Uterine Anomalies (CONUTA) common ESHRE/ESGE Working Group and invited Experts, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Sotirios H Saravelos
- Congenital Uterine Anomalies (CONUTA) common ESHRE/ESGE Working Group and invited Experts, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Stephan Gordts
- Congenital Uterine Anomalies (CONUTA) common ESHRE/ESGE Working Group and invited Experts, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Caterina Exacoustos
- Congenital Uterine Anomalies (CONUTA) common ESHRE/ESGE Working Group and invited Experts, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Dominique Van Schoubroeck
- Congenital Uterine Anomalies (CONUTA) common ESHRE/ESGE Working Group and invited Experts, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Carmina Bermejo
- Congenital Uterine Anomalies (CONUTA) common ESHRE/ESGE Working Group and invited Experts, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Nazar N Amso
- Congenital Uterine Anomalies (CONUTA) common ESHRE/ESGE Working Group and invited Experts, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Geeta Nargund
- Congenital Uterine Anomalies (CONUTA) common ESHRE/ESGE Working Group and invited Experts, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Dirk Timmerman
- Congenital Uterine Anomalies (CONUTA) common ESHRE/ESGE Working Group and invited Experts, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Apostolos Athanasiadis
- Congenital Uterine Anomalies (CONUTA) common ESHRE/ESGE Working Group and invited Experts, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Sara Brucker
- Congenital Uterine Anomalies (CONUTA) common ESHRE/ESGE Working Group and invited Experts, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Carlo De Angelis
- Congenital Uterine Anomalies (CONUTA) common ESHRE/ESGE Working Group and invited Experts, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Marco Gergolet
- Congenital Uterine Anomalies (CONUTA) common ESHRE/ESGE Working Group and invited Experts, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Tin Chiu Li
- Congenital Uterine Anomalies (CONUTA) common ESHRE/ESGE Working Group and invited Experts, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Vasilios Tanos
- Congenital Uterine Anomalies (CONUTA) common ESHRE/ESGE Working Group and invited Experts, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Basil Tarlatzis
- Congenital Uterine Anomalies (CONUTA) common ESHRE/ESGE Working Group and invited Experts, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Roy Farquharson
- Congenital Uterine Anomalies (CONUTA) common ESHRE/ESGE Working Group and invited Experts, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Luca Gianaroli
- Congenital Uterine Anomalies (CONUTA) common ESHRE/ESGE Working Group and invited Experts, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - Rudi Campo
- Congenital Uterine Anomalies (CONUTA) common ESHRE/ESGE Working Group and invited Experts, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium
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De Neubourg D, Bogaerts K, Blockeel C, Coetsier T, Delvigne A, Devreker F, Dubois M, Gillain N, Gordts S, Wyns C. How do cumulative live birth rates and cumulative multiple live birth rates over complete courses of assisted reproductive technology treatment per woman compare among registries? Hum Reprod 2015; 31:93-9. [PMID: 26537922 DOI: 10.1093/humrep/dev270] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 09/29/2015] [Indexed: 11/12/2022] Open
Abstract
STUDY QUESTION How do the national cumulative (multiple) live birth rates over complete assisted reproduction technology (ART) courses of treatment per woman in Belgium compare to those in other registries? SUMMARY ANSWER Cumulative live birth rates (CLBRs) remain high with a low cumulative multiple live birth rate when compared with other registries and publications. WHAT IS KNOWN ALREADY In ART, a reduction in the multiple live birth rate could be achieved by reducing the number of embryos transferred. It has been shown that by doing so, live birth rates per cycle were maintained, particularly when the augmentation effect of attached frozen-thawed cycles was considered. STUDY DESIGN, SIZE, DURATION A retrospective cohort study included all patients with a Belgian national insurance number who were registered in the national ART registry (Belrap) and who started a first fresh ART cycle between 1 July 2009 until 31 December 2011 with follow up until 31 December 2012. We analysed 12 869 patients and 38 008 cycles (both fresh and attached frozen cycles). PARTICIPANTS, MATERIALS, SETTINGS, METHODS CLBRs per patient who started a first ART cycle including fresh and consecutive frozen cycles leading to a live birth. Conservative estimates of cumulative live birth assumed that patients who did not return for treatment had no chance of achieving an ART-related live birth, whereas optimal estimates assumed that women discontinuing treatment would have the same chance of achieving a live birth as those continuing treatment. A maximum of six fresh ART cycles with corresponding frozen cycles was investigated and compared with other registries and publications. MAIN RESULTS AND ROLE OF CHANCE The CLBR was age dependent and declined from 62.9% for women <35 years, to 51.4% for women 35-37 years, to 34.1% for women 38-40 years and 17.7% for women 41-42 years in the conservative analysis after six cycles. In the optimal estimate, the CLBR declined from 85.9% for women <35 years, to 72.0% for women 35-37 years, to 50.4% for women 38-40 years and 36.4% for women 41-42 years. The cumulative multiple live birth rates for the whole population were 5.1 and 8.6% for the conservative and optimal estimate, respectively. LIMITATIONS, REASONS FOR CAUTION Conservative and optimal estimates use assumptions for the whole ART population and do not take the individual patient into account. WIDER IMPLICATIONS OF THE FINDINGS These data reinforce the validity of the Belgian model of coupling reimbursement of ART costs to a restriction in the number of embryos transferred. Our data can improve decision-making in medical ART practice both on the patient level and for society at large and could provide health care takers and insurance companies with a valid model. STUDY FUNDING COMPETING INTERESTS none.
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Affiliation(s)
- D De Neubourg
- Leuven University Fertility Centre, University Hospitals Leuven, 3000 Leuven, Belgium
| | - K Bogaerts
- I-BioStat, KU Leuven, 3000 Leuven and Universiteit Hasselt, 3500 Hasselt, Belgium
| | - C Blockeel
- Centre for Reproductive Medicine, Universitair Ziekenhuis Brussel, 1090 Brussels, Belgium
| | - T Coetsier
- Fertility Centre, AZ St Lucas, 9000 Ghent, Belgium
| | - A Delvigne
- Centre de Procréation Médicalement Assistée, Clinique Saint-Vincent, 4000 Liège, Belgium
| | - F Devreker
- Laboratoire de Procréation Médicalement Assistée, Université Libre de Bruxelles, Hôpital Erasme, 1070 Brussels, Belgium
| | - M Dubois
- Centre de Procréation Médicalement Assistée, Université de Liège, 4000 Liège, Belgium
| | - N Gillain
- Nutrition, Environment and Health, University of Liège, 4000 Liège, Belgium
| | - S Gordts
- Leuven Institute for Fertility and Embryology, 3000 Leuven, Belgium
| | - C Wyns
- Department of Gynaecology-Andrology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, 1200 Brussels, Belgium
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Van den Bosch T, Dueholm M, Leone FPG, Valentin L, Rasmussen CK, Votino A, Van Schoubroeck D, Landolfo C, Installé AJF, Guerriero S, Exacoustos C, Gordts S, Benacerraf B, D'Hooghe T, De Moor B, Brölmann H, Goldstein S, Epstein E, Bourne T, Timmerman D. Terms, definitions and measurements to describe sonographic features of myometrium and uterine masses: a consensus opinion from the Morphological Uterus Sonographic Assessment (MUSA) group. Ultrasound Obstet Gynecol 2015; 46:284-98. [PMID: 25652685 DOI: 10.1002/uog.14806] [Citation(s) in RCA: 351] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2014] [Revised: 01/18/2015] [Accepted: 01/27/2015] [Indexed: 05/14/2023]
Abstract
The MUSA (Morphological Uterus Sonographic Assessment) statement is a consensus statement on terms, definitions and measurements that may be used to describe and report the sonographic features of the myometrium using gray-scale sonography, color/power Doppler and three-dimensional ultrasound imaging. The terms and definitions described may form the basis for prospective studies to predict the risk of different myometrial pathologies, based on their ultrasound appearance, and thus should be relevant for the clinician in daily practice and for clinical research. The sonographic features and use of terminology for describing the two most common myometrial lesions (fibroids and adenomyosis) and uterine smooth muscle tumors are presented.
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Affiliation(s)
- T Van den Bosch
- Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium
| | - M Dueholm
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - F P G Leone
- Department of Obstetrics and Gynecology, Clinical Sciences Institute L Sacco, University of Milan, Milan, Italy
| | - L Valentin
- Department of Obstetrics and Gynecology, Skåne University Hospital, Lund University, Malmö, Sweden
| | - C K Rasmussen
- Department of Obstetrics and Gynecology, Aarhus University Hospital, Aarhus, Denmark
| | - A Votino
- Department of Obstetrics and Gynecology, Brugmann University Hospital, Brussels, Belgium
| | - D Van Schoubroeck
- Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium
| | - C Landolfo
- Department of Obstetrics and Gynecology, Sant' Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - A J F Installé
- KU Leuven, Department of Electrical Engineering (ESAT), STADIUS, Center for Dynamical Systems, Signal Processing and Data Analytics, Leuven, Belgium
- iMinds Medical IT, Leuven, Belgium
| | - S Guerriero
- Department of Obstetrics and Gynaecology, Azienda Ospedaliera Universitaria of Cagliari and University of Cagliari, Cagliari, Italy
| | - C Exacoustos
- Department of Biomedicine and Prevention, Obstetrics and Gynecological Clinic, University of Rome 'Tor Vergata', Rome, Italy
| | - S Gordts
- L.I.F.E. (Leuven Institute for Fertility & Embryology), Leuven, Belgium
| | - B Benacerraf
- Departments of Radiology and Obstetrics & Gynecology, Harvard Medical School, Boston, MA, USA
| | - T D'Hooghe
- Leuven University Fertility Centre, University Hospitals KU Leuven, Leuven, Belgium
| | - B De Moor
- KU Leuven, Department of Electrical Engineering (ESAT), STADIUS, Center for Dynamical Systems, Signal Processing and Data Analytics, Leuven, Belgium
- iMinds Medical IT, Leuven, Belgium
| | - H Brölmann
- Department of Obstetrics and Gynecology, VU University Medical Center, Amsterdam, The Netherlands
| | - S Goldstein
- Department of Obstetrics and Gynecology, New York University School of Medicine, New York, NY, USA
| | - E Epstein
- Department of Obstetrics and Gynecology, Karolinska University Hospital, Stockholm, Sweden
| | - T Bourne
- Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium
- Queen Charlotte's and Chelsea Hospital, Imperial College, London, UK
| | - D Timmerman
- Department of Obstetrics and Gynecology, University Hospitals KU Leuven, Leuven, Belgium
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Di Spiezio Sardo A, Campo R, Gordts S, Spinelli M, Cosimato C, Tanos V, Brucker S, Li TC, Gergolet M, De Angelis C, Gianaroli L, Grimbizis G. The comprehensiveness of the ESHRE/ESGE classification of female genital tract congenital anomalies: a systematic review of cases not classified by the AFS system. Hum Reprod 2015; 30:1046-58. [PMID: 25788565 PMCID: PMC4400201 DOI: 10.1093/humrep/dev061] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Accepted: 02/11/2015] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION How comprehensive is the recently published European Society of Human Reproduction and Embryology (ESHRE)/European Society for Gynaecological Endoscopy (ESGE) classification system of female genital anomalies? SUMMARY ANSWER The ESHRE/ESGE classification provides a comprehensive description and categorization of almost all of the currently known anomalies that could not be classified properly with the American Fertility Society (AFS) system. WHAT IS KNOWN ALREADY Until now, the more accepted classification system, namely that of the AFS, is associated with serious limitations in effective categorization of female genital anomalies. Many cases published in the literature could not be properly classified using the AFS system, yet a clear and accurate classification is a prerequisite for treatment. STUDY DESIGN, SIZE AND DURATION The CONUTA (CONgenital UTerine Anomalies) ESHRE/ESGE group conducted a systematic review of the literature to examine if those types of anomalies that could not be properly classified with the AFS system could be effectively classified with the use of the new ESHRE/ESGE system. An electronic literature search through Medline, Embase and Cochrane library was carried out from January 1988 to January 2014. Three participants independently screened, selected articles of potential interest and finally extracted data from all the included studies. Any disagreement was discussed and resolved after consultation with a fourth reviewer and the results were assessed independently and approved by all members of the CONUTA group. PARTICIPANTS/MATERIALS, SETTING, METHODS Among the 143 articles assessed in detail, 120 were finally selected reporting 140 cases that could not properly fit into a specific class of the AFS system. Those 140 cases were clustered in 39 different types of anomalies. MAIN RESULTS AND THE ROLE OF CHANCE The congenital anomaly involved a single organ in 12 (30.8%) out of the 39 types of anomalies, while multiple organs and/or segments of Müllerian ducts (complex anomaly) were involved in 27 (69.2%) types. Uterus was the organ most frequently involved (30/39: 76.9%), followed by cervix (26/39: 66.7%) and vagina (23/39: 59%). In all 39 types, the ESHRE/ESGE classification system provided a comprehensive description of each single or complex anomaly. A precise categorization was reached in 38 out of 39 types studied. Only one case of a bizarre uterine anomaly, with no clear embryological defect, could not be categorized and thus was placed in Class 6 (un-classified) of the ESHRE/ESGE system. LIMITATIONS, REASONS FOR CAUTION The review of the literature was thorough but we cannot rule out the possibility that other defects exist which will also require testing in the new ESHRE/ESGE system. These anomalies, however, must be rare. WIDER IMPLICATIONS OF THE FINDINGS The comprehensiveness of the ESHRE/ESGE classification adds objective scientific validity to its use. This may, therefore, promote its further dissemination and acceptance, which will have a positive outcome in clinical care and research. STUDY FUNDING/COMPETING INTERESTS None.
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Affiliation(s)
- A Di Spiezio Sardo
- Congenital Uterine Malformations (CONUTA) Common ESHRE/ESGE Working Group, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - R Campo
- Congenital Uterine Malformations (CONUTA) Common ESHRE/ESGE Working Group, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - S Gordts
- Congenital Uterine Malformations (CONUTA) Common ESHRE/ESGE Working Group, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - M Spinelli
- Department of Obstetrics and Gynecology, University of Naples 'Federico II', Naples, Italy
| | - C Cosimato
- Department of Obstetrics and Gynecology, University of Salerno, Fisciano (SA), Italy
| | - V Tanos
- Congenital Uterine Malformations (CONUTA) Common ESHRE/ESGE Working Group, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - S Brucker
- Congenital Uterine Malformations (CONUTA) Common ESHRE/ESGE Working Group, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - T C Li
- Congenital Uterine Malformations (CONUTA) Common ESHRE/ESGE Working Group, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - M Gergolet
- Congenital Uterine Malformations (CONUTA) Common ESHRE/ESGE Working Group, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - C De Angelis
- Congenital Uterine Malformations (CONUTA) Common ESHRE/ESGE Working Group, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - L Gianaroli
- Congenital Uterine Malformations (CONUTA) Common ESHRE/ESGE Working Group, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium
| | - G Grimbizis
- Congenital Uterine Malformations (CONUTA) Common ESHRE/ESGE Working Group, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium
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Gordts S, Puttemans P, Gordts S, Brosens I. Ovarian endometrioma in the adolescent: a plea for early-stage diagnosis and full surgical treatment. ACTA ACUST UNITED AC 2015; 12:21-30. [PMID: 25774119 PMCID: PMC4349957 DOI: 10.1007/s10397-014-0877-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 12/26/2014] [Indexed: 11/09/2022]
Abstract
The incidence and severity of endometriosis in adolescent are comparable with the incidence in adult women. The mean delay between the onset of symptoms and the final diagnosis varies between 6.4 and 11.7 years. The longer the diagnosis is delayed, the more the endometriosis can progress to a more severe stage certainly in the group of patients with pelvic pain. The evolution of endometriosis and its progressivity are not predictable, and the severity of the disease is not directly related to the degree of pain. Endometriotic cysts have a detrimental effect on the ovarian reserve by the evolution in time and the surgical excision technique. Already, in small endometriotic cysts (<4 cm), loss of follicular reserve is present together with the formation of fibrosis in the cortex of the ovary. Early diagnosis of endometriosis in the adolescent deserves our full attention. Non-invasive imaging techniques like 2-D and 3-D ultrasound are helpful in the early diagnosis. Early ablative surgery is recommendable. Although laparoscopy is traditionally recommended, transvaginal laparoscopy has been shown to be most effective in ablating endometriomas with a maximum diameter of 3 cm. Early detection and intervention will contribute to a better quality of life in these adolescents and also to a lower damage of the ovarian tissue by a less invasive ablative surgery.
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Affiliation(s)
- Stephan Gordts
- Leuven Institute for Fertility & Embryology, Tiensevest 168, 3000 Leuven, Belgium
| | - Patrick Puttemans
- Leuven Institute for Fertility & Embryology, Tiensevest 168, 3000 Leuven, Belgium
| | - Sylvie Gordts
- Leuven Institute for Fertility & Embryology, Tiensevest 168, 3000 Leuven, Belgium
| | - Ivo Brosens
- Leuven Institute for Fertility & Embryology, Tiensevest 168, 3000 Leuven, Belgium
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Gordts S. Editorial. Facts Views Vis Obgyn 2015; 7:147-8. [PMID: 26977263 PMCID: PMC4788328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- S. Gordts
- Leuven Institute for Fertility & Embryology
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Lopes AS, Frederickx V, Van Kerkhoven G, Campo R, Puttemans P, Gordts S. Survival, re-expansion and cell survival of human blastocysts following vitrification and warming using two vitrification systems. J Assist Reprod Genet 2014; 32:83-90. [PMID: 25381622 DOI: 10.1007/s10815-014-0373-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 10/20/2014] [Indexed: 11/25/2022] Open
Abstract
PURPOSE This study evaluated and compared survival, re-expansion, and percentage of live cells of individual Days 5 and 6 human blastocysts that were vitrified and warmed with the Vit Kit Freeze/Thaw (Irvine Scientific, CA), or with two protocols using the Global Fast Freeze/Thaw Kits (LifeGlobal, Canada). METHODS Frozen/thawed Day 2-3 or discarded embryos were cultured to blastocyst (culture day 5-6). Group 1 blastocysts were vitrified with the Vit Kit (n = 29) and High Security Vitrification (HSV) devices. Group 2 (n = 47) and Group 3 (n = 48) blastocysts were cryopreserved with the Global Fast Freeze Kit and 0.25 ml straws, using a direct plunge or a -100 °C holding step, respectively. Group 4 (Controls, n = 30) were not vitrified. Blastocysts were subsequently cultured for 24 h, assessed for survival and expansion, and then stained individually with propidium iodide and Hoechst. Live and total cell number was assessed with ImageJ (NIH), and the percentage of live cells calculated for each blastocyst. RESULTS The percentage of live cells was not different between vitrified and control (non-vitrified) blastocysts, thus vitrification did not affect cell survival. Survival (following thawing and after 24 h culture), re-expansion, and percentage of live cells were not different for blastocysts vitrified and warmed between the two vitrification/warming kits, or between the two protocols for the Global Fast Freeze/Thaw Kits. CONCLUSIONS Blastocyst vitrification can be achieved with equal success using simplified protocols and cheaper and easy to load freezing straws, providing simultaneously increased safety, and efficiency with lower cost, when compared with vitrification using specialized embryo vitrification devices.
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Affiliation(s)
- Ana S Lopes
- LIFE-Leuven Institute for Fertility and Embryology, Tiensevest 168, 3000, Leuven, Belgium,
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Abstract
In 1908, Cullen described the first cases of cystic adenomyosis in his textbook on adenomyomata. Although not very common, with the introduction of noninvasive imaging techniques such as magnetic resonance imaging (MRI) and 3-D transvaginal ultrasound, an increasing number of cases have been reported. Patients primarily complain of severe dysmenorrhea, chronic pelvic pain, and dysfunctional uterine bleeding. Currently, it is unclear whether adenomyosis and, more specifically, cystic adenomyosis can be an underlying reason for impaired fertility and reproductive outcome. With the postponement of childbearing, the number of patients with adenomyosis and cystic adenomyosis seeking fertility treatment is increasing. Therefore, in these patients, uterine exploration should include not only the evaluation of the endometrial cavity but also the exploration of the sub-endometrial zone. Indirect imaging techniques, combined with office mini-hysteroscopy, offer the possibility of complete uterine exploration. Two patients with cystic adenomyosis are described in this paper: one had the chief complaint of menorrhagia and the other was referred for evaluation of infertility and severe dysmenorrhea. The aim of these case reports is to present hysteroscopic dissection and ablation of adenomyotic cysts as an alternative procedure for the surgical management of this condition.
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Affiliation(s)
- S Gordts
- Leuven Institute for Fertility & Embryology, Tiensevest 168, 3000 Leuven, Belgium
| | - R Campo
- Leuven Institute for Fertility & Embryology, Tiensevest 168, 3000 Leuven, Belgium
| | - I Brosens
- Leuven Institute for Fertility & Embryology, Tiensevest 168, 3000 Leuven, Belgium
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De Neubourg D, Bogaerts K, Wyns C, Camus M, Delbaere A, Delvigne A, De Sutter P, Dubois M, Gordts S, Lejeune B, Leroy F, Vandekerckhove F, D'Hooghe T. Reply: the danger of ignoring pregnancy and delivery rates in ART. Hum Reprod 2014; 29:1830-1. [PMID: 24491298 DOI: 10.1093/humrep/deu010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- D De Neubourg
- LUFC - Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - K Bogaerts
- I-BioStat, Katholieke Universiteit Leuven and Universiteit Hasselt, Leuven, Belgium
| | - C Wyns
- Department of Gynaecology-Andrology, Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - M Camus
- Centre for Reproductive Medicine, Free University of Brussels, Brussels, Belgium
| | - A Delbaere
- Fertility Clinic, Dept Ob/Gyn, Hopital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - A Delvigne
- Centre de PMA, Clinique Saint-Vincent, Liège, Belgium
| | - P De Sutter
- Department of Reproductive Medicine, University Hospital Gent, Gent, Belgium
| | - M Dubois
- Centre de Procréation Médicalement Assistée, Université de Liège, Liège, Belgium
| | - S Gordts
- Leuven Institute for Fertility and Embryology, Leuven, Belgium
| | - B Lejeune
- Centre de Procréation Médicalement Assistée, Centre Hospitalier Inter Régional Edith Cavell, Braine l'Alleud, Belgium
| | - F Leroy
- Department of Obstetrics and Gynaecology, Université Libre de Bruxelles, Brussels, Belgium
| | - F Vandekerckhove
- Department of Reproductive Medicine, University Hospital Gent, Gent, Belgium
| | - T D'Hooghe
- LUFC - Department of Obstetrics and Gynaecology, University Hospitals Leuven, Leuven, Belgium Department of Development and Regeneration, KU Leuven, Leuven, Belgium
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Brosens I, Gordts S, Puttemans P, Benagiano G. Pathophysiology proposed as the basis for modern management of the ovarian endometrioma. Reprod Biomed Online 2014; 28:232-8. [DOI: 10.1016/j.rbmo.2013.09.024] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 07/05/2013] [Accepted: 09/12/2013] [Indexed: 11/28/2022]
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Grimbizis GF, Gordts S, Di Spiezio Sardo A, Brucker SY, De Angelis C, Gergolet M, Li TC, Tanos V, Brölmann HH, Gianaroli L, Campo R. Reply: are the ESHRE/ESGE criteria of female genital anomalies for diagnosis of septate uterus appropriate? Hum Reprod 2014; 29:868-9. [PMID: 24480715 DOI: 10.1093/humrep/deu002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- G F Grimbizis
- Congenital Uterine Malformations (CONUTA) Common ESHRE/ESGE Working Group, ESGE Central Office, Diestsgvest 43/0001, 3000 Leuven, Belgium
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Brosens I, Gordts S, Benagiano G. Endometriosis in adolescents is a hidden, progressive and severe disease that deserves attention, not just compassion. Hum Reprod 2013; 28:2026-31. [PMID: 23739215 PMCID: PMC3712662 DOI: 10.1093/humrep/det243] [Citation(s) in RCA: 104] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Revised: 04/06/2013] [Accepted: 04/29/2013] [Indexed: 11/16/2022] Open
Abstract
Endometriosis in the adolescent has, in recent years, been discovered to be a challenging problem in gynaecology. Although the pain may start at a young age, even before the onset of menstruation, the diagnosis by laparoscopy is almost always postponed for several years, by which time destructive lesions have affected the tubo-ovarian structures and severely compromised fecundability. Several factors may play a role, but one important reason for this disease progression is likely to be the delay in diagnosis. Therefore, transvaginal ultrasounds and transvaginal access with a less invasive needle endoscopy are recommended for exploration of the pelvis, diagnosis of endometriosis and treatment at an early stage before severe lesions develop.
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Affiliation(s)
- I Brosens
- Leuven Institute for Fertility and Embryology, Leuven, Belgium.
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De Neubourg D, Bogaerts K, Wyns C, Albert A, Camus M, Candeur M, Degueldre M, Delbaere A, Delvigne A, De Sutter P, Dhont M, Dubois M, Englert Y, Gillain N, Gordts S, Hautecoeur W, Lesaffre E, Lejeune B, Leroy F, Ombelet W, Perrier D'Hauterive S, Vandekerckhove F, Van der Elst J, D'Hooghe T. The history of Belgian assisted reproduction technology cycle registration and control: a case study in reducing the incidence of multiple pregnancy. Hum Reprod 2013; 28:2709-19. [PMID: 23820420 DOI: 10.1093/humrep/det269] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
STUDY QUESTION What is the effect of a legal limitation of the number of embryos that can be transferred in an assisted reproductive technology (ART) cycle on the multiple delivery rate? SUMMARY ANSWER The Belgian national register shows that the introduction of reimbursement of ART laboratory costs in July 2003, and the imposition of a legal limitation of the number of embryos transferred in the same year, were associated with a >50% reduction of the multiple pregnancy rate from 27 to 11% between 2003 and the last assessment in 2010, without any reduction of the pregnancy rate per cycle. WHAT IS KNOWN ALREADY Individual Belgian IVF centres have published their results since the implementation of the law, and these show a decrease in the multiple pregnancy rate on a centre by centre basis. However, the overall national picture remains unpublished. STUDY DESIGN, SIZE, DURATION Cohort study from 1990 to 2010 of all ART cycles in Belgium (2685 cycles in 1990 evolving to 19 110 cycles in 2010), with a retrospective analysis from 1990 to 2000 and prospective online data collection since 2001. PARTICIPANTS/MATERIALS, SETTING, METHODS Registration evolved from paper written reports per centre to a compulsory online registration of all ART cycles. From 2001 up to mid-2009, data were collected from Excel spread sheets or MS Access files into an MS Access database. Since mid-2009, data collection is done via a remote and secured web-based system (www.belrap.be) where centres can upload their data and get immediate feedback about missing data, errors and inconsistencies. MAIN RESULTS AND THE ROLE OF CHANCE National Belgian registration data show that reimbursement of IVF laboratory costs in July 2003, coupled to a legal limitation in the number of embryos transferred in utero, were associated with a 50% reduction of the multiple pregnancy rate from 27 to 11% without reduction of the pregnancy rate per cycle, and with an increase in the number of fresh and frozen ART cycles due to improved access to treatment. LIMITATIONS, REASONS FOR CAUTION There is potential underreporting of complications of ART treatment, pregnancy outcome and neonatal health. WIDER IMPLICATIONS OF THE FINDINGS Over the 20 years of registration, the pregnancy rate has remained constant, despite the reduction in the number of embryos transferred, optimization of laboratory procedures and stimulation protocols, introduction of quality systems and implementation of the EU Tissue Directive over the period 2004-2010. STUDY FUNDING/COMPETING INTEREST(S) No external funding was sought for this study. None of the authors has any conflict of interest to declare.
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Affiliation(s)
- D De Neubourg
- Department of Obstetrics and Gynaecology, LUFC, University Hospitals Leuven, Leuven, Belgium
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Grimbizis GF, Gordts S, Di Spiezio Sardo A, Brucker S, De Angelis C, Gergolet M, Li TC, Tanos V, Brölmann H, Gianaroli L, Campo R. The ESHRE/ESGE consensus on the classification of female genital tract congenital anomalies. Hum Reprod 2013; 28:2032-44. [PMID: 23771171 PMCID: PMC3712660 DOI: 10.1093/humrep/det098] [Citation(s) in RCA: 385] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
STUDY QUESTION What classification system is more suitable for the accurate, clear, simple and related to the clinical management categorization of female genital anomalies? SUMMARY ANSWER The new ESHRE/ESGE classification system of female genital anomalies is presented. WHAT IS KNOWN ALREADY Congenital malformations of the female genital tract are common miscellaneous deviations from normal anatomy with health and reproductive consequences. Until now, three systems have been proposed for their categorization but all of them are associated with serious limitations. STUDY DESIGN, SIZE AND DURATION The European Society of Human Reproduction and Embryology (ESHRE) and the European Society for Gynaecological Endoscopy (ESGE) have established a common Working Group, under the name CONUTA (CONgenital UTerine Anomalies), with the goal of developing a new updated classification system. A scientific committee (SC) has been appointed to run the project, looking also for consensus within the scientists working in the field. PARTICIPANTS/MATERIALS, SETTING, METHODS The new system is designed and developed based on (i) scientific research through critical review of current proposals and preparation of an initial proposal for discussion between the experts, (ii) consensus measurement among the experts through the use of the DELPHI procedure and (iii) consensus development by the SC, taking into account the results of the DELPHI procedure and the comments of the experts. Almost 90 participants took part in the process of development of the ESHRE/ESGE classification system, contributing with their structured answers and comments. MAIN RESULTS AND THE ROLE OF CHANCE The ESHRE/ESGE classification system is based on anatomy. Anomalies are classified into the following main classes, expressing uterine anatomical deviations deriving from the same embryological origin: U0, normal uterus; U1, dysmorphic uterus; U2, septate uterus; U3, bicorporeal uterus; U4, hemi-uterus; U5, aplastic uterus; U6, for still unclassified cases. Main classes have been divided into sub-classes expressing anatomical varieties with clinical significance. Cervical and vaginal anomalies are classified independently into sub-classes having clinical significance. LIMITATIONS, REASONS FOR CAUTION The ESHRE/ESGE classification of female genital anomalies seems to fulfill the expectations and the needs of the experts in the field, but its clinical value needs to be proved in everyday practice. WIDER IMPLICATIONS OF THE FINDINGS The ESHRE/ESGE classification system of female genital anomalies could be used as a starting point for the development of guidelines for their diagnosis and treatment. STUDY FUNDING/COMPETING INTEREST(S) None.
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Affiliation(s)
- Grigoris F Grimbizis
- Congenital Uterine Malformations (CONUTA) common ESHRE/ESGE Working Group, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium.
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Gandhi G, Allahbadia G, Kagalwala S, Allahbadia A, Ramesh S, Patel K, Hinduja R, Chipkar V, Madne M, Ramani R, Joo JK, Jeung JE, Go KR, Lee KS, Goto H, Hashimoto S, Amo A, Yamochi T, Iwata H, Morimoto Y, Koifman M, Lahav-Baratz S, Blais E, Megnazi-Wiener Z, Ishai D, Auslender R, Dirnfeld M, Zaletova V, Zakharova E, Krivokharchenko I, Zaletov S, Zhu L, Li Y, Zhang H, Ai J, Jin L, Zhang X, Rajan N, Kovacs A, Foley C, Flanagan J, O'Callaghan J, Waterstone J, Dineen T, Dahdouh EM, St-Michel P, Granger L, Carranza-Mamane B, Faruqi F, Kattygnarath TV, Gomes FLAF, Christoforidis N, Ioakimidou C, Papas C, Moisidou M, Chatziparasidou A, Klaver M, Tilleman K, De Sutter P, Lammers J, Freour T, Splingart C, Barriere P, Ikeno T, Nakajyo Y, Sato Y, Hirata K, Kyoya T, Kyono K, Campos FB, Meseguer M, Nogales M, Martinez E, Ariza M, Agudo D, Rodrigo L, Garcia-Velasco JA, Lopes AS, Frederickx V, Vankerkhoven G, Serneels A, Roziers P, Puttermans P, Campo R, Gordts S, Fragouli E, Alfarawati S, Spath K, Wells D, Liss J, Lukaszuk K, Glowacka J, Bruszczynska A, Gallego SC, Lopez LO, Vila EO, Garcia MG, Canas CL, Segovia AG, Ponce AG, Calonge RN, Peregrin PC, Hashimoto S, Amo A, Ito K, Nakaoka Y, Morimoto Y, Alcoba DD, Valerio EG, Conzatti M, Tornquist J, Kussler AP, Pimentel AM, Corleta HE, Brum IS, Boyer P, Montjean D, Tourame P, Gervoise-Boyer M, Cohen J, Lefevre B, Radio CI, Wolf JP, Ziyyat A, De Croo I, Tolpe A, Degheselle S, Van de Velde A, Tilleman K, De Sutter P, Van den Abbeel E, Kagalwala S, Gandhi G, Allahbadia G, Kuwayama M, Allahbadia A, Chipkar V, Khatoon A, Ramani R, Madne M, Alsule S, Inaba M, Ohgaki A, Ohtani A, Matsumoto H, Mizuno S, Mori R, Fukuda A, Morimoto Y, Umekawa Y, Yoshida A, Tanigiwa S, Seida K, Suzuki H, Tanaka M, Vahabi Z, Yazdi PE, Dalman A, Ebrahimi B, Mostafaei F, Niknam MR, Watanabe S, Kamihata M, Tanaka T, Matsunaga R, Yamanaka N, Kani C, Ishikawa T, Wada T, Morita H, Miyamura H, Nishio E, Ito M, Kuwahata A, Ochi M, Horiuchi T, Dal Canto M, Guglielmo MC, Fadini R, Renzini MM, Albertini DF, Novara P, Lain M, Brambillasca F, Turchi D, Sottocornola M, Coticchio G, Kato M, Fukunaga N, Nagai R, Kitasaka H, Yoshimura T, Tamura F, Hasegawa N, Nakayama K, Takeuchi M, Ohno H, Aoyagi N, Kojima E, Itoi F, Hashiba Y, Asada Y, Kikuchi H, Iwasa Y, Kamono T, Suzuki A, Yamada K, Kanno H, Sasaki K, Murakawa H, Matsubara M, Yoshida H, Valdespin C, Elhelaly M, Chen P, Pangestu M, Catt S, Hojnik N, Kovacic B, Roglic P, Taborin M, Zafosnik M, Knez J, Vlaisavljevic V, Mori C, Yabuuchi A, Ezoe K, Takayama Y, Aono F, Kato K, Radwan P, Krasinski R, Chorobik K, Radwan M, Stoppa M, Maggiulli R, Capalbo A, Ievoli E, Dovere L, Scarica C, Albricci L, Romano S, Sanges F, Barnocchi N, Papini L, Vivarelli A, Ubaldi FM, Rienzi L, Rienzi L, Bono S, Capalbo A, Spizzichino L, Rubio C, Ubaldi FM, Fiorentino F, Ferris J, Favetta LA, MacLusky N, King WA, Madani T, Jahangiri N, Aflatoonian R, Cater E, Hulme D, Berrisford K, Jenner L, Campbell A, Fishel S, Zhang XY, Yilmaz A, Hananel H, Ao A, Vutyavanich T, Piromlertamorn W, Saenganan U, Samchimchom S, Wirleitner B, Lejeune B, Zech NH, Vanderzwalmen P, Albani E, Parini V, Smeraldi A, Menduni F, Antonacci R, Marras A, Levi S, Morreale G, Pisano B, Di Biase A, Di Rosa A, Setti PEL, Puard V, Cadoret V, Tranchant T, Gauthier C, Reiter E, Guerif F, Royere D, Yoon SY, Eum JH, Park EA, Kim TY, Yoon TK, Lee DR, Lee WS, Cabal AC, Vallejo B, Campos P, Sanchez E, Serrano J, Remohi J, Nagornyy V, Mazur P, Mykytenko D, Semeniuk L, Zukin V, Guilherme P, Madaschi C, Bonetti TCS, Fassolas G, Izzo CR, Santos MJDL, Beltran D, Garcia-Laez V, Escriba MJ, Grau N, Escrich L, Albert C, Zuzuarregui JL, Pellicer A, LU Y, Nikiforaki D, Meerschaut FV, Neupane J, De Vos WH, Lierman S, Deroo T, Heindryckx B, De Sutter P, Li J, Chen XY, Lin G, Huang GN, Sun ZY, Zhong Y, Zhang B, Li T, Zhang SP, Ye H, Han SB, Liu SY, Zhou J, Lu GX, Zhuang GL, Muela L, Roldan M, Gadea B, Martinez M, Perez I, Meseguer M, Munoz M, Castello C, Asensio M, Fernandez P, Farreras A, Rovira S, Capdevila JM, Velilla E, Lopez-Teijon M, Kovacs P, Matyas SZ, Forgacs V, Reichart A, Rarosi F, Bernard A, Torok A, Kaali SG, Sajgo A, Pribenszky CS, Sozen B, Ozturk S, Yaba-Ucar A, Demir N, Gelo N, Stanic P, Hlavati V, ogoric S, Pavicic-Baldani D, prem-Goldtajn M, Radakovic B, Kasum M, Strelec M, Canic T, imunic V, Vrcic H, Ajina M, Negra D, Ben-Ali H, Jallad S, Zidi I, Meddeb S, Bibi M, Khairi H, Saad A, Escrich L, Grau N, Meseguer M, Gamiz P, Viloria T, Escriba MJ, Lima ET, Fernandez MP, Prieto JAA, Varela MO, Kassa D, Munoz EM, Morita H, Watanabe S, Kamihata M, Matsunaga R, Wada T, Kani K, Ishikawa T, Miyamura H, Ito M, Kuwahata A, Ochi M, Horiuchi T, Nor-Ashikin MNK, Norhazlin JMY, Norita S, Wan-Hafizah WJ, Mohd-Fazirul M, Razif D, Hoh BP, Dale S, Cater E, Woodhead G, Jenner L, Fishel S, Andronikou S, Francis G, Tailor S, Vourliotis M, Almeida PA, Krivega M, Van de Velde H, Lee RK, Hwu YM, Lu CH, Li SH, Vaiarelli A, Antonacci R, Smeraldi A, Desgro M, Albani E, Baggiani A, Zannoni E, Setti PEL, Kermavner LB, Klun IV, Pinter B, Vrtacnik-Bokal E, De Paepe C, Cauffman G, Verheyen G, Stoop D, Liebaers I, Van de Velde H, Stecher A, Wirleitner B, Vanderzwalmen P, Zintz M, Neyer A, Bach M, Baramsai B, Schwerda D, Zech NH, Wiener-Megnazi Z, Fridman M, Koifman M, Lahav-Baratz S, Blais I, Auslender R, Dirnfeld M, Akerud H, Lindgren K, Karehed K, Wanggren K, Hreinsson J, Rovira S, Capdevila JM, Freijomil B, Castello C, Farreras A, Fernandez P, Asensio M, Lopez-Teijon M, Velilla E, Weiss A, Neril R, Geslevich J, Beck-Fruchter R, Lavee M, Golan J, Ermoshkin A, Shalev E, Shi W, Zhang S, Zhao W, Xue XIA, Wang MIN, Bai H, Shi J, Smith HL, Shaw L, Kimber S, Brison D, Boumela I, Assou S, Haouzi D, Ahmed OA, Dechaud H, Hamamah S, Dasiman R, Nor-Shahida AR, Wan-Hafizah WJ, Norhazlin JMY, Mohd-Fazirul M, Salina O, Gabriele RAF, Nor-Ashikin MNK, Ben-Yosef D, Shwartz T, Cohen T, Carmon A, Raz NM, Malcov M, Frumkin T, Almog B, Vagman I, Kapustiansky R, Reches A, Azem F, Amit A, Cetinkaya M, Pirkevi C, Yelke H, Kumtepe Y, Atayurt Z, Kahraman S, Risco R, Hebles M, Saa AM, Vilches-Ferron MA, Sanchez-Martin P, Lucena E, Lucena M, Heras MDL, Agirregoikoa JA, Martinez E, Barrenetxea G, De Pablo JL, Lehner A, Pribenszky C, Murber A, Rigo J, Urbancsek J, Fancsovits P, Bano DG, Sanchez-Leon A, Marcos J, Molla M, Amorocho B, Nicolas M, Fernandez L, Landeras J, Adeniyi OA, Ehbish SM, Brison DR, Egashira A, Murakami M, Nagafuchi E, Tanaka K, Tomohara A, Mine C, Otsubo H, Nakashima A, Otsuka M, Yoshioka N, Kuramoto T, Choi D, Yang H, Park JH, Jung JH, Hwang HG, Lee JH, Lee JE, Kang AS, Yoo JH, Kwon HC, Lee SJ, Bang S, Shin H, Lim HJ, Min SH, Yeon JY, Koo DB, Kuwayama M, Higo S, Ruvalcaba L, Kobayashi M, Takeuchi T, Yoshida A, Miwa A, Nagai Y, Momma Y, Takahashi K, Chuko M, Nagai A, Otsuki J, Kim SG, Lee JH, Kim YY, Kim HJ, Park IH, Sun HG, Lee KH, Song HJ, Costa-Borges N, Belles M, Herreros J, Teruel J, Ballesteros A, Pellicer A, Calderon G, Nikiforaki D, Vossaert L, Meerschaut FV, Qian C, Lu Y, Parys JB, De Vos WH, Deforce D, Deroo T, Van den Abbeel E, Leybaert L, Heindryckx B, De Sutter P, Surlan L, Otasevic V, Velickovic K, Golic I, Vucetic M, Stankovic V, Stojnic J, Radunovic N, Tulic I, Korac B, Korac A, Fancsovits P, Pribenszky C, Lehner A, Murber A, Rigo J, Urbancsek J, Elias R, Neri QV, Fields T, Schlegel PN, Rosenwaks Z, Palermo GD, Gilson A, Piront N, Heens B, Vastersaegher C, Vansteenbrugge A, Pauwels PCP, Abdel-Raheem MF, Abdel-Rahman MY, Abdel-Gaffar HM, Sabry M, Kasem H, Rasheed SM, Amin M, Abdelmonem A, Ait-Allah AS, VerMilyea M, Anthony J, Bucci J, Croly S, Coutifaris C, Maggiulli R, Rienzi L, Cimadomo D, Capalbo A, Dusi L, Colamaria S, Baroni E, Giuliani M, Vaiarelli A, Sapienza F, Buffo L, Ubaldi FM, Zivi E, Aizenman E, Barash D, Gibson D, Shufaro Y, Perez M, Aguilar J, Taboas E, Ojeda M, Suarez L, Munoz E, Casciani V, Minasi MG, Scarselli F, Terribile M, Zavaglia D, Colasante A, Franco G, Greco E, Hickman C, Cook C, Gwinnett D, Trew G, Carby A, Lavery S, Asgari L, Paouneskou D, Jayaprakasan K, Maalouf W, Campbell BK, Aguilar J, Taboas E, Perez M, Munoz E, Ojeda M, Remohi J, Rega E, Alteri A, Cotarelo RP, Rubino P, Colicchia A, Giannini P, Devjak R, Papler TB, Tacer KF, Verdenik I, Scarica C, Ubaldi FM, Stoppa M, Maggiulli R, Capalbo A, Ievoli E, Dovere L, Albricci L, Romano S, Sanges F, Vaiarelli A, Iussig B, Gala A, Ferrieres A, Assou S, Vincens C, Bringer-Deutsch S, Brunet C, Hamamah S, Conaghan J, Tan L, Gvakharia M, Ivani K, Chen A, Pera RR, Bowman N, Montgomery S, Best L, Campbell A, Duffy S, Fishel S, Hirata R, Aoi Y, Habara T, Hayashi N, Dinopoulou V, Partsinevelos GA, Bletsa R, Mavrogianni D, Anagnostou E, Stefanidis K, Drakakis P, Loutradis D, Hernandez J, Leon CL, Puopolo M, Palumbo A, Atig F, Kerkeni A, Saad A, Ajina M, D'Ommar G, Herrera AK, Lozano L, Majerfeld M, Ye Z, Zaninovic N, Clarke R, Bodine R, Rosenwaks Z, Mazur P, Nagorny V, Mykytenko D, Semeniuk L, Zukin V, Zabala A, Pessino T, Outeda S, Blanco L, Leocata F, Asch R, Wan-Hafizah WJ, Rajikin MH, Nuraliza AS, Mohd-Fazirul M, Norhazlin JMY, Razif D, Nor-Ashikin MNK, Machac S, Hubinka V, Larman M, Koudelka M, Budak TP, Membrado OO, Martinez ES, Wilson P, McClure A, Nargund G, Raso D, Insua MF, Lotti B, Giordana S, Baldi C, Barattini J, Cogorno M, Peri NF, Neuspiller F, Resta S, Filannino A, Maggi E, Cafueri G, Ferraretti AP, Magli MC, Gianaroli L, Sioga A, Oikonomou Z, Chatzimeletiou K, Oikonomou L, Kolibianakis E, Tarlatzis BC, Sarkar MR, Ray D, Bhattacharya J, Alises JM, Gumbao D, Sanchez-Leon A, Amorocho B, Molla M, Nicolas M, Fernandez L, Landeras J, Duffy S, Campbell A, Montgomery S, Hickman CFL, Fishel S, Fiorentino I, Gualtieri R, Barbato V, Braun S, Mollo V, Netti P, Talevi R, Bayram A, Findikli N, Serdarogullari M, Sahin O, Ulug U, Tosun SB, Bahceci M, Leon AS, Gumbao D, Marcos J, Molla M, Amorocho B, Nicolas M, Fernandez L, Landeras J, Cardoso MCA, Aguiar APS, Sartorio C, Evangelista A, Gallo-Sa P, Erthal-Martins MC, Mantikou E, Jonker MJ, de Jong M, Wong KM, van Montfoort APA, Breit TM, Repping S, Mastenbroek S, Power E, Montgomery S, Duffy S, Jordan K, Campbell A, Fishel S, Findikli N, Aksoy T, Gultomruk M, Aktan A, Goktas C, Ulug U, Bahceci M, Petracco R, Okada L, Azambuja R, Badalotti F, Michelon J, Reig V, Kvitko D, Tagliani-Ribeiro A, Badalotti M, Petracco A, Pirkevi C, Cetinkaya M, Yelke H, Kumtepe Y, Atayurt Z, Kahraman S, Aydin B, Cepni I, Serdarogullari M, Findikli N, Bayram A, Goktas C, Sahin O, Ulug U, Bahceci M, Rodriguez-Arnedo D, Ten J, Guerrero J, Ochando I, Perez M, Bernabeu R, Okada L, Petracco R, Azambuja R, Badalotti F, Michelon J, Reig V, Tagliani-Ribeiro A, Kvitko D, Badalotti M, Petracco A, Reig V, Kvitko D, Tagliani-Ribeiro A, Okada L, Azambuja R, Petracco R, Michelon J, Badalotti F, Petracco A, Badalotti M. Embryology. Hum Reprod 2013. [DOI: 10.1093/humrep/det210] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Grimbizis GF, Gordts S, Di Spiezio Sardo A, Brucker S, De Angelis C, Gergolet M, Li TC, Tanos V, Brölmann H, Gianaroli L, Campo R. The ESHRE-ESGE consensus on the classification of female genital tract congenital anomalies. ACTA ACUST UNITED AC 2013; 10:199-212. [PMID: 23894234 PMCID: PMC3718988 DOI: 10.1007/s10397-013-0800-x] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Accepted: 04/08/2013] [Indexed: 11/12/2022]
Abstract
The new ESHRE/ESGE classification system of female genital anomalies is presented, aiming to provide a more suitable classification system for the accurate, clear, correlated with clinical management and simple categorization of female genital anomalies. Congenital malformations of the female genital tract are common miscellaneous deviations from normal anatomy with health and reproductive consequences. Until now, three systems have been proposed for their categorization, but all of them are associated with serious limitations. The European Society of Human Reproduction and Embryology (ESHRE) and the European Society for Gynaecological Endoscopy (ESGE) have established a common Working Group, under the name CONUTA (CONgenital UTerine Anomalies), with the goal of developing a new updated classification system. A scientific committee has been appointed to run the project, looking also for consensus within the scientists working in the field. The new system is designed and developed based on: (1) scientific research through critical review of current proposals and preparation of an initial proposal for discussion between the experts, (2) consensus measurement among the experts through the use of the DELPHI procedure and (3) consensus development by the scientific committee, taking into account the results of the DELPHI procedure and the comments of the experts. Almost 90 participants took part in the process of development of the ESHRE/ESGE classification system, contributing with their structured answers and comments. The ESHRE/ESGE classification system is based on anatomy. Anomalies are classified into the following main classes, expressing uterine anatomical deviations deriving from the same embryological origin: U0, normal uterus; U1, dysmorphic uterus; U2, septate uterus; U3, bicorporeal uterus; U4, hemi-uterus; U5, aplastic uterus; U6, for still unclassified cases. Main classes have been divided into sub-classes expressing anatomical varieties with clinical significance. Cervical and vaginal anomalies are classified independently into sub-classes having clinical significance. The ESHRE/ESGE classification of female genital anomalies seems to fulfil the expectations and the needs of the experts in the field, but its clinical value needs to be proved in everyday practice. The ESHRE/ESGE classification system of female genital anomalies could be used as a starting point for the development of guidelines for their diagnosis and treatment.
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Affiliation(s)
- Grigoris F Grimbizis
- Congenital Uterine Anomalies (CONUTA) common ESHRE-ESGE Working Group, ESGE Central Office, Diestsevest 43/0001, 3000 Leuven, Belgium ; First Department of Obstetrics & Gynecology, Aristotle University of Thessaloniki, Tsimiski 51 Street, 54623 Thessaloniki, Greece
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Abstract
The introduction of in-vitro fertilisation within reproductive medicine has prompted questions to be asked about the relevance of reproductive surgery. Reproductive surgery is more than a competing discipline; it is complementary to the techniques of in-vitro fertilisation. As a complementary discipline, reproductive surgery covers the field of tubal and ovarian pathology and correction of uterine alterations. In recent decades, more attention has been paid to the importance of the uterus in the process of conception and implantation. The place of reproductive surgery and the existing controversies in the treatment of uterine congenital and acquired pathology, tubal, and ovarian surgery are discussed. Continuous training and accreditation programmes for reproductive technologies and surgery are more important than ever.
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Affiliation(s)
- Stephan Gordts
- Leuven Institute for Fertility and Embryology, Tiensevest 168, 3000 Leuven, Belgium.
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Brosens I, Puttemans P, Gordts S, Campo R, Gordts S, Benagiano G. Early stage management of ovarian endometrioma to prevent infertility. Facts Views Vis Obgyn 2013; 5:309-14. [PMID: 24753958 PMCID: PMC3987377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
There are now convincing data showing that cystectomy of the endometrioma is not only no cure of infertility, but may harm follicle reserve. The question arises why is cystectomy for an endometrioma, in contrast with other -benign cysts, a risk for follicle reserve and how can ovarian damage be prevented. Surgical specimens of ovaries with endometrioma in situ show in the majority of cases manifestly a combined -extra-ovarian and intra-ovarian pathology with the cortex invaginated to form a pseudocyst. The extra-ovarian pathology includes endometrial lining of the cortex, bleeding and adhesions with surrounding tissues. The intra-ovarian pathology is characterized by microscopic stromal implants, fibrosis, smooth muscle metaplasia and -arteriosclerosis, all affecting follicle reserve in the endometrioma bed. Clinically, ovarioscopy allows differential diagnosis (e.g. luteal cyst) and evaluation of the degree of fibrosis and darkening of the cortical wall. Transvaginal colour Doppler sonography can demonstrate the presence and extent of devascularisation in the endometrioma bed. Given this reality, surgery should be based on evaluation of the pathology of the endometrioma bed, but not on the mere size of the chocolate cyst. The main clinical problem is indeed the delayed diagnosis and consequently advanced irreversible cortical damage. Therefore, the sooner endometriomas are diagnosed, the better, because it increases the chances that vascularisation of the endometrioma bed is preserved. Finally, ablation, but not excision is the treatment of choice. The diagnosis of endometriosis is traditionally based on laparoscopy, but in a sexually active adolescent transvaginal endoscopy can be proposed.
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Affiliation(s)
- I. Brosens
- Leuven Institute for Fertility and Embryology, Leuven, Belgium.
| | - P. Puttemans
- Leuven Institute for Fertility and Embryology, Leuven, Belgium.
| | - Sy. Gordts
- Leuven Institute for Fertility and Embryology, Leuven, Belgium.
| | - R. Campo
- Leuven Institute for Fertility and Embryology, Leuven, Belgium.
| | - S. Gordts
- Leuven Institute for Fertility and Embryology, Leuven, Belgium.
| | - G. Benagiano
- Department of Gynaecology, Obstetrics and Urology, Sapienza University, Rome, Italy.
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Gergolet M, Campo R, Verdenik I, Kenda Suster N, Gordts S, Gianaroli L. No clinical relevance of the height of fundal indentation in subseptate or arcuate uterus: a prospective study. Reprod Biomed Online 2012; 24:576-82. [PMID: 22417666 DOI: 10.1016/j.rbmo.2012.01.025] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2011] [Revised: 01/23/2012] [Accepted: 01/24/2012] [Indexed: 01/12/2023]
Abstract
The American Fertility Society has classified the arcuate uterus as a minor malformation with a benign clinical behaviour. The aim of this prospective study was to verify whether there is any scientific basis for this differentiation. Patients with at least one early miscarriage and a subseptate or arcuate uterus were admitted for hysteroscopic metroplasty. Patients were allocated to a subseptate uterus group, with an indentation of 1.5 cm or more, or an arcuate uterus group, with a smaller indentation. The miscarriage rates after metroplasty were similar between the two groups (14.0% in the subseptate uterus group versus 11.1% in the arcuate uterus group). Before metroplasty, the miscarriage rates were significantly higher in subseptate uterus group, as well as in the arcuate uterus group (both P<0.001). According to these results, there is no evidence to support that the arcuate uterus has a different effect on the reproductive outcome in comparison to the subseptate uterus, neither before nor after surgical correction of the anomaly. Since there is no scientific basis for a separate classification of the arcuate uterus, a review of the classifications of uterine congenital anomalies should be considered as necessary. Congenital uterine malformations have been classified by the American Fertility Society (AFS) since 1988. Although the AFS classification received wide acceptance and is still the most broadly used system, it is associated with various limitations in effective categorization of the anomalies. It is interesting that, until now, none of the other available options have been able to effectively replace the AFS system. Numerous papers indicate septate or subseptate (partial septate) uterus (AFS class V) is a possible cause of an unfavourable pregnancy outcome. Arcuate uterus (AFS class VI), a slight malformation similar to septate uterus, should differ from septate or subseptate uterus, because this 'minor' malformation should behave benignly with respect to the septate uterus. The aim of this study was to scientifically validate the difference between the arcuate and subseptate uterus in their effect on reproductive outcome through the results of a metroplasty in both groups of patients. A group of 96 patients, who underwent metroplasty after at least one early miscarriage, was divided into two groups according to the severity of the congenital uterine malformation. Our results indicate that there are no differences in pregnancy outcome after metroplasty either in patients with septate or arcuate utera. The poor pregnancy outcome in women with septate uterus seems not to be correlated to the dimension of the septum itself. There are no scientific bases for a separate classification of the arcuate uterus and it is proposed that a review of the classification of uterine congenital anomalies is necessary.
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Affiliation(s)
- Marco Gergolet
- S.I.F.E.S. d.o.o., Reproductive Surgery, Sedejeva 6, 5000 Nova Gorica, Slovenia.
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