DOCSLIB.ORG

Adenomyosis and Infertility—Review of Medical and Surgical Approaches

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Adenomyosis and Infertility—Review of Medical and Surgical Approaches International Journal of Environmental Research and Public Health Review Adenomyosis and Infertility—Review of Medical and Surgical Approaches Maria Szubert 1,* , Edward Koziróg 1, Olga Olszak 2, Klaudia Krygier-Kurz 1, Jakub Kazmierczak 1 and Jacek Wilczynski 1 1 Clinic of Surgical and Oncologic Gynecology, 1st Department of Gynecology and Obstetrics, Medical University of Lodz, 90-419 Lodz, Poland; [email protected] (E.K.); [email protected] (K.K.-K.); [email protected] (J.K.); [email protected] (J.W.) 2 Clinic of Perinatology, 1st Department of Gynecology and Obstetrics, Medical University of Lodz, 90-419 Lodz, Poland; [email protected] * Correspondence: [email protected]; Tel.: +48-426804722 or +48-604402786; Fax: +48-426860471 Abstract: The aim of this review is to clarify the relative association between adenomyosis and infertility and the possible treatment for an infertile patient. Although adenomyosis is detected more often in women of late reproductive age, its influence on pregnancy rates is important, especially considering the tendency to delay pregnancy among women in developed countries. In this article, we present a critical analysis of the literature data concerning the impact of adenomyosis on fertility. The possible effects of treatment on the pregnancy rate will also be discussed. We conducted a literature search; publications from Pubmed, Embase and Cochrane databases published from 1982 to 2019 were retrieved using terms ’adenomyosis and infertility’ and ’adenomyosis and pregnancy Citation: Szubert, M.; Koziróg, E.; outcomes’, extensively studied in the aspects of diagnosis, pathogenesis of infertility and possible Olszak, O.; Krygier-Kurz, K.; Kazmierczak, J.; Wilczynski, J. treatment methods. Molecular studies have given deep insight into the pathogenesis of adenomyosis Adenomyosis and Infertility—Review in the recent few years, but there is a huge discrepancy between in vitro studies and praxis. Oral of Medical and Surgical Approaches. contraceptive pills, anti-prostaglandins, oral or parenteral progestins, danazol and gonadotrophin- Int. J. Environ. Res. Public Health 2021, releasing hormone (GnRH) analogues have all been used to control menstrual pain and menorrhagia 18, 1235. https://doi.org/10.3390/ in women with adenomyosis, but they temporarily suppress the menstrual cycle. Additionally, ijerph18031235 endometrial ablation and hysterectomy used to alleviate pain caused by adenomyosis exclude pregnancy planning. The development of imaging techniques—ultrasound and MRI—enables Academic Editors: the diagnosis of adenomyosis with very high accuracy nowadays, but the methods of treatment Wioletta Zukiewicz-Sobczak, mentioned above have not given satisfactory results in women planning pregnancy. For these Paulina Wojtyla-Buciora, patients, the high-intensity-focused ultrasound method (HIFU) and combined treatment before Izabela R ˛ackaand Andrzej Wojtyla assisted reproductive techniques can prove beneficial in adenomyosis patients. Received: 19 December 2020 Accepted: 26 January 2021 Keywords: adenomyosis; infertility; GnRH; in vitro fertilisation Published: 30 January 2021 Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affil- 1. Introduction iations. The aim of this article was to provide readers with the newest information useful in the management of infertility in adenomyosis patients. Adenomiosis, well-described at the end of the 19th century, still remains a mysterious disease with severe implications on fertility. We conducted a literature search—publications from Pubmed, Embase and Cochrane Copyright: © 2021 by the authors. databases published from 1982 to 2019 were retrieved using terms ‘adenomyosis and Licensee MDPI, Basel, Switzerland. infertility’ and ‘adenomyosis and pregnancy outcomes’. Data of this search are provided in This article is an open access article Figure1. We focused on all aspects of infertility in adenomyosis: Symptoms, pathological distributed under the terms and background, diagnostics and possible management. conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/). Int. J. Environ. Res. Public Health 2021, 18, 1235. https://doi.org/10.3390/ijerph18031235 https://www.mdpi.com/journal/ijerph Int. J. Environ. Res. Public Health 2021, 18, 1235 2 of 12 Int. J. Environ. Res. Public Health 2021, 18, x FOR PEER REVIEW 2 of 13 Figure 1. Process of data extraction. 2. Definition Definition and Symptoms Adenomyosis is is defined defined as as an an invasion invasion of ofthe the endometrium endometrium into into the uterine the uterine myome- my- triumometrium,, which which results results in an inenlargement an enlargement of the ofuterus, the uterus, formation formation of adenom of adenomyoticyotic tumou tu-rs, profusemours, profusemenstrual menstrual and inter and-menstrual inter-menstrual bleeding bleeding and recurrent and recurrent pain pain.. Microscopically Microscopically ec- topicectopic nonneoplastic, nonneoplastic, endometrial endometrial glands glands and and stroma stroma surrounded surrounded by the by hypertrophic the hypertrophic and hyperplasticand hyperplastic myometrium myometrium are n areoted noted.. The prevalence of adenomyosis fluctuates fluctuates between 5 and 70 70%% [1]. [1]. Before the age of 40 years,years, thethe diseasedisease affects affects 2 2 in in 10 10 women, women, whereas whereas between between 40 and40 and 50 years, 50 years the, incidence the inci- denceincreases increases to 8 in to 10 8 in women 10 women [2]. However,[2]. However the, incidencethe incidence of adenomyosis of adenomyosis is difficultis difficult to toestablish establish due due to theto the lack lack of a of unified a unified definition definition and diagnosticand diagnostic criteria criteria based based on noninvasive on nonin- vasivediagnostic diagnostic tests [ 3test]. Theres [3]. There are no are pathognomonic no pathognom clinicalonic clinical features features for adenomyosis, for adenomyosis, nor norlaparoscopic laparoscopic criteria criteria that that could could be implemented be implemented for thefor diagnosisthe diagnosis [4]. [4]. InIn fact, adenomyosis was previously diagnosed in premenopausal women only on thethe basis of pathological examinationexamination after hysterectomy [[5,6].5,6]. Nowadays, the diagnosis isis based on imaging techniques such as transvaginal ultrasound scan (US) and magnetic resonance imaging (MRI) [7]. [7]. In In one third of cases,cases, adenomyosisadenomyosis isis asymptomatic.asymptomatic. The most common clinical symptoms ar aree menorrhagia (up to 50% of patients), dysmenorrhea (30%) and metrorrhagia (20%),(20%), with other medical conditions such as enlarged uterus and infertilityinfertility [2,6]. [2,6]. Adenomyosis may may be be accompanied by by other mild o oestrogen-dependentestrogen-dependent benign benign dis- dis- oordersrders such as endometriosisendometriosis (70 (70%),%), uterine fibroidsfibroids (50%) and endometrialendometrial hyperplasia (35%). In thethe retrospectiveretrospective analysisanalysis of of 945 945 patients patients who who underwent underwent hysterectomy, hysterectomy, a signifi- a sig- nificantcant positive positive correlation correlation was was found found between between the progression the progression of adenomyosis of adenomyosis and history and his- of prior abortion, history of previous pregnancies and occurrence of leiomyoma. By contrast, tory of prior abortion, history of previous pregnancies and occurrence of leiomyoma. By there was no correlation with smoking, normal delivery, caesarean section, endometrial contrast, there was no correlation with smoking, normal delivery, caesarean section, en- hyperplasia or ovarian endometriosis [8]. dometrial hyperplasia or ovarian endometriosis [8]. 3. Pathogenesis 3. Pathogenesis The pathogenesis of adenomyosis is still unclear. It may develop de novo from a metaplasticThe pathogenesis transformation of adenom of theyosis embryological is still unclear. pluripotent It may develop mullerian de novo remnants. from a met- The aplasticsecond theory,transformation suggested of bythe Bergeron embryologic et al.,al ispluripotent an invasion mullerian of the basal remnants. endometrium The second into theory,the myometrium suggested through by Bergeron an altered et al. or, is absent an invasion JZ (junctional of the basal zone—the endometrium area representing into the myometriumthe internal myometrium) through an al [tered9]. The or invaginationabsent JZ (junctional and intramyometrial zone—the area spreading representing may the be internal myometrium) [9]. The invagination and intramyometrial spreading may be due Int. J. Environ. Res. Public Health 2021, 18, 1235 3 of 12 due to higher oestradiol receptor expression in the adenomyotic foci. Another hypothesis formulated by Leyendecker et al. concerns ’auto-traumatisation’ of the uterus which leads to the TIAR (Tissue Injury And Repair) mechanism as the main cause of adenomyosis [10]. According to the authors, high intrauterine pressure, especially during menstruations, can cause a rupture of the archimyometrium mainly in the cornual region of the uterus. The TIAR mechanism causes a vicious cycle of hyper-estrogenic activity and expression of P450 aromatase. The TIAR mechanism can also occur after multiple D and C procedures (dilatation and curettage). Many macromolecules such as hormones, cytokines and antigens might play a role in the pathogenesis
Load more

Recommended publications
  • Membrane Attack Complex in Myocardial Ischemia/Reperfusion Injury: a Systematic Review for Post Mortem Applications
    diagnostics Review Membrane Attack Complex in Myocardial Ischemia/Reperfusion Injury: A Systematic Review for Post Mortem Applications Cristina Mondello 1,*, Elvira Ventura Spagnolo 2,*, Luigi Cardia 3 , Daniela Sapienza 1, Serena Scurria 1, Patrizia Gualniera 1 and Alessio Asmundo 1 1 Department of Biomedical and Dental Sciences and Morphofunctional Imaging, University of Messina, via Consolare Valeria, 1, 98125 Messina, Italy; [email protected] (D.S.); [email protected] (S.S.); [email protected] (P.G.); [email protected] (A.A.) 2 Section Legal Medicine, Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Via del Vespro, 129, 90127 Palermo, Italy 3 IRCCS Centro Neurolesi Bonino-Pulejo, 98100 Messina, Italy; [email protected] * Correspondence: [email protected] (C.M.); [email protected] (E.V.S.); Tel.: +39-347062414 (C.M.); +39-3496465532 (E.V.S.) Received: 19 October 2020; Accepted: 31 October 2020; Published: 2 November 2020 Abstract: The complement system has a significant role in myocardial ischemia/reperfusion injury, being responsible for cell lysis and amplification of inflammatory response. In this context, several studies highlight that terminal complement complex C5b-9, also known as the membrane attack complex (MAC), is a significant contributor. The MAC functions were studied by many researchers analyzing the characteristics of its activation in myocardial infarction. Here, a systematic literature review was reported to evaluate the principal features, advantages, and limits (regarding the application) of complement components and MAC in post mortem settings to perform the diagnosis of myocardial ischemia/infarction. The review was performed according to specific inclusion and exclusion criteria, and a total of 26 studies were identified.
    [Show full text]
  • Infertility Diagnosis and Treatment
    UnitedHealthcare® Oxford Clinical Policy Infertility Diagnosis and Treatment Policy Number: INFERTILITY 008.12 T2 Effective Date: July 1, 2021 Instructions for Use Table of Contents Page Related Policies Coverage Rationale ....................................................................... 1 • Follicle Stimulating Hormone (FSH) Gonadotropins Documentation Requirements ...................................................... 2 • Human Menopausal Gonadotropins (hMG) Definitions ...................................................................................... 3 • Preimplantation Genetic Testing Prior Authorization Requirements ................................................ 3 Applicable Codes .......................................................................... 3 Related Optum Clinical Guideline Description of Services ................................................................. 3 • Fertility Solutions Medical Necessity Clinical Benefit Considerations .................................................................. 7 Guideline: Infertility Clinical Evidence ........................................................................... 8 U.S. Food and Drug Administration ........................................... 14 References ................................................................................... 15 Policy History/Revision Information ........................................... 18 Instructions for Use ..................................................................... 18 Coverage Rationale See Benefit Considerations
    [Show full text]
  • Absolute Measurement of the Tissue Origins of Cell-Free DNA in the Healthy State and Following Paracetamol Overdose Danny Laurent1, Fiona Semple1, Philip J
    Laurent et al. BMC Medical Genomics (2020) 13:60 https://doi.org/10.1186/s12920-020-0705-2 RESEARCH ARTICLE Open Access Absolute measurement of the tissue origins of cell-free DNA in the healthy state and following paracetamol overdose Danny Laurent1, Fiona Semple1, Philip J. Starkey Lewis2, Elaine Rose1, Holly A. Black1, Jennifer Coe1, Stuart J. Forbes2, Mark J. Arends3, James W. Dear4 and Timothy J. Aitman1* Abstract Background: Despite the emergence of cell-free DNA (cfDNA) as a clinical biomarker in cancer, the tissue origins of cfDNA in healthy individuals have to date been inferred only by indirect and relative measurement methods, such as tissue-specific methylation and nucleosomal profiling. Methods: We performed the first direct, absolute measurement of the tissue origins of cfDNA, using tissue-specific knockout mouse strains, in both healthy mice and following paracetamol (APAP) overdose. We then investigated the utility of total cfDNA and the percentage of liver-specific cfDNA as clinical biomarkers in patients presenting with APAP overdose. Results: Analysis of cfDNA from healthy tissue-specific knockout mice showed that cfDNA originates predominantly from white and red blood cell lineages, with minor contribution from hepatocytes, and no detectable contribution from skeletal and cardiac muscle. Following APAP overdose in mice, total plasma cfDNA and the percentage fraction originating from hepatocytes increased by ~ 100 and ~ 19-fold respectively. Total cfDNA increased by an average of more than 236-fold in clinical samples from APAP overdose patients with biochemical evidence of liver injury, and 18-fold in patients without biochemically apparent liver injury. Measurement of liver-specific cfDNA, using droplet digital PCR and methylation analysis, revealed that the contribution of liver to cfDNA was increased by an average of 175-fold in APAP overdose patients with biochemically apparent liver injury compared to healthy subjects, but was not increased in overdose patients with normal liver function tests.
    [Show full text]
  • Burn Wound Infec Tion Infection Is One of the Commonest Causes of Death in Burn Patients, Particularly Those with Extensive Damage
    Burn wound infec tion Infection is one of the commonest causes of death in burn patients, particularly those with extensive damage. H RODE, MB ChB, MMed (Surg), FCS (SA), FRCS (Ed) Professor Rode is Emeritus Professor of Paediatric Surgery at the Red Cross War Memorial Children’s Hospital and the University of Cape Town. He became Chief Specialist and Head of the Department in 1997. He is the past president of the South African Association of Paediatric Surgeons (SAAPS), the South African Burn Association and the Child Accident Prevention Foundation of Southern Africa. He was secretary to SAAPS, the Finance and General Purpose Committee of the Colleges of Medicine, the European Club for Paediatric Burns and the Pan-African Paediatric Surgical Association and is on the Executive Committee of the College of Surgeons. He serves on the editorial board of 3 paediatric surgical journals, has a lifetime interest in thermal injuries and has written extensively on the subject. I DO VALE, MB ChB Dr I do Vale graduated MB ChB from the University of the Witwatersrand in 2006 and is currently working as a medical officer in the Department of Surgery in the Johannesburg General Hospital. She has successfully completed the ACLS, BSS and ATLS courses as well as the primary examination from the CMSA. She wants to specialise in plastic and reconstructive surgery, focusing on congenital hand surgery, reconstruction of burn injuries and cleft palate repair. A J W MILLAR, MB ChB, FRCS (Ed), FRCS (Eng), DCH, FRACS, FCS (SA) Professor Millar qualified at the University of Cape Town with surgical training in paediatric and general surgery in the UK, the Red Cross War Memorial Children’s Hospital, and the Royal Children’s Hospital, Melbourne.
    [Show full text]
  • Insulin Enhancement of the Antitumor Activity of Chemotherapeutic Agents
    www.nature.com/scientificreports OPEN Insulin enhancement of the antitumor activity of chemotherapeutic agents in colorectal cancer is linked with downregulating PIK3CA and GRB2 Siddarth Agrawal1*, Marta Woźniak1, Mateusz Łuc1, Sebastian Makuch1, Ewa Pielka1, Anil Kumar Agrawal2, Joanna Wietrzyk 3, Joanna Banach3, Andrzej Gamian4, Monika Pizon5 & Piotr Ziółkowski1 The present state of cancer chemotherapy is unsatisfactory. New anticancer drugs that marginally improve the survival of patients continue to be developed at an unsustainably high cost. The study aimed to elucidate the efects of insulin (INS), an inexpensive drug with a convincing safety profle, on the susceptibility of colon cancer to chemotherapeutic agents: 5-fuorouracil (FU), oxaliplatin (OXA), irinotecan (IRI), cyclophosphamide (CPA) and docetaxel (DOC). To examine the efects of insulin on cell viability and apoptosis, we performed an in vitro analysis on colon cancer cell lines Caco-2 and SW480. To verify the results, we performed in vivo analysis on mice bearing MC38 colon tumors. To assess the underlying mechanism of the therapy, we examined the mRNA expression of pathways related to the signaling downstream of insulin receptors (INSR). Moreover, we performed Western blotting to confrm expression patterns derived from the genetic analysis. For the quantifcation of circulating tumor cells in the peripheral blood, we used the maintrac method. The results of our study show that insulin- pretreated colon cancer cells are signifcantly more susceptible to commonly used chemotherapeutics. The apoptosis ratio was also enhanced when INS was administered complementary to the examined drugs. The in vivo study showed that the combination of INS and FU resulted in signifcant inhibition of tumor growth and reduction of the number of circulating tumor cells.
    [Show full text]
  • Pathological Study of Facial Eczema (Pithomycotoxicosis) in Sheep
    animals Article Pathological Study of Facial Eczema (Pithomycotoxicosis) in Sheep Miguel Fernández 1,2,* , Valentín Pérez 1,2 , Miguel Fuertes 3, Julio Benavides 2, José Espinosa 1,2 , Juan Menéndez 4,†, Ana L. García-Pérez 3 and M. Carmen Ferreras 1,2 1 Departamento de Sanidad Animal, Facultad de Veterinaria, Universidad de León, C/Prof. Pedro Cármenes s/n, E-24071 León, Spain; [email protected] (V.P.); [email protected] (J.E.); [email protected] (M.C.F.) 2 Instituto de Ganadería de Montaña (IGM), CSIC-Universidad de León, Finca Marzanas s/n, E-24346 León, Spain; [email protected] 3 Department of Animal Health, NEIKER-Basque Institute for Agricultural Research and Development, Basque Research and Technology Alliance (BRTA), Parque Científico y Tecnológico de Bizkaia, P812, E-48160 Derio, Spain; [email protected] (M.F.); [email protected] (A.L.G.-P.) 4 Area de Sistemas de Producción Animal, Servicio Regional de Investigación y Desarrollo Agroalimentario, SERIDA, E-33300 Villaviciosa, Asturias, Spain; [email protected] * Correspondence: [email protected]; Tel.: +34-987-291232 † Current address: Centro Veterinario Albéitar, E-33204 Gijón, Spain. Simple Summary: Facial eczema (FE) is a secondary photosensitization disease of farm ruminants caused by the sporidesmin A, present in the spores of the saprophytic fungus Pithomyces chartarum. This study communicates an outbreak of ovine FE in Asturias (Spain) and characterizes the local immune response that may contribute to liver damage promoting cholestasis and progression Citation: Fernández, M.; Pérez, V.; towards fibrosis and cirrhosis. Animals showed clinical signs of photosensitivity and lower gain Fuertes, M.; Benavides, J.; Espinosa, J.; Menéndez, J.; García-Pérez, A.L.; of weight, loss of wool and crusting in the head for at least 6 months after the FE outbreak.
    [Show full text]
  • Recurrent Miscarriage
    Elizabeth Taylor, MD, FRCSC, Mohammed Bedaiwy, MD, PhD, Mahmoud Iwes, MD Recurrent miscarriage Management of pregnancy loss includes investigating causes, addressing modifiable risk factors, and providing supportive care in the first trimester of pregnancy. ABSTRACT: Early miscarriages are arly miscarriage has been re­ Genetic causes those occurring within the first 12 ported to occur in 17% to 31% The risk of miscarriage increases completed weeks of gestation. Re- E of pregnancies,1,2 and is de­ with maternal age. At age 20 to 24 current miscarriage, defined as two fined as a nonviable intrauterine the risk is approximately 10%, with or more consecutive pregnancy loss- pregnancy with either an empty ges­ risk increasing to nearly 80% by age es, affects 3% of couples trying to tational sac or a gestational sac con­ 45.5 The relationship between mis­ conceive and can cause consider- taining an embryo or fetus without carriage risk and maternal age can be able distress. The risk of miscarriage fetal heart activity within the first explained by the increasing rate of oo­ increases with maternal age. Genet- 12 completed weeks of gestation.3 cyte aneuploidy that occurs as women ic abnormalities, uterine anomalies, Recurrent miscarriage occurs in 3% grow older. In one study, oocytes and endocrine dysfunction can all of couples trying to conceive. The examined during in vitro fertilization lead to miscarriage. Other causes of American Society for Reproductive (IVF) treatment had only a 10% risk miscarriage are autoimmune disor- Medicine (ASRM) defines recurrent of being aneuploid in women younger ders such as antiphospholipid syn- miscarriage as two or more failed than age 35, but by age 43 the risk of drome and chronic endometritis.
    [Show full text]
  • Male Infertility and Risk of Nonmalignant Chronic Diseases: a Systematic Review of the Epidemiological Evidence
    282 Male Infertility and Risk of Nonmalignant Chronic Diseases: A Systematic Review of the Epidemiological Evidence Clara Helene Glazer, MD1 Jens Peter Bonde, MD, DMSc, PhD1 Michael L. Eisenberg, MD2 Aleksander Giwercman, MD, DMSc, PhD3 Katia Keglberg Hærvig, MSc1 Susie Rimborg4 Ditte Vassard, MSc5 Anja Pinborg, MD, DMSc, PhD6 Lone Schmidt, MD, DMSc, PhD5 Elvira Vaclavik Bräuner, PhD1,7 1 Department of Occupational and Environmental Medicine, Address for correspondence Clara Helene Glazer, MD, Department of Bispebjerg University Hospital, Copenhagen NV, Denmark Occupational and Environmental Medicine, Bispebjerg University 2 Departments of Urology and Obstetrics/Gynecology, Stanford Hospital, Copenhagen NV, Denmark University School of Medicine, Stanford, California (e-mail: [email protected]). 3 Department of Translational Medicine, Molecular Reproductive Medicine, Lund University, Lund, Sweden 4 Faculty Library of Natural and Health Sciences, University of Copenhagen, Copenhagen K, Denmark 5 Department of Public Health, University of Copenhagen, Copenhagen, Denmark 6 Department of Obstetrics/Gynaecology, Copenhagen University Hospital, Hvidovre, Denmark 7 Mental Health Center Ballerup, Ballerup, Denmark Semin Reprod Med 2017;35:282–290 Abstract The association between male infertility and increased risk of certain cancers is well studied. Less is known about the long-term risk of nonmalignant diseases in men with decreased fertility. A systemic literature review was performed on the epidemiologic evidence of male infertility as a precursor for increased risk of diabetes, cardiovascular diseases, and all-cause mortality. PubMed and Embase were searched from January 1, 1980, to September 1, 2016, to identify epidemiological studies reporting associations between male infertility and the outcomes of interest. Animal studies, case reports, reviews, studies not providing an accurate reference group, and studies including Downloaded by: Stanford University.
    [Show full text]
  • Autopsy Case Report and Review of the Literature Karyna C
    Fatal Neonatal Echovirus 6 Infection: Autopsy Case Report and Review of the Literature Karyna C. Ventura, M.D., Hal Hawkins, M.D., Ph.D., Michael B. Smith, M.D., David H. Walker, M.D. Department of Pathology, University of Texas Medical Branch, Galveston, Texas CASE REPORT A full-term, healthy male neonate was delivered by caesarian section to a 26-year-old primigravida A full-term boy appropriate for his gestational age woman who had a history of fever and upper respi- was born via caesarian section to a 26-year-old G1P0 ratory tract infection. On the fourth day of life, the Latin American woman who had a medical history of a well-controlled seizure disorder for which she was neonate developed a sepsis-like syndrome, acute receiving carbamazepine. She had received regular respiratory and renal failure, and disseminated in- prenatal care, with negative prenatal serologic tests travascular coagulopathy. He died 13 days after for human immunodeficiency virus, hepatitis B virus, birth. Postmortem examination revealed jaundice, and syphilis. Two weeks before delivery, she experi- anasarca, massive hepatic necrosis, adrenal hemor- enced fever and an upper respiratory tract infection. rhagic necrosis, renal medullary hemorrhage, hem- At birth, the infant weighed 3838 g and had an Apgar orrhagic noninflammatory pneumonia, and severe score of 9. The neonate was put under an oxygen encephalomalacia. Echovirus type 6 was isolated hood, then was later slowly weaned from it. On his from blood, liver, and lungs. Although uncommon, fourth day of life, the neonate developed fever echovirus type 6 infection may produce a spectrum (38.6°C) and was observed to have decreased activity.
    [Show full text]
  • Diagnostic Evaluation of the Infertile Female: a Committee Opinion
    Diagnostic evaluation of the infertile female: a committee opinion Practice Committee of the American Society for Reproductive Medicine American Society for Reproductive Medicine, Birmingham, Alabama Diagnostic evaluation for infertility in women should be conducted in a systematic, expeditious, and cost-effective manner to identify all relevant factors with initial emphasis on the least invasive methods for detection of the most common causes of infertility. The purpose of this committee opinion is to provide a critical review of the current methods and procedures for the evaluation of the infertile female, and it replaces the document of the same name, last published in 2012 (Fertil Steril 2012;98:302–7). (Fertil SterilÒ 2015;103:e44–50. Ó2015 by American Society for Reproductive Medicine.) Key Words: Infertility, oocyte, ovarian reserve, unexplained, conception Use your smartphone to scan this QR code Earn online CME credit related to this document at www.asrm.org/elearn and connect to the discussion forum for Discuss: You can discuss this article with its authors and with other ASRM members at http:// this article now.* fertstertforum.com/asrmpraccom-diagnostic-evaluation-infertile-female/ * Download a free QR code scanner by searching for “QR scanner” in your smartphone’s app store or app marketplace. diagnostic evaluation for infer- of the male partner are described in a Pregnancy history (gravidity, parity, tility is indicated for women separate document (5). Women who pregnancy outcome, and associated A who fail to achieve a successful are planning to attempt pregnancy via complications) pregnancy after 12 months or more of insemination with sperm from a known Previous methods of contraception regular unprotected intercourse (1).
    [Show full text]
  • Heavy Menstrual Bleeding
    25/06/2018 Definition • Heavy menstrual bleeding (HMB) is defined as excessive menstrual blood loss which interferes with a woman's physical, social, emotional and/or material quality of life. Heavy Menstrual Bleeding (HMB): Replaced ‘menorrhagia’ Objective definition of HMB >80mL/ cycle or duration of >7 days Causes and Management • It can occur alone or in combination with other symptoms (e.g. intermenstrual bleeding, pelvic pain, pressure symptoms) Dr. William (Wee-Liak) Hoo, MD MRCOG Consultant Gynaecologist Prevalence King’s College Hospital NHS FT • The prevalence of HMB in objective studies (9 to 14%) and subjective studies 20 to 52%) in studies based on subjective assessment. • In the UK, almost 1.5 million women consult their General Practitioners UKCPA Women’s Health Group Masterclass (GPs) each year with menstrual complaints and the annual treatment cost Friday 22nd June 2018 exceeds £65 million. Causes • Uterine: Uterine fibroids (dysmenorrhoea, palpable mass, pressure symptoms) Adenomyosis (dysmenorrhoea, subfertility) Endometrial polyps (intermenstrual bleeding) Pelvic inflammatory disease (PID)/ infection (vaginal discharge, pelvic pain, intermenstrual and postcoital bleeding and pyrexia) Malignancy or atypical hyperplasia (irregular/ postcoital/ intermenstrual bleeding, pelvic pain, weight loss). • Ovarian: Polycystic ovary syndrome (acne, hursuitism) • Systemic diseases: Hypothyroidism (fatigue, constipation, cold intolerance and hair and skin changes) Coagulation disorders (e.g. von Willebrand disease) Liver
    [Show full text]
  • Age and Fertility: a Guide for Patients
    Age and Fertility A Guide for Patients PATIENT INFORMATION SERIES Published by the American Society for Reproductive Medicine under the direction of the Patient Education Committee and the Publications Committee. No portion herein may be reproduced in any form without written permission. This booklet is in no way intended to replace, dictate or fully define evaluation and treatment by a qualified physician. It is intended solely as an aid for patients seeking general information on issues in reproductive medicine. Copyright © 2012 by the American Society for Reproductive Medicine AMERICAN SOCIETY FOR REPRODUCTIVE MEDICINE Age and Fertility A Guide for Patients Revised 2012 A glossary of italicized words is located at the end of this booklet. INTRODUCTION Fertility changes with age. Both males and females become fertile in their teens following puberty. For girls, the beginning of their reproductive years is marked by the onset of ovulation and menstruation. It is commonly understood that after menopause women are no longer able to become pregnant. Generally, reproductive potential decreases as women get older, and fertility can be expected to end 5 to 10 years before menopause. In today’s society, age-related infertility is becoming more common because, for a variety of reasons, many women wait until their 30s to begin their families. Even though women today are healthier and taking better care of themselves than ever before, improved health in later life does not offset the natural age-related decline in fertility. It is important to understand that fertility declines as a woman ages due to the normal age- related decrease in the number of eggs that remain in her ovaries.
    [Show full text]