Pelvic Adhesions Research Articles

Pen Yan Jing Tablets Alleviates Pelvic Inflammatory Disease by Inhibiting Akt/NF-κB Pathway.

Purpose: Pen Yan Jing tablets (PYJ), a Chinese patent medicine, has being used for pelvic inflammatory disease (PID) effectively. This study was designed to explore the underlying mechanisms of PYJ for treating PID. Methods: A rat model of PID was established by mixed bacteria liquid plus mechanical damage. After PYJ treatment, the morphology of uteri and extent of pelvic adhesion were observed. The pathological changes were evaluated by hematoxylin-eosin (HE) staining. The protein expressions of CD68, intercellular cell adhesion molecule-1 (ICAM-1), vascular cell adhesion molecule-1 (VCAM-1), monocyte chemotactic protein-1 (MCP-1) and cyclooxygenase-2 (COX-2) were quantitated by immunohistochemistry. A cell model of lipopolysaccharide (LPS)-activated RAW 264.7 macrophages was performed. The cell proliferation and NO level were measured by CCK-8 and Griess method, respectively. The tumor necrosis factor-α (TNF-α) and interleukin-6 (IL-6) levels were detected by ELISA. The protein kinase B (Akt)/nuclear factor kappa-B (NF-κB) pathway-related protein expressions were assayed by western blot or immunofluorescence. Results: PYJ alleviated pelvic adhesion and inflammatory lesions of uteri in PID rats. PYJ down-regulated protein expressions of ICAM-1, VCAM-1, MCP-1, COX-2, p-Akt, p-IκB kinaseα/β (p-IKKα/β), p-IκBα, p65, and p-p65 in uteri of PID rats. Moreover, PYJ medicated serum inhibited abnormal cell proliferation, NO release, levels of TNF-α and IL-6, nuclear translocation of p65, and protein expressions of p-Akt, p-p65 and p-IκBα in LPS-activated RAW 264.7 macrophages. Conclusions: Taken together, PYJ may alleviates PID through inhibiting Akt/NF-κB pathway.

Prevalence of pelvic adhesions on ultrasound examination in women with previous abdominopelvic surgery

Background: Pelvic adhesions caused many problems ranging from obstructed tubes associated with infertility, to pelvic tenderness, and painful intercourse, to chronic pelvic pain. Curiously, adhesions could be very extensive, yet relatively silent. They might remain silent indefinitely, or long after the causative event, become symptomatic. The aim of the work was to assess the prevalence and location of pelvic adhesions by ultrasonography in women with a history of abdominopelvic surgery and to identify risk factors and symptoms associated with it. Methods: This prospective observational study was conducted on (110) women at the Department of Gynecology & Obstetrics, Tanta University Hospitals. Starting from September 2019 till July 2022.all cases will included by Special Clinical Tests. Abdominal scar assessment was performed in the operating room while the patient was anesthetized, lying in the supine position under a standard operating light source that was focused on the abdomen and sliding sign will be observed. Results: As a regard of previous operation done for all patients, 13 patients underwent general operations as appendectomy in 11 patients (10%) and Appendectomy and cesarean in 2 patients (1.8%) while 97 patients underwent gynecological operation as cesarean in 87 patients (79.1%), ovarian cystectomy in 4 patients (3.6%), salpingectomy and cesarean in 2 patents (1.8%), laparoscopy in 2 patients (1.8%) and ovarian cystectomy and cesarean in 2 patients (1.8%). Among 110 patients, there was a negative sliding sign in 18 patients (16.4%) while there was a positive sliding sign in 92 patients (83.6%). there were 51 non symptomizing cases, 9 patients (17.6%) out of 51 patients were with adhesions. There were 59 symptomizing cases, 9 patients (15.3%). Conclusion: In conclusion, Sliding sign by abdominal or vaginal ultrasound could be used as an accurate and easy diagnostic tool in predicting intra-abdominal adhesions. This technique may aid clinical decisions in patients undergoing repeat CS.

Diagnostic Laparoscopy to assess tubal and pelvic pathology in patients of subfertility: A retrospective analysis

Aims: To assess the tubal pathology contributing to primary and secondary infertility by laparoscopic examination.
 Methods: The study was carried out in the department of Obstetrics and gynecology, Grande International Hospital. This is a retrospective study conducted in tertiary care hospital over a period of 2 yrs. From 2020 February to 2022 January. All patients with complaints of infertility (primary and secondary) who were admitted, evaluated and operated for infertility in Obstetrics and Gynaecology department of Grande international Hospital.
 Results: Of the 52 patients minimum age was 20 and maximum was 46 with mean age of 30.52±4.885. Thirty eight patients had primary infertility and 14 had secondary. Forty patients had normal uterus while 12 had enlarged uterus. Hydrosalpinx was found in 11.5 % and 30.8% in right and left tube respectively. Pyosalpinx was found in 9.6% and 7.7% in right and left tube respectively. Bilateral tubes were patent in 22 cases while bilateral blocked tube was found in 13 cases so rest 17 cases had unilateral tubal block. Pelvic adhesions were found in 44.2 % cases. Most of them were associated with endometriosis (15.4%) followed by ovarian cyst (11.5%) and fibroid uterus (11.5%).
 Conclusions: Majority had normal tubal pathology followed by edematous tube, hydrosalpinx and pyosalpinx. Endometriosis, fibroid and ovarian cyst were commonly associated conditions.

Surgical Management of Adnexal Masses in Pregnancy

Background and Aim: The incidence of suspicious adnexal masses is on the rise during pregnancy due to advancement of ultrasonography in the modern era. The prevalence of adnexal masses varied from 6% to 25% in gestational age of <20 weeks during pregnancy. However, due to a paucity of large randomized studies, little is known regarding their treatment during pregnancy. The present study aimed to assess the surgical management of suspected adnexal masses during pregnancy. Material and Methods: This retrospective study was carried out on 28 suspected adnexal masses pregnant women in the Department of Gynecology, Saidu Group of Teaching Hospital Swat during the period from March 2022 to August 2022. Patients with definite indications were assessed through surgical intervention, tumor markers, MRI (Magnetic Resonance Imaging), and as per International Ovarian Tumour Analysis (IOTA) ultrasound rules. Pregnant women who had a laparoscopy or laparotomy before 20 weeks of pregnancy to treat an adnexal mass were enrolled. SPSS version 28 was used for data analysis. Results: The overall mean age was 28.4 ± 1.9 years with an age range from 18 years to 35 years. The mean gestational age was 16.4± 1.7 weeks. Of the total 28 suspected adnexal masses, the prevalence of benign and malignant cases were 22 (78.6%) and 6 (21.4%) respectively. Out of 28 cases, about 18 (64.3%) had laparoscopic surgery and 10 (35.7%) had laparotomy. The left upper quadrant entry technique was used in 17 (60.7%) cases. Due to extensive pelvic adhesion, 3 (10.7%) required conversion from laparoscopic to laparotomy surgery. The laparoscopic group lost considerably less blood (66.7 ±52.4 vs 148.9 ±178.0 mL, P.051) and had hospitalization for short duration (2.6 ±0.9 vs 3.7 ±1.2 days, P.005) than the laparotomy group. One woman miscarried shortly after undergoing surgery. Obstetric outcomes did not differ significantly between the laparoscopy and laparotomy groups. Conclusion: The present study concluded that surgical treatment of adnexal masses appears to benefit both the mother and the fetus during pregnancy. Thorough clinical examination, individualized imaging, and prompt action assist in the identification and management of suspected adnexal masses during pregnancy. Keywords: Surgical management, Adnexal masses, Pregnancy, Laparoscopy, Laparotomy

Ectopic pregnancy risk factors in infertile patients: a 10-year single center experience

The present retrospective study included both intrauterine insemination and in vitro assisted reproductive technologies (ART) procedures performed from January 2009 to December 2018 at a tertiary-care Fertility Centre. The purpose was to assess the incidence of ectopic pregnancy (EP) in infertile population who undergoes ART and to identify any risk factor impacting the occurrence of EP after ART. Among 27,376 cycles, 7352 pregnancies were achieved, of which 132 were EPs, the 1.80% (95% CI 1.5–2.1) of all pregnancies. In fresh embryo transfer cycles, a history of prior pelvic adhesions showed the greatest impact on the incidence of EP (aOR 2.49 95% CI 1.53–4.07 p < 0.001). Other factors associated with EP incidence were also identified, such as female age, basal FSH, the transfer of blastocyst embryos and difficulties during the embryo transfer procedure. In frozen embryo transfer cycles, the only factor influencing the incidence of EP was anti Müllerian hormone (AMH) serum concentration (aOR 0.81 95% CI 0.65–1.00, p = 0.048). To conclude, the incidence of EP observed was comparable to that reported after natural conception. On the other hand, pre-existing risk factors, traditionally more common in infertile population, appeared to influence the incidence of EP and should thus be modified if possible.

7902 Severe Adhesions? Don't Panic, Don't Open, the Robot Is Here. Robotic Approach to Perform Hysterectomy in Severe Pelvic Adhesive Disease

<h3>Study Objective</h3> To show an example of using minimally invasive approach instead of laparotomy during hysterectomy complicated by severe pelvic adhesions, to demonstrate the feasibility of robotic surgery in cases with severe pelvic adhesions, demonstrate that robotic surgery might be a potentially superior alternative for hysterectomy complicated by severe adhesions and to review tips and tricks to prevent bowel and bladder injuries. <h3>Design</h3> Video presentation. <h3>Setting</h3> Surgical procedure. <h3>Patients or Participants</h3> N/A. <h3>Interventions</h3> N/A. <h3>Measurements and Main Results</h3> N/A. <h3>Conclusion</h3> Evidence of benefits of robotic surgery over laparoscopy have been implemented multiple times but there is not consensus to declare superiority of robotic over laparoscopic surgery. One of the major benefits of robotic surgery already demonstrated is the lower rate of unplanned conversion to open surgery. In conclusion Robotic surgery might be a potentially superior alternative for hysterectomy complicated by severe adhesions.

Robotic hysterectomy for the treatment of refractory menometrorrhagia and squamous endometrial morules: A case report

Introduction: Abnormal uterine bleeding (AUB) is a common presentation in the field of gynecology. Proper diagnosis and management of this condition can be difficult and permanent treatment options, including robotic hysterectomy, may be necessary. In patients with a history of previous abdominal surgery, pelvic adhesions may present obstacles to this surgical approach. Case Report: In this case report, a 41-year-old woman desired permanent treatment for AUB. The patient underwent endometrial biopsy which revealed inexplicit squamous morules. She opted for permanent treatment via robotic hysterectomy. Her operation was complicated by the presence of dense pelvic adhesions caused by previous surgeries. Conclusion: This report aims to detail the potential difficulties in the clinical management of inconclusive biopsy results and in using a robotic approach to hysterectomy in the setting of pelvic adhesions. Authors encourage ongoing clinical investigation to determine the optimal methods for diagnosing and treating AUB.

Hysterosalpingography and Coelioscopy in the Exploration of Tubal Patency during Infertility Assessment

Introduction: Infertility can have serious psychological and social repercussions on the life of a couple. Hysterosalpingography and laparoscopy are necessary exams for the exploration of tubal infertility. The aim of this study was to determine the concordance between these two exams in our daily practice. Patients and Methods: Our study was retrospective, cross-sectional, descriptive and comparative. It took place from January 2020 to August 2022 at the 'GRACE' medical clinic. Data were collected using a survey form and obtained from the patients' records, hysterosalpingography results and operative reports. Data were analyzed with SPSS version 20.0 software. Results: A total of 33 patients met our inclusion criteria. They had a mean age of 29.61+/-6.11 years with a minimum age of 18 years and a maximum of 42 years. Pelvic adhesions were the most common lesions found at laparoscopy. Hysterosalpingography was more specific (Sp=83.33%) than sensitive (Se=60%) in the diagnosis of proximal tubal obstructions. The sensitivity of hysterosalpingography was higher (Se=72.22%) than its specificity (Sp=20%) in the diagnosis of distal tubal obstructions. The concordance rate between the two exams (kappa) was 44% in the diagnosis of proximal tubal obstructions and 8.1% in the case of distal tubal obstructions. Conclusion: Our results corroborate those of the literature. Rather than substituting one for the other, hysterosalpingography and laparoscopy remain complementary examinations in the diagnosis of tubal infertility.

SURGICAL TECHNIQUES FOR EXCISION OF FUNCTIONAL HORN IN PROXIMITY TO UNICORNUATE UTERUS

The presentation of an unicornuate uterus with functional horn obstruction is rare and has the potential to cause pain, endometriosis and pelvic adhesions. Most often, functional horns require surgical excision, which can be safely performed laparoscopically. The objective of this video is to highlight the laparoscopic techniques utilized to excise a functional horn associated with an unicornuate uterus.

Inflammatory Bowel Disease and Pregnancy

Inflammatory Bowel Disease and Pregnancy

Analysis of Different Routes of Hysterectomy Based on a Prospective Algorithm and Their Complications in a Tertiary Care Institute.

Introduction Hysterectomy is the most common gynaecological operation worldwide. The objective of the study is to analyze the various routes of hysterectomy and its complications when the decision of route is based on using a prospective algorithm tree. Methodology. It is an observational study to analyze the route of hysterectomy based on using a prospective algorithm. The decision tree is based on pelvic pathology, uterine size, vaginal access, pelvic adhesion, competency of the surgeon, choice of the patient, and complication of different routes of hysterectomy. Data were collected from preoperative, intraoperative, and postoperative records. Demographic factors, indications, routes of hysterectomy, and complications were recorded and analyzed by using SPSS software version 22. Observation. Among the malignant or suspected malignant pathology groups, TAH was performed in 89 cases and TLH was performed in 3 cases. Among the benign disease groups, VH was performed in 137(38.2%) cases, TAH was performed in 118(32.9%) cases, and TLH was performed in 104 (28.9%) cases. Operative time and a number of blood transfusions were significantly less with VH (p value < 0.0001 and 0.004) compared to abdominal and total laparoscopic hysterectomy. Postoperative complication such as fever was more with abdominal hysterectomy (<i>p-</i>value<0.00001) compared to VH and TLH. Vaginal discharge was more with VH and TLH compared to TAH (p value −0.004) and wound infection was more in the abdominal route (p value 0.001). Conclusion The abdominal route was the route of choice for surgery in malignancy or suspected malignant pathology. In benign pathology, VH was the most common and preferable route of surgery. Complications were found to be minimal with vaginal hysterectomy.

CLINICAL OUTCOMES OF REVERSAL OF HARTMANN’S PROCEDURE

Background. Reversal of Hartmann’s procedure (HP) is one of the most complex surgical interven­tions in abdominal surgery with high morbidity rates of up to 58% in the patients after HP and mortality of up to 3.6%. Objective. This was a retrospective observational study to analyze the Hartmann’s reversal (HR) outcomes. Methods. The study involved 31 patients (16 males and 15 females), average age 59.6±10.31 (range 26-80), who underwent HR at Ternopil Regional Hospital in 2010 - 2021. The reasons for the HP were: cancer in 20 (64.5%) cases, perforation of the diverticulum – 6 (19.3%), traumatic rupture – 3 (9.7%) and Crohn’s disease - 2 (6.4%) cases. Results. Median time from Hartmann’s procedure to reversal was 11.13±9.24 months (interval 3-38). Intraoperative time was 210.33±56.91 minutes (range 120-330). HR was performed in 30 (96.8 %) patients. Dense pelvic adhesions of the stump of the rectum was diagnosed in 13 (41.9%) patients. Hand-sewn anastomosis was performed for 22 (71%) patients, stapler anastomosis – 4 (12.9%), pull-through technique – 3 (9.7%) patients. AL occurred in 3 (9.7%) patients on the 15th, 23rd and 35th postoperative days. pseudomembranous colitis was diagnosed in 2 (6.4%) patients with AL. The mortality rate was 1 (3.3%) as a result of septic complications due to AL; this case was not operated by a colorectal surgeon due to administrative issue in the hospital. Conclusions. Hartmann’s reversal is still one of the most difficult operations in colorectal surgery with high incidence of postoperative complications. Sound selection of patients with low comorbidity and in suitable time period is crucial for successful HR.

Role of diagnostic laparoscopy in chronic pelvic pain in females: A study from tertiary care centre in Patna, Bihar

Chronic pelvic pain in females is one of the most bemusing problems that are faced by doctors in day to day practice as physical signs are nonspecific. Laparoscopy is one of the worthy tools in cases of chronic pelvic pain as not only it establishes the diagnosis but often treatment can be instituted in the same sitting. The present study aimed to evaluate whether diagnostic value of laparoscopy is worth in cases with chronic pelvic pain in females.This study was done in the department of General Surgery and Reproductive Medicine at Indira Gandhi Institute of Medical sciences, Patna, Bihar from July 2019 to March 2021. Seventy five female patients were included in this study. The analysis and interpretation of the data were performed using Microsoft excel. The quantitative data obtained were expressed as percentage in tabular form.: The studied patients were in the age group ranging from 15 – 65 years. Most patients 40 % (n=30) complaint of pain in right lower quadrant of abdomen. The most common finding during diagnostic laparoscopy was found to be tubercular pathology (22.67%) followed by pelvic adhesions (18.67%). Other diagnoses were pelvic inflammatory disease, endometriosis, cysts etc.Diagnostic Laparoscopy is a safe and effective tool to establish the aetiology of chronic pelvic pain and allows for appropriate interventions. It can serve as a time saving and cost effective implement for these patients with uncertain diagnosis.

Pelvic adhesion: A challenge of all gynecologic surgeries

Pelvic adhesion: A challenge of all gynecologic surgeries

Real-Time Near-Infrared ICG Fluorescence Ureterography in Complex Rectal Resections: A Report of Two Cases

Iatrogenic ureteric injuries are a well-documented consequence of non-urological abdomino-pelvic surgeries. Colorectal resections for benign inflammatory diseases are associated with obliteration of the planes. In such situations, identifying and securing the ureter during laparoscopy is challenging due to the absence of tactile feedback. We describe the use of real-time near-infrared Indocyanine green (ICG) fluorescence guidance to avoid iatrogenic ureteric injuries during complex colorectal resections featuring extensive pelvic adhesions. The inert nature of ICG, its affinity for urothelium, ability to detect leaks, low cost, and convenience of use with real-time augmented images during surgery make real-time, near-infrared ICG fluorescence ureterography a crucial tool in a colorectal surgeon's armamentarium during complex colorectal surgery.

Robotic surgery in gynaecology: Scientific Impact Paper No. 71 (July 2022).

The use of robotic-assisted keyhole surgery in gynaecology has expanded in recent years owing to technical advances. These include 3D viewing leading to improved depth perception, limitation of tremor, potential for greater precision and discrimination of tissues, a shorter learning curve and improved comfort for surgeons compared with conventional keyhole and open abdominal surgery. Robotic-assisted keyhole surgery, compared with conventional keyhole surgery, improves surgical performance without increasing operating time, minimises blood loss and intra- or postoperative complications, while reducing the need to revert to abdominal surgery. Moreover, surgeons using a robot experience fewer skeletomuscular problems of their own in the short and long term than those operating without a robot as an additional tool. This Scientific Impact Paper looks at the use of a robot in different fields of gynaecological surgery. A robot could be considered safe and a more effective surgical tool than conventional keyhole surgery for women who have to undergo complex gynaecology surgery or have associated medical issues such as body-mass index (BMI) at 30 kg/m2 or above or lung problems. The introduction of the use of robots in keyhole surgery has resulted in a decrease in the number of traditional open surgeries and the risk of conversion to open surgery after traditional keyhole surgery; both of which should be considered when examining the cost-benefit of using a robot. Limitations of robotic-assisted surgery remain the associated higher costs. In womb cancer surgery there is good evidence that introducing robotics into the service improves outcomes for women and may reduce costs.

Mood Swing during Menstruation: Confounding Factors and Drug Use.

Premenstrual syndrome (PMS) is a physiologic process in women where mood swing is one of the symptoms influencing the psycho-emotional, physical, and behavioral reactions exhibited by women during menstruation. This study elucidates the effect of mood swing, confounding factors and healthcare-seeking behaviors of women in an educational environment. Exactly 328 women who were within reproductive ages 16 and 35 years participated in this study. A survey method was adopted; validated and standardized questionnaires were administered to confidentially assess the effect of mood swing via PMS. All data were analyzed with SPSS 25.0; descriptive method was adopted and results were expressed in percentages. Mood swing was discovered as a symptom overlapping with psycho-emotional, physical, and behavioral symptoms during menstruation. The overall PMS prevalence was 67.4% while PMDD prevalence was 25.6%. Psycho-emotional symptoms: anger, irritability, depression. Physical symptoms: coldness, paleness, food craving, breast tenderness, digestive changes. Behavioral symptoms: social withdrawal, nocturnal social activity, absenteeism, poor work or academic performance, increased libido. Confounding factors include stress, gynecological conditions such as endometriosis, uterine fibroid, ovarian cyst, pelvic adhesion, and polycystic ovarian syndrome. Also, 22.9% had a family history of bipolar disorder (BD) while 30.2% had previous diagnosis. Severe pain was a major factor for seeking treatment; Paracetamol, and Piroxicam were frequently used drugs. Severe PMS triggers mood swing and can badly affect academic or work activities; victims either endure the pain due to socio-cultural and financial factors or take unsuitable medications where abuse is inevitable.

Pregnancy, delivery, and neonatal outcomes among women with incarcerated uteri: A population-based study of a large US database

ObjectiveIncarcerated uterus occurs at a rate of 1:3000 pregnancies. Previous studies focused on risk factors and management options, providing limited information about pregnancy outcomes. This study evaluates the effect of incarcerated uterus on pregnancy, delivery, and neonatal outcomes. MethodsRetrospective study using the Healthcare Cost and Utilization Project Nationwide Inpatient Sample from 2004 to 2014. Incarcerated uterus was identified using ICD-9 code 654.3X. Multivariate logistic regression analysis was used to compare maternal and neonatal outcomes among women with and without incarcerated uterus while adjusting for confounders. ResultsIncarcerated uteri were identified in 370 pregnancies, and 9,096,418 pregnancies were control cases. Compared to controls, women with incarcerated uterus were more likely to be Caucasian, have smoked during pregnancy, have had a previous caesarean section, have thyroid disease, endometriosis, leiomyomas, pelvic inflammatory disease and adhesions, and ovarian cyst (P-value < 0.05 all). Women with incarcerated uterus were more likely to have placenta previa (aOR 3.1, 95% CI 1.3–7.4), deliver by caesarean section (aOR 2.4, 95% CI 1.8–3.1), have postpartum hemorrhage (aOR 2.8, 95% CI 1.8–4.4), and require blood transfusion (aOR 5.2, 95% CI 3.1–8.8). Hydronephrosis occurred more often in women with incarcerated uterus (0.8% versus 0.1%). Moreover, they were more likely to have infants with congenital anomalies (aOR 4.0, 95% CI 1.5–10.6). Rates of preeclampsia, preterm birth, and small for gestational age were similar between the two groups (P-value > 0.05, all). ConclusionWomen with incarcerated uterus were more likely to encounter adverse delivery and neonatal outcomes compared to the general population. These findings may help guide prenatal counseling and prenatal surveillance.

P-299 Impact of endometriosis on responsiveness to ovarian hyperstimulation and embryo development: quantitative and qualitative aspects

Abstract Study question The present study was designed to better elucidate if endometriosis may affect follicologenesis and embryo development within a cycle of ovarian hyperstimulation for IVF (In Vitro Fertilization). Summary answer Endometriosis women showed fewer oocytes retrieved and a higher rate of unexpected poor response albeit number of patients without good quality embryos was similar. What is known already The pathogenetic mechanisms explaining the association between endometriosis and infertility are not fully explained. Pelvic adhesions and inflammation may play a role but other detrimental effects are presumably involved. They include reduced ovarian reserve, altered oocyte competence, impaired endometrial receptivity and association with other conditions affecting fertility such as adenomyosis. To note, even if in vitro fertilization is expected to overcome the pelvic detrimental milieu, the success rate of the procedure is lower in women with endometriosis. Study design, size, duration We designed a clinical retrospective study in order to analyse the impact of the disease on ovarian hyperstimulation and embryo development. Women were selected among those undergoing IVF cycles between January 2014 and December 2020. The primary outcome was the number of women without top quality embryos. Secondary outcomes included the rate of unexpected poor response (retrieval of ≤ 3 oocytes), cumulative clinical pregnancy rate and cumulative birth rate. Participants/materials, setting, methods Our study was performed at the Infertility Unit of the Fondazione IRCSS Ca’ Granda Ospedale Maggiore Policlinico of Milan. We included 496 subjects with a good ovarian reserve as demonstrated by serum Anti-mullerian hormone (AMH) &amp;gt; 1,1 ng/ml. Two hundreds and forty-eight women with endometriosis were identified and matched with two hundreds and forty-eight women without the disease according to age, pharmacological regimen, study period and AMH levels. Main results and the role of chance The number of women without good quality embryos did not differ between exposed and unexposed subjects (16% vs 16%, p = 1.00). The adjusted OR was 0.85 (95%CI: 0.51-1.44, p = 0.56). The clinical pregnancy rate and the live birth rate were also similar. We observed a lower number of oocytes retrieved and a higher rate of unexpected poor response (23% vs 13%, p = 0.005) in women with endometriosis. At subgroup analysis, the higher rate of unexpected poor responders persisted only in previously operated women (27% vs 13%, p = 0.02). Limitations, reasons for caution The evaluation of embryo quality was only based on morphological criteria. The histological diagnosis of endometriosis was lacking in unoperated women (128 subjects). Finally, our conclusions concern ovarian hyperstimulation and may not be extrapolated to natural reproductive processes. Wider implications of the findings Despite being generally reassuring, our findings do not completely exclude some mild negative effects on folliculogenesis. Effects demonstrated could be due to anatomical distortions of the pelvis causing an inefficient response of the ovarian parenchyma to hyperstimulation. We cannot exclude that the post-surgical healing process may alter local vascular supply. Trial registration number NA

Huayu Sanjie Enema Liquid Relieves Pain in Endometriosis Model Rats by Inhibiting Inflammation, Peripheral Sensitization, and Pelvic Adhesion.

The objective of this study is to observe the effect of relieving pain of Huayu Sanjie enema liquid (HYSJ-EL) on endometriosis model rats and to explore its mechanism of action. Of 24 female Sprague Dawley rats, six were randomly selected as the sham operation group (normal control group). The remaining rats were used to establish rat models of endometriosis through autologous endometrial transplantation combined with estrogen injection. Successfully modeled rats were randomly divided into the model, indomethacin (Western medicine group), and HYSJ-EL (Chinese herbs group) treatment groups. The thermal pain threshold of rats was measured, and hematoxylin and eosin staining was used to observe pathological changes after sampling. Serum levels of prostaglandin E2 (PGE2), interleukin-6 (IL-6), macrophage inflammatory protein-2 (MIP-2), plasminogen activator inhibitor-1 (PAI-1), and transforming growth factor-β (TGF-β) were measured using an enzyme-linked immunosorbent assay (ELISA). Furthermore, the protein and mRNA expression levels of transient receptor potential vanilloid-1 (TRPV1) and tumor necrosis factor-α (TNF-α) in the endometrium and endometriotic lesions were measured using Western blotting and quantitative real-time PCR assays, respectively. Compared to the model group, the heat pain threshold of rats in the HYSJ-EL group was significantly increased (P < 0.01), and the serum levels of PGE2, IL-6, MIP-2, PAI-1, and TGF-β were significantly decreased (P < 0.01), as well as the expression of TRPV1 and TNF-α protein and mRNA in the tissue of the ectopic lesion was significantly decreased (P < 0.05). These results indicate that the Huayu Sanjie enema liquid exerts analgesic effects on endometriosis by inhibiting inflammation, peripheral nerve sensitization, and pelvic adhesion.