Presence Of Endometriosis Research Articles

Impact of endometriosis on the quality of sexual life of women of reproductive age in Poland

Aim. The aim of this study is to demonstrate the impact of endometriosis on the quality of sexual life of women in Poland, through a comparative analysis of a population of healthy women and those struggling with the condition. Methods. The study was conducted using the validated FSFI questionnaire and the author’s supplementary questions. Information about the survey was made available on social networks and groups for women with endometriosis, as well as to healthy women constituting a control group. The CAWI technique was used in the study. The survey consisted of questions divided into mod- ules: metric data, having endometriosis and previous treatment, sexuality before and after possible treatment, and for healthy women - current assessment of the quality of sexual life. Results. Endometriosis negatively affects the quality of sexual life of women of reproductive age in Poland. Decreased quality of sexual life occurring in women with endometriosis indicates the presence of clinically significant sexual dysfunctions. Dyspareunia (a type of sexual dysfunction that manifests itself as pain during intercourse (Lew-Starowicz, Lew-Starowicz, & Skrzypulec-Plinta, 2020)) is signifi- cantly more common in women with endometriosis than in healthy women in Poland. 69 percentage points more women indicate the presence of dyspareunia when suffering from endometriosis compared to healthy women. Treatment reduces pain symptoms in women suffering from endometriosis. 24 per- centage points more women show no symptoms of dyspareunia after treatment, compared to women before treatment. The presence of endometriosis does not significantly affect women’s sense of sexual at- tractiveness. Women with endometriosis, despite the presence of pain, engage in sexual activity as often as healthy women. Treatment of endometriosis, both pharmacological and surgical, increases the quality of sexual life of women of reproductive age in Poland.

Adenomyosis and Adolescence: A Challenging Diagnosis and Complex Management

Adenomyosis is a chronic, hormone-related disease characterized by the presence of the endometrial glands and stroma within the myometrium. This condition can manifest in various features, focal or diffuse adenomyosis or as an adenomyoma, and it may involve different uterine walls (posterior, anterior, and/or lateral walls). The disease can also be classified into different degrees, as mild, moderate and severe, which can be associated with more intense symptoms, although this correlation is not always directly proportional. In fact, adenomyosis can be asymptomatic in about a third of cases or it can significantly impact patients’ quality of life through painful symptoms, such as dysmenorrhea and dyspareunia, abnormal uterine bleeding—particularly heavy menstrual bleeding—and potential effects on fertility. Historically, adenomyosis has been considered a disease primarily affecting premenopausal women over the age of 40, often multiparous, because the diagnosis was traditionally based on surgical reports from hysterectomies performed after the completion of reproductive desire. Data on the presence of adenomyosis in adolescent patients remain limited. However, in recent years, advancements in noninvasive diagnostic tools and increased awareness of this pathology have enabled earlier diagnoses. The disease appears to have an early onset during adolescence, with a tendency to progress in terms of extent and severity over time. Adenomyosis often coexists with endometriosis, which also has an early onset. Therefore, it is important, when diagnosing adenomyosis, to also screen for concomitant endometriosis, especially deep endometriosis in the posterior compartment. The aim of this narrative review is to investigate the prevalence of different types and degrees of adenomyosis in younger patients, assess the associated symptoms, and describe the most appropriate diagnostic procedures for effective therapeutic management and follow-up, with the goal of improving the quality of life for these young women.

Cardio-Metabolic Risk Profile of Women With Endometriosis: A Population-Based Study.

Endometriosis (EM) and metabolic disorders are frequent health problems among reproductive-aged women worldwide. Cardio-metabolic risk profile of women with EM is not well understood. We aimed to investigate the cardio-metabolic risk profile of Iranian reproductive-aged women with EM. This study included 976 female participants aged 20-45 years of Tehran Lipid and Glucose Study. Endometriosis was diagnosed based on the participants' self-reported previous diagnosis of EM, which was confirmed by reviewing the relevant medical documentation. All biochemical measures (low-density lipoprotein cholesterol [LDL], high-density lipoprotein cholesterol [HDL], triglycerides [TG], and fasting blood glucose concentrations [FBG]) and measurement of systolic blood pressure (SBP) and diastolic blood pressure (DBP) and anthropometric parameters were performed according to the standard protocol of TLGS. Logistic regression analysis was performed to estimate the odds ratio of cardio-metabolic disease. Of the 976 study participants, 161 individuals (16.5%) had a confirmed diagnosis of endometriosis. There were no significant differences in the median of metabolic parameters among women with and without endometriosis (p > 0.05). The prevalence of metabolic syndrome was significantly higher in women with EM group compared to the non-EM group (21.9% vs. 14.9%). The presence of endometriosis was associated with an increased odds of metabolic syndrome (adjusted odds ratio 1.99 [95% CI 1.20-3.30]; p = 0.007). And endometriosis significantly increased odds of low HDL by 2.07 (1.02-4.20); after adjustment, it still remained significant (p = 0.03). Endometriosis also increased odds of high waist circumstance significantly (1.58 [1.06-2.37]; p = 0.02). Women with endometriosis may be at an increased risk of developing metabolic syndrome, high waist circumstance and low HDL compared to their counterparts without the condition. Given the potential cardio-metabolic implications, healthcare providers should consider assessing the metabolic profile of women diagnosed with endometriosis.

Endometriotic tissue fragments are viable after cryopreservation in an ex vivo tissue model recapitulating the fibrotic microenvironment.

Is it possible to establish an ex vivo endometriosis model using cryopreserved endometriotic tissue fragments? Cryopreserved endometriotic tissue fragments remain viable after thawing and during at least 3days of culture and can therefore be used to establish an ex vivo endometriosis model to efficiently test potential therapeutic agents. Endometriosis is the most prevalent benign gynecologic disease with an enormous societal burden; however, curative therapies are still lacking. To efficiently test potential new therapies, an ex vivo model based on previously cryopreserved endometriotic tissue that recapitulates the different endometriosis subtypes and their microenvironment is highly desirable. Endometriotic tissue fragments of three different subtypes were obtained from 28 patients by surgical resection. After cryopreservation and thawing, viability and metabolic activity of these tissue fragments were assessed. Viability was compared with fresh fragments from 11 patients directly after surgical removal. Experimental intervention studies were performed in cryopreserved and thawed tissue fragments from two patients to confirm the usability of these tissues for ex vivo intervention studies. Endometriotic tissue fragments (n = 45) were cryopreserved according to three different protocols. After thawing, fragments were cultured for 24 h. A resazurin-based assay was performed to assess the metabolic activity of the tissue fragments. In addition, cell type-specific viability was analyzed by VivaFix, Hoechst 33342, and α-smooth muscle actin immunofluorescence staining and confocal microscopy. The presence of endometriosis was histologically confirmed based on hematoxylin-eosin staining. Cryopreserved and thawed tissue fragments were treated for 72 h with pirfenidone or metformin and COL1A1 and CEMIP gene expressions were assessed using RT-PCR and RT-qPCR, either in the whole tissue fragments or in myofibroblasts isolated by laser capture microdissection. Metabolic activity of endometriotic tissue fragments obtained from peritoneal (PER), ovarian (OMA), and deep (DE) endometriotic lesions was well preserved after cryopreservation in a dimethyl sulfoxide-based medium and was comparable with fresh tissue fragments. Relative metabolic activity compared to fresh tissue was 70% (CI: 92-47%) in PER, 43% (CI: 53-15%) in OMA and 94% (CI: 186-3%) in DE lesions. In fragments from PE lesions 92% (CI: 87-96%), from OMA lesions 95% (CI: 91-98%), and from DE lesions 88% (CI: 78-98%) of cells were viable after cryopreservation and thawing followed by a 24-h culture period. Differences in gene expression of fibrotic markers COL1A1 and CEMIP after 72-h treatment with pirfenidone or metformin could be detected in whole tissue fragments and in isolated myofibroblasts, indicating that cryopreserved and thawed endometriotic tissue fragments are suitable for testing anti-fibrotic interventions. N/A. Viability and metabolic activity of the endometriotic tissue fragments may have been partially compromised by damage sustained during the surgical procedure, contributing to inter-sample variance. The storage of viable endometriotic tissue fragments for later usage in an ex vivo model creates the possibility to efficiently test potential new therapeutic strategies and facilitates the exchange of viable endometriotic tissue between different research laboratories. This study was not financially supported by external funding. The authors declare no competing interest. N/A.

P-279 Significant increased isolation of escherichia coli in Iranian women with endometriosis: a case control – study

Abstract Study question Considering the role of bacterial infection in causing endometriosis, we decided to compare the cultures of endometriosis-affected women a in this study Summary answer Considering the possible role of E. coli in the progression and/or recurrence of endometriosis and also infertility What is known already (5). Due to the finding of endotoxin of E. coli species in the peritoneal cavity and menstrual fluid of endometriosis patients, infection with this bacterium has recently been proposed as an effective factor in the occurrence and growth of endometriosis lesions. Study design, size, duration This prospective case-control study was carried out in the Women’s Department of Shiraz University of Medical Sciences in collaboration with the Bacteriology and Virology Department between 60 participants. Participants/materials, setting, methods 30 women with endometriosis in stages 3 and 4 of the disease, and 30 women without endometriosis who were candidates for surgery due to benign uterine diseases, underwent endometrial biopsy with Novak Kort in sterile conditions before starting their operation, and the results of their endometrial culture were analyzed and compared in terms of the presence of Enterobacter spp., Klebsiella spp., and E. coli species. Main results and the role of chance Based on the comparison between the two groups, only E. coli species had a significant association with the presence of endometriosis (P = 0.001). There was no significant relationship between the location of endometriosis in the pelvic cavity and culture results. Parity among the E. coli negative group was significantly higher compared to the E. coli positive group (P < 0.001). Limitations, reasons for caution Lack of sample trail for repeat testing and antibiotic susceptibility testing, low taxonomical resolution, and costly laboratory setup and maintenance are other limitations of this technology Wider implications of the findings we suggest that in women who have endometriosis and recurrent IVF failure and also in cases of endometriosis recurrence after surgical treatment, treatment of couples with appropriate antibiotics and repeated culture along with subsequent antibiotic susceptibility testing until their culture becomes negative could be beneficial. Trial registration number IR.SUMS.MED.REC.1400.097

Significant increased isolation of Escherichia coli in Iranian women with endometriosis: a case control – study

BackgroundThe role of bacterial contamination in the development and progression of endometriosis lesions is currently a hot topic for gynecologists. In this study, we decided to compare the endometrial cultures of women affected by endometriosis with those of non-endometriotic women, focusing on specific microbial pathogens.Material and methodIn this cross-sectional case-control study, 30 women with endometriosis in stages 4 of the disease whose endometriosis was confirmed based on clinical, ultrasound, and histopathological findings, and 30 women without endometriosis who were candidates for surgery due to benign uterine diseases with regular menstrual cycle, underwent endometrial biopsy with Novak Kort in sterile conditions before starting their operation, and the results of their endometrial culture were analyzed and compared.ResultsResults of the study indicate that there were no significant differences in terms of age, BMI, smoking, education level, place of residency, use of the intrauterine device, or vaginal douche, and age of menarche between the case and control groups. The only demographic difference observed was in parity, where the control group had a significantly higher parity than the case group (P = 0.001). Out of the 60 cultures, only 15 samples were positive in the endometriosis group, and E. coli was the most prevalent species, with 10 (33.3%) samples testing positive for it. Klebsiella spp. and Enterobacteria spp. were also detected in 3 (10.0%) and 2 (6.7%) samples, respectively. The comparison between the two groups showed that only E. coli had a significant association with the presence of endometriosis (P = 0.001). There was no significant relationship between the location of endometriosis in the pelvic cavity and culture results. It was observed that parity among the E. coli negative group was significantly higher compared to the E. coli positive group (P < 0.001).ConclusionBased on The high occurrence of E. coli in women with endometriosis, along with its potential involvement in the progression and/or recurrence of this condition, the researchers propose that treating women with endometriosis and recurrent IVF failure, as well as those with endometriosis recurrence after surgical treatment, with suitable antibiotics and repeated culture until the culture becomes negative, could be beneficial.

P-285 Serum progesterone level may not impact ongoing pregnancy rate (OPR) in patients with endometriosis undergoing frozen-warmed-blastocyst transfer employing hormone replacement treatment (HRT) with subcutaneous progesterone

Abstract Study question Do serum progesterone (P4) levels on frozen embryo transfer (FET)-1 day impact OPRs in patients with endometriosis undergoing HRT-FET with subcutaneous progesterone (sc P)? Summary answer In HRT cycles employing sc P, serum P4 levels on FET-1 day do not affect OPRs in patients with or without endometriosis. What is known already In HRT-FET cycles employing vaginal P, reproductive outcomes are improved by serum P4 monitoring and employing a rescue protocol, if needed. However, there is paucity of data for the need of serum P4 monitoring in HRT cycles employing sc P. Endometriosis is associated with P4 resistance. There is only one study evaluating the impact of serum P4 levels on reproductive outcomes in patients with endometriosis; in this study lacking a control group and employing vaginal P gel 90 mg/12 hours supplemented by daily 50 mg intramuscular P, a threshold of 37.1 ng/ml has been reported for improved live birth rates. Study design, size, duration Retrospective cohort study. 451 consecutive patients undergoing their first HRT- vitrified warmed blastocyst transfer during November 2021-June 2023 at Anatolia IVF Centre were included. 44 patients had endometriosis with surgical and/or ultrasound findings and the remaining 407 patients did not harbor endometriosis. The presence of adenomyosis was an exclusion criterion. Following 10-12 days of 6 mg/day estradiol valereate use, sc P 25 mg/12hours (Prolutex, Ibsa) was administered. The primary outcome measure was OPR. Participants/materials, setting, methods Serum P4 levels were measured 4-5 hours after morning administration of sc P on FET-1 day. The impact of serum P4 on OPRs was assessed at various percentiles adjusting for female age, body mass index, prior birth, preimplantation genetic testing for aneuploidy, number/grade of blastocysts transferred. Multivariate regression models were performed in the whole cohort incorporating polynomial P4 terms and endometriosis interactions; optimal model for OPR prediction was selected using the lowest Akaike Information Criteria. Main results and the role of chance Patients with (27/44, 61.4%) and without (214/407, 52.6%) endometriosis had comparable OPRs. In the endometriosis group, the 10th, 50th, and 90th percentiles of serum P4 were 15.6, 25.1, and 35.4 ng/ml, respectively, compared to 14.9, 23.5, and 35.6 ng/ml in the non-endometriosis group. In the endometriosis group, the OPRs were 60.0%, 66.7%, 56.3%, and 60.0% for the &amp;lt;10p, 10-50p, 50-90p, &amp;gt;90p groups, respectively. These figures were 46.3%, 50.3%, 56.8%, and 51.2%, in the non-endometriosis group, respectively. In the endometriosis group, taking the 50-90p group as the reference, the adjusted odds ratios (aORs) for OPR of &amp;lt; 10p, 10-50p, and &amp;gt;90p groups were 1.24 [0.03, 50.45], 1.77 [0.31, 10.24], and 2.08 [0.05, 80.23], respectively. In the non-endometriosis group, the respective aORs were 0.85 [0.40, 1.79], 0.80 [0.49, 1.29], and 0.72 [0.34, 1.50]. In the multivariate regression analysis to determine the optimal model, neither serum P4 levels (aOR for linear term: 1.11 [0.98, 1.26]; for quadratic term: 0.998 [0.996, 1.00]) nor the diagnosis of endometriosis (OR: 1.48 [0.74, 2.98]) significantly predicted ongoing pregnancy after adjusting for confounders. Additionally, the optimal model did not include the interaction term, suggesting that endometriosis does not significantly modify the impact of serum P4 levels on OPRs. Limitations, reasons for caution The study’s limitations include retrospective study design, a limited sample size of the endometriosis cohort, absence of laparoscopy for endometriosis exclusion in the non-endometriosis group, and lack of data on endometriosis phenotypes. Wider implications of the findings In HRT-FET cycles employing sc P 25 mg/12hours neither serum P4 nor the presence of endometriosis have an impact on OPRs. Endometriosis may not modify the impact of serum P4 on OPRs suggesting a lack of P resistance in such cycles or the overcoming of P resistance by this regimen. Trial registration number not applicable

O-146 Serum Progesterone levels do not differ between patients with endometriosis and unaffected patients who conceive after Hormone Replacement Therapy-Frozen Embryo Transfer (HRT-FET) cycles

Abstract Study question Do endometriosis women who achieve a live birth (LB) after Hormone Replacement Therapy-Frozen Embryo Transfer (HRT-FET) have different transfer-day progesterone levels than controls? Summary answer In women achieving a LB after HRT-FET, serum progesterone levels on the day of the transfer did not differ between endometriosis and unaffected patients. What is known already In HRT-FET, several studies have highlighted the correlation between serum progesterone levels at the time of frozen embryo transfer and LB rates. In the pathophysiology of endometriosis, progesterone resistance is typically described in the eutopic endometrium. This has led to the hypothesis that women with endometriosis may require higher progesterone levels to achieve a LB, especially in HRT-FET cycles without a corpus luteum. Study design, size, duration We conducted an observational cohort study at the university-based reproductive medicine center of our institution, focusing on women who underwent a single autologous frozen blastocyst transfer after HRT using exogenous estradiol and micronized vaginal progesterone for endometrial preparation between January 2019 and December 2021. Women were included only once during the study period. Serum progesterone levels were measured on the morning of the FET by a single laboratory. Participants/materials, setting, methods Patients were divided into groups based on whether they had endometriosis or not and whether they achieved a LB. The diagnosis of endometriosis was based on published imaging criteria (transvaginal sonography/magnetic resonance imaging) and/or confirmed histology. The primary outcome was progesterone levels on the day of the HRT-FET leading to a LB in patients with endometriosis compared to unaffected women. Subgroup analyses were performed based on the presence of deep infiltrating endometriosis or adenomyosis. Main results and the role of chance A total of 1784 patients were included. The mean age of the women was 35.1 ± 4.1 years. Five hundred and sixty women had endometriosis, while 1224 did not. 179/560 (32.0%) with endometriosis and 381/1224 (31.2%) without endometriosis achieved a LB. Among women who achieved a LB after HRT-FET, there was no significant difference in the mean progesterone level on the day of the HRT-FET between those with endometriosis and those without (13.6 ± 4.3 ng/mL versus 13.2 ± 4.4 ng/mL, respectively; p = 0.302). In the subgroup of women with deep infiltrating endometriosis (n = 142) and adenomyosis (n = 100), the mean progesterone level was 13.1 ± 4.1 ng/mL and 12.6 ± 3.7 ng/mL, respectively, with no significant difference compared to endometriosis-free patients. After adjustment for BMI, parity, duration of infertility, and tobacco use, neither the presence of endometriosis (coefficient 0.38; 95% CI -0.63 to 1.40; p = 0.457) nor the presence of adenomyosis (coefficient 0.97; 95%CI -0.24 to 2.19; p = 0.114) was associated with the progesterone level on the day of HRT-FET. Among women who did not conceive, there was no significant difference in the mean progesterone level on the day of the HRT-FET between those with endometriosis and those without (p = 0.709). Limitations, reasons for caution The primary limitation of our study is associated with its observational design. Extrapolating our results to other laboratories or different routes and/or dosages of administering progesterone also requires validation. Wider implications of the findings This study shows that patients diagnosed with endometriosis do not require higher progesterone levels on the day of a frozen blastocyst transfer to achieve a LB in hormonal replacement therapy cycles. Trial registration number NA

P-668 Progesterone levels on the thawed embryo transfer day in artificial cycles with vaginal progesterone are not a predictor of clinical pregnancy: a prospective study

Abstract Study question Are serum progesterone (P) levels on the thawed embryo transfer day a good predictor of clinical pregnancy with own oocytes in artificial endometrial preparation cycles? Summary answer In artificial endometrial preparation cycles, serum P levels on the thawed embryo transfer day are not a good predictor of clinical pregnancy with own oocytes. What is known already Some studies have shown that low serum P levels on the thawed embryo transfer (ET) day are associated with a lower pregnancy rate after artificial endometrial preparation (AEP) cycles. Other studies have shown that serum P is not a good predictor of pregnancy rates. Furthermore, studies are inconclusive about which cutoff level for P on ET day correlates with better gestational outcomes. Study design, size, duration Prospective cohort study with 235 patients who underwent ET after AEP cycle with estradiol valerate and vaginal micronized P (200 mg/ 8 h). All patients underwent blastocyst-stage or cleavage-stage ET with embryos from their own oocytes, without preimplantation genetic testing for aneuploidies, after AEP cycle, with a triple layer endometrium &amp;gt; 7 mm. The study was carried out at the Human Reproduction Center of Ribeirão Preto Clinical Hospital from November 2021 to June 2023. Participants/materials, setting, methods Blood was collected between 8–10 am on the thawed ET day and serum P concentration was measured. The primary outcome was clinical pregnancy (CP) beyond pregnancy week 8. A ROC curve detected the best P cutoff level that correlated with higher CP rate. Thereafter, patients were categorized into those with serum P above and below the cutoff level. Multivariate logistic regression was performed to verify which variables were predictors of CP and P levels. Main results and the role of chance Serum P measured on the ET day showed no significant difference between patients who had CP and those who did not (12.76 +4.1 versus 11.9 + 5.6, p 0.3318). The cutoff level for serum P measured on the ET day above which correlates with higher CP rate was 10.6 ng/mL (AUC 0.58), with a sensibility of 72% and specificity of 44%. Patients who had serum P on the day of ET above this value had a significantly higher CP rate than those who had it below this value (25.9% versus 14.6%) (p 0.0372). However, when the multivariate logistic regression model was performed, there was no significant difference in the CP between the groups (OR 2, 95%IC: 0.9-5). Predictors of CP in the study were the presence of at least one top-quality embryo transferred (OR 2.6, 95%IC: 1-6.6) and the transfer of embryo at the blastocyst-stage (OR 5.2, 95%IC: 1.9-14). The presence of endometriosis was negatively associated with CP (OR 0.2, 95%IC: 0.09-0.9). Limitations, reasons for caution The small sample size is a limitation. We included the blastocyst-stage and the cleavage-stage embryo transfer. Only women with vaginal micronized P were included. Extrapolation to other P administration forms needs to be evaluated. Wider implications of the findings Monitoring serum P levels on the day of ET in AEP cycles with vaginal micronized P is not justified as serum P levels are not a good predictor of CP in cycles with own oocytes. Trial registration number Not applicable

Assessment of the Pelvic Pain Experienced by Infertile Women is of Prime Importance for Diagnosing Endometriosis

ObjectiveTo provide evidence regarding the significance of painful symptoms among women suffering from infertility. DesignAn observational retrospective cross-sectional study. SettingsUniversity hospital-based research center. PatientsInfertile patients aged between 18 and 42 years surgically explored for benign gynecological conditions between 01-2004 and 12-2020. InterventionsFor each patient, a standardized questionnaire was completed during a face-to-face interview conducted by the surgeon in the month preceding the surgery. Preoperative assessment the pain symptoms was recorded. Pain intensity was assessed with a 10cm visual analog scale (VAS). The pain was considered to be severe when the VAS score was ≥ 7. Measurements and Main ResultsSurgery was performed in 839 infertile women. 451 women had severe pelvic pain. Infertile patients with severe pain significantly more often had endometriosis (67.4% versus 30.7% respectively; p <.001) than infertile women without severe pelvic pain, and especially deep infiltrating lesions (43.2% versus 8.5% respectively; p <.001). Moreover, these women more often had intestinal endometriosis lesions (28.4% vs 1.8%; p <.001). After multivariable regression analysis, the presence of endometriosis, irrespective of the phenotype (superficial lesions (OR1.84 [1.19–2.86] and/or ovarian endometrioma OR 2.79 [1.70–4.59] and/or deep infiltrating endometriosis OR 4.49 [2.69–7.51]), and the presence of at least one intestine endometriosis lesion (OR6.49 [2.69–7.51] were significantly associated with severe pelvic pain. ConclusionSevere pelvic pain is significantly associated with endometriosis and especially deep infiltrating lesions in a population of infertile women. These results demonstrate the importance of thorough questioning regarding pelvic pain symptoms during the initial management of infertile patients.

Are there associations between clinical and embryological factors with pregnancy loss following transfer of a single euploid embryo?

First trimester pregnancy losses are commonly attributed to chromosomal abnormalities. The causes of pregnancy loss following transfer of a euploid embryo are not fully elucidated. The aim of this study was to evaluate clinical and embryological parameters for pregnancy failure following the transfer of a single euploid embryo. Pregnancy outcomes of single euploid embryo transfers from a single centre between January 2017 and March 2020 were retrospectively evaluated. Several clinical and embryological parameters were evaluated in consideration to pregnancy outcomes; total pregnancy loss and live birth. Endometrial preparation type, number of previous frozen embryo transfer cycles, history of recurrent pregnancy loss, higher body mass index, presence of endometriosis and/or adenomyosis and embryo quality were found to be significantly different between two groups. Morphokinetic parameter analysis of 523 euploid embryos using time-lapse imaging did not show any statistical differences between the two groups, however a significantly higher rate of uneven blastomeres in the cleavage stage was observed in the total preganncy loss group. Evaluation of clinical and embryological data can reveal possible factors associated with pregnancy loss that can facilitate improved patient consultation. Feasible interventions can potentially increase the chance of achieving a live birth.

Progesterone levels do not differ between patients with or without endometriosis/adenomyosis both in those who conceive after hormone replacement therapy-frozen embryo transfer cycles and those who do not.

Do women with endometriosis who achieve a live birth (LB) after HRT-frozen embryo transfer (HRT-FET) have different progesterone levels on the day of transfer compared to unaffected women? In women achieving a LB after HRT-FET, serum progesterone levels on the day of the transfer did not differ between patients with endometriosis and unaffected patients. In HRT-FET, several studies have highlighted the correlation between serum progesterone levels at the time of FET and LB rates. In the pathophysiology of endometriosis, progesterone resistance is typically described in the eutopic endometrium. This has led to the hypothesis that women with endometriosis may require higher progesterone levels to achieve a LB, especially in HRT-FET cycles without a corpus luteum. We conducted an observational cohort study at the university-based reproductive medicine center of our institution, focusing on women who underwent a single autologous frozen blastocyst transfer after HRT using exogenous estradiol and micronized vaginal progesterone for endometrial preparation between January 2019 and December 2021. Women were included only once during the study period. Serum progesterone levels were measured on the morning of the FET by a single laboratory. Patients were divided into groups based on whether they had endometriosis or not and whether they achieved a LB. The diagnosis of endometriosis was based on published imaging criteria (transvaginal sonography/magnetic resonance imaging) and/or confirmed histology. The primary outcome was progesterone levels on the day of the HRT-FET leading to a LB in patients with endometriosis compared to unaffected women. Subgroup analyses were performed based on the presence of deep infiltrating endometriosis or adenomyosis. A total of 1784 patients were included. The mean age of the women was 35.1 ± 4.1 (SD) years. Five hundred and sixty women had endometriosis, while 1224 did not. About 179/560 (32.0%) with endometriosis and 381/1224 (31.2%) without endometriosis achieved a LB. Among women who achieved a LB after HRT-FET, there was no significant difference in the mean progesterone level on the day of the HRT-FET between those with endometriosis and those without (13.6 ± 4.3 ng/ml vs 13.2 ± 4.4 ng/ml, respectively; P = 0.302). In the subgroup of women with deep infiltrating endometriosis (n = 142) and adenomyosis (n = 100), the mean progesterone level was 13.1 ± 4.1 ng/ml and 12.6 ± 3.7 ng/ml, respectively, with no significant difference compared to endometriosis-free patients. After adjusting for BMI, parity, duration of infertility, tobacco use, and geographic origin, neither the presence of endometriosis (coefficient 0.38; 95% CI: -0.63 to 1.40; P = 0.457) nor the presence of adenomyosis (coefficient 0.97; 95% CI: -0.24 to 2.19; P = 0.114) was associated with the progesterone level on the day of HRT-FET. Among women who did not conceive, there was no significant difference in the mean progesterone level on the day of the HRT-FET between those with endometriosis and those without (P = 0.709). The primary limitation of our study is associated with its observational design. Extrapolating our results to other laboratories or different routes and/or dosages of administering progesterone also requires validation. This study shows that patients diagnosed with endometriosis do not require higher progesterone levels on the day of a frozen blastocyst transfer to achieve a LB in hormonal replacement therapy cycles. None declared. N/A.

Nomogram for predicting difficult total laparoscopic hysterectomy: a multi-institutional, retrospective model development and validation study.

Total laparoscopic hysterectomy (TLH) is the most commonly performed gynaecological surgery. However, the difficulty of the operation varies depending on the patient and surgeon. Subsequently, patient's outcomes and surgical efficiency are affected. The authors aimed to develop and validate a preoperative nomogram to predict the operative difficulty in patients undergoing TLH. This retrospective study included 663 patients with TLH from Southwest Hospital and 102 patients from 958th Hospital in Chongqing, China. A multivariate logistic regression analysis was used to identify the independent predictors of operative difficulty, and a nomogram was constructed. The performance of the nomogram was validated internally and externally. The uterine weight, history of pelvic surgery, presence of adenomyosis, surgeon's years of practice, and annual hysterectomy volume were identified as significant independent predictors of operative difficulty. The nomogram demonstrated good discrimination in the training dataset [area under the receiver operating characteristic curve (AUC), 0.827 (95% CI, 0.783-0.872], internal validation dataset [AUC, 0.793 (95% CI, 0.714-0.872)], and external validation dataset [AUC, 0.756 [95% CI, 0.658-0.854)]. The calibration curves showed good agreement between the predictions and observations for both internal and external validations. The developed nomogram accurately predicted the operative difficulty of TLH, facilitated preoperative planning and patient counselling, and optimized surgical training. Further prospective multicenter clinical studies are required to optimize and validate this model.

Endometriosis-associated ovarian cancer: a different clinical entity

ObjectiveTo compare survival outcomes and patterns of recurrence between endometriosis-associated ovarian cancer patients and non-endometriosis-associated ovarian cancer patients.MethodsThis retrospective study included data of consecutive patients with endometrioid or clear cell...

PURE vs. mixed clear cell ovarian carcinomas: Is there any impact on survival?

ObjectiveOur primary aim in this study is to define the clinical characteristics of patients with clear-cell ovarian carcinoma and evaluate the prognostic factors affecting survival. Study designRecords of 85 patients, operated between 2000 and 2018, for an adnexal mass and whose final pathology reported clear cell ovarian carcinoma were reviewed. The study considered demographic data, clinical characteristics of the patients, as well as pure and mixed-type clear cell histology. The patients' follow-up time, disease-free and overall survival recorded. The primary outcomes were disease-free survival (DFS) and overall survival (OS). ResultsThe median age of the patients at diagnosis was 52. In 64.7 % of the cases, clear cell histology was pure, while the others (35.3 %) were mixed. Patients with ovarian endometriosis constituted 27.1 % of the whole population. The median OS for the entire population was 92 months (95 %CI:72–124). On univariate and multivariate analyses, advanced age was found to have a significant independent impact on OS and DFS (p < 0.05) and, was associated with a worse prognosis. Also, the multivariate analyses showed that the presence of endometriosis has a significant independent impact on OS (p < 0.05). When examining the relationship between the histological origin (mixed vs. pure) and 5-year survival, the mixed type showed longer OS and DFS rates (76.8 % vs. 69.8 %, 61.5 % vs. 53.8 %), the difference was not statistically significant (p > 0.05). ConclusionThis retrospective study showed that although mixed type histological origin was associated with higher OS and DFS rates compared to pure type in patients with CCOC, the difference was not statistically significant. Advanced age and the presence of endometriosis was found to have a significant independent effect on OS and DFS and was associated with a worse prognosis. Overall, this study provides useful insights into the clinical characteristics of patients with CCOC and identifies important prognostic factors affecting survival.

Adenomyosis among patients undergoing postpartum hysterectomy for uncontrollable uterine bleeding: Amulticenter, observational, retrospective, cohort study on histologically-based prevalence and clinical characteristics.

To assess the prevalence of adenomyosis at pathologic examination, and its association with obstetric complications, peripartum maternal clinical characteristics and neonatal birth weight in patients undergoing postpartum hysterectomy due to postpartum hemorrhage (PPH). A multicenter, observational, retrospective, cohort study was carried out including all women who underwent postpartum hysterectomy due to PPH at gestational week 23+0 or later, between January 2010 and May 2023. Patients were categorized into two groups based on the presence of adenomyosis at pathologic examination, and were compared for obstetric complications, peripartum maternal clinical characteristics, and neonatal birth weight. The histologically-based prevalence of adenomyosis in patients undergoing postpartum hysterectomy due to PPH was 39.4%. Adenomyosis was associated with a longer hospitalization time (regression coefficient: 4.43 days, 95% CI: 0.34-8.52, P = 0.034) and a higher risk of hypertensive disorders (OR: 5.82, 95% CI: 1.38-24.46, P = 0.016), threatened preterm labor (OR: 3.34, 95% CI: 1.08-10.31, P = 0.036), urgent/emergency C-section (OR: 24.15, 95% CI: 2.60-223.96, P = 0.005), postpartum maternal complications (OR: 4.96, 95% CI: 1.48-16.67, P = 0.012), maternal intensive care unit admission (OR: 3.56, 95% CI: 1.05-12.05, P = 0.041), and low birth weight neonates (OR: 3.8, 95% CI: 1.32-11.02, P = 0.013). In patients undergoing postpartum hysterectomy due to PPH, adenomyosis is a highly prevalent condition among, and is associated with adverse obstetric, maternal, and neonatal outcomes.

Presence of endometriosis and chronic overlapping pain conditions negatively impacts the pain experience in women with chronic pelvic-abdominal pain: A cross-sectional survey.

Evidence of overlap between endometriosis and chronic pain conditions is emerging; however, little is known about how the pain experience differs based on the presence or absence of endometriosis. In a sample of women reporting chronic pelvic-abdominal pain (CPP), the aim of this study was to characterize differences in pain symptomatology between women with and without endometriosis and to examine the influence of chronic overlapping pain conditions (COPCs) on pain among these two groups. This was a cross-sectional study, based on an online survey. Participants (aged 18+ years) completed a survey collecting pain diagnoses and symptoms assessing pelvic pain severity, pain interference, and pain impact. Independent sample t-tests, chi-square, and multiple linear regression models were employed to analyze group differences in pain symptomatology and COPCs. Of the 525 respondents with CPP, 25% (n = 133) reported having endometriosis. Women with endometriosis were younger at the onset of pelvic pain, relative to women without endometriosis (p = 0.04). There were no differences in age, race, ethnicity, or duration of pelvic pain between women with and without endometriosis. Women with endometriosis reported higher pelvic pain severity (+0.8, 95% CI = 0.4-1.1), pain interference (+5.9, 95% CI = 2.4-9.3), and pain impact (+1.9, 95% CI = 0.8-2.9). Endometriosis was associated with a higher number of COPCs (p = 0.003), with 25% (n = 33) of women reporting ⩾3 overlapping pain conditions compared with 12% (n = 45) of those without endometriosis. Women with endometriosis had a higher frequency of fibromyalgia (p < 0.001), chronic fatigue syndrome (p < 0.001), and temporomandibular disorder (p = 0.001). The number of COPCs was associated with higher pain severity, interference, and impact, independently of endometriosis. Women with endometriosis experienced higher levels of pain-related burden and COPCs compared with those without endometriosis. Pain intensity, interference, and impact increased with a higher number of pain conditions regardless of endometriosis presence.

Comparison of Benign, Borderline, and Malignant Ovarian Seromucinous Neoplasms on MR Imaging.

This study aimed to compare MRI findings among benign, borderline, and malignant ovarian seromucinous neoplasms. We retrospectively analyzed MRI data from 24 patients with ovarian seromucinous neoplasms-seven benign, thirteen borderline, and six malignant. The parameters evaluated included age, tumour size, morphology, number, height, apparent diffusion coefficient (ADC) values, T2 ratios, time-intensity curve (TIC) descriptors, and TIC patterns of the mural nodules. Additionally, we examined the T2 and T1 ratios of the cyst contents, tumour markers, and the presence of endometriosis. We used statistical tests, including the Kruskal-Wallis and Fisher-Freeman-Halton exact tests, to compare these parameters among the three aforementioned groups. The cases showed papillary architecture with internal branching in 57% of benign, 92% of borderline, and 17% of malignant cases. Three or fewer mural nodules were seen in 57% of benign, 8% of borderline, and 17% of malignant cases. Compared to benign and borderline tumours, mural nodules of malignant neoplasms had significantly increased height (P = 0.015 and 0.011, respectively), lower means ADC values (P = 0.003 and 0.035, respectively). The mural nodules in malignant cases also demonstrated significantly lower T2 ratios than those in the benign cases (P = 0.045). Most neoplasms displayed an intermediate-risk TIC pattern, including 80% benign, 83% borderline, and 60% malignant neoplasms, and no significant differences were observed. Most benign and borderline tumours exhibited a papillary architecture with an internal branching pattern, whereas this feature was less common in malignant neoplasms. Additionally, benign tumours had fewer mural nodules compared to borderline tumours. Malignant neoplasms were characterized by mural nodules with increased height and lower ADC values than those in benign and borderline tumours. Interestingly, all three groups predominantly exhibited an intermediate-risk TIC pattern, emphasizing the complexity of diagnosing seromucinous neoplasms using MRI.

Evaluation of Association Between Adenomyosis and Cesarean Scar Defect.

This study aims to investigate and compare quantitative factors of the cesarean scar defect (CSD) in symptomatic patients with and without uterine adenomyosis. This study was conducted as a case-control study. Patients who met the inclusion criteria were divided into two groups: with adenomyosis (case) and without adenomyosis (control). The demographic data, medical history, and sonohysterography findings were extracted from the patient's documents and archived images. During 2 years, 310 symptomatic women with a history of previous cesarean section underwent sonohysterography. Among them, 204 patients met the inclusion criteria. The most common chief complaints were post-menstrual bleeding (34.3%) and prolonged bleeding (27%). Cesarean scar depth and width significantly differed between these two groups, and patients with underlying adenomyosis had significantly larger defects (P-value of .009 and .005, respectively). Mean RMT/AMT ratio was 31.83% in the case group and 42.88% in the control group. In our study, RMT/AMT ratios were significantly lower in the case group (P-value of .001). In addition, we performed analysis on a subgroup of patients with one prior cesarean section. Similar results were achieved with a lower RMT/AMT ratio in case group (mean of 31.20% in case group and 46.47% in control group; P-value of .000). Our study showed a strong association between the presence of adenomyosis and larger clinically more significant CSDs. To establish a causative relationship, we suggest a prospective cohort study to follow up the patients and compare the evolution of CSD in patients with and without adenomyosis.

Impact of adenomyosis on IVF outcomes in women undergoing donor oocyte transfers: a prospective observational study

To prospectively examine the association between adenomyosis type, location, and severity with reproductive outcomes in patients undergoing single embryo transfer (SET) with embryos derived from donor oocytes. A prospective observational cohort study. University-affiliated in-vitro fertilization center. Infertile patients with (n=114) and without (n=114) adenomyosis who received their first donor oocyte transfer between January 2019 and January 2023 were included in the study. Adenomyosis was confirmed with the presence of at least one direct feature visualized by 2D/3D transvaginal ultrasound, and classified according to type (diffuse, focal), localization (inner/outer myometrium and/or the junctional zone) and uterine extension (mild, moderate, severe). Following an artificial or natural endometrial preparation cycle, patients underwent SET in the blastocyst stage. The primary outcome was the implantation rate. The secondary outcomes were clinical pregnancy, live birth, and miscarriage rate following SET. (s): The presence of adenomyosis did not significantly affect the implantation, clinical pregnancy, or live birth rates. However, women with adenomyosis had a significantly higher miscarriage rate compared to those without adenomyosis (20.2% vs. 9.6 %, respectively; p=0.04). The multivariate analysis assessed possible risk factors for each clinical outcome considered in the study and showed that adenomyosis affected the risk of miscarriage. Specifically, TVS-detection of adenomyosis in the junctional zone was associated with over three-fold higher odds of miscarriage (RR 3.28, 95% CI 1.38-7.78; p=0.004). Conversely, adenomyosis features detected exclusively in the outer myometrium were associated with a higher ongoing pregnancy (RR 0.30, 95% CI 0.13-0.72; p=0.004). Diffuse adenomyosis in the JZ and severe adenomyosis raised the odds of miscarriage four-fold (RR 2.29, 95% CI 1.22-4.30; p=0.015; and RR 2.20, 95% CI 1.19-4.04; p=0.005). (s): This study demonstrated that while adenomyosis did not significantly reduce the odds of implantation, the direct signs of adenomyosis in the junctional zone and disease severity are significant risk factors for miscarriage in patients receiving donor oocyte transfers. This study highlights the importance of thorough ultrasound examination and detailed adenomyosis classification in the assessment and management of infertile patients.