Tubal Infertility Research Articles

MiR-19b-3p inhibits cell viability and proliferation and promotes apoptosis by targeting IGF1 in KGN cells

Background Endometriosis (EM) is a major cause of infertility, but the pathogenesis and mechanisms are not yet fully elucidated. MiR-19b-3p is involved in many diseases, but its functional role in EM-associated infertility remains unexplored. This study aimed to examine miR-19b-3p abundance and IGF1 concentration in cumulus cells (CCs) and follicular fluid of EM-associated infertility patients, and to investigate the potential role of miR-19b-3p in KGN cells by identifying its target and elucidating the underlying mechanisms. Results The results from the case-control study indicated that, compared to the control group consisting of patients with tubal infertility, patients with EM-associated infertility exhibited a lower percentage of mature oocytes. MiR-19b-3p level was elevated in CCs from EM-associated infertility patients. IGF1 was identified as a direct target of miR-19b-3p and was negatively regulated by miR-19b-3p in KGN cells. Overexpression of miR-19b-3p significantly inhibited cell viability and proliferation, promoted apoptosis, and arrested the cell cycle at G0/G1 phase in KGN cells. The effects of miR-19b-3p were reversed by co-transfection of IGF1, and the biological effects of miR-19b-3p in KGN cells were mediated by IGF1. Additionally, miR-19b-3p targeted IGF1 to down-regulate AKT phosphorylation and participate in the apoptotic pathway in KGN cells. Conclusions This study demonstrates that miR-19b-3p level is elevated in CCs and IGF1 concentration is decreased in follicular fluid in patients with EM-associated infertility. MiR-19b-3p regulates the biological effects of KGN cells by targeting IGF1.

In Vitro Fertilization (IVF) Outcomes in Patients With Endometriosis Compared to Patients With Tubal Factor Infertility in Indonesia: A Retrospective Study.

Endometriosis is a disease characterized by dysmenorrhea, chronic pelvic pain, and infertility. The pathogenesis of endometriosis and its relationship to infertility are still not fully understood. In vitro fertilization (IVF) is considered an effective treatment for patients with endometriosis-associated infertility. This study compared the pregnancy rates of endometriosis patients who underwent IVF with those of patients with tubal obstruction. This was a retrospective cross-sectional study of 225 patients with endometriosis and tubal factor infertility who underwent IVF at Yasmin Clinic, Dr. Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia, between January 2013 and August 2021. Demographic data, anti-Mullerian hormone (AMH) levels, the initial and total dose of recombinant follicle stimulating hormone (rFSH), the total dose of recombinant luteinizing hormone (rLH), stimulation duration, oocyte maturation rates, fertilization rates, embryo cleavage rates, and pregnancy rates (biochemical, clinical and ongoing) were obtained. AMH level, number of oocytes retrieved, and embryo cleavage rates were significantly lower in the endometriosis group. Initial and total doses of rFSH and total dose of rLH were higher, and the duration of stimulation was longer in the endometriosis group compared to the tubal factor group. In the endometriosis group, the biochemical (47.3% vs. 52.7%, p=0.375), clinical (43.1% vs. 56.9%, p=0.215), and ongoing (45.5% vs. 54.5%, p=0.511) pregnancy rates were lower than those in the tubal factor group. However, there were no statistically significant differences between the two groups. There was no significant difference in pregnancy rates between the short antagonist and ultra-long protocols (three months of downregulation). From multivariate analysis, only rLH supplementation was found to be significantly related to pregnancy outcomes in patients with endometriosis. AMH levels, number of oocytes retrieved, and embryo cleavage rates were lower in patients with endometriosis. However, pregnancy rates were not significantly different from patients with tubal factors. Supplementation with rLH may improve pregnancy rates in patients with endometriosis who have undergone IVF programs.

Pre- and Procedural Factors Influencing the Success of In Vitro Fertilization: Evaluating Embryo Quality and Clinical Pregnancy in Cases of Tubal Factor Infertility.

Introduction: While tubal occlusion is a prevalent cause of infertility, accounting for 11-35% of infertility cases among women, there remains a limited understanding of the factors influencing clinical pregnancy following in vitro fertilization (IVF). Methods: In our retrospective, cross-sectional cohort study conducted at a single tertiary center, medical records of women aged 19 to 43 years were analyzed. Logistic regression models were employed to identify the prognostic factors associated with clinical pregnancy after IVF in patients with tubal factor infertility, excluding cases with hydrosalpinx. Results: Data from 219 women diagnosed with tubal occlusion were compared to 1140 cases with non-tubal indication, covering a total of 1359 IVF cycles. A lower maternal age (adjusted odds ratio [AOR]: 0.89, p = 0.001) and a higher embryo quality (AOR: 1.26, p = 0.01) emerged as important factors in clinical pregnancy in the tubal infertility group. Moreover, a lower maternal (AOR:0.91, p < 0.01) and paternal age (p = 0.001), and favorable semen quality (AOR: 1.32, p = 0.03) were critical determinants in the non-tubal infertility group. BMI was generally higher in tubal infertility patients (p = 0.01). Furthermore, FSH level (AOR: 0.93, p = 0.004), AMH level (p < 0.04), number of embryos transferred (AOR: 2.04, p < 0.001), and embryo quality (AOR: 1.26, p < 0.001) came into prominence only in the non-tubal infertility group. The clinical pregnancy rate (34.2%) of women with tubal occlusion did not differ significantly from those in other forms of infertility undergoing IVF (35.4%). Conclusions: Although tubal infertility is typically anticipated to yield the highest clinical pregnancy rates following IVF, it is crucial to acknowledge that both maternal and paternal characteristics can also significantly impact the outcomes.

Chronic lower abdominal pain in an elderly female patient: a case report about sigmoid colon fistula and pelvic abdominal infection

An elderly woman patient presented with a history of recurrent right lower abdominal pain accompanied by fever and abnormal vaginal discharge for 36 years worse for two weeks. Conservative medical treatment was ineffective, by laparoscopic exploration combined with intraoperative colonoscopy, the presence of a sigmoid colon fistula and pelvic abdominal infection with foreign bodies were confirmed. It was hypothesized that the occurrence of recurrent right lower abdominal pain and intestinal fistula may be potentially associated with tubal injection sterilization performed 36 years ago.

A Retrospective Study of Leparoscopic Evaluation of Tubal Factors in Case of Infertility

Background: Tubal factor infertility accounts for a large portion of female factor infertility. The most prevalent cause of tubal factor infertility is pelvic inflammatory disease and acute salpingitis. Tubal factor infertility accounts for approximately 25-35% of cases of female infertility. The aim of this study was to determine the role of leparoscopic evaluation of Tubal factors in case of infertility. Methods: A retrospective study was carried out at Department of Gynae and Obstetrics UHC, Dhamrai, Dhaka, Bangladesh from January to December 2023. 55 patients were selected for laparoscopic evaluation. Inclusion criteria were patients with no prior pelvic surgery, normal bimanual pelvic examination, normal semen parameters of partner and no ovulatory dysfunction. After obtaining thorough history &amp; detailed examination, patients were informed about the procedure and written informed consent was taken. Results: 55 patients underwent laparoscopy during the study period. Most patients 10 were in the age group of ˂20 yr, 15 were between 21-30 yr &amp; 20 were 31- 40 yr of age and 10 were between 36 – 40 yrs of age. Among these 55 patients 24 patients had primary infertility while 31 had presented with secondary infertility. Diagnostic laparoscopy revealed normal pelvic organs in 9 (16.3%) cases, Chronic pelvic inflammatory disease in 3 (5.4%), endometriosis in 13 (23.6%) and congenital anomalies of uterus in 1(1.8%) cases. 7.2% cases had bilateral tubal block, 27.3% had unilateral block and in 7.2% cases though the tubes were found patent significant peritubal adhesions were noted. Tubal pathology was detected in 55.5% cases of primary infertility and 42.1% cases of secondary infertility. Among those who had tubal pathology, nonspecific pelvic inflammatory disease was noted in 33.3% and genital tuberculosis was diagnosed in 2.7% cases. The most common complications were pyrexia, shoulder tip pain, nausea and vomiting. Conclusion: Laparoscopy is a safe and effective diagnostic tool in evaluating tubal status of infertile patients. Laparoscopy and chromopertubation test should be recommended as a first step in the investigation of infertile women with tubal factor.

Research progress of ferroptosis in female infertility

Ferroptosis is a novel type of programmed cell death dependent on iron and characterized by the accumulation of lipid peroxides in cells and is closely related to various diseases. Female infertility is a global health concern, which is associated with a variety of factors. The etiology remains unknown in many women with infertility. With further investigation into the pathogenesis of infertility, a growing number of studies have demonstrated the close connections between infertility and ferroptosis. Through a literature review, it is found that ferroptosis is closely involved in endometriosis- and polycystic ovarian syndrome (PCOS)-associated infertility and tubal factor infertility. Iron overload increases the resistance to ferroptosis, and ferroptosis in some cells accelerates endometrial lesion growth. Moreover, iron overload may be hazardous to oocytes. This review may shed some light on the diagnosis and treatment of female infertility.

Tubal Sterilization Rates by State Abortion Laws After the Dobbs Decision

This study examines whether the use of sterilization procedures changed after the Dobbs ruling by restrictiveness of state abortion laws.

Comparative Analysis of Laparoscopic and Open Tubal Ligation: Insights from a Retrospective Study in a Tertiary University Hospital

Background: Female sterilization remains a prevalent contraceptive method globally, despite a declining trend in prevalence over the past decades. Methods: To compare the outcomes of tubal ligation between laparoscopic and open surgical approaches, conducted at the Jordan University Hospital from 2010 to 2021. Results: 242 females underwent tubal ligation with 131 had open surgery and 111 had laparoscopic surgery. The median follow-up period for the cohort was 8 years. For the entire study cohort, the mean age at the time of surgery was 37.77 years (standard deviation (SD) = 4.589). A statistically significant (p &lt; 0.0001) difference in age was found, with mean age being older in the laparoscopy group. However, there were no significant differences between the two groups in terms of gravidity (p = 0.9499) or parity (p = 0.4867). Remarkably, only two pregnancies were documented during the follow-up period, both of which were observed in the laparoscopic surgery group. Overall free-from-pregnancy rate at 8 years was 98.79%; 97.59% in the laparoscopy group and 100% in the open surgery group. Conclusions: Both open and laparoscopic tubal sterilization are equally effective permanent contraceptives. While our study contributes to the understanding of tubal ligation outcomes, further research, particularly in developing countries like Jordan, is warranted to address the unique needs and challenges of diverse populations in reproductive healthcare.

Transcriptome analysis reveals that defects in cell cycle regulation contribute to preimplantation embryo arrest

Patients with preimplantation embryo arrest (PREMBA) often experience assisted reproductive failure primarily due to the lack of transferable embryos, and the molecular mechanisms underlying PREMBA remain unclear. In our study, the embryos from five women with recurrent preimplantation embryo arrest and three women with tubal factor infertility were used for single-embryo transcriptome sequencing. Meanwhile, the transcriptomes of normal human preimplantation embryos obtained from GSE36552 were utilized to perform a comparative analysis with the transcriptomes of PREMBA embryos. Our results showed dysregulation of the cell cycle phase transition might be a potential pathogenic factor contributing to PREMBA. Through integrated analysis of the differentially expressed genes (DEGs) and weighted gene co-expression network analysis (WGCNA), we identified a number of hub genes using the protein-protein interaction network. The top 5 hub genes were as follows: CCNB2, BUB1B, CDC25A, CCNB3, and PLK3. The expression of hub genes was validated in PREMBA embryos and donated embryos using RT-qPCR. The knockdown of Ccnb2 in mouse zygotes led to an increase in embryo fragmentation, a rise in apoptosis, and a reduction in blastocyst formation. Furthermore, silencing the expression of CDC25A in HEK293T cells resulted in a decrease in cell proliferation and an increase in apoptosis, providing further support for our findings. Our findings could predict the development outcomes of preimplantation embryos and be used as potential therapeutic targets to prevent recurrent failures of IVF/ICSI attempts.

A Retrospective Study on Risk Factors, Clinical Presentation AndManagementOfEctopic Pregnancy In Tertiary Care Centre, Rajasthan

Background: Ectopic pregnancy is not an uncommon condition and is potentially a life-threatening emergency. There is a rising trend in incidence which necessitates the gynecologists to have comprehensive knowledge about the disease. Aim of the study: To determine the incidence, risk factors, clinical features and management. Materials and Methods: This study is conducted in the Department of Obstetrics and Gynecology of Umaid Hospital, Jodhpur. It is a retrospective descriptive study on patients who presented to our department with clinical features of ectopic pregnancy and later confirmed with intraoperative findings or ultrasound, in the 6 month period from January 2024 to June 2024. Results: A total of 84 patients were diagnosed to have ectopic pregnancy with an incidence of 1.8 percent. Previous ectopic pregnancy found in 3.57% of pregnancy. Tubal surgeries were carried out in 4.7% . H/O previous abortion/MTP found in 26.19% of cases . Previous abdominopelvic surgeries including caesarean sections were responsible for 22.61% of ectopic pregnancy. PID was found in 16.6% of cases History of tuberculosis was found in 3.57% of cases. In this study, 13.09% cases were using an intrauterine device (IUD) as a method of contraception. Combining OCPs and IUD, 21.39% cases had ectopic pregnancy Surgical treatment with salpingectomy was done in majority of the cases and medical management in 4 patients. Blood transfusions were given in 83.3% of cases. The postoperative period is uneventful in all the cases. Conclusion: Ectopic pregnancy is the leading cause of maternal mortality in first trimester. In spite of advanced diagnostic techniques, it poses great diagnostic difficulties due to varied signs and symptoms. Previous tubal surgery pelvic inflammatory disease and infertility are the risk factors of tubal pregnancy

A Decision Aid to Support Tubal Sterilization Decision-Making Among Pregnant Women: The MyDecision/MiDecisión Randomized Clinical Trial

A Decision Aid to Support Tubal Sterilization Decision-Making Among Pregnant Women: The MyDecision/MiDecisión Randomized Clinical Trial

Normal sperm quality despite partial deletion of sY84 in the AZFa region: A case report.

The complete absence of the azoospermia factor A (AZFa) region typically results in nonobstructive azoospermia. Partial deletions of the AZFa region are particularly noteworthy due to the limited and enigmatic reports of partial deletions in the AZFa region. Here, we present a rare case report of partial deletion of sY84 in the AZFa region but exhibiting normal sperm quality. The aim of this case report is to gain a deeper insight into the impact of AZFa region deletion on male fertility and to guide future clinical decisions and treatment strategies. A 25-year-old man presented to the hospital with his 25-year-old wife due to recurrent spontaneous abortions. Routine semen analysis, sperm morphology analysis, acrosomal enzyme analysis, sperm DNA fragmentation indexed, and peripheral blood karyotype analysis revealed no abnormalities. Y chromosome microdeletion was detected by real-time fluorescence polymerase chain reaction, which showed that sY84 could not be amplified and sY86 was amplified nonspecifically. The man was diagnosed with partial deletions in the AZFa region. The wife underwent in vitro fertilization treatment for tubal infertility and recurrent spontaneous abortions. The couple successfully delivered a healthy daughter weighing 2.7 kg at 39 weeks of gestation, following 2 assisted reproductive pregnancies. Our findings contribute to expanding our knowledge of the AZFa region. A sY84 deficiency in the AZFa region may not lead to spermatogenesis failure and may potentially be one of the factors causing recurrent miscarriages, which needs to be confirmed by further data.

Pregnancy after Tubal Sterilization in the United States, 2002 to 2015

BackgroundTubal sterilization is the most commonly used method of contraception in the United States. Because contraceptive effectiveness influences contraceptive selection, we examined typical use failure rates after tubal sterilization in the United States.MethodsWe estimated rates of pregnancy after tubal sterilization using data from four waves of the National Survey of Family Growth (NSFG), representative samples of U.S. women aged 15 to 44 years, collected in 2002, 2006 to 2010, 2011 to 2013, and 2013 to 2015. Survey weighting was used in survival analysis to examine time to first pregnancy after tubal sterilization. Data from these participants were censored after a tubal reversal procedure, infertility treatment, hysterectomy, or bilateral oophorectomy. Reported pregnancy rates after tubal sterilization procedures were examined by using Kaplan–Meier curves and then multivariable Cox proportional-hazards models to examine the effects of age at tubal sterilization, race/ethnicity, education, Medicaid funding, and postpartum versus interval procedures.ResultsPregnancy after tubal sterilization was reported by 2.9 to 5.2% of participants across NSFG waves. In the most recent survey wave (2013 to 2015), the estimated percentage of participants with pregnancies within the first 12 months after a tubal sterilization procedure was 2.9%; at 120 months after tubal sterilization, the estimated percentage with a pregnancy was 8.4%. At all the time points examined, pregnancy after tubal sterilization was less common after postpartum procedures than after interval procedures; however, this difference was not evident in multivariable models. In multivariable models, chance of pregnancy decreased with age at time of tubal sterilization. Race/ethnicity, education, and Medicaid funding were not consistently associated with pregnancy after tubal sterilization.ConclusionsThese data suggest that there may be nontrivial rates of pregnancy after tubal sterilization.

Evaluation of ovarian reserve and the assisted reproductive technology (ART) cycles’ outcome as well as the relapse rate within one year after ART in women with multiple sclerosis: a case-control study

ObjectiveTo compare the ovarian reserve and the results of infertility treatment, as well as to investigate the relapse rate in the first year after the assisted reproductive technology (ART) cycle in patients with multiple sclerosis (MS) referred to Royan Institute.Materials and methodsThis retrospective study was carried out to evaluate all women diagnosed with MS and referred to Royan Institute for assessment and treatment of possible infertility between 2011 and 2022. The control group consisted of randomly selected healthy women with tubal factor infertility who were referred for treatment during the same time period and matched in terms of age. A comparison was made between groups in terms of ovarian reserve and infertility treatment outcomes. Additionally, patients with MS who met the criteria were monitored via telephone to evaluate the symptoms, disability and relapse rate both pre- and post-ART.ResultsOver the course of a decade, the database documented a total of 60 cases diagnosed with MS. Upon examination of the records, it was found that in 27 patients only admission was done without any hormonal assessment or infertility treatment cycle and 5 patients proceeded with the intrauterine insemination cycle. Eventually, 28 women with MS underwent the ART cycle and all of them were treated with interferon beta, glatiramer acetate, or some oral disease modifying therapies. No statistically significant difference in terms of the basal levels of luteinizing hormone, follicle-stimulating hormone and anti-Müllerian hormone was found between the MS and control groups (P > 0.05). Two groups were comparable in terms of menstrual status. The study revealed that both groups exhibited similarities in terms of the controlled ovarian stimulation protocol and duration, the dosage of gonadotropin administered, as well as the ovarian response type, clinical pregnancy rate, and live birth rate (P > 0.05). After follow up, only 2 patients (9.5%) reported relapse of symptoms within one year after ART.ConclusionThe ovarian reserve and ovarian stimulation cycle and pregnancy outcomes following the ART cycle in MS patients were similar to the age-matched control group. The relapse rate of multiple sclerosis did not show a significant increase within a year following the ART cycle.

Advances in vaccine development for Chlamydia trachomatis.

Chlamydia trachomatis is the most prevalent bacterial sexually transmitted infection globally. Antibiotic treatment is highly effective, but infection is often asymptomatic resulting in most individuals going undetected and untreated. This untreated infection can ascend to the upper female genital tract to cause pelvic inflammatory disease, tubal factor infertility, and ectopic pregnancy. Chlamydia screening and treatment programs have failed to control this epidemic and demonstrate the need for an efficacious vaccine to prevent transmission and disease. Animal models and human epidemiological data reveal that natural immunity can provide partial or short-lived sterilizing immunity. These data further demonstrate the importance of eliciting interferon gamma (IFNγ)-producing cluster of differentiation 4 (CD4) T cells (Th1 and Th1/17 cells) that can likely synergize with antibody-mediated opsonophagocytosis to provide optimal protection. These studies have guided preclinical rational vaccine design for decades and the first Phase 1 clinical trials have recently been completed. Recent advances have led to improvements in vaccine platforms and clinically safe adjuvants that help provide a path forward. This review describes vaccine models, correlates of immunity, antigen and adjuvant selection, and future clinical testing for Chlamydia vaccine development.

P-737 Congenital tubal anomalies: exploring its relationship with tubal factor infertility: observational-descriptive study

Abstract Study question Is there any relation between congenital Fallopian tube anomalies and tubal factor infertility in subset of infertile women? Summary answer Nearly 15% of women who underwent diagnostic laparoscopy revealed congential tubal anomaly (15%), including total or partial agenesis of tubes. What is known already The fallopian tubes play a crucial role in the reproductive process. These structures are 10-12 cm in length, consists of four parts from proximal to distal side: intramural, isthmic, ampullary and fimbrial [1]. Any abnormalities in their development or structure can severely affect fertility. Fallopian tube agenesis, whether partial or complete, constitutes one such anomaly. While there have been numerous advances in the understanding and management of fallopian tube disorders, partial or complete fallopian tube agenesis remains an enigmatic entity with unknown prevalance in the general population. Study design, size, duration Observational study was conducted between 2020 and 2023. All couples with primary infertility were evaluated in an outpatient clinic using basic hormone analysis, semen analysis, sonography and hysterosalpingogram as a standard of care. All women with suspected tubal pathology were offered to have diagnostic laparoscopy (LS) in order to confirm the anomaly. When tubal and/or Mullerian anomalies were detected, urinary system was examined by intravenous pyelography. Other suspected pathologies were examined by abdominopelvic CT x-ray. Participants/materials, setting, methods All women with suspected tubal pathology were offered to have diagnostic laparoscopy in order to confirm the anomaly. Surgeries was performed by two experienced surgeons, after having informed consent. When tubal and/or Mullerian anomalies were detected, urinary system was examined by intravenous pyelography. Other suspected pathologies were examined by abdominopelvic CT x-ray imaging. All anomalies have been reported in an electronic database. Main results and the role of chance A total of 4230 infertile couples were admitted to clinics. Mean age of women in the study population is 30±2.3 years. Overall duration of infertility is 1.2±0.6 years. Among them, 895 women were diagnosed to have suspected tubal pathology after HSG examination (21%). Diagnostic LS was performed to 220 women. Flowchart of the patients is given in figure-1. Among them, 113 (51,3%) women revealed tubal pathologies/anomalies and 107 (49,7%) revealed normal findings. Total of 34 women revealed congenital proximal and/or distal tubal anomaly. Half of these cases (17/34) were complete agenesis and remaning were either with proximal or mid-distal portion agenesis. Majority of women 32/34 (94 %) with tubal pathology revealed at least 1 uterine anomaly as well. Among them, 19 (55.9 %) of these patients was confirmed to have unicornuate uterus, 6 (17.6 %) had uterus didelphys, 4 (11.8 %) had bicornuate uterus, and 3 (8.8%) had uterine septum. No uterine anomaly was observed in 2 (5.9 %) patients. Total of 16 women (14%) were diagnosed to have other system anomalies. Limitations, reasons for caution Lack of a control group in normal population in order to compare incidences. Secondly, our sample size is not enough to precisely conclude on exact prevalances. Third, we did not report fertility data following LS. Wider implications of the findings Tubal factor infertility is one of the major etiologic factor among primary infertility cases and congenital tubal anomalies were reported to be relatively higher (15%) in these younger women contrary to general expectations. Second important finding is high congenital uterine anomaly incidence in women with congenital tubal anomalies. Trial registration number not applicable

Modelling and comparing the use of IVF and ICSI in Australia

PurposeThis study estimates the need of IVF/ICSI in Australia as compared to its actual uptake.MethodsWe created a model estimating for the annual demand for IVF/ICSI in a hypothetical infertile population, using demographic data from medical literature and Australian government databases. For each category of infertility (tubal, severe male, endometriosis, anovulation and unexplained), our estimated need for IVF/ICSI was compared to the actual IVF/ICSI uptake (ANZARD 2019). The model consisted of three categories depending on couples’ cause of infertility, i.e. couples with absolute indications for IVF/ICSI (couples with severe male factor infertility and tubal obstruction); couples with anovulatory infertility (couples with ovulation disorders) and couples with ovulatory infertility (couples suffering from unexplained infertility and endometriosis). The model was applied to each of these categories to determine the number of couples that would require IVF/ICSI treatment after failing to conceive naturally or after following alternative treatment plans. The main outcomes of this study were the estimate of IVF/ICSI cycles and the difference between the estimate and the reported number of IVF/ICSI cycles (2019 ANZARD report).ResultsWe estimated that approximately 35,300 couples required IVF/ICSI treatment in Australia in 2019, while in 2019 according to ANZARD, 46,000 couples underwent IVF/ICSI. A higher uptake of IVF/ICSI cycles than expected was specifically reported in couples with unexplained infertility, ovulation disorders and endometriosis, while for tubal and severe male infertility uptake seemed adequate.ConclusionIn Australia, there seems to be overservicing of IVF/ICSI, specifically for unexplained, ovulatory and endometriosis-related infertility.

Macrophage Phenotype Induced by Circulating Small Extracellular Vesicles from Women with Endometriosis.

Evidence suggests that immune system dysfunction and macrophages are involved in the disease establishment and progression of endometriosis. Among the factors involved in this alteration in macrophage activity, Small Extracellular Vesicles (sEVs) have been described to play a role favoring the switch to a specific phenotype with controversial results. This study aims to investigate the potential effect of circulating sEVs in the plasma of well-characterized patients with endometriosis on the polarization of macrophages. sEVs were isolated from the plasma of patients diagnosed with endometriosis confirmed by histopathological analysis. Two groups of patients were recruited: the endometriosis group consisted of patients diagnosed with endometriosis by imaging testing (gynecological ultrasonography and/or magnetic resonance imaging), confirmed by histopathologic study (n = 12), and the control group included patients who underwent laparoscopy for tubal sterilization without presurgical suspicion of endometriosis and without endometriosis or signs of any inflammatory pelvic condition during surgery (n = 12). Human THP1 monocytic cells were differentiated into macrophages, and the effect of sEVs on cell uptake and macrophage polarization was evaluated by fluorescent labeling and measurement of the IL1B, TNF, ARG1, and MRC1 expression, respectively. Although no changes in cell uptake were detected, sEVs from endometriosis induced a polarization of macrophages toward an M2 phenotype, characterized by lower IL1B and TNF expression and a tendency to increase MRC1 and ARG1 levels. When macrophages were stimulated with lipopolysaccharides, less activation was also detected after treatment with endometriosis sEVs. Finally, endometriosis sEVs also induced the expression of the nuclear receptor peroxisome proliferator-activated receptor-gamma (PPARG); however, treatment with rosiglitazone, a PPARG agonist, had no effect on the change in macrophage phenotype. We conclude that circulating sEVs in women with endometriosis have a certain capacity to shift the activation state of macrophages toward an M2 phenotype, but this does not modify the uptake level or the response to PPARG ligands.

Migrated tubal sterilisation clip presenting as a subcutaneous gluteal foreign body 24 years later: a case report and literature review

BackgroundThe incidence of sterilisation clip migration is reportedly 25%. However, less than 1% of those who experience clip migration will present with pain, an abscess, or spontaneous extrusion. Here we present a rare case of sterilisation clip migration through the entire pelvic floor.Case presentationA 66-year-old female was referred from community to the Surgical Emergency Unit with a possible metallic foreign body under the skin following an attempted routine gluteal cyst excision. The patient first noticed a lump under the skin 2 years ago which gradually became more apparent and tender over the previous 2 months. The patient denied recent trauma, had no co-morbidities and had a sterilisation procedure 24 years prior. Examination revealed a non-mobile solid structure just beneath the skin 5 cm laterally from the anal verge. Inflammatory markers were normal and an ultrasound confirmed a 15 × 7 mm foreign body in the subcutaneous tissues. The foreign body was excised easily under local anaesthesia, revealing a closed Filshie sterilisation clip. The wound was closed primarily, and recovery was uncomplicated.ConclusionsThis was a case of sterilisation clip migration to the subcutaneous gluteal region. A literature review revealed 34 case reports of sterilisation clip migration, mostly to the bladder. Patients with a previous sterilisation procedure and suspected subcutaneous foreign body without trauma should elicit a high index of suspicion for migrated sterilisation clips. These clips can migrate through multiple layers of muscle and fascia, including the pelvic floor.

Investigating possibilities for surveillance of long term chlamydia complications in the Netherlands: A qualitative study.

Chlamydia trachomatis (chlamydia) is one of the most reported bacterial sexually transmitted infections (STI) worldwide. Chlamydia can cause long term complications such as pelvic inflammatory disease (PID), ectopic pregnancy (EP) and tubal factor infertility (TFI). Changing testing strategies, for example reduced asymptomatic testing, influence chlamydia surveillance, highlighting the need for exploring alternative ways of monitoring chlamydia. We investigated the possibility of introducing routine surveillance of chlamydia related long term complications. A qualitative study including 15 in-depth interviews with a purposive sample of gynaecologists, general practitioners (GP), sexual health and emergency doctors was conducted in the Netherlands in 2021-2022. A semi-structured interview guide focused on experiences with diagnosis and registration of PID, EP and TFI and how a change in asymptomatic chlamydia testing strategy might influence this. Interviews were transcribed and analysed using a thematic approach. Analysis showed that gynaecologists most frequently reported diagnosing PID, EP and TFI. Other professions rarely diagnose these complications, with emergency doctors only diagnosing EP. Most respondents reported unique registration codes for PID and EP, but the coding for TFI is more ambiguous. They reflected that diagnosis and registration of PID, EP and TFI are handled differently within their professions. Most respondents acknowledged registration in diagnostic codes as a useful surveillance tool. They expressed concerns in representativeness (e.g. differences in interpretation of diagnosis criteria) and data quality for surveillance. Patient files of gynaecologists are likely to be most complete for monitoring trends of diagnosed chlamydia related long term complications in the Netherlands. However, when establishing a chlamydia complication surveillance system, professionals should be engaged in further standardizing diagnosis and registration practices. This will improve the quality and interpretability of complication surveillance and facilitate comparison between countries.