Uterine Factor Research Articles

Uterus Transplantation from Deceased Donors: First Italian Experience

Background: Uterus transplantation (UTx) is currently the only available treatment for absolute uterine factor infertility. Deceased donors have recently emerged as a valid alternative to living donors for uterus transplantation, with similar results. Methods: We report the first experience in Italy of uterus transplantation from deceased donors. Three uterus transplantations from deceased donors were performed at the Organ Transplant Unit of the University Hospital of Catania, Italy, between August 2020 and January 2022. Results: Two patients underwent UTx due to Mayer–Rokitansky–Küster–Hauser syndrome, while one patient had a previous hysterectomy due to benign disease. The donors’ ages were between 25 and 43 years and the mean cold ischemia time was 18.3 h. The mean age of the recipients was 31.6 years, and the mean recipient surgery duration was 5.3 h, with a mean blood loss of 766.66 mL. Two recipients developed a post-transplant hematoma, which was treated conservatively. No uterus recipient needed a re-operation during the first 30 days after transplantation. No histological signs of acute rejection were detected at the cervical biopsies performed at 1, 3, and 6 months after transplantation. First menstruation occurred in all recipients after 39 ± 12 days after transplantation. One live birth was reported 15 months after UTx. One graft was lost three months after UTx due to graft thrombosis. Conclusions: Uterus transplantation from deceased donors is emerging as a valid alternative to living donors in order to increase the donor pool.

Psychological well‐being of women with uterine infertility before considering uterus transplantation as a treatment option

BackgroundWhile uterus transplantation offers a promising treatment option for women with uterine factor infertility (UFI), the potential for graft failure and lack of organ availability could have subsequent psychological repercussions for women. Exploring baseline psychological well‐being for women with UFI who could become uterine transplant recipients is essential to identify specific psychological challenges to be considered prior to transplantation. UFI can be congenital uterine absence, namely Mayer‐Rokitansky‐Küster‐Hauser syndrome (MRKH), or acquired uterine absence (hysterectomy).ObjectiveTo analyse baseline psychological well‐being among women with UFI.Design and settingA survey including demographic data and two internationally validated psychological questionnaires, Depression, Anxiety and Stress Scale (DASS‐21),13 and Fertility Quality of Life (FertiQoL), was disseminated to women with UFI. Data from these instruments was compared between groups and then to data that uses these tools in the general infertility population.Results/outcomesThe study included 39 women (mean age 29.54 years). Higher scores for moderate symptoms of depression, anxiety, and stress were reported for the entire UFI cohort. More women with congenital UFI showed ‘severe’ symptoms for depression/anxiety, compared to women with acquired UFI. Women with acquired UFI showed poorer FertiQoL scores compared to both women with congenital UFI and to the general infertility population scores in previously published data.ConclusionClinicians should consider accessing increased psychological support for women with UFI when discussing fertility options including uterine transplant, and they may need to tailor this support depending on whether the patient has congenital or acquired UFI.

Recipients' age, fresh embryo and blastocyst-stage embryo transfer as favorable factors in a transnational oocyte donation program.

In Italy, egg donation is being allowed again following the ruling by the Constitutional Court N. 162/2014. Nevertheless, the number of voluntary donors is insignificant, probably because no reimbursement is provided. Therefore, the great majority of egg donation cycles are performed by using imported cryopreserved oocytes from foreign countries. However, recent evidence has questioned the overall efficacy of this strategy in comparison with the shipment of frozen sperm and vitrified embryos. Retrospective cohort study, conducted at ANDROS Day Surgery Clinic Palermo, Italy in the period 2016-2022, with the objective of evaluating the efficiency of each batch of vitrified oocytes, in terms of completed cycles. The cryopreserved donated oocytes came from a single Spanish clinic (Next Fertility, Valencia, Spain). The primary outcome was the cumulative live birth rate (CLBR). The secondary outcomes were the cumulative ongoing pregnancy rate (COPR), the cumulative clinical pregnancy rate (CCPR) and the miscarriage rate. The CLBR totaled 35.1%, the COPR 36.8%, the CCPR 49.2% and the miscarriage rate 24.7%. In the multivariate analysis, the probability of success was significantly higher in younger recipients, in fresh embryo transfer and in blastocyst-stage embryo transfer. Our "transnational" donation program with vitrified oocytes has good success rates. The main focus of our analysis is the negative effect of advancing recipient age on success rates, outlining a possible, important role of age-related uterine factor on implantation mechanisms. This aspect should be emphasized during the counselling with couples much more than is routinely done.

Modern concepts about the problem of endometrial infertility against the backdrop of the "thin endometrium" (literature review)

Endometrial infertility is the cause of inadequate implantation and serves as an obstacle to the onset and progression of spontaneous pregnancy and the implementation of assisted reproductive technology (ART) programs. One of the most common mechanisms for the development of infertility is endometrial thinning. Despite the abundance of publications, today there are no generally accepted diagnostic criteria and treatment and rehabilitation approaches for this pathology, which encourages continued scientific research in this direction. Aim was to highlight the problem of decreased fertility caused by “thin endometrium”. To create the review, the bibliographic method was applied and domestic and foreign literary sources from the Pubmed, MedLine, RSCI, e-library and Cyberleninka search engine databases were used. The search depth was 10 years. The following search phrases were used: “uterine factor of infertility”, “endometrial factor of infertility”, “thin endometrium”. Seventy five sources that were included in this review were studied and analyzed. Data presented in the literature indicate that endometrial causes of infertility are associated with incompetence of the uterine cavity mucosa, which may manifest itself as a phenomenon of ”thin endometrium”, the development mechanisms of which have not yet been fully studied. Determining the functional status of the endometrium is very important for predicting the onset of pregnancy in the natural cycle or in ART programs, since even in the presence of a good quality embryo, endometrial deficiency can prevent adequate implantation. Thus, before planning a subsequent pregnancy, it is necessary to diagnose and, if possible, neutralize or correct endometrial causes of infertility. One of the main markers of readiness for implantation at the moment is the thickness of the endometrium.

Analysis of two reperfusion techniques in uterine transplantation in an experimental model.

Uterine transplantation was developed for the treatment of absolute uterine factor infertility. As it is a new modality of transplantation, there is still room for technical improvement. A factor that impacts graft survival in organ transplantation is the warm ischemia time. In uterine transplantation specifically, at least two vascular anastomoses are performed on each side of the uterus, and the graft revascularization takes place when the vascular clamps of the arteries and veins are released on both sides simultaneously. For this reason, the warm ischemia time in uterine transplant is expected to be considerably long. The purpose of this study was to compare the sequential technique of uterine graft revascularization, which aims to reduce the warm ischemia time of the procedure, with the simultaneous revascularization technique. For the procedure, the uterine auto-transplantation technique was performed using 10 non-pregnant adult ewes weighing about 45 kg, divided into two groups: simultaneous revascularization group (5 animals) and sequential revascularization group (5 animals). To evaluate the groups, we analyzed the procedure and warm ischemia times, graft macroscopy, hemodynamic, laboratory, and histological parameters of the uterus. The sequential revascularization technique group had similar surgical procedure times, and the warm ischemia time was significantly shorter with medians of 32 min in the sequential group versus 72 min in the simultaneous group (p < 0.008). The graft macroscopy and hemodynamic, laboratory, and histological parameters evaluated were similar between the groups. The sequential revascularization technique proved to reduce the warm ischemia time in the sheep uterine auto-transplantation model without compromising graft viability.

Male factor infertility and implication of fertility treatment in low resource settings

Introduction: The prevalence of infertility has increased worldwide. The etiological factors are also changing in trend and prominence. Male infertility is driving the epidemic in many regions of the world. Therefore, the aim of this study was to explore male factor infertility in the Gambia. Methodology: The design was a longitudinal descriptive study of subfertile couples at a specialist tertiary hospital in Banjul, the Gambia, from August 2022 to May 2023. Data were extracted from patients folders and entered into a computer database. Descriptive statistics were used to analyze the data and results expressed in tables, graphs, and percentages. Results: Total number of subfertile couples analyzed was 152: male factor 69 (45.4%), ovulation disorder 34 (22.4%), tubal factor 20 (13.2%), uterine factor 8 (5.3%), and unexplained 21 (13.8%). The median age of male folk was 50 years, with an age range of 31 to 64 years. The rates of asthenoteratozospermia, oligospermia, and azospermia were 37.8%, 36.2%, and 26%, respectively. In azoospermic males, over 75% had elevated FSH (12–44 miu/mL). Conclusions: The prevalence of male infertility is at 45.4%, which is 3-fold and 2-fold higher than tubal and ovarian factors, respectively. Male infertility is a problem with obvious implications. The predominant types of male infertility we observed in this study will almost always require multidisciplinary care and ICSI.

The prevalence and etiology of infertility in a tertiary specialist hospital in the Gambia

Background: Infertility is a public health problem that has received little or no attention in most sub-Saharan Africa, especially in the Gambia. The prevalence of infertility in the Gambia is increasing from 9.0% in 1998 to 14.3% in 2017. Tubal factor was the predominant leading cause for decades, but recent reviews suggest that male factor is driving the epidermic of infertility worldwide. Therefore, the aim of this study was to determine the prevalence and etiological factors of infertility in our practice. Methodology: The design was a retrospective quantitative study. Data collection tool was developed and variables were retrieved from case notes between August 2022 to March 2023 at a specialist hospital in the Gambia. The data were entered into a computer database and analyzed using descriptive statistics. Results: Total number of women in the reproductive age of 15–49 years that attended gynecology clinic was 1475. Two hundred eighty-five couples (285) had infertility. The prevalence of infertility is 19.3% ~1:5 couples. The causes showed male factor 69 (45.4%), ovulation disorder 34 (22.4%), tubal factor 20 (13.2%), uterine factor 8 (5.3%), and unexplained 21(13.8%). Ovarian factors showed age-related poor ovarian reserve. Overall, male factor infertility was 53%, and female factor infertility was 47%. Conclusions: The prevalence of infertility is increasing and male factor is 3-folds and 2-folds higher than tubal and ovarian factors, respectively. The study observed increasing desire of fertility among female in advanced age. Universal access to assisted reproductive technology is essential.

Sentinel node mapping decreases the risk of failed detection of isolated positive para-aortic lymph node in endometrial cancer

BackgroundIsolated positive para-aortic lymph node metastasis in endometrial cancer is an uncommon event, ranging from 1% to 3%.ObjectiveOur aim was to evaluate the impact of sentinel lymph node (SLN) mapping...

Psychological and emotional profiles of Australian uterine transplant potential recipients: A comparison with international trials.

Uterus transplant (UTx) has emerged as a groundbreaking solution for individuals with uterine factor infertility (UFI). This study is the first in Australia to explore the psychosocial functioning of potential recipients assessed for the nation's initial UTx clinical trial and to compare their psychological profiles with those from international UTx trials. This is a mixed methods prospective study incorporating standardized psychological measures and semi-structured interviews. Conducted at a tertiary hospital in Sydney, Australia, the study involved 10 female Australian UTx potential recipients with UFI undergoing assessment for UTx surgery. Participants underwent comprehensive psychological evaluation using validated measures and in-depth semi-structured interviews. Quantitative measurement tools included the Hospital Anxiety and Depression Scale, Short Form-36 Health Survey, Fertility Quality of Life, and the Stanford Integrated Psychosocial Assessment for Transplantation. Thematic analysis was conducted on qualitative data from semi-structured interviews. The Australian UTx potential recipients reported significantly higher Short Form-36 (SF-36) scores compared to the Australian general population in general health (p < 0.04), bodily pain (p < 0.02), social functioning (p < 0.02), and emotional well-being (p < 0.01). Compared with international UTx cohorts, the Australian UTx group showed comparable SF-36 outcomes, with minor variations observed for general health and physical function domains. Hospital Anxiety and Depression Scale scores revealed lower anxiety, but slightly higher depression levels compared to international UTx trial cohorts. Fertility quality-of-life scores were significantly higher in the Australian UTx group compared to women experiencing primary infertility across four domains (p < 0.001). Thematic analysis of interviews highlighted the complex emotional impact of infertility, strong family and social support, and the perception of UTx as a transformative opportunity to achieve wholeness and motherhood. UTx represents a novel treatment option for women with UFI. This is the first qualitative study in Australia, it demonstrates the connection between women with UFI and their motivations for parenthood. These findings highlight the importance of tailored psychological assessments and establish a foundation for future research exploring the psychological characteristics of patient candidacy for UTxs.

ROLE OF UTTARBASTI IN STRI VANDHYATVA W.S.R. FEMALE INFERTILITY IN DIFFERENT RESPONSIBLE FACTORS

Failure to conceive after one or more years of regular, unprotected coitus is known as vandhyatva. The female component accounts for 40–55% of the cases, making it a significant problem in the modern day, given the rising number of occurrences brought on by a confluence of unhealthy environmental, social, psychological, and nutritional variables. The most frequent reasons for infertility in women are uterine, tubal, and ovulatory factors, among others. According to Ayurveda, Vata is the primary cause of all illnesses about the female reproductive system, including Vandhyatva. A key component of treating female vandhyatva is panchakarma. In the old literature of Ayurveda, Basti Karma is regarded as the most significant treatment for Vataja diseases; consequently, Uttarbasti is highlighted here.

Recommendations from the 2024 Australian evidence-based guideline for unexplained infertility: ADAPTE process from the ESHRE evidence-based guideline on unexplained infertility.

The 2024 Australian evidence-based guideline for unexplained infertility provides clinicians with evidence-based recommendations for the optimal diagnostic workup for infertile couples to establish the diagnosis of unexplained infertility and optimal therapeutic approach to treat couples diagnosed with unexplained infertility in the Australian health care setting. The guideline recommendations were adapted for the Australian context from the rigorous, comprehensive European Society of Human Reproduction and Embryology (ESHRE) 2023 Evidence-based guideline: unexplained infertility, using the ADAPTE process and have been approved by the Australian National Health and Medical Research Council. The guideline includes 40 evidence-based recommendations, 21 practice points and three research recommendations addressing: definition - defining infertility and frequency of intercourse, infertility and age, female and male factor infertility; diagnosis - ovulation, ovarian reserve, tubal factor, uterine factor, laparoscopy, cervical/vaginal factor, male factor, additional testing for systemic conditions; and treatment - expectant management, active treatment, mechanical-surgical procedures, alternative therapeutic approaches, quality of life. CHANGES IN ASSESSMENT AND MANAGEMENT RESULTING FROM THE GUIDELINE: This guideline refines the definition of unexplained infertility and addresses basic diagnostic procedures for infertility assessment not considered in previous guidelines on unexplained infertility. For therapeutic approaches, consideration of evidence quality, efficacy, safety and, in the Australian setting, feasibility, acceptability, cost, implementation and ultimately recommendation strength were integrated across multidisciplinary expertise and consumer perspectives in adapting recommendations to the Australian context by using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework, which had not been used in past guidelines on unexplained infertility to formulate recommendations. The Australian process also included an established data integrity check to ensure evidence could be trusted to guide practice. Practice points were added and expanded to consider the Australian setting. No evidence-based recommendations were underpinned by high quality evidence, with most having low or very low quality evidence. In this context, research recommendations were made including those for the Australian context. The full guideline and technical report are publicly available online and can be accessed at https://www.monash.edu/medicine/mchri/infertility and are supported by extensive translation resources, including the free patient ASKFertility mobile application (https://www.askfertility.org/).

Epigenetic alteration of uterine Leukemia Inhibitory Factor gene after glyphosate or a glyphosate-based herbicide exposure in rats

Glyphosate-based herbicides (GBHs) or its active ingredient, glyphosate (Gly), induce implantation failure in rats. We aimed to elucidate a mechanism of action of these compounds assessing the transcriptional and epigenetic status of the receptivity marker, leukemia inhibitory factor (Lif) gene. F0 rats were orally exposed to GBH or Gly at 3.8 or 3.9 mg Gly/kg/day, respectively, from gestational day (GD) 9 until weaning. F1 females were mated and uterine samples collected at GD5. Methylation-sensitive restriction enzymes (MSRE) sites and transcription factors were in silico predicted in regulatory regions of Lif gene. DNA methylation status and histone modifications (histone 3 and 4 acetylation (H3Ac and H4Ac) and H3 lysine-27-trimethylation (H3K27me3)) were assessed. GBH and Gly decreased Lif mRNA levels and caused DNA hypermethylation. GBH increased H3Ac levels, whereas Gly reduced them; both compounds enhanced H3K27me3 levels. Finally, both GBH and Gly induced similar epigenetic alterations in the regulatory regions of Lif.

Factors That Influence the Incidence of Retained Placenta in Maternity Women in Kanekes Village, Baduy Tribe, Indonesia

Introduction: The World Health Organization (WHO) states that one of the causes of bleeding is retained placenta. Retained placenta accounts for 2-3% of maternal deaths in developing countries. Various factors, including maternal, uterine, and retention factors, influence placental retention. The study aimed to determine the factors affecting the incidence of retained placenta in mothers giving birth in Kanekes Village, Baduy Tribe, Indonesia. Material and Methods: This research uses an analytical survey method with a case-control design. There were 27 cases of placental retention experienced by women who gave birth vaginally. The researcher created the data collection format sheet instrument himself. The statistical test used is the chi-square test. Results: The relationship between age and the incidence of retained placenta from 54 respondents was obtained from the chi-square statistical test on the age variable with a p = 0.010 &lt;0.05 value. The relationship between parity and the incidence of retained placenta (p = 0.04). However, non-significant results were found in the relationship between birth assistance and the incidence of retained placenta (p = 0.750). Conclusions: The results show a relationship between age and parity factors and retained placenta incidence. However, in the birth assistance variable, the results show no relationship between birth assistance factors and the incidence of placental retention.

Evaluation of 40 Cases of Sub-Fertile Couples in OPD of Holy Family Red Crescent Medical College and Hospital, Dhaka

Background: Subfertility is defined as the inability to conceive after one year of unprotected intercourse, affects about 80 million couples worldwide, male factors contribute to 40-50% of these cases. The condition has a multifactorial pathogenesis affecting sperm function, highlighting the need for comprehensive diagnostic and treatment strategies. Objective: The study aimed to understand subfertility causes better through thorough history taking, clinical examination, and necessary investigations, thereby informing improved treatment strategies. Method and Materials: This descriptive cross-sectional study was conducted on 40 couples seeking treatment at the OPD, Department of Obstetrics and Gynecology, Holy Family Red Crescent Medical College and Hospital, Dhaka from 1 July 2023 to 31 December 2023. Couples with infertility for over one year who agreed to participate were included via convenience sampling. Data were collected on socio- demographic factors and certain relevant questions where asked to find the causes of infertility. Female participants underwent pelvic ultrasound, thyroid function tests, serum prolactin, and random blood sugar tests for Male. Semen analysis was performed following WHO 2010 guidelines. The data were analyzed using IBM SPSS Statistics for Windows, version 23. Results: Among the 40 subfertility patients, the majority (25%) were aged between 26-30 years, with a mean age of 24.21 ± 2.04 years and a mean BMI of 23.08 ± 1.54. The duration of marriage was 5-10 years for 40%, under 5 years for 32.5%, and over 10 years for 27.5%. Subfertility lasted less than 6 years for 60% and 6-10 years for 40%. Female factors alone were responsible for 30% of cases, male factors and unexplained causes each accounted for 25%, and combined factors were 20%. Semen analysis showed normal results in 60% of cases, with abnormalities in 40%. Endometriosis and PCOS each affected 25%, tubal factors 20%, and hyperprolactinemia and uterine factors 15%. ........

Deceased Donor Uterus Transplantation: A Narrative Review of the First 24 Published Cases.

Uterus transplantation is the surgical treatment for absolute uterine factor infertility (AUFI), a congenital or acquired condition characterized by the absence of a uterus. More than 80 transplants have been performed worldwide, resulting in more than 30 live births, originating both from living and deceased donors. The collection of published articles on deceased donor uterus transplantations was performed in PubMed and SCOPUS by searching for the terms "Uterus transplantation" AND "deceased donor"; from the 107 articles obtained, only case reports and systematic reviews of deceased donor uterus transplantations and the resulting live births were considered for the present manuscript. The extracted data included the date of surgery (year), country, recipient (age and cause of AUFI) and donor (age and parity) details, outcome of recipient surgery (hysterectomy), and live births (date and gestational age). The search of peer-reviewed publications showed 24 deceased donor uterus transplantations and 12 live births (a birth rate of 66%) with a 25% occurrence of graft loss during follow-up (6 of 24). Among this series, twelve transplants were performed in the USA (seven births), five in the Czech Republic (one birth), three in Italy (one birth), two in Turkey (two births), and two in Brazil (one birth). The median recipient age was 29.8 years (range 21-36), while the median donor age was 36.1 years (range 20-57). Of 24 recipients, 100% were affected by MRKH (Mayer-Rokitanski-Kuster-Hauser) syndrome. Two live births were reported from nulliparous donors. Deceased donor uterus transplantation birth rates are very similar to the living donor rates reported in the literature, but ethical implications could be less important in the first group. It is necessary to register every case in the International Registry for Uterus Transplantation in order to perform a systematic review and comparison with living donor rates.

Uterine Biosynthesis through Tissue Engineering: An Overview of Current Methods and Status.

In the last few decades, the rates of infertility among women have been on the rise, usually due to complications with the uterus and related tissue. A wide variety of reasons can cause uterine factor infertility and can be congenital or a result of disease. Uterine transplantation is currently used as a means to enable women with fertility issues to have a natural birth. However, multiple risk factors are involved in uterine transplantation that threaten the lives of the growing fetus and the mother, as a result of which the procedure is not prominently practiced. Uterine tissue engineering provides a potential solution to infertility through the regeneration of replacement of damaged tissue, thus allowing healing and restoration of reproductive capacity. It involves the use of stem cells from the patient incorporated within biocompatible scaffolds to regenerate the entire tissue. This manuscript discusses the need for uterine tissue engineering, giving an overview of the biological and organic material involved in the process. There are numerous existing animal models in which this procedure has been actualized, and the observations from them have been compiled here. These models are used to develop a further understanding of the integration of engineered tissues and the scope of tissue engineering as a treatment for uterine disorders. Additionally, this paper examines the scope and limitations of the procedure.

Exploring the Nexus of Steroidal Hormone Receptor, Uterine VEGF Expression and NADPH-d Interaction in Buffalo Uterus During Oestrous Cycle With Seasonal Variation.

The reproductive efficiency in buffalo is highly influenced by seasonal variability. Angiogenesis in the reproductive cycle is important for optimal physiological functioning of uterus. Estrogen receptor-α (ERα), vascular endothelial growth factor (VEGF) and reduced nicotinamide adenine dinucleotide phosphatase diaphorase (NADPH-d) are vital indicators for the uterine angiogenic process. This study was conducted to see the effect of season on the expression of different uterine angiogenic factors. Season wise (winter and summer) and phase wise (follicular and luteal), immune staining intensity of buffalo uterus was measured by calculating the optical density value (OD) for ERα and VEGF. Percentage of immuno-positive cell count for ERα was done. Histoenzymic NADPH-d expression was analysed. Expression of all these factors increased during follicular phase of oestrous cycle in order to support the angiogenesis; however, the expression was significantly lower (p ≤ 0.05) in term of OD value as well as percentage count of immuno-positive cells during summer season indicating lower angiogenic activity that subsequently affected reproduction in buffalo.

What is the cure for absolute infertility? Biomedicalisation and routinisation of surrogacy and uterus transplantation in Nordic medical journals

AbstractThis article investigates 20 years of discursive struggles in Nordic medical journals around the process of legitimating and routinising gestational surrogacy and uterus transplantation in Finland and Sweden. The comparative analysis through critical discourse analysis suggests that influential health care professionals have contributed to different levels of legal and cultural adaptation of the methods, prioritising non-commercial gestational surrogacy in Finland and uterus transplantation in Sweden. The article identifies central discursive turning points in the medical journal discussions by interpreting them against the background of medical and policy developments in Finland and Sweden during the analysed twenty-year period. Legitimation and routinisation of surrogacy and uterus transplantation were developed through biomedicalisation by representing them as infertility treatments and emphasising the relational dynamics between donors and recipients—a connection that in the Nordic context is often based on kinship or close relationships. The diagnosis of absolute uterine factor infertility was central to representing women as on the boundary between fertile and infertile, as they may have functioning ovaries. Through the biomedicalised rhetoric of equal opportunities for biogenetic motherhood, the diagnosed women’s ambiguous reproductive status was used to legitimise the two methods as cures for absolute infertility, thereby reinforcing hegemonic family and kinship norms.

Uterus transplantation: A scoping review focused on obstetric outcomes.

Congenital uterine anomalies include a wide diversity of uterine malformations that can compromise reproductive potential. Uterus transplantation (UTx) proposes an innovative treatment for absolute uterine factor infertility; however, there is a lack of standardized protocols to guide clinical management among this population. To describe recipient and donor characteristics and obstetric outcomes in patients undergoing UTx. We performed a literature search using the PubMed database to retrieve available scientific articles. We analyzed the references of included articles to assess additional articles that could be eligible to be included in the review. Likewise, we identified further studies using other methods, including Google Scholar. Titles and abstracts were screened in duplicate to select original reports with information available for the outcomes of interest. This review assessed the advantages and disadvantages of the techniques used, patient characteristics, obstetric and non-obstetric complications, functional duration of the organ, and neonatal outcomes. Among the 36 reports included in this review we found 55 pregnancies and 38 live births following UTx and a higher success rate for invivo uterine donations. The most common obstetric complications reported included miscarriage, pre-eclampsia, and gestational hypertension. The most common non-obstetric complications reported include episodes of rejection, acute kidney injury, anemia, and cholestasis. Living donors required a comprehensive preoperative workup, decreasing organ rejection, infection, and vascular complications. More studies are needed to standardize the UTx procedure and improve obstetric, fetal, and neonatal outcomes. Further understanding of which recipient and donor characteristics minimize complications will significantly decrease the risk of adverse outcomes.

Asparaginase-like protein 1 as a prognostic tissue biomarker in clinicopathologically and molecularly characterized endometrial cancer

ObjectivePrognostic stratification of endometrial cancer involves the assessment of stage, uterine risk factors, and molecular classification. This process can be further refined through annotation of prognostic biomarkers, notably L1 cell adhesion molecule (L1CAM) and hormonal receptors. Loss of asparaginase-like protein 1 (ASRGL1) has been shown to correlate with poor outcome in endometrial cancer. Our objective was to assess prognostication of endometrial cancer by ASRGL1 in conjunction with other available methodologies. Study DesignThis was a retrospective study of patients who underwent primary treatment at a single tertiary center. Tumors were molecularly classified by the Proactive Molecular Risk Classifier for Endometrial Cancer. Expression of ASRGL1, L1CAM, estrogen receptor, and progesterone receptor was determined by immunohistochemistry. ASRGL1 expression intensity was scored into four classes. ResultsIn a cohort of 775 patients, monitored for a median time of 81 months, ASRGL1 expression intensity was related to improved disease-specific survival in a dose-dependent manner (P < 0.001). Low expression levels were associated with stage II–IV disease and presence of uterine factors, i.e. high grade, lymphovascular space invasion, and deep myometrial invasion (P < 0.001 for all). Among the molecular subgroups, low expression was most prevalent in p53 abnormal carcinomas (P < 0.001). Low ASRGL1 was associated with positive L1CAM expression and negative estrogen and progesterone receptor expression (P < 0.001 for all). After adjustment for stage and uterine factors, strong ASRGL1 staining intensity was associated with a lower risk for cancer-related deaths (hazard ratio 0.56, 95 % confidence interval 0.32–0.97; P = 0.038). ASRGL1 was not associated with the outcome when adjusted for stage, molecular subgroups, L1CAM, and hormonal receptors. When analyzed separately within the different molecular subgroups, ASRGL1 showed an association with disease-specific survival specifically in “no specific molecular profile” subtype carcinomas (P < 0.001). However, this association became nonsignificant upon controlling for confounders. ConclusionsLow ASRGL1 expression intensity correlates with poor survival in endometrial cancer. ASRGL1 contributes to more accurate prognostication when controlled for stage and uterine factors. However, when adjusted for stage and other biomarkers, including molecular subgroups, ASRGL1 does not improve prognostic stratification.