Role of Laparoscopy in Diagnosis and Treatment of Endometriosis Associated with Infertility: A Prospective Analysis

Objective: Endometriosis is often considered as an enigma due to its varied clinical presentation and challenges in diagnosis. The objective of this study is to evaluate the role of laparoscopy in diagnosis and treatment of endometriosis associated with infertility.Materials and Methods: Infertile females diagnosed to have endometriosis during or before undergoing laparoscopic surgery from August 2018 to February 2020 were followed up for spontaneous conception for 6 months following laparoscopy. Revised American Fertility Society (r-AFS) scoring system was used to score endometriosis and stage the disease (stage I-IV). Surgical interventions were done on individual cases basis following ESHRE guidelines.Results: Fifty infertile females diagnosed with endometriosis during or before laparoscopy were recruited for the study. Mean age of patients was 28.58 (±4.21) years. Thirty-four (68%) patients had primary infertility and 16 (32%) has secondary infertility. Mean duration infertility was 3.33 (±1.43). Only 37 patients (74%) had evidence of endometriosis in pre-operative ultrasonography. During the follow up period of first 6 months after surgery 34 (68%) patients conceived spontaneously. Lower mean endometriosis score (p=0.00) and early stage of endometriosis (p=0.00) were associated with higher chances of conception. But, female age, duration and type infertility, USG findings, and type of surgical interventions did not affect pregnancy rate.Conclusion: Laparoscopy helps in diagnosis of endometriosis. Laparoscopic therapeutic interventions for endometriosis increase the probability of spontaneous conception in infertile females. Lower surgical score and early stages of endometriosis are associated with higher chance of conception.

Agenesis Serviks

Background : Cervical agenesis is an extremely rare congenital anomaly of female reproductive system with manifestation on the absence of uterine cervix with normal development of uterine and secondary sex signs. According to the American Fertility Society, cervical agenesis is classified as type IB Müllerian anomaly. Symptoms are include primary amenorrhea, cyclic abdominal lower pain and infertility.Objective : To report the treatment of cervical agenesis.Case Report : Reportedly, a woman, 28 years old, came with complaints of primary amenorrhea, cyclic abdominal lower pain and 3 years of primary infertility. From speculum and transvaginal ultrasonography examination, the uterine was slightly smaller than normal, without cervical uterine, found adhesion, both ovarian were normal. Laparoscopic utero-vaginal anastomosis was performed and catheter condom was maintained in the cervical canal for 3 months. Two weeks after catheter was removed, a hysteroscopy was performed, but the canal was found closed.Conclusion : In this case, after the laparoscopic utero-vaginal anastomosis was performed, the cervical canal which has been made, is found closed. So, a further evaluation is needed to get more effective results.Keywords: Type IB Müllerian anomaly, cervical agenesis, primary amenorrhea, infertility, laparoscopic utero-vaginal anastomosis

A prospective study of endometriosis and its outcome at tertiary care centre

Background: This study was conducted to detect various presenting clinical features, type and severity of pelvic endometriosis according to revised American fertility society classification. Objective of this study was to assess outcome of endometriosis after medical and surgical treatment in form of pregnancy, reduction of symptoms like dysmenorrhoea, dyspareunia and others.Methods: This prospective study conducted at one of tertiary care teaching institutes for period of 3 years from January 2011 to December 2013. A total number of 100 patients of pelvic endometriosis were examined and divided according to Revised American Fertility Society Classification on bases of severity, type and clinical features and laparoscopic findings. After 1 year of follow up, outcome assessed after completion of medical and surgical treatment in form of pregnancy, reduction of dysmenorrhoea and dyspareunia and other symptoms.Results: This study showed most affected patients (46%) belongs to 26-30 years of age group, dysmenorrhoea was the most common presenting symptoms in 76% patients. Most common site affected (52%) was ovaries. Laparoscopy was done in 86% patients. Most patients (44%) were benefited with fulguration of endometriotic nodules. 62% of patients were given oral contraceptive pills or progesterone pills after definitive surgery as freely available in Governmental setup and fewer side effects as compared to Danazol and GnRH analogues. 40 patients became pregnant after medical and surgical treatment, where 60 patients had reduced dysmenorrhoea and 20 patients had reduced dyspareunia.Conclusions: Laparoscopy is gold standard diagnostic as well as therapeutic tool in pelvic endometriosis as it can rule out other causes of infertility without interfering normal anatomy.

Comparison of Intrauterine Suitable Balloon and Foley Balloon in the Prevention of Adhesion after Hysteroscopic Adhesiolysis

Objective. To compare the effect of intrauterine suitable balloon (ISB) and Foley balloon (FB) in the prevention of adhesion after hysteroscopic adhesiolysis in patients with intrauterine adhesions (IUAs). Methods. A retrospective study was conducted on 150 women with moderate and severe IUAs, who underwent hysteroscopic adhesiolysis. According to the postoperative placement of the ISB or FB, the cohort was divided into the ISB group and the FB group. A second-look hysteroscopy was performed at 3 months postsurgery. The scoring system proposed by the American Fertility Society (AFS) was used to evaluate the adhesion during hysteroscopy. Subgroup analysis was carried out based on the degree of IUAs. Results. (1) In the ISB group, only 25% (19/76) women presented adhesion reformation after surgery, while, in the FB group, the adhesion reformation was observed in 35.1% (26/74) patients; however, the difference was not statistically significant (P>0.05). Subsequently, the adhesion reformation rate (29.5%, 13/44) after surgery with an ISB for severe intrauterine adhesions was significantly lower as compared to that (53.6%, 15/28) with FB (P<0.05). (2) In the ISB group, the reduction in the adhesion score after surgery was 8 points, which was significantly higher than the 7 points in the FB group (P<0.05). Conclusion. The ISB is better than the FB in preventing the adhesion reformation and reducing the AFS score after hysteroscopic adhesiolysis in severe IUAs. Also, it can effectively prevent the adhesion reformation in severe IUAs with a similar effect on moderate IUAs.

The association of body mass index with endometriosis and disease severity in women with pain

Introduction: There is a well-established inverse relationship between body mass index and frequency of endometriosis. However, these population-based studies have relied mostly on self-reported cases of endometriosis, rather than surgically confirmed endometriosis where disease severity has been objectively assessed. The aim of the current retrospective study was to establish whether the established relationship between endometriosis and low body mass index was independent of disease severity. Methods: Women with menstrual and/or pelvic pain undergoing laparoscopy for suspected endometriosis were recruited for this retrospective study (n = 509). Women were grouped by body mass index (kg/m2) according to World Health Organization criteria: underweight (<18.5), normal (18.5–24.99), pre-obese (25–29.99) or obese (≥30). Endometriosis was scored according to the revised American Fertility Society system. Data were analysed based on body mass index and endometriosis status to identify any relationship between body mass index and disease. Results: The average body mass index of women with endometriosis was 25.0 kg/m2. The body mass index distribution of women with endometriosis differed relative to women in the general population. As expected, fewer obese women had endometriosis than in the lower body mass index categories. However, the obese women who did have endometriosis had significantly higher revised American Fertility Society scores compared to women with normal and pre-obese body mass indices. Discussion: Our results are consistent with the established finding of an inverse relationship between body mass index and endometriosis. The novel finding from this study is that obesity is associated with increased disease severity and reduced frequency of stage I endometriosis. It remains unclear what role body mass index has in the cause or effect of endometriosis; we speculate that body mass index may be useful for sub-classifying the disease.

Producing Life, Conceiving Reason

Chapter 2 examines how during the 1980’s the in vitro embryo went from a rare laboratory object to an element of widespread clinical practice. In response to the rapid growth of this largely unregulated industry the American Fertility Society created an Ethics Committee in 1985. The chapter examines the deliberations of that committee, including how it created a new scientific term—the “preembryo”—to shape public discourse.

Demographic and Clinical Features of Endometrial Polyps in Patients with Endometriosis

Aims. To compare the clinical features of endometrial polyps (EPs) between patients with endometriosis (EM) (EM group) and without EM (non-EM group).Methods and Results. Seventy-six cases in the EM group and 133 cases in the non-EM group underwent laparotomy or hysteroscopy and laparoscopy; later, it was confirmed that the results by pathology from July 2002 to April 2008 in the Department of Gynecology and Obstetrics at the First Affiliated Hospital of Sun Yat-sen University. The recurrence of EPs was followed up after the surgery until 2013. The following parameters were assessed: age, gravidity, parity, infertility, and menstrual cycle changes, as well as polyps diameters, locations, number, association with the revised American Fertility Society (r-AFS) classification, and their recurrence. On review, 76 EPs cases of EM group histologically resembled EPs but the majority of EPs with EM occurred in primary infertility cases and in fewer pregnancy rate women who had stable and smaller EPs without association with the AFS stage. The recurrence rate of EPs in EM group was higher than that in non-EM group.Conclusion. It is important to identify whether infertile patients with EM are also having EPs. Removing any coexisting EPs via hysteroscopy would be clinically helpful in treating endometriosis-related infertility in these patients.