Pub Date : 2024-11-01DOI: 10.1016/j.fertnstert.2024.08.341
Stephanie Hallisey M.D., Lawrence Engmann M.D.
{"title":"Beyond the diagnosis: a call for equity in polycystic ovary syndrome fertility care across racial and socioeconomic lines","authors":"Stephanie Hallisey M.D., Lawrence Engmann M.D.","doi":"10.1016/j.fertnstert.2024.08.341","DOIUrl":"10.1016/j.fertnstert.2024.08.341","url":null,"abstract":"","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":"122 5","pages":"Page 827"},"PeriodicalIF":6.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142105957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.fertnstert.2024.09.027
Ruben Alvero M.D.
Great strides have been made in society and in reproductive endocrinology and infertility in support of lesbian, gay, bisexual, transgender, and queer/questioning. Although many of the concepts used in heterosexual reproduction can be applied to the lesbian, gay, bisexual, transgender, and queer/questioning plus community, there are specific differences that should be understood to provide the highest level of care to this community.
{"title":"LGBTQ+ family building: progress but lots more to do","authors":"Ruben Alvero M.D.","doi":"10.1016/j.fertnstert.2024.09.027","DOIUrl":"10.1016/j.fertnstert.2024.09.027","url":null,"abstract":"<div><div>Great strides have been made in society and in reproductive endocrinology and infertility in support of lesbian, gay, bisexual, transgender, and queer/questioning. Although many of the concepts used in heterosexual reproduction can be applied to the lesbian, gay, bisexual, transgender, and queer/questioning plus community, there are specific differences that should be understood to provide the highest level of care to this community.</div></div>","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":"122 5","pages":"Pages 772-773"},"PeriodicalIF":6.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142282738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.fertnstert.2024.06.006
Ethics Committee of the American Society for Reproductive Medicine
Medical providers have an ethical duty to disclose clinically significant errors involving gametes and embryos. Although not mandatory, disclosure of errors causing no harm or near misses is recommended. In addition, clinics should have written policies in place for reducing and disclosing errors.
Divulgación de errores médicos y eventos adversos que involucran gametas y embriones: una opinión del Comité de Ética
Los proveedores de salud tienen un deber ético de divulgar errores clínicamente significativos que involucran gametas y embriones. Aunque no es obligatorio, la divulgación de errores que no causan daño o “near misses” es recomendada. Además, las clínicas deberían tener políticas escritas establecidas para reducir y divulgar errores.
{"title":"Disclosure of medical errors and untoward events involving gametes and embryos: an Ethics Committee opinion","authors":"Ethics Committee of the American Society for Reproductive Medicine","doi":"10.1016/j.fertnstert.2024.06.006","DOIUrl":"10.1016/j.fertnstert.2024.06.006","url":null,"abstract":"<div><div>Medical providers have an ethical duty to disclose clinically significant errors involving gametes and embryos. Although not mandatory, disclosure of errors causing no harm or near misses is recommended. In addition, clinics should have written policies in place for reducing and disclosing errors.</div></div><div><div>Divulgación de errores médicos y eventos adversos que involucran gametas y embriones: una opinión del Comité de Ética</div><div>Los proveedores de salud tienen un deber ético de divulgar errores clínicamente significativos que involucran gametas y embriones. Aunque no es obligatorio, la divulgación de errores que no causan daño o “<em>near misses</em>” es recomendada. Además, las clínicas deberían tener políticas escritas establecidas para reducir y divulgar errores.</div></div>","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":"122 5","pages":"Pages 814-820"},"PeriodicalIF":6.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141751491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.fertnstert.2024.06.022
{"title":"Feasibility and efficacy of a subcutaneous catheter for controlled ovarian stimulation","authors":"","doi":"10.1016/j.fertnstert.2024.06.022","DOIUrl":"10.1016/j.fertnstert.2024.06.022","url":null,"abstract":"","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":"122 5","pages":"Pages 945-947"},"PeriodicalIF":6.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141467279","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.fertnstert.2024.06.025
<div><h3>Importance</h3><div>Oocyte preservation for planned fertility delay, also referred to as social oocyte preservation or colloquially as “egg freezing,” has become increasingly popular in the last few decades. Previous literature has suggested that there are gaps in counseling and expectations regarding the expected thaw rates and outcomes of preserved oocytes.</div></div><div><h3>Objective</h3><div>To characterize the literature on social oocyte preservation, specifically the return rates, thaw rates, clinical pregnancy rates, and live birth rates.</div></div><div><h3>Data sources</h3><div>We conducted a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses of 7 databases (MEDLINE, EMBASE, Emcare, CINAHL, the Cochrane Library, Web of Science: Core Collection, and Scopus) until January 1, 2024. The Risk Of Bias In Non-randomized Studies of Interventions tool was used for critical appraisal.</div></div><div><h3>Study selection and synthesis</h3><div>All original human research that reported data for individuals who underwent autologous oocyte preservation for planned fertility delay (i.e., not for medical indications such as chemotherapy) was included for analysis. A meta-analysis was conducted using descriptive statistics and pooled prevalence rates. Title and abstract screening and data extraction were conducted in duplicate by 2 independent reviewers for all studies until full agreement on eligibility was achieved through consensus-based discussion.</div></div><div><h3>Main outcomes</h3><div>Return rate among those who froze oocytes for planned fertility delay, as well as live birth rate and clinical pregnancy rate among these patients.</div></div><div><h3>Results</h3><div>After screening 1,540 references, a total of 27 studies encompassing 13,724 patients were included. Follow-up ranged from 4 to 19 years, with a median follow-up time of 7 years. A total of 17,418 oocyte retrieval cycles for planned fertility delay were reported, with most individuals undergoing a single cryopreservation cycle. Overall, 10.8% of individuals returned to thaw their eggs, with an aggregate oocyte survival rate of 81.4%. The implantation rate was 44.4% and clinical pregnancy rate was 34.2%. A live birth was reported for 28.9% of individuals across all age groups who returned to thaw eggs.</div></div><div><h3>Conclusions and relevance</h3><div>Individuals should be counseled regarding the low return rates after oocyte preservation for planned fertility delay.</div></div><div><div>Tasas de retorno y resultados de embarazo después de la preservación de ovocitos para la planificación en el retraso de la fertilidad: una revisión sistemática y metanálisis</div></div><div><h3>Importancia</h3><div>La preservación de ovocitos para el retraso planificado de la fertilidad, también conocida como preservación social de ovocitos o coloquialmente como "congelación de óvulos", se ha vuelto cada vez más popular en las últimas décadas
{"title":"Return rates and pregnancy outcomes after oocyte preservation for planned fertility delay: a systematic review and meta-analysis","authors":"","doi":"10.1016/j.fertnstert.2024.06.025","DOIUrl":"10.1016/j.fertnstert.2024.06.025","url":null,"abstract":"<div><h3>Importance</h3><div>Oocyte preservation for planned fertility delay, also referred to as social oocyte preservation or colloquially as “egg freezing,” has become increasingly popular in the last few decades. Previous literature has suggested that there are gaps in counseling and expectations regarding the expected thaw rates and outcomes of preserved oocytes.</div></div><div><h3>Objective</h3><div>To characterize the literature on social oocyte preservation, specifically the return rates, thaw rates, clinical pregnancy rates, and live birth rates.</div></div><div><h3>Data sources</h3><div>We conducted a systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses of 7 databases (MEDLINE, EMBASE, Emcare, CINAHL, the Cochrane Library, Web of Science: Core Collection, and Scopus) until January 1, 2024. The Risk Of Bias In Non-randomized Studies of Interventions tool was used for critical appraisal.</div></div><div><h3>Study selection and synthesis</h3><div>All original human research that reported data for individuals who underwent autologous oocyte preservation for planned fertility delay (i.e., not for medical indications such as chemotherapy) was included for analysis. A meta-analysis was conducted using descriptive statistics and pooled prevalence rates. Title and abstract screening and data extraction were conducted in duplicate by 2 independent reviewers for all studies until full agreement on eligibility was achieved through consensus-based discussion.</div></div><div><h3>Main outcomes</h3><div>Return rate among those who froze oocytes for planned fertility delay, as well as live birth rate and clinical pregnancy rate among these patients.</div></div><div><h3>Results</h3><div>After screening 1,540 references, a total of 27 studies encompassing 13,724 patients were included. Follow-up ranged from 4 to 19 years, with a median follow-up time of 7 years. A total of 17,418 oocyte retrieval cycles for planned fertility delay were reported, with most individuals undergoing a single cryopreservation cycle. Overall, 10.8% of individuals returned to thaw their eggs, with an aggregate oocyte survival rate of 81.4%. The implantation rate was 44.4% and clinical pregnancy rate was 34.2%. A live birth was reported for 28.9% of individuals across all age groups who returned to thaw eggs.</div></div><div><h3>Conclusions and relevance</h3><div>Individuals should be counseled regarding the low return rates after oocyte preservation for planned fertility delay.</div></div><div><div>Tasas de retorno y resultados de embarazo después de la preservación de ovocitos para la planificación en el retraso de la fertilidad: una revisión sistemática y metanálisis</div></div><div><h3>Importancia</h3><div>La preservación de ovocitos para el retraso planificado de la fertilidad, también conocida como preservación social de ovocitos o coloquialmente como \"congelación de óvulos\", se ha vuelto cada vez más popular en las últimas décadas","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":"122 5","pages":"Pages 902-917"},"PeriodicalIF":6.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141534101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.fertnstert.2024.07.036
Shelun Tsai M.D. , Aleksandra Uzelac B.Sc., M.Sc., M.D. , Steven R. Lindheim M.D., M.M.M. , Nigel Pereira M.D.
<div><h3>Objective</h3><div>To describe the intraoperative and postoperative implications arising from the unexpected diagnosis of a Müllerian anomaly during the surgical management of an ectopic pregnancy.</div></div><div><h3>Design</h3><div>Video article.</div></div><div><h3>Setting</h3><div>Academic center.</div></div><div><h3>Patient(s)</h3><div>A 39-year-old nulligravid woman with anovulation and irregular menstrual cycles presented to the office. Her urine pregnancy test result was incidentally positive; the serum β-human chorionic gonadotropin level was 5,644 mIU/mL. Outpatient transvaginal ultrasonography demonstrated a 2.1 × 1.7 × 2.2–cm thick-walled structure in the left adnexa without an intrauterine pregnancy. These findings were highly suspicious for a left tubal ectopic pregnancy. The patient was consented for laparoscopy with planned left salpingectomy. The patient included in this video gave consent for publication of the video and posting of the video online including social media, the journal website, scientific literature websites (e.g., PubMed, ScienceDirect, and Scopus), and other applicable sites.</div></div><div><h3>Intervention(s)</h3><div>Diagnostic laparoscopy did not show an obvious left tubal ectopic pregnancy. Instead, a right unicornuate uterus with a dilated rudimentary left uterine horn was seen. Both fallopian tubes and ovaries appeared normal. These laparoscopic findings were consistent with an ectopic pregnancy in the rudimentary horn. However, in the absence of informed consent for a hemihysterectomy and no evidence of ectopic rupture or bleeding within the pelvis, we decided to proceed with excision of the ectopic pregnancy from the uterine horn. An incision was made over the anterior surface of the uterine horn, and the pregnancy sac was dissected from the underlying myometrium and excised in its entirety. Left salpingectomy was also performed. The patient was discharged home the same day, and her β-human chorionic gonadotropin levels decreased to <5 mIU/mL within 28 days of surgery.</div></div><div><h3>Main Outcome Measure(s)</h3><div>Complete resolution of a left rudimentary uterine horn ectopic pregnancy through surgical excision of the pregnancy sac without hemihysterectomy.</div></div><div><h3>Result(s)</h3><div>Postoperative hysterosalpingography demonstrated a right unicornuate uterus with normal fill and spill of the right fallopian tube. Magnetic resonance imaging of the pelvis confirmed the findings of a right unicornuate uterus with a noncommunicating left rudimentary uterine horn that did not contain any endometrial tissue. Thus, the patient did not require an interval hemihysterectomy. She underwent letrozole and intrauterine insemination treatment 5 months after the initial surgery, which resulted in a clinical intrauterine pregnancy. However, this pregnancy was terminated in the early second trimester because of findings of trisomy 18. She conceived naturally 1 year later, and this pregnancy
目的描述在宫外孕手术治疗过程中，意外诊断出穆勒氏管异常所带来的术中和术后影响：视频文章：地点：学术中心：一名39岁的无排卵妇女前来就诊，她无排卵且月经周期不规律。她的尿妊娠试验偶然呈阳性；血清β-人绒毛膜促性腺激素（β-hCG）水平为5,644 mIU/mL。门诊经阴道超声检查（TVUS）显示，左侧附件有一个 2.1 x 1.7 x 2.2 厘米的厚壁结构，但没有宫内妊娠。这些结果高度怀疑是左侧输卵管异位妊娠。患者同意进行腹腔镜检查，并计划进行左侧输卵管切除术。该视频中的患者同意在社交媒体、期刊网站、科学文献网站（如PubMed、ScienceDirect、Scopus等）和其他适用网站上公布和张贴该视频：诊断性腹腔镜检查未发现明显的左侧输卵管异位妊娠。取而代之的是右侧单角子宫和扩张的左侧子宫角。输卵管和卵巢均正常。这些腹腔镜检查结果与宫角发育不良的异位妊娠一致。然而，由于患者没有在知情同意的情况下进行半子宫切除术，也没有宫外孕破裂或盆腔出血的迹象，我们决定继续进行宫角异位妊娠切除术。我们在子宫角前表面做了一个切口，将妊娠囊从下层子宫肌层中剥离出来，并将其全部切除。同时还进行了左侧输卵管切除术。患者当天出院回家，β-hCG水平降至主要结果指标：通过手术切除妊娠囊而不进行半子宫切除术，彻底解决左侧子宫角未发育异位妊娠：术后子宫输卵管造影（HSG）显示右侧单角子宫，右侧输卵管正常充盈和溢出。盆腔核磁共振成像（MRI）证实了右侧单角子宫的结果，左侧子宫角不发育，不含任何子宫内膜组织。因此，患者无需进行间歇性半切除术。初次手术后 5 个月，她接受了来曲唑和宫腔内人工授精治疗，结果出现了临床宫内妊娠。然而，由于发现了 18 三体综合征，这次妊娠在第二孕期早期被终止。一年后，她自然受孕，并在妊娠 39 周时经阴道足月分娩：结论：未确诊或意外的穆勒氏管畸形会影响异位妊娠术中和术后的标准处理。
{"title":"Surgical management of an ectopic pregnancy in the setting of an unexpected Müllerian anomaly: intraoperative and postoperative implications","authors":"Shelun Tsai M.D. , Aleksandra Uzelac B.Sc., M.Sc., M.D. , Steven R. Lindheim M.D., M.M.M. , Nigel Pereira M.D.","doi":"10.1016/j.fertnstert.2024.07.036","DOIUrl":"10.1016/j.fertnstert.2024.07.036","url":null,"abstract":"<div><h3>Objective</h3><div>To describe the intraoperative and postoperative implications arising from the unexpected diagnosis of a Müllerian anomaly during the surgical management of an ectopic pregnancy.</div></div><div><h3>Design</h3><div>Video article.</div></div><div><h3>Setting</h3><div>Academic center.</div></div><div><h3>Patient(s)</h3><div>A 39-year-old nulligravid woman with anovulation and irregular menstrual cycles presented to the office. Her urine pregnancy test result was incidentally positive; the serum β-human chorionic gonadotropin level was 5,644 mIU/mL. Outpatient transvaginal ultrasonography demonstrated a 2.1 × 1.7 × 2.2–cm thick-walled structure in the left adnexa without an intrauterine pregnancy. These findings were highly suspicious for a left tubal ectopic pregnancy. The patient was consented for laparoscopy with planned left salpingectomy. The patient included in this video gave consent for publication of the video and posting of the video online including social media, the journal website, scientific literature websites (e.g., PubMed, ScienceDirect, and Scopus), and other applicable sites.</div></div><div><h3>Intervention(s)</h3><div>Diagnostic laparoscopy did not show an obvious left tubal ectopic pregnancy. Instead, a right unicornuate uterus with a dilated rudimentary left uterine horn was seen. Both fallopian tubes and ovaries appeared normal. These laparoscopic findings were consistent with an ectopic pregnancy in the rudimentary horn. However, in the absence of informed consent for a hemihysterectomy and no evidence of ectopic rupture or bleeding within the pelvis, we decided to proceed with excision of the ectopic pregnancy from the uterine horn. An incision was made over the anterior surface of the uterine horn, and the pregnancy sac was dissected from the underlying myometrium and excised in its entirety. Left salpingectomy was also performed. The patient was discharged home the same day, and her β-human chorionic gonadotropin levels decreased to <5 mIU/mL within 28 days of surgery.</div></div><div><h3>Main Outcome Measure(s)</h3><div>Complete resolution of a left rudimentary uterine horn ectopic pregnancy through surgical excision of the pregnancy sac without hemihysterectomy.</div></div><div><h3>Result(s)</h3><div>Postoperative hysterosalpingography demonstrated a right unicornuate uterus with normal fill and spill of the right fallopian tube. Magnetic resonance imaging of the pelvis confirmed the findings of a right unicornuate uterus with a noncommunicating left rudimentary uterine horn that did not contain any endometrial tissue. Thus, the patient did not require an interval hemihysterectomy. She underwent letrozole and intrauterine insemination treatment 5 months after the initial surgery, which resulted in a clinical intrauterine pregnancy. However, this pregnancy was terminated in the early second trimester because of findings of trisomy 18. She conceived naturally 1 year later, and this pregnancy","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":"122 5","pages":"Pages 951-953"},"PeriodicalIF":6.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141859481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.fertnstert.2024.07.034
Luca Giannella M.D., Leonardo Natalini M.D., Andrea Ciavattini M.D.
<div><h3>Objective</h3><div>To report a rare, misleading fibroid degeneration involving a nonfunctional, noncommunicating horn in a woman with a unicornuate uterus. Although the presence of a functional rudimentary horn may lead to signs and symptoms that recommend its removal, nonfunctional cases are rarely reported, and because of their apparent functional inactivity, the need for their removal has not yet been reported. No previous report showed the possibility of a degenerative process in a nonfunctional rudimentary horn causing patient discomfort.</div></div><div><h3>Design</h3><div>This is a step-by-step narrated video showing a unique case of fibroid degeneration and growth of a nonfunctional, noncommunicating rudimentary horn in a unicornuate uterus (American Society for Reproductive Medicine classification 2021) and its surgical management.</div></div><div><h3>Setting</h3><div>University academic hospital.</div></div><div><h3>Patient(s)</h3><div>A 48-year-old White nulliparous premenopausal woman was referred to our institution because of abdominal pain and an enlarging adnexal mass. Her personal history showed primary infertility with a previous diagnosis of unicornuate uterus. Given the possibility of ectopic ureters in these occurrences, complete computed tomography was performed, and no genitourinary alterations were found. Preoperative imaging (ultrasound evaluation, computed tomography, and magnetic resonance imaging) provided a provisional diagnosis of a suspicious ovarian fibroma.</div></div><div><h3>Intervention(s)</h3><div>Considering the patient’s age, lack of desire for pregnancy, and volumetric increase in the adnexal mass, a laparoscopic intervention to perform mass removal and prophylactic bilateral salpingectomy was planned. The patient was counseled about the low risk of an underlying malignant transformation. Therefore, the decision to remove the intact mass via a minilaparotomy at the end of the surgery was shared. Once the abdominal cavity was entered, the right unicornuate uterus was found in anatomical continuity with the ipsilateral broad ligament, fallopian tube, and ovary. These structures were wholly attached to the right pelvic wall. On the other side, cranially compared with the right hemiuterus, a roundish myoma-like mass was detected in direct connection with the left broad ligament, fallopian tube, and ovary. In light of a changed intraoperative finding, amputation of the left rudimentary horn and prophylactic bilateral salpingectomy were performed.</div></div><div><h3>Main Outcome Measure(s)</h3><div>Showing the fibroid degeneration and growth of a nonfunctional, noncommunicating rudimentary horn in a unicornuate uterus (American Society for Reproductive Medicine classification 2021) treated laparoscopically.</div></div><div><h3>Result(s)</h3><div>Laparoscopic removal of the uterine horn was successful, and no intraoperative and postoperative complications occurred. The patient was in good health at the 6-
目的：报告一名患有单角子宫的妇女发生的一种罕见的、容易引起误解的子宫肌瘤变性，其中涉及到一个无功能、不沟通的子宫角。虽然功能性瘤角的存在可能会导致一些症状和体征，从而建议切除，但无功能性瘤角的病例却鲜有报道。以前没有任何报告显示无功能的原角可能出现退行性病变，导致患者不适：这是一个循序渐进的解说视频，展示了一例独特的单角子宫（ASRM 分类 2021）中无功能、无交流的原始角的肌瘤变性和生长及其手术治疗：地点：意大利安科纳 A.O.U. delle Marche - Università Politecnica delle Marche 大学学术医院：一名 48 岁的高加索无绝经期妇女因腹痛和附件肿块增大转诊至我院。她的个人病史显示为原发性不孕，之前诊断为单角子宫。考虑到这些情况可能存在异位输尿管，我们对她进行了全面的计算机断层扫描，结果没有发现泌尿生殖系统的改变。术前成像（超声评估、计算机断层扫描和磁共振）提供了可疑卵巢纤维瘤的临时诊断：考虑到患者的年龄、无怀孕意愿以及附件肿块体积增大，计划通过腹腔镜手术切除肿块并进行预防性双侧输卵管切除术。医生告知患者潜在恶变的风险很低。因此，双方共同决定在手术结束时通过小型腹腔镜手术切除完整的肿块。进入腹腔后，发现右侧单角子宫与同侧阔韧带、输卵管和卵巢在解剖学上是连续的。这些结构与右侧盆壁完全相连。在另一侧，与右侧半子宫相比，发现了一个圆形肌瘤样肿块，与左侧阔韧带、输卵管和卵巢直接相连。鉴于术中发现的变化，对患者进行了左侧粗隆截除和预防性双侧输卵管切除术：显示单角子宫（ASRM分类2021）经腹腔镜治疗后肌瘤变性和无功能、不沟通的原发角生长情况：结果：腹腔镜下子宫角切除术非常成功，术中术后均未出现并发症。六个月随访时，患者健康状况良好。组织病理学检查证实子宫肌瘤变性且无子宫内膜：结论：文献中缺乏关于不发育无功能角无症状病例的报道，因此妇科医生认为这是一种无声的穆勒氏畸形。这个独特的病例表明，即使是无功能的不发育角，也可能发生有症状的转变过程，需要进行手术。这一信息可能有助于为妇女提供更全面的咨询，也有助于在诊断误诊的穆勒氏异常时考虑发生这种情况的可能性。考虑到这一点，手术治疗也可以更好地进行规划，因为与附件病变相比，技术方面会发生变化。
{"title":"A misleading case of Müllerian anomaly: fibroid degeneration and growth involving nonfunctional, noncommunicating rudimentary horn","authors":"Luca Giannella M.D., Leonardo Natalini M.D., Andrea Ciavattini M.D.","doi":"10.1016/j.fertnstert.2024.07.034","DOIUrl":"10.1016/j.fertnstert.2024.07.034","url":null,"abstract":"<div><h3>Objective</h3><div>To report a rare, misleading fibroid degeneration involving a nonfunctional, noncommunicating horn in a woman with a unicornuate uterus. Although the presence of a functional rudimentary horn may lead to signs and symptoms that recommend its removal, nonfunctional cases are rarely reported, and because of their apparent functional inactivity, the need for their removal has not yet been reported. No previous report showed the possibility of a degenerative process in a nonfunctional rudimentary horn causing patient discomfort.</div></div><div><h3>Design</h3><div>This is a step-by-step narrated video showing a unique case of fibroid degeneration and growth of a nonfunctional, noncommunicating rudimentary horn in a unicornuate uterus (American Society for Reproductive Medicine classification 2021) and its surgical management.</div></div><div><h3>Setting</h3><div>University academic hospital.</div></div><div><h3>Patient(s)</h3><div>A 48-year-old White nulliparous premenopausal woman was referred to our institution because of abdominal pain and an enlarging adnexal mass. Her personal history showed primary infertility with a previous diagnosis of unicornuate uterus. Given the possibility of ectopic ureters in these occurrences, complete computed tomography was performed, and no genitourinary alterations were found. Preoperative imaging (ultrasound evaluation, computed tomography, and magnetic resonance imaging) provided a provisional diagnosis of a suspicious ovarian fibroma.</div></div><div><h3>Intervention(s)</h3><div>Considering the patient’s age, lack of desire for pregnancy, and volumetric increase in the adnexal mass, a laparoscopic intervention to perform mass removal and prophylactic bilateral salpingectomy was planned. The patient was counseled about the low risk of an underlying malignant transformation. Therefore, the decision to remove the intact mass via a minilaparotomy at the end of the surgery was shared. Once the abdominal cavity was entered, the right unicornuate uterus was found in anatomical continuity with the ipsilateral broad ligament, fallopian tube, and ovary. These structures were wholly attached to the right pelvic wall. On the other side, cranially compared with the right hemiuterus, a roundish myoma-like mass was detected in direct connection with the left broad ligament, fallopian tube, and ovary. In light of a changed intraoperative finding, amputation of the left rudimentary horn and prophylactic bilateral salpingectomy were performed.</div></div><div><h3>Main Outcome Measure(s)</h3><div>Showing the fibroid degeneration and growth of a nonfunctional, noncommunicating rudimentary horn in a unicornuate uterus (American Society for Reproductive Medicine classification 2021) treated laparoscopically.</div></div><div><h3>Result(s)</h3><div>Laparoscopic removal of the uterine horn was successful, and no intraoperative and postoperative complications occurred. The patient was in good health at the 6-","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":"122 5","pages":"Pages 948-950"},"PeriodicalIF":6.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141792331","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.fertnstert.2024.09.008
Bethany Dubois B.A. , Hajer Naveed B.A. , Katrina S. Nietsch M.S. , Isabelle C. Band B.A. , Pedro Brandão M.D., Ph.D., E.F.O.G., E.F.R.M. , Samantha L. Estevez M.D.
Reciprocal in vitro fertilization (IVF) and intravaginal culture (IVC) are two technologies that allow same-sex female couples to jointly contribute biologically to a pregnancy. This systematic review aimed to synthesize the clinical outcomes of each method including live birth rate, clinical pregnancy rate, embryo quality, and perinatal complications. A dual-reviewer protocol identified eight studies on reciprocal IVF and ten studies on IVC. In retrospective studies reporting on a total of 1,405 reciprocal IVF cycles, reciprocal IVF has demonstrated similar cycle and pregnancy outcomes to autologous IVF. One study that reported on pregnancy complications found a comparable rate of hypertensive disease in pregnancy between patients undergoing reciprocal IVF and intrauterine insemination. However, a lack of prospective studies on reciprocal IVF limits the generalizability of these results. Overall, small prospective and retrospective studies reporting on a total of 776 IVC cycles show that IVC offers good cycle and pregnancy outcomes, comparable to IVF. However, randomized prospective studies reported that the rate of quality embryo creation in IVC may be lower than in IVF. Although both reciprocal IVF and IVC show promise for same-sex female couples and the larger lesbian, gay, bisexual, transgender, intersex, asexual, and other sexual or gender minorities community, this review has highlighted the need for larger, prospective, more diverse studies on methods of shared biological contribution for family building.
{"title":"A systematic review of reproductive technologies for shared conception in same-sex female couples","authors":"Bethany Dubois B.A. , Hajer Naveed B.A. , Katrina S. Nietsch M.S. , Isabelle C. Band B.A. , Pedro Brandão M.D., Ph.D., E.F.O.G., E.F.R.M. , Samantha L. Estevez M.D.","doi":"10.1016/j.fertnstert.2024.09.008","DOIUrl":"10.1016/j.fertnstert.2024.09.008","url":null,"abstract":"<div><div>Reciprocal in vitro fertilization (IVF) and intravaginal culture (IVC) are two technologies that allow same-sex female couples to jointly contribute biologically to a pregnancy. This systematic review aimed to synthesize the clinical outcomes of each method including live birth rate, clinical pregnancy rate, embryo quality, and perinatal complications. A dual-reviewer protocol identified eight studies on reciprocal IVF and ten studies on IVC. In retrospective studies reporting on a total of 1,405 reciprocal IVF cycles, reciprocal IVF has demonstrated similar cycle and pregnancy outcomes to autologous IVF. One study that reported on pregnancy complications found a comparable rate of hypertensive disease in pregnancy between patients undergoing reciprocal IVF and intrauterine insemination. However, a lack of prospective studies on reciprocal IVF limits the generalizability of these results. Overall, small prospective and retrospective studies reporting on a total of 776 IVC cycles show that IVC offers good cycle and pregnancy outcomes, comparable to IVF. However, randomized prospective studies reported that the rate of quality embryo creation in IVC may be lower than in IVF. Although both reciprocal IVF and IVC show promise for same-sex female couples and the larger lesbian, gay, bisexual, transgender, intersex, asexual, and other sexual or gender minorities community, this review has highlighted the need for larger, prospective, more diverse studies on methods of shared biological contribution for family building.</div></div>","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":"122 5","pages":"Pages 774-782"},"PeriodicalIF":6.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142282724","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-30DOI: 10.1016/j.fertnstert.2024.10.037
Vincent Puy, Badria Bennani Smires, Jean-Pierre Siffroi, Julie Barberet, Marion Bendayan, Oxana Blagosklonov, Florence Brugnon, Rosalie Cabry-Goubet, Marie-Ange Clarotti, Sophie Catteau-Jonard, Céline Chalas, Lucie Chansel-Debordeaux, Béatrice Delepine, Laetitia Hesters, Stéphanie Lattès, Floriane Lefeuve, Arthur Luton, Catherine Metzler-Guillemain, Sophie Mirallié, Joffrey Mons, Valerica-Gabriela Oancea, Nathalie Rives, Nathalie Sermondade, Anna Tournier, Catherine Vincent-Delorme, Gérard Tachdjian, Eva Pipiras, Florence Eustache
Objective: To study karyotypes of more than 8,200 oocyte donor candidates in nulliparous or multiparous women compared to a reference population.
Design: A retrospective observational multicentric study.
Subjects: The study included two cohorts of oocyte donor candidates recruited between January 2005 and October 2021: multiparous women with at least one child at the time of recruitment, and nulliparous women. Both were compared to a reference population composed of female newborns from literature.
Exposure: Not applicable.
Main outcome measures: Blood lymphocyte karyotype.
Results: A total of 8229 oocyte donor candidates from 22 fertility centers were included in this study. Nulliparous women (n=1890) and multiparous ones (n=6339) were compared to 8102 female newborns. Overall, 65 candidates were carriers of chromosomal abnormalities and were therefore excluded from the donation process (0.79%, 95% CI: 0.60-0.98). The occurrence of balanced structural chromosomal rearrangements was globally increased in the study population (0.49%, 95% CI: 0.34-0.64) compared to female newborns (0.24%, 95% CI: 0.34-0.64, p=0.0086). The number of reciprocal translocations was increased 5-fold in nulliparous oocyte donor candidates (0.37%, 95% CI: 0.10-0.64, p=0.013). The incidence of sex chromosome mosaicism was notably increased in multiparous oocyte donor candidates, with 17 cases (0.27%, 95% CI: 0.14-0.40, p=0.0052). Among chromosomal aberration carriers only two nulliparous women (one reciprocal translocation and one sex chromosome mosaicism) had fertility issues with a diagnosis of premature ovarian failure.
Conclusion: In this comprehensive 16-years French experience of karyotyping in oocyte donor candidates, we confirmed an increased incidence of balanced structural chromosomal rearrangements, especially among those without children at the time of recruitment. Karyotyping could be considered to identify any chromosomal abnormalities that may not be easily detectable through medical questioning. These abnormalities pose an inherent genetic risk for gamete recipients if left undetected.
{"title":"Chromosomal abnormalities in oocyte donor candidates: a French survey of over 8200 karyotypes.","authors":"Vincent Puy, Badria Bennani Smires, Jean-Pierre Siffroi, Julie Barberet, Marion Bendayan, Oxana Blagosklonov, Florence Brugnon, Rosalie Cabry-Goubet, Marie-Ange Clarotti, Sophie Catteau-Jonard, Céline Chalas, Lucie Chansel-Debordeaux, Béatrice Delepine, Laetitia Hesters, Stéphanie Lattès, Floriane Lefeuve, Arthur Luton, Catherine Metzler-Guillemain, Sophie Mirallié, Joffrey Mons, Valerica-Gabriela Oancea, Nathalie Rives, Nathalie Sermondade, Anna Tournier, Catherine Vincent-Delorme, Gérard Tachdjian, Eva Pipiras, Florence Eustache","doi":"10.1016/j.fertnstert.2024.10.037","DOIUrl":"https://doi.org/10.1016/j.fertnstert.2024.10.037","url":null,"abstract":"<p><strong>Objective: </strong>To study karyotypes of more than 8,200 oocyte donor candidates in nulliparous or multiparous women compared to a reference population.</p><p><strong>Design: </strong>A retrospective observational multicentric study.</p><p><strong>Subjects: </strong>The study included two cohorts of oocyte donor candidates recruited between January 2005 and October 2021: multiparous women with at least one child at the time of recruitment, and nulliparous women. Both were compared to a reference population composed of female newborns from literature.</p><p><strong>Exposure: </strong>Not applicable.</p><p><strong>Main outcome measures: </strong>Blood lymphocyte karyotype.</p><p><strong>Results: </strong>A total of 8229 oocyte donor candidates from 22 fertility centers were included in this study. Nulliparous women (n=1890) and multiparous ones (n=6339) were compared to 8102 female newborns. Overall, 65 candidates were carriers of chromosomal abnormalities and were therefore excluded from the donation process (0.79%, 95% CI: 0.60-0.98). The occurrence of balanced structural chromosomal rearrangements was globally increased in the study population (0.49%, 95% CI: 0.34-0.64) compared to female newborns (0.24%, 95% CI: 0.34-0.64, p=0.0086). The number of reciprocal translocations was increased 5-fold in nulliparous oocyte donor candidates (0.37%, 95% CI: 0.10-0.64, p=0.013). The incidence of sex chromosome mosaicism was notably increased in multiparous oocyte donor candidates, with 17 cases (0.27%, 95% CI: 0.14-0.40, p=0.0052). Among chromosomal aberration carriers only two nulliparous women (one reciprocal translocation and one sex chromosome mosaicism) had fertility issues with a diagnosis of premature ovarian failure.</p><p><strong>Conclusion: </strong>In this comprehensive 16-years French experience of karyotyping in oocyte donor candidates, we confirmed an increased incidence of balanced structural chromosomal rearrangements, especially among those without children at the time of recruitment. Karyotyping could be considered to identify any chromosomal abnormalities that may not be easily detectable through medical questioning. These abnormalities pose an inherent genetic risk for gamete recipients if left undetected.</p>","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142563858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-30DOI: 10.1016/j.fertnstert.2024.10.039
Madeline G Kroeger, Jessica D Kresowik
{"title":"Should We Rescue Clubbed Fallopian Tubes?","authors":"Madeline G Kroeger, Jessica D Kresowik","doi":"10.1016/j.fertnstert.2024.10.039","DOIUrl":"https://doi.org/10.1016/j.fertnstert.2024.10.039","url":null,"abstract":"","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2024-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142564041","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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