Intrauterine Adhesions following Conservative Treatment of Uterine Fibroids

Uterine fibroids are common in women of reproductive age and various conservative treatments are available. In order to achieve a successful conservative treatment of fibroids, functional integrity of the uterus is as important as tumor removal or symptoms relief. In this context, intrauterine adhesions must be recognized as a possible complication of conservative management of uterine fibroids, but diagnostic pitfalls might justify an underestimation of their incidence. Hysteroscopic myomectomy can cause adhesions as a result of surgical trauma to the endometrium. The average reported incidence is around 10% at second-look hysteroscopy, but it is higher in certain conditions, such as the case of multiple, apposing fibroids. Transmural myomectomies also have the potential for adhesion, especially when combined with uterine ischemia. Uterine arteries embolization also carries a risk of intracavitary adhesions. Prevention strategies including bipolar resection, barrier gel or postoperative estradiol, might be useful, but stronger evidence is needed. In view of current knowledge, we would recommend a prevention strategy based on a combination of surgical trauma minimization and identification of high-risk cases. Early hysteroscopic diagnosis and lysis possibly represents the best means of secondary prevention and treatment of postoperative intrauterine adhesions

Psychopathology is associated with reproductive health risk in European adolescents

Background: Reproductive and mental health are key domains of adolescent wellbeing but possible interrelationships are poorly understood. This cross-sectional study evaluated the association between psychopathology and reproductive health risk among European adolescents. Methods: A structured self-report questionnaire was delivered to 12,395 pupils of 179 randomly selected schools in 11 European countries within the EU funded “Saving and Empowering Young Lives in Europe” (SEYLE) project. The questionnaire included items about sexual initiation and reproductive health risk factors, such as number of sexual partners, frequency of condom use, and pregnancy involvement. Psychopathology was evaluated with validated instruments and/or ad-hoc questions. Results: Of 11,406 respondents (median age 15; interquartile range [IQR] 14–15; 57% females), 18.8% reported sexual initiation. Sixty percent of them also reported at least one reproductive risk factor. Sexual initiation was significantly more common among pupils older than 15 years (38% versus 13.2% younger pupils) and males (21.3% versus 16.9% females). It was also more common among pupils with depression (age/sex-adjusted odds ratio [aOR] 1.871), anxiety (aOR 2.190), severe suicidal ideation (aOR 2.259), self-injurious behaviour (aOR 2.892), and suicide attempts (aOR 3.091). These associations were particularly strong among pupils ≤15 years old and, for overt psychopathology, among pupils with low non-sexual risk behaviour profile and females. Depression (aOR 1.937), anxiety (aOR 2.282), severe suicidal ideation (aOR 2.354), self-injurious behaviour (aOR 3.022), and suicide attempts (aOR 3.284) were associated with higher reproductive health risk, defined by an increasing number of coexisting reproductive risk factors. Conclusions: These findings suggest an alignment between mental and reproductive health risk and support the value of cross-domain collaboration in adolescent health. The association between psychopathology and reproductive health risk, as well as its variations with age, sex, and associated risk behaviours, should be considered when designing health-promoting or disease-preventing interventions for adolescents

Significado oncológico de los pólipos endometriales

The association of endometrial polyps and endometrial neoplasia is still controversial. Our main objectives were to study the frequency, the characteristics and possible associated factors of endometrial neoplasia in a population of 1390 consecutive patients referred for hysteroscopy following ultrasonographic diagnosis of endometrial polyps. Sixteen cases of endometrial neoplasia were diagnosed (1.15%). All the patients had symptoms and fifteen of them were post-menopausal (93.8%). The neoplasia was not confined to the polyp in most of the cases. Patients with a higher risk disease were significantly younger. In a nested case-control study, 64 controls with benign endometrial polyps were compared to the 16 cases of endometrial neoplasia. The cases were significantly older (p<.001) and had a greater BMI (p<.001). Other factors significantly associated with endometrial neoplasia were postmenopausal status and bleeding. At multivariate analysis with logistic regression, the only factors independently associated with endometrial neoplasia were older age (OR 1.102; 95%CI 1.015-1.198) and bleeding (OR 13.7; 95%Cl 1.486-126.278). In conclusion, the prevalence of endometrial neoplasia in patients with an ultrasonographic diagnosis of endometrial polyp is low, and the malignancy is commonly not confined to the polyp. Bleeding and older age are independently associated with neoplasia, and no case of cancer was found in asymptomatic women.La asociación entre pólipos endometriales y cáncer es controvertida. Nuestros objetivos principales eran estudiar la prevalencia y las características de neoplasia endometrial, y potenciales factores asociados, en una población de 1390 pacientes consecutivas remitidas a histeroscopia tras el diagnostico ecografico de pólipo endometrial. Se identificaron 16 casos de neoplasia (1.15%). Todas estas pacientes tenían síntomas y 15 de ellas eran postmenopausicas (93.8%). La neoplasia no estaba circunscrita al pólipo en la mayoría de los casos. La pacientes con cáncer de alto riesgo eran significativamente mas jóvenes. En un estudio de caso-control nested, 64 controles con pólipos endometriales benignos se compararon con los 16 casos de neoplasia endometrial. Los casos resultaron ser de mayor edad (p<.001), y de mayor IMC (p<.001). Otros factores significativos asociados a la neoplasia fueron el estado postmenopausico, y el sangrado. Al realizar un análisis multivariante con regresión logística se confirmó la asociación estadísticamente significativa entre neoplasia de endometrio y mayor edad (OR 1.102; 95%CI 1.015-1.198), y sangrado (OR 13.7; 95%CI 1.486-126.278). En conclusión, la prevalencia de neoplasia endometrial en mujeres con diagnostico ecografico de pólipo endometrial es baja, y el cáncer no suele estar circunscrito al pólipo. Sangrado y mayor edad son significativamente asociados a la neoplasia, y no encontramos ningún caso de cáncer en mujeres asintomáticas

Endometrial cancer in a woman undergoing hysteroscopy for recurrent IVF failure

Abstract Background: Hysteroscopy, despite being the undisputed gold standard for the examination of the uterine cavity, is controversial as a routine procedure in infertile women. However, benign intrauterine conditions are common in women suffering repeated in vitro fertilization (IVF) failure, and growing evidence suggests a unique diagnostic and therapeutic role for hysteroscopy. Endometrial malignancy, on the contrary, is unreported by large published series of women with repeated IVF failures undergoing hysteroscopy, and its impact on fertility, for obvious reasons, has not been studied. Results: An unsuspected endometrial cancer was diagnosed in an asymptomatic 38-year-old woman undergoing hysteroscopy because of several repeated failures of in vitro fertilization and embryo transfer. Conclusions: Endometrial cancer can be found at hysteroscopy in young women with repeated IVF failures. The possibility of repeatedly unsuccessful fertility treatments should be taken into account when counseling infertile women about conservative treatment of endometrial cancer

Short-term and long-term results of resectoscopic myomectomy with and without pretreatment with GnRH analogs in premenopausal women

The aim of this study was to analyze the safety and efficacy of resectoscopic myomectomy and to evaluate the influence of GnRH analog pretreatment on short- and long-term surgery outcome

Is a positive family history of endometriosis a risk factor for endometrioma recurrence after laparoscopic surgery?

A total of 148 patients were followed up for an average of 30.1 ± 17 months following to laparoscopic excision of ovarian endometriomas by a single surgical team. Bivariate and multivariate analyses were used to investigate the association between endometrioma recurrence and several factors, age, body mass index, family history, cyst diameter, number and location, adhesions or peritoneal implants, occurrence of spillage, postoperative treatment with gonadotropin-releasing hormone agonist, or pregnancies. The overall recurrence rate of the endometriomas was 18.2%. At bivariate analysis, recurrence rate was significantly higher in patients with a positive family history of endometriosis (40% vs 14.8%). Recurrence was also more frequent, albeit nonsignificantly, in patients with a history of dysmenorrhea, intraoperative spillage, and postoperative hormonal suppression. At multivariate analysis with logistic regression, a positive family history of endometriosis was the only variable independently associated with endometrioma recurrence following laparoscopic removal (odds ratio 3.245; 95% confidence interval: 1.090-9.661). Keywords endometrioma, endometriosis, laparoscopy, recurrence, family histor

How Predictable Is the Operative Time of Laparoscopic Surgery for Ovarian Endometrioma?

Endometriosis is a tricky albeit common disease whose management largely relies on laparoscopy. We have studied the operative times of laparoscopic endometrioma surgery in order to assess their predictability and possible predictors. One hundred forty-eight laparoscopies were included, with a median operative time of 70 minutes (mean 75.14; 95% CI: 70.03–80.24). Half of the cases had a duration within 15–20 minutes above or below the median (IQR: 55–93.75), but the whole dataset ranged from 20 to 180 minutes, and the standard deviation was relatively large (31.4). Surgical times were significantly related to technical (number and size of the cysts) and nontechnical factors (age, parity, dysmenorrhea, and family history). At multiple logistic regression, after adjusting for number and size of the cysts, surgical times below the first quartile were associated with older age (>30 years old: aOR: 3.590; 95% CI: 1.417–9.091) and parity (≥1 delivery: aOR: 3.409; 95% CI: 1.343–8.651). Longer times, above the third quartile, were instead predicted by a familial anamnesis of endometriosis (aOR: 3.639; 95% CI: 1.246–10.627). Our findings indicate highly variable surgical times, which are predicted by unexpected nontechnical factors. This is consistent with the complexity of endometriosis and its treatment. Productivity and efficiency in endometriosis surgery should focus on the quality of healthcare outcomes rather than on the time spent in the operating theatres

Acceptance and willingness-to-pay for oocyte cryopreservation in medical versus age-related fertility preservation scenarios among Swedish female university students

Abstract Oocytes can be effectively cryopreserved and stored for future use in in-vitro fertilisation. Oocyte cryopreservation (OC) can therefore mitigate different threats to female fertility, but attitudes and policies often seem more favourable in medical rather than age-related fertility preservation scenarios. The value of OC for potential candidates may be perceived differently depending on the indications, although relevant empirical data are lacking. An adequately powered sample of Swedish female university students (n = 270; median age 25; range 19–35) were randomly delivered a medical (n = 130) or age-related (n = 140) fertility preservation scenario within an online survey. Sociodemographic factors, reproductive experiences, and awareness about OC were not significantly different between the groups. Differences in four outcomes were studied: proportions of respondents (1) positive to the use of OC, (2) positive to public funding for OC, or (3) open to considering OC; and (4) willingness-to-pay (WTP) for OC, measured in thousand Swedish krona (K SEK) through contingent valuation. There were no significant differences in the proportions of respondents positive to the use of OC (medical: 96%; age-related: 93%) or open to consider it (medical: 90%; age-related: 88%) in each scenario. However, public funding had significantly greater support in the medical scenario (85%) than in the age-related one (64%). The median WTP (45 K SEK ≈ 4.15 K EUR) approximated the current Swedish market price for a single elective cycle and was not significantly different between the scenarios (Cliff’s delta − 0.009; 95%CI − 0.146, 0.128). These findings suggest that it may be inappropriate to justify counselling and priority policies only on the assumption that fertility preservation with OC for medical indications is more beneficial to women than when the same technique is used for age-related reasons. However, it would be interesting to investigate further why public funding appears more debatable than the treatment itself