Robotic Tubal Anastomosis: Technical Aspects

The authors conclude that robotic technology can facilitate the performance of robotic tubal anastomosis

Laparoscopic Management of Transcervical Fallopian Tube Prolapse

Laparoscopic total salpingectomy appears to provide effective treatment with minimal invasiveness for transcervical fallopian tube prolapse

Clinical Effectiveness of Modified Laparoscopic Fimbrioplasty for the Treatment of Minimal Endometriosis and Unexplained Infertility

Objective. To study the reproductive outcomes of modified laparoscopic fimbrioplasty (MLF), a surgical technique designed to increase the working surface area of the fimbriated end of the fallopian tube. We postulated that an improvement in fimbrial function through MLF will improve reproductive outcomes. Design. Retrospective cohort study. Setting. Academic tertiary-care medical center. Patients. Women with minimal endometriosis or unexplained infertility, who underwent MLF during diagnostic laparoscopy (n=50) or diagnostic laparoscopy alone (n=87). Intervention. MLF involved gentle, circumferential dilatation of the fimbria and lysis of fimbrial adhesions bridging the fimbrial folds. Main Outcome Measures. The primary outcome was pregnancy rate and the secondary outcome was time to pregnancy. Results. The pregnancy rate for the MLF group was 40.0%, compared to 28.7% for the control group. The average time to pregnancy for the MLF group was 13 weeks, compared to 18 weeks for the control group. The pregnancy rate in the MLF group was significantly higher for patients ≤35 ys (51.5% versus 28.8%), but not for those >35 ys (17.6% versus 28.6%). Conclusion. MLF was associated with a significant increase in pregnancy rate for patients ≤35 ys

Hormonal, follicular and endometrial dynamics in letrozole-treated versus natural cycles in patients undergoing controlled ovarian stimulation

The objective of this study was to compare letrozole-stimulated cycles to natural cycles in 208 patients undergoing intrauterine insemination (IUI) between July of 2004 and January of 2007. Group I (n = 47) received cycle monitoring only (natural group), Group II (n = 125) received letrozole 2.5 mg/day on cycle days three to seven, and Group III (n = 36) received letrozole 5 mg/day on cycle days three to seven. There were no differences between the groups in endometrial thickness or P4 on the day of hCG. Estradiol levels had higher variation in the second half of the follicular phase in both letrozole-treated groups compared to the control group. Estradiol per preovulatory follicle was similar in both letrozole cycles to that observed in the natural cycles. LH was lower on the day of hCG administration in the letrozole 2.5 mg/day group vs. the natural group. In summary, letrozole results in some minor changes in follicular, hormonal and endometrial dynamics compared to natural cycles. Increased folliculogenesis and pregnancy rates were observed in the letrozole-treated groups compared to the natural group. These findings need to be confirmed in larger, prospective studies

A Patient Registry for the Management of Uterine Fibroids in Canada: Protocol for a Multicenter, Prospective, Noninterventional Study

Background: Uterine fibroids are the most common benign tumor in women. Among those with fibroids, approximately 30% become symptomatic, with abnormal uterine bleeding, pelvic pain, and bulk symptoms. Despite the high prevalence of fibroids, little information is available regarding symptoms, treatment choices, and outcomes for patients. Objective: A Canada-wide patient registry was established to understand the real-world practice. This registry included patient presentation and treatment preferences, health care provider attitudes, and clinical outcomes in the management of symptomatic uterine fibroids. Methods: This study is a prospective, noninterventional, observational patient registry. It will include women diagnosed with uterine fibroids and being managed for symptoms. Participant inclusion criteria were (1) at least 18 years of age, (2) premenopausal with a confirmed diagnosis of uterine fibroids, and associated symptoms, and (3) initiating treatment (drug intervention, procedure intervention, or a combination of both) or watchful waiting. Patients (or legal representative) must understand the nature of the project and provide written informed consent before enrollment. Participant exclusion criteria were (1) they have known or suspected clinically significant pelvic pathology not associated with uterine fibroids, and (2) they are undergoing an emergency hysterectomy at the initial visit. Outcomes will be evaluated in the context of routine clinical practice. Results: Participant recruitment of this registry began in July 2015. This study currently has a total sample of 1500 patients. Conclusions: This registry, a first in Canada, will accumulate evidence on the risks and benefits of watchful waiting, and medical and procedural interventions. It will contribute to enhancing access to treatment options for patients

REVIEW-Strategies for fertility preservation and gonadal protection during gonadotoxic chemotherapy and radiotherapy

With the recent report of a pregnancy and delivery after autotransplantation of cryopreserved-thawed ovarian cortical strips, preservation of the reproductive potential resurfaced. There is a growing academic and public interest in exploring the available strategies for fertility preservation in patients at risk. This is due to the increasing incidence of cancer during the reproductive age. The overall survival and cure rates of reproductive age cancers are improving due to improvements in cancer therapy. Reproductive derangement is one of the major consequences of cytotoxic chemotherapy and radiotherapy. GnRh analogues concomitant therapy, laparoscopic ovarian transposition, oocyte cryopreservation, embryo cryopreservation and transplantation of cryopreserved-thawed ovarian tissue, are all strategies for fertility preservation in patients at risk. However, no evidence-based strategy is available yet. This article discusses the mechanisms of reproductive failure after gonadotoxic therapy and the currently available fertility preservation strategies

REVIEW- Biological and reproductive implications of stem cell research and therapeutics: prospects in the Middle East

Objective: To explore the potential ways in which stem cell research is linked to research and clinical aspects of Obstetrics and Gynecology practice. Moreover, to explore the possible applications most tailored to the needs and resources of the Middle East. Design: Medical and biological databases were searched for references to stem cells. Summary: Stem cells are undifferentiated cells that are capable of self-renewal and differentiation to more specialized cells. The discovery of different sources of stem cells enhanced research in this field substantially. Obstetrics and Gynecology is likely to have many points of intersection and cross talk with stem cell research either as a source or as a benefactor. Stem cell research could offer various solutions to gynecological tumors, perinatal pathologies, infertility management and placental development studies. The source of stem cells is mostly dependant on obstetrical-related supplies. Therefore, obstetricians and gynecologists should be aware of the significance of this research to their practice. This review is a aimed at exploring the possibilities of building a basis for stem cell research in the Middle East, with special emphasis on cultural and ethical issues, and resources in the area

Evidence based surgical management of endometriosis

The management approach to patients with pelvic endometriosis is multidimensional. One must consider several factors such as patient’s age, parity, extent of the disease, and menopausal status when planning treatment strategies. The main goals of therapy are targeted at symptom control and achieving fertility in women who so desire. Medical and/or surgical therapies can be considered in these patients. Individualized patient care is essential for the success of treatment. In this review, we focus our discussion on surgical approach strategies and the management of endometriosis with an emphasis on pain and fertility outcomes