Multispectral imaging of organ viability during uterine transplantation surgery in rabbits and sheep

Uterine transplantation surgery (UTx) has been proposed as a treatment for permanent absolute uterine factor infertility (AUFI) in the case of the congenital absence or surgical removal of the uterus. Successful surgical attachment of the organ and its associated vasculature is essential for the organ’s reperfusion and long-term viability. Spectral imaging techniques have demonstrated the potential for the measurement of hemodynamics in medical applications. These involve the measurement of reflectance spectra by acquiring images of the tissue in different wavebands. Measures of tissue constituents at each pixel can then be extracted from these spectra through modeling of the light–tissue interaction. A multispectral imaging (MSI) laparoscope was used in sheep and rabbit UTx models to study short- and long-term changes in oxygen saturation following surgery. The whole organ was imaged in the donor and recipient animals in parallel with point measurements from a pulse oximeter. Imaging results confirmed the re-establishment of adequate perfusion in the transplanted organ after surgery. Cornual oxygenation trends measured with MSI are consistent with pulse oximeter readings, showing decreased StO2 immediately after anastomosis of the blood vessels. Long-term results show recovery of StO2 to preoperative levels

Age-related fertility decline: is there a role for elective ovarian tissue cryopreservation?

Age-related fertility decline (ARFD) is a prevalent concern amongst western cultures due to the increasing age of first-time motherhood. Elective oocyte and embryo cryopreservation remain the most established methods of fertility preservation, providing women the opportunity of reproductive autonomy to preserve their fertility and extend their childbearing years to prevent involuntary childlessness. Whilst ovarian cortex cryopreservation has been used to preserve reproductive potential in women for medical reasons, such as in pre- or peripubertal girls undergoing gonadotoxic chemotherapy, it has not yet been considered in the context of ARFD. As artificial reproductive technology (ART) and surgical methods of fertility preservation continue to evolve, it is a judicious time to review current evidence and consider alternative options for women wishing to delay their fertility. This article critically appraises elective oocyte cryopreservation as an option for women who use it to mitigate the risk of ARFD and introduces the prospect of elective ovarian cortex cryopreservation as an alternative

Endometrial autotransplantation in rabbits: Potential for fertility restoration in severe Asherman's syndrome

[EN] Objective: Uterine transplantation is now considered a feasible treatment for women with absolute uterine factor infertility and has been successfully performed for a woman with Asherman's syndrome (AS). The endometrium is a clinically and histologically distinct entity from the surrounding myometrium. Endometrial transplantation (ETx) may offer a less invasive option, with less immunogenic impact, to restore fertility in women with severe AS. The objective of this study was to assess the feasibility of ETx by evaluating surgical and reproductive outcomes following endometrial autotransplantation in a rabbit model. Study design: A longitudinal study assessing surgical, biochemical, radiological, reproductive and histological outcomes following endometrial autotransplantation in ten New Zealand white rabbits. Results: Ten procedures were performed, including 8 endometrial auto-transplants (ETx) and 2 endometrial resections (ER), to control against endometrial regeneration. Eight procedures were successful, whereas two rabbits from the ETx group died intra-operatively. Three rabbits were euthanised at 48, 72 and 96 h post-operatively to assess gross and histological appearances. Two rabbits, one from the ETx group and one from the ER group, died four weeks and eight weeks post-operatively. Three rabbits subsequently underwent two cycles of in-vitro fertilization. The first cycle resulted in an implantation rate of 57% in the un-operated uteri. In two rabbits who underwent ETx, an implantation rate of 28.6% was seen. In the second cycle, an implantation rate of 61.9 % (13 implantations) was observed in the control uteri. In the two ETx females, an implantation rate of 14.3 % was seen. No pregnancies were seen in either cycle in the animals who underwent ER. Despite successful implantations in both cycles in the ETx rabbits, no livebirths were achieved. Following death or euthanasia there was gross and microscopic evidence of viable endometrium following ETx, but not following ER. Conclusion: This study has revealed, for the first time, the feasibility of ETx with gross and microscopic evidence of viable endometrium, and the demonstration of clinical pregnancies. Whilst further studies are essential, and the achievement of successful livebirths fundamental, ETx may offer a potential fertility restoring opportunity for women with severe, treatment refractory cases of AS.The study was funded by registered charity Womb Transplant UK (1138559).Jones, BP.; Vali, S.; Saso, S.; Garcia-Dominguez, X.; Chan, M.; Thum, M.; Ghaem-Maghami, S.... (2020). Endometrial autotransplantation in rabbits: Potential for fertility restoration in severe Asherman's syndrome. European Journal of Obstetrics & Gynecology and Reproductive Biology. 248:14-23. https://doi.org/10.1016/j.ejogrb.2020.03.011S1423248Asherman, J. G. (1950). TRAUMATIC INTRA-UTERINE ADHESIONS. BJOG: An International Journal of Obstetrics and Gynaecology, 57(6), 892-896. doi:10.1111/j.1471-0528.1950.tb06053.xHooker, A. B., de Leeuw, R., van de Ven, P. M., Bakkum, E. A., Thurkow, A. L., Vogel, N. E. A., … Huirne, J. A. F. (2017). Prevalence of intrauterine adhesions after the application of hyaluronic acid gel after dilatation and curettage in women with at least one previous curettage: short-term outcomes of a multicenter, prospective randomized controlled trial. Fertility and Sterility, 107(5), 1223-1231.e3. doi:10.1016/j.fertnstert.2017.02.113Wallach, E. E., Schenker, J. G., & Margalioth, E. J. (1982). Intrauterine adhesions: an updated appraisal. Fertility and Sterility, 37(5), 593-610. doi:10.1016/s0015-0282(16)46268-0Westendorp, I. C., Ankum, W. M., Mol, B. W., & Vonk, J. (1998). Prevalence of Asherman’s syndrome after secondary removal of placental remnants or a repeat curettage for incomplete abortion. Human Reproduction, 13(12), 3347-3350. doi:10.1093/humrep/13.12.3347Wallach, E., & Czernobilsky, B. (1978). Endometritis and Infertility. Fertility and Sterility, 30(2), 119-130. doi:10.1016/s0015-0282(16)43448-5Baradwan, S., Baradwan, A., & Al-Jaroudi, D. (2018). The association between menstrual cycle pattern and hysteroscopic march classification with endometrial thickness among infertile women with Asherman syndrome. Medicine, 97(27), e11314. doi:10.1097/md.0000000000011314Hooker, A. B., Lemmers, M., Thurkow, A. L., Heymans, M. W., Opmeer, B. C., Brolmann, H. A. M., … Huirne, J. A. F. (2013). Systematic review and meta-analysis of intrauterine adhesions after miscarriage: prevalence, risk factors and long-term reproductive outcome. Human Reproduction Update, 20(2), 262-278. doi:10.1093/humupd/dmt045Yu, D., Wong, Y.-M., Cheong, Y., Xia, E., & Li, T.-C. (2008). Asherman syndrome—one century later. Fertility and Sterility, 89(4), 759-779. doi:10.1016/j.fertnstert.2008.02.096Yamamoto, N., Takeuchi, R., Izuchi, D., Yuge, N., Miyazaki, M., Yasunaga, M., … Inoue, Y. (2013). Hysteroscopic adhesiolysis for patients with Asherman’s syndrome: menstrual and fertility outcomes. Reproductive Medicine and Biology, 12(4), 159-166. doi:10.1007/s12522-013-0149-xThomson, A. J. M., Abbott, J. A., Kingston, A., Lenart, M., & Vancaillie, T. G. (2007). Fluoroscopically guided synechiolysis for patients with Asherman’s syndrome: menstrual and fertility outcomes. Fertility and Sterility, 87(2), 405-410. doi:10.1016/j.fertnstert.2006.06.035Deans, R., & Abbott, J. (2010). Review of Intrauterine Adhesions. Journal of Minimally Invasive Gynecology, 17(5), 555-569. doi:10.1016/j.jmig.2010.04.016Song, D., Liu, Y., Xiao, Y., Li, T.-C., Zhou, F., & Xia, E. (2014). A Matched Cohort Study Comparing the Outcome of Intrauterine Adhesiolysis for Asherman’s Syndrome After Uterine Artery Embolization or Surgical Trauma. Journal of Minimally Invasive Gynecology, 21(6), 1022-1028. doi:10.1016/j.jmig.2014.04.015Panchal, S., Patel, H., & Nagori, C. (2011). Endometrial regeneration using autologous adult stem cells followed by conception by in vitro fertilization in a patient of severe Asherman′s syndrome. Journal of Human Reproductive Sciences, 4(1), 43. doi:10.4103/0974-1208.82360Singh, N., Mohanty, S., Seth, T., Shankar, M., Dharmendra, S., & Bhaskaran, S. (2014). Autologous stem cell transplantation in refractory Asherman′s syndrome: A novel cell based therapy. Journal of Human Reproductive Sciences, 7(2), 93. doi:10.4103/0974-1208.138864Tan, J., Li, P., Wang, Q., Li, Y., Li, X., Zhao, D., … Kong, L. (2016). Autologous menstrual blood-derived stromal cells transplantation for severe Asherman’s syndrome. Human Reproduction, 31(12), 2723-2729. doi:10.1093/humrep/dew235Santamaria, X., Cabanillas, S., Cervelló, I., Arbona, C., Raga, F., Ferro, J., … Simón, C. (2016). Autologous cell therapy with CD133+ bone marrow-derived stem cells for refractory Asherman’s syndrome and endometrial atrophy: a pilot cohort study. Human Reproduction, 31(5), 1087-1096. doi:10.1093/humrep/dew042Puntambekar, S., Telang, M., Kulkarni, P., Puntambekar, S., Jadhav, S., Panse, M., … Phadke, U. (2018). Laparoscopic-Assisted Uterus Retrieval From Live Organ Donors for Uterine Transplant: Our Experience of Two Patients. Journal of Minimally Invasive Gynecology, 25(4), 622-631. doi:10.1016/j.jmig.2018.01.009Saso, S., Haddad, J., Ellis, P., Lindsay, I., Sebire, N., McIndoe, A., … Smith, J. (2011). Placental site trophoblastic tumours and the concept of fertility preservation. BJOG: An International Journal of Obstetrics & Gynaecology, 119(3), 369-374. doi:10.1111/j.1471-0528.2011.03230.xViudes‐de‐Castro, M. P., Marco‐Jiménez, F., Más Pellicer, A., García‐Domínguez, X., Talaván, A. M., & Vicente, J. S. (2019). A single injection of corifollitropin alfa supplemented with human chorionic gonadotropin increases follicular recruitment and transferable embryos in the rabbit. Reproduction in Domestic Animals, 54(4), 696-701. doi:10.1111/rda.13411Garcia-Dominguez, X., Marco-Jimenez, F., Viudes-de-Castro, M. P., & Vicente, J. S. (2019). Minimally Invasive Embryo Transfer and Embryo Vitrification at the Optimal Embryo Stage in Rabbit Model. Journal of Visualized Experiments, (147). doi:10.3791/58055Esteves, P. J., Abrantes, J., Baldauf, H.-M., BenMohamed, L., Chen, Y., Christensen, N., … Mage, R. (2018). The wide utility of rabbits as models of human diseases. Experimental & Molecular Medicine, 50(5), 1-10. doi:10.1038/s12276-018-0094-1Graur, D., Duret, L., & Gouy, M. (1996). Phylogenetic position of the order Lagomorpha (rabbits, hares and allies). Nature, 379(6563), 333-335. doi:10.1038/379333a0Saso, S., Petts, G., David, A. L., Thum, M.-Y., Chatterjee, J., Vicente, J. S., … Smith, J. R. (2015). Achieving an early pregnancy following allogeneic uterine transplantation in a rabbit model. European Journal of Obstetrics & Gynecology and Reproductive Biology, 185, 164-169. doi:10.1016/j.ejogrb.2014.12.017Saso, S., Petts, G., Chatterjee, J., Thum, M.-Y., David, A. L., Corless, D., … Smith, J. R. (2014). Uterine allotransplantation in a rabbit model using aorto-caval anastomosis: a long-term viability study. European Journal of Obstetrics & Gynecology and Reproductive Biology, 182, 185-193. doi:10.1016/j.ejogrb.2014.09.029Ozsoy, M., Gonul, Y., Bal, A., Ozkececi, Z. T., Celep, R. B., Adali, F., … Tosun, M. (2015). Effect of IL-18 binding protein on hepatic ischemia-reperfusion injury induced by infrarenal aortic occlusion. Annals of Surgical Treatment and Research, 88(2), 92. doi:10.4174/astr.2015.88.2.92Hare, A., & Olah, K. (2005). 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Options for acquiring motherhood in absolute uterine factor infertility:adoption, surrogacy and uterine transplantation

Key content Following the diagnosis of absolute uterine factor infertility (AUFI), women may experience considerable psychological harm as a result of a loss of reproductive function and the realisation of permanent and irreversible infertility. Adoption enables women with AUFI, and their partners, to experience social and legal parenthood, also often providing benefits for the adopted child. Surrogacy offers the opportunity to have genetically related offspring. Outcomes are generally positive in both surrogates and the children born as a result. Uterine transplantation is the only option to restore reproductive anatomy and functionality. While associated with considerable risk, it allows the experience of gestation and the achievement of biological, social and legal parenthood. Learning objectives To gain an understanding of the routes to parenthood available for women with AUFI experiencing involuntary childlessness, such as adoption, surrogacy and, most recently, uterine transplantation To consider a suggested management plan to facilitate counselling in women with AUFI who experience involuntary childlessness. Ethical issues In the UK, whilst the number of children requiring adoption continues to increase, the number being adopted from care is decreasing. Some cultures may hold ethical or religious beliefs that surrogacy is unacceptable, and its legal position in many jurisdictions is problematic. Restrictive selection criteria and high costs may limit future availability of uterine transplantatio

Fertility preservation and realignment in transgender women

Medical care for transgender people is multi-faceted and attention to individual reproductive aspirations and planning are an essential, yet often overlooked aspect of care. Given the impact of hormonal therapy and other gender affirmation procedures on reproductive function, extensive counselling and consideration of fertility preservation is recommended prior to their commencement. This review article explores the reproductive aspirations of transgender women and considers the current disparity between stated desires regarding utilisation of fertility preservation services. Current fertility preservation options and prospective treatments currently showing promise in the research arena are explored

The Role of Cellular and Molecular Markers on Implantation Rate and Pregnancy Outcome Following in-vitro Fertilisation Treatment

EThOS - Electronic Theses Online ServiceGBUnited Kingdo

Uterine Transplantation in Transgender Women

Gender dysphoria, defined as the persistent discomfort with one's gender identity or biological sex, affects between 0.5%‐1.4% of adult males. Treatment aims at congruence, to allow those who experience it to find comfort within their gendered self, which optimises psychological wellbeing and self‐fulfilment. Whilst many experiencing gender dysphoria require partial treatment or social transition, others only find comfort following surgical intervention to change their external genitalia and sexual characteristics. Traditionally, infertility has been an unfortunate consequence of the realignment of a transgender person's body with their gender identity