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fibroid and infertility

Jaime Alfaro-Alfaro, María de Los Ángeles Flores-Manzur, Roberto Nevarez-Bernal, Rodrigo Ayala-Yáñez
Laparoscopic myomectomy offers a real benefit to infertile patients with uterine fibroids and peritoneal adhesions. The procedure requires a skilled surgeon and laparoscopy technique to minimize adhesion formation and other proven benefits. Restrictions arise since this procedure requires power morcellation for fibroid tissue extraction. Two years ago, the Food and Drug Administration in the United States of America (FDA) issued the alert on power morcellation for uterine leiomyomas, addressing the risk of malignant cell spreading within the abdominal cavity (actual risk assessment from 1 in 360 to 1 in 7400 cases)...
2016: Case Reports in Obstetrics and Gynecology
Anupam Kapur, Ranjeeta Angomchanu, Madhusudan Dey
BACKGROUND: Fibroid or myoma is the commonest reported tumor of uterus, and is one of the important reasons for hysterectomy in our setting. Different drugs are available for medical management of fibroid uterus including mifepristone, a progesterone antagonist. Varying dosage regimen for mifepristone was studied as medical management of fibroid uterus. The aim of the project was to study the effect of mifepristone on the symptoms and size of fibroids, especially using a low-dose regimen for 6 months...
October 2016: Journal of Obstetrics and Gynaecology of India
Y M Kabadi, B Harsha
OBJECTIVE: To study the role of hysterolaparoscopy in the evaluation and management of female infertility. MATERIALS AND METHODS: A retrospective study of the 94 case files of all the patients who underwent diagnostic hysterolaparoscopy for infertility between January 2014 to June 2015 in the department of Obstetrics and Gynecology, Karnataka Institute of Medical Sciences, Hubli. These infertile women were confirmed to have normal ovulatory cycles, hormonal assays and seminogram report...
October 2016: Journal of Obstetrics and Gynaecology of India
Maitri Raghavendra Kulkarni, Indranil Dutta, Dilip Kumar Dutta
BACKGROUND AND OBJECTIVES: Leiomyoma of uterus forms the most common type of benign tumor of uterus and also the most common pelvic tumor in women. The symptomatology continues to be variable. Surgery has for long been the main mode of therapy for the myomas. For women who wish to retain the uterus for future pregnancies or other reasons, myomectomy is preferred. Recent trend has been toward nonsurgical approaches like GnRH hormone analogs/agonists, RU 486, or selective uterine artery embolization, laparoscopic cryoablation, radiofrequency thermal ablation, and MRGUs...
October 2016: Journal of Obstetrics and Gynaecology of India
Camran Nezhat, Anjie Li, Sozdar Abed, Erika Balassiano, Rose Soliemannjad, Azadeh Nezhat, Ceana H Nezhat, Farr Nezhat
BACKGROUND AND OBJECTIVES: The relationship between leiomyoma and endometriosis is poorly understood. Both contribute to considerable pain and may cause subfertility or infertility in women. We conducted this retrospective study to assess the rate of coexistence of endometriosis in women with symptomatic leiomyoma. The primary outcome measured was the coexistence of histology-proven endometriosis in women with symptomatic leiomyoma. METHODS: This is a retrospective review of a data-based collection of medical records of 244 patients treated at a tertiary medical center, who were evaluated for symptomatic leiomyoma from March 2011 through December 2015...
July 2016: JSLS: Journal of the Society of Laparoendoscopic Surgeons
Nuri Peker, Savas Gundogan, Fatih Sendag
To present the feasibility of laparoscopic management of huge myoma nascendi DESIGN: Step by step explanation of the surgery using video SETTING: Uterine fibroids are the most common benign neoplasm of the female reproductive tract with the estimated incidence of 25-30% at reproductive age. Patients generally have no symptoms however patients those have symptoms such as severe pelvic pain, heavy uterine bleeding or infertility may undergo surgery. The traditional management is surgery however uterine artery embolization, hormonal therapy using GnRH (Gonadotropin-Releasing Hormone) agonists or SERM (Selective Estrogen Receptor Modulator) should be preferred as the medical approach...
September 12, 2016: Journal of Minimally Invasive Gynecology
Nuri Peker, Savaş Gundogan, Fatih Şendağ
To present the feasibility of laparoscopic management of huge cervical myoma DESIGN: Step by step explanation of the surgery using video SETTING: Uterine fibroids are the most common benign neoplasm of the female reproductive tract with the estimated incidence of 25-30% at reproductive age. Patients generally have no symptoms however patients those have symptoms such as severe pelvic pain, heavy uterine bleeding or infertility may undergo surgery. The traditional management is surgery however uterine artery embolization, hormonal therapy using GnRH (Gonadotropin-Releasing Hormone) agonists or SERM (Selective Estrogen Receptor Modulator) should be preferred as the medical approach...
September 12, 2016: Journal of Minimally Invasive Gynecology
Jacques Donnez, Marie-Madeleine Dolmans
Uterine fibroids (also known as leiomyomas or myomas) are the most common form of benign uterine tumors. Clinical presentations include abnormal bleeding, pelvic masses, pelvic pain, infertility, bulk symptoms and obstetric complications.Almost a third of women with leiomyomas will request treatment due to symptoms. Current management strategies mainly involve surgical interventions, but the choice of treatment is guided by patient's age and desire to preserve fertility or avoid 'radical' surgery such as hysterectomy...
July 27, 2016: Human Reproduction Update
Suyash Naval, Rucha Naval, Sudarshan Naval, Jayshree Rane
STUDY OBJECTIVE: To demonstrate key steps in performing safe laparoscopic multiple myomectomy. DESIGN: Video focuses on step wise description of all the major steps of surgical technique. SETTING: About one-third of women with fibroids present with symptoms that are severe enough to warrant treatment. We demonstrate a case of 27 year old female with complaints of secondary infertility and menorrhagia. On examination the uterus was enlarged up to 24 weeks size...
July 19, 2016: Journal of Minimally Invasive Gynecology
Annu Makker, Madhu Mati Goel, Dipti Nigam, Vikram Bhatia, Abbas Ali Mahdi, Vinita Das, Amita Pandey
This study was designed to examine the expression and cellular distribution of homeobox (HOX) genes (HOXA10 and HOXA11) and cell adhesion molecules (E-cadherin, N-cadherin, and β-catenin) during the window of implantation in infertile women with noncavity-distorting intramural (IM) fibroids (n = 18) and in fertile controls (n = 12). Quantitative real-time polymerase chain reaction and immunohistochemistry were used to evaluate the messenger RNA (mRNA) levels and protein expression, respectively. When compared to fertile controls, reduced HOXA10 and HOXA11 transcript and protein levels were observed in infertile women...
July 12, 2016: Reproductive Sciences
Shilpa Bhandari, Ishita Ganguly, Pallavi Agarwal, Aparna Singh, Nitika Gupta
CONTEXT: Fibroids are the most common tumors of the uterine cavity. Most of them are diagnosed during the reproductive age when the fertility is an important concern for the female. However, complications can occur after removal of fibroid (myomectomy) too for future pregnancy. Though myomectomy has been sighted as a cause of intrauterine adhesions data regarding the effect of myomectomy on endometrial cavity is lacking. AIMS: Evaluate the incidence of intrauterine adhesion formation after myomectomy and to identify the associated factors...
April 2016: Journal of Human Reproductive Sciences
Ibrahim Alkatout, Liselotte Mettler, Veronika Günther, Nicolai Maass, Christel Eckmann-Scholz, Mohamed Elessawy, Michael Anapolski
Uterine leiomyomas are the most frequent benign tumors of the female genital tract. Fibroids are associated with a variety of clinical problems, e.g. bleeding disorders, bulk-related symptoms or infertility. For women wishing to preserve their uterus, fibroids can be surgically removed by hysteroscopy, laparoscopy or laparotomy. The purpose of our review is to show that hysterectomy offers the only definitive solution. The indication for treatment has to be taken carefully after weighing up alternative treatment methods, such as expectant management, medical treatment or interventional radiologic methods, and after obtaining informed consent...
June 22, 2016: Minimally Invasive Therapy & Allied Technologies: MITAT
P Purohit, K Vigneswaran
The precise impact of fibroids, which are the most common benign gynaecological tumours in women, on reproductive function and infertility is unknown. The need to treat submucosal fibroids is widely accepted, but fibroids in other locations and sizes continue to present a clinical conundrum. This article examines the mechanisms by which fibroids affect implantation and fertility, and stratifies their impact on basis of size, location and nature. It also explores the evidence base of the available treatment modalities in specific relation to improving fertility outcomes...
2016: Current Obstetrics and Gynecology Reports
Péter Török, Róbert Póka
Uterine fibroid is the most common tumor in women of reproductive age. Depending on the size and location they can cause variety of symptoms. The clinical presentation may include bleeding disorders, infertility, pelvic pain and dysmenorrhea as well. Detection and precise evaluation of the number, size and location of myomas is possible due to advances in imaging and endoscopic methods. Treatment of fibroids depends on the severity and type of symptoms. There are medical, radiological and surgical options for treatment...
May 22, 2016: Orvosi Hetilap
Ahmed M Soliman, Machaon Bonafede, Amanda M Farr, Jane Castelli-Haley, Craig Winkel
BACKGROUND: Endometriosis affects over 10 million women in the United States. Depot leuprolide acetate (LA), a gonadotropin-releasing hormone agonist, has been used extensively for the treatment of women with endometriosis but is associated with hypoestrogenic symptoms and bone mineral density loss. The concomitant use of add-back therapies, specifically norethindrone acetate (NETA), can alleviate these adverse effects. OBJECTIVE: To compare adherence to and persistence with LA treatment and time to endometriosis-related surgery among women treated with NETA and women treated with LA plus other add-back therapies or LA only...
May 2016: Journal of Managed Care & Specialty Pharmacy
Ayman Shehata, Naglaa Hussein, Ahmed El Halwagy, Adel El Gergawy, Mohamed Khairallah
Uterine fibroids are benign tumors of the myometrium with a diverse range of manifestations. Fibroids can dramatically increase in size during pregnancy due to the increase in estrogen levels. After delivery, the fibroids usually shrink back to their pre-pregnancy size. Uterine myomas may have many complications, including abnormal uterine bleeding, infertility, pressure on nearby organs, degeneration, and malignant transformation. No previous reports have indicated that a fistula may develop between a uterine fibroid and the bowel loops, although previous studies have documented the occurrence of fistulas from the uterus to the bowel following myomectomy or uterine artery embolization performed to treat a myoma...
March 2016: Clinical and Experimental Reproductive Medicine
Yvette S Groszmann, Beryl R Benacerraf
The comprehensive "one-stop shop" ultrasound evaluation of an infertile woman, performed around cycle days 5 to 9, will reveal abundant information about the anatomy and morphology of the pelvic organs and thereby avoid costly radiation and iodinated contrast exposure. We propose a two-dimensional and three-dimensional ultrasound to examine the appearance and shape of the endometrium, endometrial cavity, myometrium, and junctional zone, to assess for müllerian duct anomalies fibroids, adenomyosis, and polyps...
June 2016: Fertility and Sterility
Attilio Di Spiezio Sardo, Costantino Di Carlo, Silvia Minozzi, Marialuigia Spinelli, Vanna Pistotti, Carlo Alviggi, Giuseppe De Placido, Carmine Nappi, Giuseppe Bifulco
BACKGROUND: The scientific community has been re-evaluating the clinical relevance of hysteroscopy in the diagnosis and treatment of uterine factors and its role in the infertility work-up, thanks to its potential capability to improve reproductive outcomes and reduce time to pregnancy. OBJECTIVE AND RATIONALE: The objective of this systematic review and meta-analysis was to assess the efficacy of diagnostic and operative hysteroscopy in improving the live birth rate (LBR) of infertile women, with and without intrauterine abnormalities, at any stage of the infertility work-up...
June 2016: Human Reproduction Update
L Trasande, R T Zoeller, U Hass, A Kortenkamp, P Grandjean, J P Myers, J DiGangi, P M Hunt, R Rudel, S Sathyanarayana, M Bellanger, R Hauser, J Legler, N E Skakkebaek, J J Heindel
A previous report documented that endocrine disrupting chemicals contribute substantially to certain forms of disease and disability. In the present analysis, our main objective was to update a range of health and economic costs that can be reasonably attributed to endocrine disrupting chemical exposures in the European Union, leveraging new burden and disease cost estimates of female reproductive conditions from accompanying report. Expert panels evaluated the epidemiologic evidence, using adapted criteria from the WHO Grading of Recommendations Assessment, Development and Evaluation Working Group, and evaluated laboratory and animal evidence of endocrine disruption using definitions recently promulgated by the Danish Environmental Protection Agency...
July 2016: Andrology
Andrea Tinelli, Ospan A Mynbaev, Radmila Sparic, Daniele Vergara, Silvia Di Tommaso, Michel Salzet, Michele Maffia, Antonio Malvasi
Fibroids or myomas involve large proportion of women of reproductive age. The myoma formation starts from the transformation of the myometrium, causing the progressive formation of a pseudocapsule, which is made of compressed muscle fibers. Numerous studies investigated on myoma pseudocapsule anatomy, discovering many neurotransmitters and neuropeptides, as a neurovascular bundle, influencing myometrial physiology. These substances have a positive impact on wound healing and muscular restoring, also playing a role in sexual and reproductive function...
March 22, 2016: Current Protein & Peptide Science
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