Endometriosis fertility index predicts live births following surgical resection of moderate and severe endometriosis

AbstractSTUDY QUESTIONCan live birth be accurately predicted following surgical resection of moderate-severe (Stage III –IV) endometriosis?SUMMARY ANSWERLive births can accurately be predicted with the endometriosis fertility index (EFI), with adnexal function being the most important factor to predict non-assisted reproductive technology (non-ART) fertility or the requirement for ART (www.endometriosisefi.com).WHAT IS KNOWN ALREADYFertility prognosis is important to many women with severe endometriosis. Controversy persists regarding optimal post-operative management to achieve pregnancy and the counselling of patients regarding duration of conventional treatments before undergoing ART. The EFI is reported to correlate with expectant management pregnancy rate, although external validation has been performed without specifically addressing fertility in women with moderate and severe endometriosis.STUDY DESIGN, SIZE, DURATIONRetrospective cohort study of 279 women from September 2001 to June 2016.PARTICIPANTS/MATERIALS, SETTINGS, METHODSWe included women undergoing laparoscopic resection of Stage III –IV endometriosis who attempted pregnancy post-operatively. The EFI was calculated based on detailed operative reports and surgical images. Fertility outcomes were obtained by direct patient contact. Kaplan–Meier model, log rank test and Cox regression were used for analyses.MAIN RESULTS AND THE ROLE OF CHANCEThe follow-up rate was 84% with a mean duration of 4.1...
Source: Human Reproduction - Category: Reproduction Medicine Source Type: research

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Authors: Bao-Qiang W, Jun H, Wen-Song L, Yong J, Xue-Min C, Dong-Lin S Abstract In laparoscopic cholecystectomy (LC), the treatment of iatrogenic biliary tract injury has been given much attention. However, most accidental right hepatic artery (RHA) injuries are treated with simple clipping. The reason is that the RHA has difficulty in revascularization, and it is generally considered that RHA injury does not cause serious consequences. However, some studies suggest that some cases of RHA ligation can cause a series of pathological changes correlated to arterial ischemia, such as liver abscess, bile tumor, liver at...
Source: Annals of Hepatology - Category: Gastroenterology Tags: Ann Hepatol Source Type: research
Source: BMJ Comments - Category: General Medicine Source Type: forums
This study aimed to explore the association between serum syndecan-1 and glypican-3 levels and the adverse perinatal outcome as well as the responses to the treatment of ursodeoxycholic acid (UDCA).MethodsThis prospective, case control study included 88 pregnant women (44 women with ICP and 44 healthy controls). The primary end points were the perinatal outcome and the response to UDCA therapy. A logistic regression model was used to identify the independent risk factors of adverse pregnancy outcomes and reduced response to UDCA therapy.ResultsWomen with ICP had significantly higher serum syndecan-1 (1.27 ± 0.36 ng/...
Source: Hepatobiliary and Pancreatic Diseases International - Category: Gastroenterology Source Type: research
Purpose of review To investigate the JZE alterations in gynecological and obstetrical disorders and impact on diagnosis, prognosis and treatment. Recent findings JZE was found to be significantly extended in patients with endometriosis, leading to the conclusion that endometriosis is a primary disease of the uterus, much like adenomyosis. Statistical correlation was then demonstrated between the severity of endometriosis and the depth of the adenomyosis infiltrates, hence the thickening of the JZE. Stem cells, predominantly found in the JZE were also found in histological sections of leiomyoma, suggested to be the ori...
Source: Current Opinion in Obstetrics and Gynecology - Category: OBGYN Tags: WOMEN'S HEALTH: Edited by Joseph Aquilina Source Type: research
Conclusions: Incarceration of the gravid uterus is a rare but serious complication of pregnancy. The diagnosis is clinical and confirmed with imaging, with magnetic resonance imaging being superior to delineate the distorted maternal anatomy. Reduction of the incarcerated uterus should be attempted to restore polarity and avoid unnecessary cesarean delivery. Target Audience: Obstetricians and gynecologists, family physicians Learning Objectives: After completing this activity, the learner should be better able to evaluate the published literature regarding incarceration of the gravid uterus and associated outcomes, diffe...
Source: Obstetrical and Gynecological Survey - Category: OBGYN Tags: CME Articles Source Type: research
This study provides an analysis of the risk factors of EP utilizing NHIRD. Among the 6637 people diagnosed with EP, logistic regression with age adjustment showed that the highest risk factor was endometriosis (OR  = 8.84, CI 5.13–15.23), followed by polycystic ovary (OR = 7.74, CI 3.37–17.79) and benign neoplasm of the ovary (6.01, CI 2.18–16.54). All odds ratios were determined to be statistically significant atp 
Source: Archives of Gynecology and Obstetrics - Category: OBGYN Source Type: research
CONCLUSIONS Despite the high contraceptive effectiveness of many hormonal and intrauterine reversible contraceptive methods, many HCPs, users and potential users are concerned mainly about side effects and safety of both hormonal and non-hormonal contraceptive methods, and there is scarce information about the many benefits that these methods offer beyond contraception.
Source: Human Reproduction Update - Category: OBGYN Authors: Tags: Reviews Source Type: research
​BY MATTHEW​ J. LETIZIA, DO; &JOSEPH V. M. KELLY, MD, MBA ​A 19-year-old woman with no past medical or surgical history presented to the emergency department stating that she had noticed a growth protruding from her vagina. It has been painless except during intercourse and constant in all characterizations since detection three days earlier. She denies vaginal bleeding, urinary retention, incontinence, fever, injury, and back, abdominal, and pelvic pain.​Her vital signs are normal, but her physical examination was significant for a 2.5 cm x 4 cm stalk-like, pedunculated, fluctuant, nontender, mobile, cyst...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research
Abstract: Appropriate imaging for women undergoing infertility workup depends upon the clinician’s suspicion for potential causes of infertility. Transvaginal US is the preferred modality to assess the ovaries for features of polycystic ovary syndrome (PCOS), the leading cause of anovulatory infertility. For women who have a history or clinical suspicion of endometriosis, which affects at least one third of women with infertility, both MRI and pelvic US can provide valuable information. If tubal occlusion is suspected, whether due to endometriosis, previous pelvic inflammatory disease, or other cause, hysterosalpingo...
Source: Ultrasound Quarterly - Category: Radiology Tags: ACR Appropriateness Criteria Source Type: research
CONCLUSIONS PRs are key mediators of progesterone action in uterine tissues and are essential for normal uterine function. Aberrant PR function (due to abnormal expression and/or function) is a major cause of uterine pathophysiology. Further investigation of the underlying mechanisms of PR isoform action in the uterus is required, as this knowledge will afford the opportunity to create progestin/PR-based therapeutics to treat various uterine pathologies.
Source: Human Reproduction Update - Category: OBGYN Authors: Tags: Reviews Source Type: research
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