Endometriosis and uterine malformations: infertility may increase severity of endometriosis
|
|
- Blanche Matthews
- 5 years ago
- Views:
Transcription
1 AOGS ORIGINAL RESEARCH ARTICLE Endometriosis and uterine malformations: infertility may increase severity of endometriosis JEREMY BOUJENAH 1,2, ELEONORA SALAKOS 1,M ELODIE PINTO 1, JOANNA SHORE 1, CHRISTOPHE SIFER 1,2, CHRISTOPHE PONCELET 1,2 & ALEXANDRE BRICOU 1 1 Department of Obstetrics, Gynecology and Reproductive Medecine, University Hospitals Paris Seine-Saint-Denis, Public Assistance Hospitals Paris, CHU Jean Verdier, Bondy, and 2 University Paris 13, Sorbonne Paris City, UFR SMBH, Bobigny, France Key words Endometriosis, uterine malformation, infertility, severity Correspondence Jeremy Boujenah, CHU Jean Verdier, Bondy Hospital, Avenue du 14 juillet, Bondy, France. jeremy.boujenah@gmail.com Conflict of interest The authors have stated explicitly that there are no conflicts of interest in connection with this article. Please cite this article as: Boujenah J, Salakos E, Pinto M, Shore J, Sifer C, Poncelet C, et al. Endometriosis and uterine malformations: infertility may increase severity of endometriosis. Acta Obstet Gynecol Scand 2017; 96: Received: 6 July 2016 Accepted: 9 October 2016 DOI: /aogs Abstract Introduction. The aim of our study was to compare the stage and severity of endometriosis in fertile and infertile women with congenital uterine malformations. Material and methods. We performed an observational study from September 2007 to December 2015 in a tertiary care university hospital and assisted reproductive technology center. A total of 52 patients with surgically proven uterine malformations were included. We compared 41 infertile patients with uterine malformations with 11 fertile patients with uterine malformation. The main outcome was the stage, score and type of endometriosis in regard to infertility and class of uterine malformation. Results. The rate of endometriosis did not differ between the two groups (43.9 vs. 36.4%). The mean revised American Fertility Society score was higher in infertile patients with uterine malformations (19.02 vs. 6, p < 0.05). No significant difference was found in the rate of superficial peritoneal endometriosis (43.9 vs. 37.5%). Endometrioma and deep infiltrating endometriosis were associated with uterine malformations in infertile women, respectively 14.6 and 0%. No difference in the characteristics of endometriosis was found regarding the class of malformation. Conclusions. The association of uterine malformations and infertility may increase the severity of endometriosis and raise the issue of their diagnosis and management. Abbreviations: DIE, deep infiltrating endometriosis; ESGE, European Society for Gynaecological Endoscopy; ESHRE, European Society of Human Reproduction and Embryology; MRI, magnetic resonance imaging; PMSI, Medicalization of Information Systems Program (Programme de medicalisation des systemes d information). Introduction Endometriosis and congenital uterine malformation are often diagnosed while exploring infertility. Endometriosis can be found in 35% of women experiencing both pain and infertility (1). Uterine malformations can be found in 4% of infertile women and 15% of those who have undergone recurrent abortions (2). According to Sampson s theory (3), pelvic distortion and uterine malformations may favor the development of endometriosis. This hypothesis has been supported by both an observational study using laparoscopy to diagnose endometriosis in patients with M ullerian malformations (4,5), and by the characteristics of adolescence Key Message Endometriosis should be considered in infertile women with uterine malformations. 702
2 J. Boujenah et al. Endometriosis and uterine malformations endometriosis (6). Supporting the retrograde menstruation theory, obstructive M ullerian anomalies may be more closely associated with endometriosis compared with non-obstructive anomalies (5,7,8). However, endometriosis has been reported with all three main types of genitourinary malformations (uterine, cervical and vaginal anomalies) (9 11). Recently, Song et al. demonstrated that women with cervical atresia had an increased frequency of endometriosis (12). Large amounts of retrograde menstruations may also increase the severity of endometriosis related to uterine malformation. However, this hypothesis has not been studied. Hence, when uterine malformations are diagnosed in infertile patients, the role of possible endometriosis in the pathogenesis of infertility remains a matter of debate. The aim of our study was to compare the stage and severity of endometriosis in fertile and infertile women with congenital uterine malformations. Material and methods This retrospective, observational study was conducted in the gynecology-obstetrics and assisted reproductive technology (ART) department of a tertiary care university hospital. The study was approved by the Institutional Review Board of our university according to the PMSI (national Medicalization of Information Systems Program) database, which allows retrospective and prospective studies. All women booked to deliver or for surgery in our University Hospital are informed that data are routinely entered at birth into an electronic record-keeping system for the PMSI database, and that indicators of perinatal health are analyzed. Informed consent was obtained from each woman before beginning surgery. Data were routinely and prospectively collected for all women who underwent surgery in our university center and then reviewed by a data management professional. From September 2007 to December 2015, we evaluated all consecutive infertile and fertile patients who were treated for infertility or adverse obstetrical outcome suggesting uterine malformations and who underwent hysteroscopic and laparoscopic evaluations. Data on historic, physical examination, history of infertility, surgery, postoperative follow up and subsequent fertility were collected prospectively. To assess the correct morphology of the uterus, pelvic ultrasound, diagnostic hysteroscopy, and hysterosalpingography were systematically performed before surgery. Additional modern imaging technology was used if necessary: magnetic resonance imaging (MRI) when deep infiltrating endometriosis (DIE) or adenomyosis was suspected, and 3D-hysterosonography. When hemi-uterus was suspected, MRI was performed to differentiate those with and without a rudimentary cavity before surgery. When differentiation was impossible using MRI, hysterosonography was performed before surgery. Kidney and urinary tract ultrasound was performed for patients with hemi-uterus, bicorporeal uterus and unclassified uterine malformations. Laparoscopy was performed to confirm the morphology of the uterus, to exclude other possible causes of infertility (when tubal or pelvic peritoneal factors were suspected or when infertility was unexplained) and to treat endometriosis or to remove a rudimentary cavity. Patients with anovulation or other uterine anomalies were excluded (myoma, adenomyosis). Uterine malformations were classified in accordance with the new European Society of Human Reproduction and Embryology (ESHRE)/European Society for Gynaecological Endoscopy (ESGE) consensus (13). The revised American Society for Reproductive Medicine classification and revised American Fertility Society Score were used to describe the stage and severity of endometriosis (14). As the ESHRE/ESGE classification system was only published in 2013, we reevaluated the uterine malformation retrospectively according to the imaging technique performed, the operative and imaging report and the previous established diagnosis. Two groups of women with uterine malformations were included. Group 1 consisted of infertile women with uterine malformations. These women were considered infertile when no previous spontaneous pregnancy was achieved for >18 months. Prior to surgery (operative hysteroscopy and laparoscopy), a complete evaluation including patient history and physical examination, partner semen analysis (15), hormonal profile, tubal assessment by hysterosalpingography was performed to rule out other causes of infertility. Endometrioma and DIE were diagnosed before the surgery in all cases with ultrasound and MRI. A total of 41 women were included. Group 2 consisted of fertile patients with uterine malformations. Women with a history of obstetrical adverse outcome (recurrent miscarriage defined by three or more consecutive pregnancy losses, malposition of the fetus defined by breech or transversal presentation, or preterm delivery defined as before 37 weeks of pregnancy) were considered fertile. Each patient had confirmed uterine malformation with pelvic ultrasound and diagnostic hysteroscopy after the obstetrical outcome. MRI was performed to diagnose the presence (class U4a) or absence (class U4b) of a rudimentary cavity. A total of 11 fertile women with uterine malformation were included. Statistical analyses Statistical analysis and figures were made using STATA statistical software version 11.0 (StatCorp, College Station, 703
3 Endometriosis and uterine malformations J. Boujenah et al. TX, USA). Descriptive data analysis was performed with the use of a non-parametric test: the Mann Whitney test and Wilcoxon test for continuous variables when comparing two independent variables. The chi-square test or Fisher exact test was used for qualitative variables when n < 5, and the McNemar test was used for paired data. Results Between September 2007 and December 2015, we recruited 52 patients with uterine malformations and explored by laparoscopy. The mean age of our cohort was 34 years and 1 month. The overall prevalence of endometriosis in our uterine malformation cohort was 50%. In the population, 41 women (78.8%) were infertile and 11 (21.2%) fertile. No difference was found in mean age or type of uterine malformations (Table 1). The mean revised American Society for Reproductive Medicine score was higher in infertile patients than in fertile patients with uterine malformations (19.1 vs. 6, p < 0.05), whereas the median did not differ. Minimal and mild endometriosis (stage I II) did not differ between the two groups. However, moderate and severe endometriosis (stage III IV) was more frequent in infertile than fertile women (17.5 vs. 0%). The rate of superficial peritoneal lesions was similar in the two groups. We did not observe a difference in the rate of superficial lesions. However, endometrioma (mean size 3.1 cm, systematically on the left side) and DIE was found only in infertile women with uterine malformations. Among women with septate uterus, 25 had partial septate uterus and 12 complete septate uterus (according to Table 1. Demographic and endometriosis characteristics according to fertility status. Uterine malformation with infertility n = 41 Uterine malformation without infertlity n = 11 Median age (range) 30 (21 41) 33 (20 41) NS Septate uterus 30 (73.17%) 7 (63.6%) NS Bicornuate uterus 7 (17.08%) 4 (36.4%) NS Endometriosis 18 (43.9%) 3 (27.3%) NS Median rafs score (range) 7 (4 120) 3 (2 10) NS Superficial peritoneal 18 (43.9%) 3 (37.5%) NS lesions Endometrioma 6 (14.6%) 0 NA Deep infiltrating endometriosis (uterosacral, torus, digestive, rectovaginal, bladder) 6 (14.6%) 0 NA rafs, revised American Fertility Society. Table 2. Characteristics of endometriosis according to the type of uterine malformation. ESHRE/ESGE consensus). Among patients with bicorporeal uterus (class U3), three women had a complete bicorporeal uterus and seven had partial bicorporeal uterus. Two women had a double cervix. Among women with hemi uterus (9.6% of the population, class U4) three had a rudimentary cavity. The three women with a rudimentary cavity had a functional cavity according to the ESHRE/ESGE consensus with hemato cavity for one of them. Two women with bicorporeal uterus had unilateral renal agenesis. According to the class of uterine anomaly (37 women with U3 septate uterus vs. 15 women with U4/U5 hemi uterus and bicorporeal uterus), the prevalence of endometriosis, its severity and rate of endometrioma and DIE were not different (Table 2). Whatever the fertility status, endometriosis related to uterine malformations was more frequent in women without a previous pregnancy (miscarriage, ectopic pregnancy, preterm or term delivery) (65.4 vs. 34.6%, p < 0.05). No in utero exposure to diethylstilbestrol was reported in the two groups of patients with uterine malformation. Discussion Septate uterus n = 37 Unicornuate and bicorporeal uterus n = 15 Infertility 30 (81%) 11 (68.7%) NS Endometriosis 20 (54%) 6 (37.5%) NS Endometriosis and infertility 16 (43.2%) 5 (31.2%) NS Median rafs score (range) 9 (2 124) 15 (2 120) NS Superficial peritoneal lesions 20 (55.8%) 6 (37.5%) NS Endometrioma 3 (11.7%) 3 (18.75%) NS Deep infiltrating endometriosis (uterosacral, torus, digestive, recto-vaginal, bladder) 3 (5.9%) 3 (18.75%) NS NS, not significant; rafs, revised American Fertility Society. Our results suggest a higher incidence of moderate and severe endometriosis (endometrioma and DIE) in infertile women with uterine malformations. We observed a higher rate of endometriosis in women with uterine malformations and without previous pregnancy. Several studies previously demonstrated the association between obstructive M ullerian anomalies and endometriosis and denied a link between non-obstructive malformation and endometriosis (4,5,8). These observations supported the theory of retrograde menstruation (18). However, no comparison was made with a fertile group, with or without uterine malformation (8). 704
4 J. Boujenah et al. Endometriosis and uterine malformations Other authors found an association between nonobstructive M ullerian anomalies and endometriosis (12,13,17,20), but most of these published studies involved septate uterus. Moreover, none of these studies reported the severity of the disease or distinguished fertile from infertile patients (4,5,8,12). Other authors reported that uterine malformation may contribute to the severity of endometriosis (9,10). Recently, La Monica et al. (18) reported a more advanced stage in septate uterus. However, heterogeneity in the groups (pain, infertility, abnormal bleeding), and the lack of data on obstetrical history and overall prevalence of endometriosis, limited the results of that study (18). No difference was found regarding the class of malformation; other studies reported a higher rate of endometriosis among unicornuate uterus (8) or among bicornuate or didelphic uteri with renal agenesis (20). Our different results might be explained by the low numbers in each sub-group. Our study has some limitations. We did not compare the rate and type of endometriosis with a group of patients without uterine malformations. Other limitations are the retrospective design and the few number of included women. The respective role of uterine malformations and endometriosis in the pathophysiology of infertility remains unclear (19). Whereas uterine malformation may lead to an increased risk of miscarriage, endometriosis could be an incidental finding without influencing fertility outcome (21). According to the literature and our results, infertility may increase the severity of endometriosis related to uterine malformations, but the reverse has not been proven. In our study, we considered the three types of endometriotic lesions. The pathogenesis of these three types seems to support a different explanation. In the absence of obstruction, uterine dysperistalsis has been suggested to explain endometriosis in septate uterus (22). The severity of endometriosis found in uterine anomalies evokes the theories of coelomic metaplasia or M ullerian embryonic rest, as well as genomic factors (16). These theories are often suggested for the adolescent form of endometriosis and could provide another explanation for its association with uterine malformations (23,24). Our study, however, has practical implications. Endometriosis should be considered first in infertile women with uterine malformations and second in adolescent women with uterine malformations accompanied by clinical symptoms (dysmenorrhea, dyspareunia). Thus, the imaging technology performed to assess the type of uterine malformations should also focus on possible endometriosis. Therefore, the early diagnosis by imaging of endometriosis in infertile patients with uterine anomalies should be attempted with the help of imaging exams. The decision to perform laparoscopy as well as provide Assisted Reproductive Technology in these situations needs to be evaluated by further studies in infertility management. Conclusion Our results suggest that the association of uterine malformations and infertility increases the risk of severe endometriosis. Therefore, the diagnosis of endometriosis should be considered in the etiology of infertile uterine malformations. Funding The study was not financially supported by any foundation or organization. References 1. Eskenazi B, Warner ML. Epidemiology of endometriosis. Obstet Gynecol Clin North Am. 1997;24: Saravelos SH, Cocksedge KA, Li TC. Prevalence and diagnosis of congenital uterine anomalies in women with reproductive failure: a critical appraisal. Hum Reprod Update. 2008;14: Sampson JA. Peritoneal endometriosis due to menstrual dissemination of endometrial tissue into the peritoneal cavity. Am J Obstet Gynecol. 1927;14: Olive DL, Henderson DY. Endometriosis and mullerian anomalies. Obstet Gynecol. 1987;69: Ugur M, Turan C, Mungan T, Kusßcßu E, Sen oz S, Agisß HT, et al. Endometriosis in association with m ullerian anomalies. Gynecol Obstet Invest. 1995;40: Audebert A. Characteristics of adolescent endometriosis: apropos of a series of 40 cases. Gynecol Obstet Fertil. 2000;28: Sanfilippo JS, Wakim NG, Schikler KN, Yussman MA. Endometriosis in association with uterine anomaly. Am J Obstet Gynecol. 1986;154: Fedele L, Bianchi S, Di Nola G, Franchi D, Candiani GB. Endometriosis and nonobstructive m ullerian anomalies. Obstet Gynecol. 1992;79: Tong J, Zhu L, Chen N, Lang J. Endometriosis in association with Herlyn-Werner-Wunderlich syndrome. Fertil Steril. 2014;102: Goluda M, St Gabrys M, Ujec M, Jedryka M, Goluda C. Bicornuate rudimentary uterine horns with functioning endometrium and complete cervical-vaginal agenesis coexisting with ovarian endometriosis: a case report. Fertil Steril. 2006;86:462.e Yan L, Zhao X, Qin X. MRKH syndrome with endometriosis: case report and literature review. Eur J Obstet Gynecol Reprod Biol. 2011;159:
5 Endometriosis and uterine malformations J. Boujenah et al. 12. Song X, Zhu L, Ding J, Xu T, Lang J. Clinical characteristics of congenital cervical atresia and associated endometriosis among 96 patients. Int J Gynaecol Obstet. 2016;134: Grimbizis GF, Gordts S, Di Spiezio Sardo A, Brucker S, De Angelis C, Gergolet M, et al. The ESHRE/ESGE consensus on the classification of female genital tract congenital anomalies. Hum Reprod. 2013;28: American Society for Reproductive Medicine. Revised American Society for Reproductive Medicine classification of endometriosis: Fertil Steril. 1997;67: Cooper TG, Noonan E, von Eckardstein S, Auger J, Baker HWG, Behre HM, et al. World Health Organization reference values for human semen characteristics. Hum Reprod Update. 2010;16: Burney RO, Giudice LC. Pathogenesis and pathophysiology of endometriosis. Fertil Steril. 2012;98: Nawroth F, Rahimi G, Nawroth C, Foth D, Ludwig M, Schmidt T. Is there an association between septate uterus and endometriosis? Hum Reprod. 2006;21: LaMonica R, Pinto J, Luciano D, Lyapis A, Luciano A. Incidence of septate uterus in reproductive-aged women with and without endometriosis. J Minim Invasive Gynecol. 2016;23: Acien P. Incidence of M ullerian defects in fertile and infertile women. Hum Reprod. 1997;12: Acien P, Acien M, Mazaira N, Quesada-Rico JA. Reproductive outcome in uterine malformations with or without an associated unilateral renal agenesis. J Reprod Med. 2014;59: Gergolet M, Gianaroli L, Kenda Suster N, Verdenik I, Magli MC, Gordts S. Possible role of endometriosis in the aetiology of spontaneous miscarriage in patients with septate uterus. Reprod Biomed Online. 2010;21: Leyendecker G, Kunz G, Herbertz M, Beil D, Huppert P, Mall G, et al. Uterine peristaltic activity and the development of endometriosis. Ann N Y Acad Sci. 2004;1034: Batt RE, Mitwally MFM. Endometriosis from thelarche to midteens: pathogenesis and prognosis, prevention and pedagogy. J Pediatr Adolesc Gynecol. 2003;16: Silveira SA, Laufer MR. Persistence of endometriosis after correction of an obstructed reproductive tract anomaly. J Pediatr Adolesc Gynecol. 2013;26:e
Grand Rounds Mullerian Anomalies. Sara Schaenzer, PGY-3 9/26/18
Grand Rounds Mullerian Anomalies Sara Schaenzer, PGY-3 9/26/18 Background Congenital uterine anomalies occur in 2-4% of women Three times more common in women with recurrent pregnancy loss True incidence
More informationCoexistence of Endometriosis and Uterine Dysfunction in Infertile Women
Coexistence of Endometriosis and Uterine Dysfunction in Infertile Women Ludwig Kiesel University of Münster Department of Gynecology and Obstetrics Münster, Germany Symptoms: Risk of Endometriosis Compared
More informationManaging infertility when adenomyosis and endometriosis co-exist
Managing infertility when adenomyosis and endometriosis co-exist Jinhua Leng Beijing,China Endometriosis Endometriosis (EM) is a common, benign, ovary hormone-dependent gynecologic disorder which affects
More informationManagement of Reproductive Tract Anomalies
DOI 10.1007/s13224-017-1001-8 INVITED MINI REVIEW Garima Kachhawa 1 Alka Kriplani 1 Received: 29 March 2017 / Accepted: 21 April 2017 / Published online: 2 May 2017 Ó Federation of Obstetric & Gynecological
More informationMULLERIAN DUCT ANOMALY: A CASE REPORT
MULLERIAN DUCT ANOMALY: A Sunny Goyal 1, Ankur Aggarwal 2, Hemant Kumar Mishra 3, Tushar Prabha 4, Vipin kumar Bakshi 5 HOW TO CITE THIS ARTICLE: Sunny Goyal, Ankur Aggarwal, Hemant Kumar Mishra, Tushar
More informationMiscellaneous deviations from normal anatomy resulting from embryologic maldevelopment of
Classification of fem male s genital tract malform mations 1 st Grigoris F. Grimbizis Ass. Pro ofessor st Dept of Obstetri ics & Gynecology Aristotle University of Thessaloniki Congenital Malformations
More informationAnalysis of Mullerian developmental defects in a tertiary care hospital: a four year experience
International Journal of Reproduction, Contraception, Obstetrics and Gynecology Patel SN et al. Int J Reprod Contracept Obstet Gynecol. 2015 Jun;4(3):570-574 www.ijrcog.org pissn 2320-1770 eissn 2320-1789
More informationAn Overview of Uterine Factors That Influence Implantation
An Overview of Uterine Factors That Influence Implantation Bulent Urman, M.D. Dept. of Obstetrics and Gynecology Koc University School of Medicine Assisted Reproduction Unit, American Hospital, ISTANBUL
More informationReconstructive And Conservative Surgery by Tubal Implantation in Mullerian Anomalies A Case Report
IOSR Journal of Dental and Medical Sciences (IOSR-JDMS) e-issn: 2279-0853, p-issn: 2279-0861.Volume 15, Issue 6 Ver. III (July. 2016), PP 105-110 www.iosrjournals.org Reconstructive And Conservative Surgery
More informationInternational Journal of Sexual and Reproductive Health Care
v Life Sciences Group International Journal of Sexual and Reproductive Health Care DOI http://dx.doi.org/10.17352/ijsrhc.000002 CC By Ahmed Mahmoud Abdou* and Moustafa Taha Abdelfattah Department of Gynecology
More informationA multi-centre, multinational, cross-sectional, incident case control study on Factors associated with the development of
A multi-centre, multinational, cross-sectional, incident case control study on Factors associated with the development of Endometrioma and deep infiltrating endometriosis Professor C. Chapron and the Group
More informationEMBRYOLOGIC BASIS OF FEMALE CONGENITAL TRACT MALFORMATIONS
EMBRYOLOGIC BASIS OF FEMALE CONGENITAL TRACT MALFORMATIONS Prof. Pedro Acién, MD, FRCOG Maribel Acién, MD San Juan University Hospital/ Miguel Hernández University Campus of San Juan. Alicante. Spain Instituto
More informationMoneli Golara Consultant Obstetrician and Gynaecologist Barnet Hospital Royal Free NHS Trust
Moneli Golara Consultant Obstetrician and Gynaecologist Barnet Hospital Royal Free NHS Trust Endometriosis one of the most common conditions requiring treatment Growth of endometrial like tissue outside
More informationIMJM. Combined Hysteroscopy and Laparoscopy in the Evaluation of Patients with Recurrent Pregnancy Loss. THE INTERNATIONAL MEDICAL JOURNAL Malaysia
Combined Hysteroscopy and Laparoscopy in the Evaluation of Patients with Recurrent Pregnancy Loss Khameneh MK Islamic Republic of Iran Army University of Medical Sciences, Tehran, Iran ABSTRACT Introduction:
More informationHWWS HWWS HWWS CA CA X free air
50 1 2014 2 pp. 76-80 doi: 10.11164/jjsps.50.1_76 Herlyn-Werner-Wunderlich 1 1 1 1 1 1 1 1 1 11 3 CT Herlyn-Werner-Wunderlich HWWS HWWS I Herlyn-Werner-Wunderlich HWWS obstructed hemivagina and ipsilateral
More informationCongenital MUllerian anomalies: diagnostic accuracy of three-dimensional ultrasound
FERTILITY AND STERILITY Copyright ~" 1996 American Society for Reproductive Medicine Printed on acid-free paper in U. s. A. Congenital MUllerian anomalies: diagnostic accuracy of three-dimensional ultrasound
More informationMu llerian Anomalies. Introduction
CLINICAL OBSTETRICS AND GYNECOLOGY Volume 51, Number 1, 214 222 r 2008, Lippincott Williams & Wilkins Mu llerian Anomalies LEE P. SHULMAN, MD The Anna Ross Lapham Professor in Obstetrics and Gynecology,
More informationINFERTILITY CAUSES. Basic evaluation of the female
INFERTILITY Infertility is the inability to conceive after 12 months of unprotected intercourse. There are multiple causes of infertility and a systematic way to evaluate the condition. Let s look at some
More informationFDG-PET value in deep endometriosis
Gynecol Surg (2011) 8:305 309 DOI 10.1007/s10397-010-0652-6 ORIGINAL ARTICLE FDG-PET value in deep endometriosis A. Setubal & S. Maia & C. Lowenthal & Z. Sidiropoulou Received: 3 December 2010 / Accepted:
More informationLaparoscopic Morcellation of Didelphic Uterus With Cervical and Renal Aplasia
CASE REPORT Laparoscopic Morcellation of Didelphic Uterus With Cervical and Renal Aplasia Albert Altchek, MD, Michael Brodman, MD, Peter Schlosshauer, MD, Liane Deligdisch, MD ABSTRACT This is a case report
More informationADENOMYOSIS CHRONIC PELVIC PAIN IN WOMEN IMAGING CHRONIC PELVIC PAIN IN WOMEN CHRONIC PELVIC PAIN IN WOMEN ADENOMYOSIS: PATHOLOGY ADENOMYOSIS
CHRONIC PELVIC PAIN IN WOMEN IMAGING CHRONIC PELVIC PAIN IN WOMEN MOSTAFA ATRI, MD Dipl. Epid. UNIVERSITY OF TORONTO Non-menstrual pain of 6 months Prevalence 15%: 18-50 years of age 10-40% of gynecology
More informationSexual differentiation:
Abnormal Development of Female Genitalia Dr. Maryam Fetal development of gonads, external genitalia, Mullerian ducts and Wolffian ducts can be disrupted at a variety of points, leading to a wide range
More informationContents: Benign Diseases of the Uterus
COLLEGE OF MEDICINE DEPT. OF OBSTETRICS AND GYNECOLOGY Benign Diseases of the Uterus Dr.Ayman Hussien Shaamash MBBCH, MSc., MD. (Egypt) Professor of OB./Gyn. Faculty of Medicine. King khalid University
More informationLaparoscopic excision of recurrent endometriomas: long-term outcome and comparison with primary surgery
Laparoscopic excision of recurrent endometriomas: long-term outcome and comparison with primary surgery Luigi Fedele, M.D., a Stefano Bianchi, M.D., a Giovanni Zanconato, M.D., c Nicola Berlanda, M.D.,
More informationSurgical Management of Endometriosis associated Infertility
Surgical Management of Endometriosis associated Infertility Dr. Ingrid Lok Specialist in Obstetrics and Gynaecology (Honorary Clinical Associate Professor, CUHK) HA commission training 24.2.2014 Endometriosis
More informationENDOSCOPIC TREATMENT OF UTERINE MALFORMATIONS
ENDOSCOPIC TREATMENT OF UTERINE MALFORMATIONS PROF. ANTONIO PERINO CATTEDRA DI GINECOLOGIA OSTETRICIA E FISIOPATOLOGIA DELLA RIPRODUZIONE UMANA UNIVERSITA DEGLI STUDI DI PALERMO Mullerian duct malformations
More informationPRETREATMENT ASSESSMENT & MANAGEMENT (MODULE 1 B) March, 2018
PRETREATMENT ASSESSMENT & MANAGEMENT (MODULE 1 B) March, 2018 Clinical Assessment A thorough clinical evaluation is a prerequisite for ART A thorough clinical evaluation as detailed in the female and male
More informationPOST - DOCTORAL FELLOWSHIP PROGRAMME IN REPRODUCTIVE MEDICINE. Anatomy : Male and Female genital tract
POST - DOCTORAL FELLOWSHIP PROGRAMME IN REPRODUCTIVE MEDICINE DURATION OF THE COURSE : TWO YEARS Detailed syllabus: Part 1 Basic Sciences: Anatomy : Male and Female genital tract Physiology Endocrinology
More information2/24/19. Myometrial evaluation. Size Echotexture. Homogeneous Heterogeneous. Adenomyosis Fibroids. Adenomyosis. MUSA guidelines
Content Adenomyosis and MUSA guidelines for myometrial disorders Adenomyosis MUSA guidelines Dr Lufee Wong FRANZCOG, MPH, DDU Recommended reporting guidelines Fibroids Adenomyosis Myometrial evaluation
More informationImpact of Ovarian Endometrioma Per Se and Surgery on Ovarian Reserve and Pregnancy Rate in in Vitro Fertilization Cycles
1 st SEUD Meeting, 9 May 2015, Paris, France Impact of Ovarian Endometrioma Per Se and Surgery on Ovarian Reserve and Pregnancy Rate in in Vitro Fertilization Cycles ENDOMETRIOSIS ovarian endometrioma
More informationAccuracy of transvaginal ultrasound and magnetic resonance imaging in diagnosis and extension of pelvic endometriosis
Accuracy of transvaginal ultrasound and magnetic resonance imaging in diagnosis and extension of pelvic endometriosis A.Salem, Kh. Fakhfakh, S. Mehiri, Y. Ben Brahim, F. Ben Amara, H. Rajhi, R. Hamza,
More informationAhmed Nazer, 1 Ahmed Abu-Zaid, 2 Osama AlOmar, 1 Hany Salem, 1 Ayman Azzam, 3 and Ismail A. Al-Badawi Case Report. 1.
Case Reports in Obstetrics and Gynecology Volume 2013, Article ID 450165, 4 pages http://dx.doi.org/10.1155/2013/450165 Case Report Bilateral Ectopic Hypoplastic Uteri Attached to Bilateral Pelvic Sidewalls
More informationCNGOF Guidelines for the Management of Endometriosis
CNGOF Guidelines for the Management of Endometriosis Anatomoclinical forms of endometriosis Definitions Endometriosis is defined as the presence of endometrial tissue containing both glands and stroma
More informationPre and post surgical medical therapy. Mauro Busacca M.D. Dept of Obstetrics and Gynecology University of Milan- Italy
Pre and post surgical medical therapy Mauro Busacca M.D. Dept of Obstetrics and Gynecology University of Milan- Italy introduction A disease is an open problem when two conditions are nor satisfied: The
More informationSample size a Main finding b Main limitations
1 Table 1. Available studies on the relation between endometriosis and miscarriage (1995-2015). Study (citation) Country Study period Study design Sample size a Main finding b Main limitations Matoras
More informationEndometriosis - MRI findings with anatomic-pathologic correlation
Endometriosis - MRI findings with anatomic-pathologic correlation Poster No.: C-2551 Congress: ECR 2015 Type: Educational Exhibit Authors: E. Matos, A. T. Almeida, A. Sanches; Vila Nova de Gaia/PT Keywords:
More informationThe major causes of female infertility include ovulatory dysfunction, tubal and peritoneal
Focused Issue of This Month YoungMin Choi, MD Department of Obstetrics and Gynecology, Seoul National University College of Medicine Email : ymchoi@snu.ac.kr J Korean Med Assoc 2007; 50(5): 400-405 Abstract
More informationSurgical Interruption of Pelvic Nerve Pathways for Primary and Secondary Dysmenorrhea
Page: 1 of 7 Last Review Status/Date: June 2015 for Primary and Secondary Dysmenorrhea Description Two laparoscopic surgical approaches are proposed as adjuncts to conservative surgical therapy for the
More informationIndian Journal of Basic and Applied Medical Research; September 2015: Vol.-4, Issue- 4, P
Original article: To study post intrauterine insemination conception rate among infertile women with polyp and women with normal uterine endometrium cavity 1Dr. Archana Meena, 2 Dr. Renu Meena, 3 Dr. Kusum
More informationSurgical treatment of endometriosis: location and patterns of disease at reoperation
Surgical treatment of endometriosis: location and patterns of disease at reoperation Elizabeth Taylor, M.D., and Christina Williams, M.D. Division of Reproductive Endocrinology and Infertility, Department
More informationThe many faces of Endometriosis
The many faces of Endometriosis Beryl Benacerraf M.D Harvard Medical School What is Endometriosis? Endometriosis is defined as the presence of normal endometrial tissue occurring outside of the endometrial
More informationEndometriosis د. نجمه محمود كلية الطب جامعة بغداد فرع النسائية والتوليد
Endometriosis د. نجمه محمود كلية الطب جامعة بغداد فرع النسائية والتوليد Objectives:- To know what is endometriosis The sites where it occur To explain its itiology & pathogenesis To know the clinical features
More informationSURGICAL PROBLEMS IN FERTILITY- FIBROIDS. Dr.Māris Arājs gyn-ob specialist Cell phone:
SURGICAL PROBLEMS IN FERTILITY- FIBROIDS Dr.Māris Arājs gyn-ob specialist maris@myclinicriga.lv Cell phone: +371 26556466 There is NO Industry Sponsorship and Financial Conflict of Interest for this presentation
More informationChapter 3 Theories on Endometriosis
Chapter 3 Theories on Endometriosis Sajal Gupta, Avi Harlev, Ashok Agarwal, and Elizabeth Pandithurai 3.1 Sampson s Theory There are several theories as to how endometriosis develops, but the most widely
More informationIntroduction to GYN Specialties
Outline Introduction to GYN Specialties Gynecologic Oncology* Female Pelvic Medicine and Reconstructive Surgery* Reproductive Endocrinology and Infertility* Pediatric and Adolescent Gynecology** Family
More informationDefinition Endometriosis is the presence of functioning endometrial tissue outside the cavity of the uterus.
Dept. of Obstetrics t and Gynecology Faculty of Medicine University of Sumatera Utara Endometriosis Definition Endometriosis is the presence of functioning endometrial tissue outside the cavity of the
More informationSurgery and Infertility
Surgery and Infertility Dr Phill McChesney BHB MBChB FRANZCOG MRMed CREI Laparoscopy Prior to Considering IVF Diagnostic Tubal Surgery Treatment of peritubal adhesions Reconstructive surgery Sterilization
More informationSurgical Interruption of Pelvic Nerve Pathways for Primary and Secondary Dysmenorrhea. Original Policy Date
MP 4.01.10 Surgical Interruption of Pelvic Nerve Pathways for Primary and Secondary Dysmenorrhea Medical Policy Section OB/Gyn/Reproduction Issue 12:2013 Original Policy Date 12:2013 Last Review Status/Date
More informationDiagnostic Features and Therapeutic Consequences of Hysteroscopy in Women with Abnormal Uterine Bleeding and Abortion
American Journal of Applied Sciences 9 (1): 13-17, 2012 ISSN 1546-9239 2012 Science Publications Diagnostic Features and Therapeutic Consequences of Hysteroscopy in Women with Abnormal Uterine Bleeding
More information1 - Ricardo Bassil Lasmar, MD, PhD Gynecology, Department of Maternal. and Child Health, Universidade Federal Fluminense UFF.
ORIGINAL ARTICLE Title: Validation of the ECO System in management of patients with endometriosis: a preliminary study. Authors: 1 - Ricardo Bassil Lasmar, MD, PhD Gynecology, Department of Maternal and
More informationDifference Between PCOS and Endometriosis
Difference Between PCOS and Endometriosis www.differencebetween.com Key Difference PCOS vs Endometriosis Ovaries play an important role in the reproduction and the maintenance of the female body. They
More informationCLEAR COVERAGE HYSTERECTOMY CHECKLISTS
CLEAR COVERAGE HYSTERECTOMY CHECKLISTS Click on the link below to access the checklist sheet. Abnormal Uterine Bleeding Adenomyosis Chronic Abdominal or Pelvic Pain Endometriosis Fibroids General Guidelines
More informationSurgical Interruption of Pelvic Nerve Pathways for Primary and Secondary Dysmenorrhea
Surgical Interruption of Pelvic Nerve Pathways for Primary and Secondary Dysmenorrhea Policy Number: 4.01.17 Last Review: 11/2013 Origination: 11/2007 Next Review: 11/2014 Policy Blue Cross and Blue Shield
More informationNeil Goodman, MD, FACE
Initial Workup of Infertile Couple: Female Neil Goodman, MD, FACE Professor of Medicine Voluntary Faculty University of Miami Miller School of Medicine Scope of Infertility in the United States Affects
More informationAt the conclusion of the first two year, the resident should be able to:
Reproductive Endocrinology/Infertility Rotations PGY-I COMPETENCY 1. Patient Care, Provide patient centered care that is compassionate, appropriate, and effective for the treatment of health problems and
More informationClinical Case Reports: Open Access
Clinical Case Reports: Open Access Mini Review Vol 1 Iss 2 Surgical Management of Endometriosis- A Mini Review Kanika Chopra *, Debasis Dutta and Kanika Jain Department of Minimally Invasive Gynaecology,
More informationUnilateral ovarian and fallopian tube agenesis in an infertile patient with a normal uterus
EXPERIMENTAL AND THERAPEUTIC MEDICINE 8: 831-835, 2014 Unilateral ovarian and fallopian tube agenesis in an infertile patient with a normal uterus BINGYA CHEN, CHUNBO YANG, ZAYD SAHEBALLY and HANGMEI JIN
More information福島県立医科大学学術機関リポジトリ. Citation Fukushima Journal of Medical Scienc. Rights 2010 The Fukushima Society of Med
福島県立医科大学学術機関リポジトリ TitleA case of congenital unilateral par Author(s) Yazawa, Hiroyuki; Yabe, Michihiro; Syoutaro Citation Fukushima Journal of Medical Scienc Issue Date 2010-06 URL http://ir.fmu.ac.jp/dspace/handle/1
More informationMullerian duct anomalies presenting with primary amenorrhoea
International Journal of Reproduction, Contraception, Obstetrics and Gynecology Chandrayan P et al. Int J Reprod Contracept Obstet Gynecol. 2016 Feb;5(2):300-305 www.ijrcog.org pissn 2320-1770 eissn 2320-1789
More informationPosterior Deep Endometriosis. What is the best approach? Posterior Deep Endometriosis. Should we perform a routine excision of the vagina??
Posterior Deep Endometriosis What is the best approach? Dept Gyn Obst Polyclinique Hotel Dieu CHU Clermont Ferrand France Posterior Deep Endometriosis Organs involved - Peritoneum - Uterine cervix -Rectum
More informationMagnetic resonance imaging in the assessment of complex MuÈ llerian anomalies
British Journal of Obstetrics and Gynaecology August 2001, Vol. 108, pp. 791±797 Magnetic resonance imaging in the assessment of complex MuÈ llerian anomalies Catherine L. Minto a, Nicholas Hollings b,
More informationRecent Developments in Infertility Treatment
Recent Developments in Infertility Treatment John T. Queenan Jr., MD Professor, Dept. Of Ob/Gyn University of Rochester Medical Center Rochester, NY Disclosures I don t have financial interest or other
More informationHysteroscopy - current trends and challenges
J Obstet Gynecol India Vol. 58, No. 1 : January/February 2008 pg 57-62 Original Article Hysteroscopy - current trends and challenges Gour A, Zawiejska A, Mettler L Department of Obstetrics and Gynaecology,
More informationThey are updated regularly as new NICE guidance is published. To view the latest version of this NICE Pathway see:
bring together everything NICE says on a topic in an interactive flowchart. are interactive and designed to be used online. They are updated regularly as new NICE guidance is published. To view the latest
More informationComparison of Hysterosalpingography and Combined Laparohysteroscopy for the Evaluation of Primary Infertility Nigam A, 1 Saxena P, 2 Mishra A 2
Comparison of Hysterosalpingography and Combined Laparohysteroscopy for the Evaluation of Primary Infertility Nigam A, 1 Saxena P, 2 Mishra A 2 ABSTRACT Background 1 Department of Obstetrics and Gynaecology
More informationEndometriosis. *Chocolate cyst in the ovary
Endometriosis What is endometriosis? Endometriosis is a common condition in young women. It's chronic, painful, and it often progressively gets worse over the time. *Chocolate cyst in the ovary Normally,
More informationPROLIFERATIVE ACTIVITIES OF ECTOPICAL ENDOMETRIAL CELLS IN PATIENTS WITH PRIMARY AND RECURRENT ENDOMETRIOMAS
Federal State Institute «Rostov-on-Don Scientific Research Institute of Obstetrics and Pediatrics», Rostov State Medical University PROLIFERATIVE ACTIVITIES OF ECTOPICAL ENDOMETRIAL CELLS IN PATIENTS WITH
More informationTheFormationofaScoringSystemtoDiagnoseEndometriosis. The Formation of a Scoring System to Diagnose Endometriosis
Global Journal of Medical Research: E Gynecology and Obstetrics Volume 18 Issue 1 Version 1.0 Type: Double Blind Peer Reviewed International Research Journal Publisher: Global Journals Online ISSN: 49-4618
More informationAdenomyosis Pathogenesis
S GORDTS Grado, 6 7 Mai 2011 Conflict of interest: cons Storz Adenomyosis Pathogenesis Presence of endometrial glands and stroma deep within the myometrium (>25 mm from EJZ) It is a myoproliferative disease
More informationPelvic Pain: Overlooked
EDUCATION EXHIBIT 3 Pelvic Pain: Overlooked and Underdiagnosed Gynecologic Conditions 1 CME FEATURE See accompanying test at http:// www.rsna.org /education /rg_cme.html LEARNING OBJECTIVES FOR TEST 1
More informationJohn R. Randolph, Jr., M.D.t Yu Kang Ying, M.D.:j: Donald B. Maier, M.D. Cecilia L. Schmidt, M.D. Daniel H. Riddick, M.D., Ph.D.1I
FERTILITY AND STERILITY Copyright 1986 The American Fertility Society Vol. 46. No.5. November 1986 Prinred in U.s A. Comparison of real-time ultrasonography, hysterosalpingography, and laparoscopy/hysteroscopy
More informationEndometriosis: Correlation of Severity of Pain with Stages of Disease
Journal of Bangladesh College of Physicians and Surgeons Vol. 34, No. 3, July 2016 Endometriosis: Correlation of Severity of Pain with Stages of Disease TS CHOWDHURY a, N MAHMUD b, TA CHOWDHURY c Summary:
More informationCongenital Anomalies of the Genital Tract
Congenital Anomalies of the Genital Tract Prof Keith Edmonds Queen Charlotte s and Chelsea Hospital Imperial College London SSO&G Jonkoping 2015 Should Paediatric and Adolescent Gynaecology be Centralised?
More informationPELVIC PERITONEAL DEFECTS AND ENDOMETRIOSIS: ALLEN-MASTERS SYNDROME REVISITED
FERTU.ITY AND STERILITY Copyright " 1981 The American Fertility Society Vol. 36, No. 6, December 1981 Printed in U.S A. PELVIC PERITONEAL DEFECTS AND ENDOMETRIOSIS: ALLEN-MASTERS SYNDROME REVISITED DONALD
More informationEvaluation of the Infertile Couple
Overview and Definition Infertility is defined as the inability of a couple to fall pregnant after one year of unprotected intercourse. Infertility is a very common condition as in any given year about
More informationreproductive organs. Malignant neoplasms. 4. Inflammatory disorders of female reproductive organs 2 5. Infertility. Family planning.
Thematic plan of lectures module iii. Diseases of female reproductive system. Family planning. Topic No of hours 1. Disturbances of menstrual function. Neuroendocrinological 2 syndromes in gynecology 1.
More informationComparison between hysterosalpingography and laparoscopic chromopertubation for the assessment of tubal patency in infertile women
International Journal of Reproduction, Contraception, Obstetrics and Gynecology Choudhary A et al. Int J Reprod Contracept Obstet Gynecol. 2017 Nov;6(11):4825-4829 www.ijrcog.org DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20174626
More informationAnatomic factors and recurrent pregnancy loss. M. Goddijn and C.R. Kowalik
Anatomic factors and recurrent pregnancy loss M. Goddijn and C.R. Kowalik ESHRE Campus, Manchester nov 2009 Anatomic factors and recurrent pregnancy loss Background Recurrent miscarriage work-up congenital
More informationTransverse vaginal septae: management and long-term outcomes
DOI: 10.1111/1471-0528.12899 www.bjog.org General gynaecology Transverse vaginal septae: management and long-term outcomes CE Williams, a RS Nakhal, a MA Hall-Craggs, b D Wood, c A Cutner, a SH Pattison,
More informationFibroid mapping. Haitham Hamoda MD FRCOG Consultant Gynaecologist, Subspecialist in Reproductive Medicine & Surgery King s College Hospital
Fibroid mapping Haitham Hamoda MD FRCOG Consultant Gynaecologist, Subspecialist in Reproductive Medicine & Surgery King s College Hospital Fibroids Common condition >70% of women by onset of menopause.
More informationSOUTH AFRICAN GUIDELINE FOR TREATMENT OF ENDOMETRIOSIS
SOUTH AFRICAN GUIDELINE FOR TREATMENT OF ENDOMETRIOSIS SASREG PUBLICATION Recommended treatment protocols for the South African patient population based on the European Society of Human Reproduction and
More informationA STUDY OF MULLERIAN DUCT ANOMALY ON REPRODUCTIVE AGE GROUP Debjani Roy 1
A STUDY OF MULLERIAN DUCT ANOMALY ON REPRODUCTIVE AGE GROUP Debjani Roy 1 HOW TO CITE THIS ARTICLE: Debjani Roy. A Study of Mullerian Duct Anomaly on Reproductive Age Group. Journal of Evolution of Medical
More informationAre implantation and pregnancy outcome impaired in diethylstilbestrol-exposed women after in vitro fertilization and embryo transfer~*
FERTILITY AND STERILITY Copyright 0 1990 The American Fertility Society Printed on acid-free paper in U.S.A. Are implantation and pregnancy outcome impaired in diethylstilbestrol-exposed women after in
More informationInvestigating Hysteroscopy Implementation in Infertile Women Candidate With a Normal Uterine Cavity for Laparoscopy in Hysterosalpingography
http://www.ijwhr.net Open Access doi 10.15296/ijwhr.2019.13 Original Article International Journal of Women s Health and Reproduction Sciences Vol. 7, No. 1, January 2019, 79 84 ISSN 2330-4456 Investigating
More informationThe Correlation between Serum and Peritoneal Fluid CA125 Level in Women with Pelvic Endometriosis
Original Article The Correlation between Serum and Peritoneal Fluid CA125 Level in Women with Pelvic Saghar Salehpour, M.D.* 1, Azadeh Akbari Sene, M.D. 1, Ebrahim Kalantarian Mehrjerdi, Ph.D., M.T. 2,
More informationNormal and Abnormal Development of the Genital Tract. Dr.Raghad Abdul-Halim
Normal and Abnormal Development of the Genital Tract Dr.Raghad Abdul-Halim objectives: Revision of embryology. Clinical presentation, investigations and clinical significance of most common developmental
More informationReproductive outcomes after hysteroscopic metroplasy for women with dysmorphic uterus and recurrent implantation failure
Original paper Reproductive outcomes after hysteroscopic metroplasy for women with dysmorphic uterus and recurrent implantation failure J. Ferro 1, E. Labarta 2, C. Saenz 3, P. Montoya 3, J. Remohi 4 1
More informationImproved Fertility Following Enucleation of Intramural Myomas in Infertile Women
Original Article Improved Fertility Following Enucleation of Intramural Myomas in Infertile Women Yu Cui Tian 1, Jian Hong Wu 2, Hong Mei Wang 1, Yin Mei Dai 3 1 Department of Perinatal Medicine, Beijing
More informationDienogest compared with gonadotropin-releasing hormone agonist after conservative surgery for endometriosis
doi:10.1111/jog.13023 J. Obstet. Gynaecol. Res. Vol. 42, No. 9: 1152 1158, September 2016 Dienogest compared with gonadotropin-releasing hormone agonist after conservative surgery for endometriosis Yotaro
More informationAmerican Journal of Oral Medicine and Radiology
American Journal of Oral Medicine and Radiology e - ISSN - XXXX-XXXX ISSN - 2394-7721 Journal homepage: www.mcmed.us/journal/ajomr ROLE OF 3-DIMENSIONAL (3-D) ULTRASOUND (US) IN THE DIAGNOSING THE CAUSES
More informationDiagnostic laparoscopy in primary and secondary infertility
Diagnostic laparoscopy in primary and secondary infertility Al-Sakkkal Ghada Saddallah C.A.B.O.G. Department of Obs. And Gyn., Hawler Medical University ABSTRACT Objective: To compare the diagonstic effficacy
More informationEndometriosis. Assoc.Prof.Pawin Puapornpong, Faculty of Medicine, Srinakharinwirot University.
Endometriosis Assoc.Prof.Pawin Puapornpong, Faculty of Medicine, Srinakharinwirot University. Endometriosis Definition: Ectopic Endometrial Tissue True Incidence Unknown:? 1-5% Does NOT Discriminate by
More informationCase report Paediatrics Today 2016;12(1):87-91 DOI /p
Case report Paediatrics Today 2016;12(1):87-91 DOI 10.5457/p2005-114.140 URINARY INCONTINENCE FOLLOWING VAGINAL SEPTUM RESECTION IN HERLYN-WERNER-WUNDERLICH SYNDROME A CASE REPORT Slavica PONORAC 1*, Anamarija
More informationIs the endometriosis recurrence rate increased after ovarian hyperstimulation?
Is the endometriosis recurrence rate increased after ovarian hyperstimulation? Thomas M. D Hooghe, M.D., Ph.D., Bénédicte Denys, M.D., Carl Spiessens, Ph.D., Christel Meuleman, M.D., and Sophie Debrock,
More informationQuestion Bank III - BHMS
Question Bank III - BHMS Sub:- Ob/Gy -Paper-II 1. Give the definition of Puberty. 2. Enumerate five important physical changes evident during puberty. 3. Write down the vaginal changes during puberty.
More informationNaProTechnology. An Integrated Approach to Infertility. Tracy Parnell. Geneva 2005
NaProTechnology An Integrated Approach to Infertility Tracy Parnell Geneva 2005 Outline Scientific foundations Illustrative case history Research Discussion and questions NPT Natural Procreative Technology(NPT)
More informationHysteroscopy in Uterine Anomalies: An Edge
Anshika Lekhi et al Case Report 10.5005/jp-journals-10033-1279 1 Anshika Lekhi, 2 Rahul Manchanda, 3 Sravani Chithra, 4 Nidhi Jain ABSTRACT Hysteroscopy is the inspection of the uterine cavity by endoscopy
More informationLaparoscopy and Hysteroscopy
AMERICAN SOCIETY FOR REPRODUCTIVE MEDICINE Laparoscopy and Hysteroscopy A Guide for Patients PATIENT INFORMATION SERIES Published by the American Society for Reproductive Medicine under the direction of
More informationCLINICAL PRESENTATION AND RADIOLOGY QUIZ QUESTION
Donald L. Renfrew, MD Radiology Associates of the Fox Valley, 333 N. Commercial Street, Suite 100, Neenah, WI 54956 2/12/2011 Radiology Quiz of the Week # 7 Page 1 CLINICAL PRESENTATION AND RADIOLOGY QUIZ
More information5/5/2010. Infertility FINANCIAL DISCLOSURE. Infertility Definition. Objectives. Normal Human Fertility. Normal Menstrual Cycle
Infertility FINANCIAL DISCLOSURE I HAVE NO FINANCIAL INTEREST IN ANY OF THE PRODUCTS MENTIONED IN MY PRESENTATION Bryan K. Rone, M.D. University of Kentucky Obstetrics and Gynecology I AM RECEIVING COMPENSATION
More information