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Recurrent Pregnancy Loss
Published in Vincenzo Berghella, Obstetric Evidence Based Guidelines, 2022
Reshama S. Navathe, Shabani Ahluwalia
Septum, synechiae, and/or submucous myomata can be resected hysteroscopically, but there are no trials regarding this intervention. However, there have been prospective studies suggesting higher live birth rates in women with uterine septa and RPL who undergo septum resection [32]. Repair of the bicornuate or unicornuate uterus is not suggested in these women, as outcomes are usually good without repair, whereas surgical correction is associated with higher risk of complications. Consider referral to a reproductive endocrinology specialist if necessary. There is a paucity of evidence to give a recommendation for women with fibroids and RPL. The available data suggest resection of submucosal fibroids may confer benefit [33].
Paper 2
Published in Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw, The Final FRCR, 2020
Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw
Uterus didelphys is complete duplication of the uterine horns leading to two separate uterine cavities and cervices. A unicornuate uterus is where there is just one uterine horn and fallopian tube and there may be a rudimentary horn on the contralateral side. Renal anomalies are most common with this subtype. Uterine agenesis is when the uterus has not formed at all and the upper two-thirds of the vagina will also be absent; however, the ovaries and fallopian tubes may or may not be present.
Uterine Anomalies and Recurrent Pregnancy Loss
Published in Howard J.A. Carp, Recurrent Pregnancy Loss, 2020
Daniel S. Seidman, Mordechai Goldenberg
A unicornuate uterus is the result of complete, or almost complete, arrest of development of one of the Müllerian ducts (Figure 12.1). When the arrest is incomplete (in 90% of patients with unicornuate uterus), a rudimentary horn with or without a functioning endometrium may be present. The incidence of unicornuate uterus has been estimated to be 6.3% of uterine anomalies and may be associated with urinary tract and renal anomalies. Approximately one-third of all pregnancies result in miscarriage [5,14,15]. The high miscarriage rate is mostly attributed to abnormal uterine vasculature and decreased muscle mass.
Zooming in on the endometrial factor of recurrent implantation failure
Published in Human Fertility, 2022
Chibuzor Ifenatuoha, Babatunde Okewale
The Müllerian ducts are paired structures formed during embryonic development that give rise to the uterus, Fallopian tubes, uterine cervix, and the anterior part of the vagina (Robboy et al., 2017). Typically, the formation of the Müllerian duct takes in three phases, which are: (i) organogenesis (when the ducts are formed); (ii) fusion (when the ducts fuse to form the uterus); and (iii) septal resorption (when the central septum is finally resorbed after the fusion of the ducts). Any anomaly that would result in the failure of completion of the organogenesis phase may result in uterine agenesis, hypoplasia, or a unicornuate uterus. Similarly, the failure in completion of the fusion and septal resorption phases will result in a bicornuate or didephys uterus and a septate or arcuate uterus respectively (Chandler et al., 2009). It was estimated that about 3.8 to 9.6% of the general population have abnormal uterine formation (Santamaria et al., 2018). Mutation in the homeobox genes (HOXA10 and HOXA11) are said to be responsible for Mullerian duct malformation. The homeobox gene family is commonly responsible for the regulation of the Müllerian duct formation. In addition, the HOXA10 and HOXA11 are said to also play a role in endometrial development and preparing the endometrium for implantation (Coughlan et al., 2014).
Ovotestis at 18 years: an accidental discovery in an internally displaced persons’ camp in North-Eastern Nigeria
Published in Journal of Obstetrics and Gynaecology, 2019
Hadiza Abdullahi Usman, Bala Mohammed Audu, Mohammed Bukar, Ahmed A. Mayun
The breasts were Tanner stage 1 V with scanty feminine pubic hair. There was a ‘phallus’ that was about 5 cm long and 2 cm in diameter with an excess redundant hood and fused labia minora from about 2 cm above the urethral meatus (Figure 1(A)). There was an obvious right labio-scrotal fold with a palpable swelling (possibly a gonad) measuring 4 × 2 cm in diameter. The urethral meatus opened at the base of the ‘penile’ shaft immediately above the vaginal opening (Figure 1(B)). There were no palpable masses in the inguinal canals. A rectal examination revealed a uterus that was deviated to the left side. A pelvic ultrasound showed a uterus with an AP diameter of 20.8 mm with a late proliferative endometrium. The left ovary was visualised with a dominant follicle of 17 mm. The right ovary was, however, not seen. The Buccal smear and blood film Barr bodies were greater than 50%. A diagnostic laparoscopy revealed an acentric unicornuate uterus with a normal left tube and an ovary with features of ovulation. The right tube and ovary were not seen. The right round ligament was traced into the inguinal ring. Other investigations were within normal.
In vitro fertilization-frozen embryo transfer in a patient with cytochrome P450 oxidoreductase deficiency: a case report
Published in Gynecological Endocrinology, 2018
Tianran Song, Bin Wang, Huan Chen, Jingjing Zhu, Haixiang Sun
We report on a 28-year-old woman with PORD who wanted to conceive. At 15 years of age, the patient was treated for vaginal atresia, and then presented with either irregular menses (i.e. menstrual periods lasting 8–10 days, 30–60 day cycles) or amenorrhea. Ovarian cysts were frequent but disappeared on their own. The patient, who had been married for 4 years, was not using birth control. She was never pregnant. The hysterosalpingogram showed a unicornuate uterus and bilateral fallopian tube obstruction. Hysteroscopic examination revealed a normal uterine cavity, with an intermediate endometrial thickness. The baseline FSH level was 7.3–13.78 mIU/mL, and the antral follicle count was 9–10. Genetic analysis confirmed a 46, XX karyotype. Her husband’s semen parameters were normal.