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Infertility
Published in Nazar N. Amso, Saikat Banerjee, Endometriosis, 2022
Amanda Jefferys, Valentine Akande
The question as to whether the presence of an endometrioma alone, even if unoperated, impairs ovarian function remains uncertain. Some studies have demonstrated lower rates of ovulation in women with endometriomas, regardless of size (10); whereas, others have refuted this (11), suggesting that endometriomas do not affect normal ovarian function. There is also variable data on response to ovarian hyperstimulation in women with unoperated endometrioma, with some studies demonstrating lower egg retrieval rates in women with unoperated endometrioma (12,13) compared to controls with larger (5 cm or more) endometrioma having the greatest impact (14), although overall IVF outcome appears unaffected. Other studies have suggested that the presence of endometrioma <3–4cm has no impact on response to ovarian stimulation (15–17). Finally, the presence of endometrioma, even in the absence of prior surgery, has been associated with a lower baseline AMH, and a more rapid decline in AMH levels (18). Mechanisms for this decline include compression of ovarian cortex by the endometrioma and inflammatory mechanisms.
Modalities of detection of sentinel nodes in lymphatic mapping
Published in Charles F. Levenback, Ate G.J. van der Zee, Robert L. Coleman, Clinical Lymphatic Mapping in Gynecologic Cancers, 2022
Blanca Segarra, Nuria Agusti, Pedro T. Ramirez
Five studies have assessed the combination of a radiotracer and blue dye. The detection rate was 88.1% when a radiocolloid (with or without blue dye) was used (N = 109). Three studies combined patent blue with99mTc, and the number of SLNs that have been identified only with patent blue dye were 100%, 83%, and 20%, respectively.28 When ICG alone was used, the detection rate was 93.3% (N = 15).29 Based on the published literature, it appears that, with the exception of patent blue, all other tracers have resulted in a high detection rate of SLNs. The utero-ovarian ligament and the infundibulopelvic ligament have been used as the site of injection in the majority of studies. Injection of the tracer should be performed, preferably with the adnexa still in situ, both in the suspensory ligament and the infundibulopelvic ligament. With this approach, the detection rate has exceeded 90%. In two studies, an injection into the ovarian cortex appeared to be less sensitive (71.4%, N = 21).28 Ideally, an interval of 10–15 minutes should be allowed after injection before starting SLN mapping; this provides the tracer enough time to spread to the lymph nodes (detection rate >90%).
Ovarian Ectopic Pregnancy
Published in Botros Rizk, A. Mostafa Borahay, Abdel Maguid Ramzy, Clinical Diagnosis and Management of Gynecologic Emergencies, 2020
Ovarian pregnancies may be categorized into two groups: primary and secondary ovarian pregnancies. Primary ovarian pregnancy refers to the situation in which the ovum is fertilized when it is still within the ovarian follicle, resulting in gestation within the ovarian cortex. In secondary ovarian pregnancy, fertilization initially takes place in the fallopian tube, and the resultant conception products are then implanted in the ovary. However, there is no reliable way to differentiate between primary and secondary ovarian pregnancy upon clinical evaluation or pathologic examination. Therefore, any ovarian pregnancy is generally considered primary.
Expert consensus on fertility preservation in hematopoietic stem cell transplantation in girls in China
Published in Gynecological Endocrinology, 2023
In leukemia, ovary may be invaded. The risk of retransplantation of malignant cells needs to be considered [14]. Since the first report of an patient who underwent OTC in complete remission of acute myeloid leukemia and obtained a live birth in 2017 through OTT [39], four patients with leukemia also had a child after OTT [40–42]. Time from OTT to reporting the cases varied from 24 to 61 months, no recurrence of primary disease occurred. After application of maximal safety measures, restrictive criteria may be relaxed to make OTT possible for patients with hematologic malignancy [43]. Obtaining mature and safe gametes from frozen ovarian cortex may be possible in the future with the development of in vitro activation, growth and maturation of primordial follicle and artificial ovary.
Do techniques of surgical management of ovarian endometrioma affect ovarian reserve? A narrative review
Published in Journal of Obstetrics and Gynaecology, 2022
Konstantinos Samartzis, Nikolaos Kathopoulis, Dimitris Loutradis, Athanasios Protopapas
AMH plays a pivotal role in ovarian physiology being expressed by the granulosa cells of active growing follicles from initial recruitment to cyclic selection and negatively regulates the primordial follicle recruitment (Oh et al. 2019). AMH level represents a reliable and useful marker of ovarian reserve as supported by its steady decline with increasing age and its undetectable concentration in perimenopause (Seifer et al. 2011). General consensus is that women with endometrioma have decreased serum AMH levels as compared with healthy controls and experience a progressive decline in serum AMH levels faster than that in healthy women (Kasapoglu et al. 2018). Endometrioma can affect ovarian reserve mechanically, by compression of surrounding ovarian cortex from the cyst, hampering vascular circulation and thus leading to follicle loss (Kasapoglu et al. 2018). Additionally, endometriosis-associated inflammatory reaction and increased tissue oxidative stress lead to fibrosis, followed by follicular damage and intraovarian vascular injury (RCOG 2018). Hence, it is reasonable that serum AMH level is significantly lower in patients with bilateral endometrioma compared to that of patients with unilateral endometrioma (Nieweglowska et al. 2015).
Toxic effects and molecular mechanism of doxorubicin on different organs – an update
Published in Toxin Reviews, 2022
Kaviyarasi Renu, Lakshmi Prasanna Pureti, Balachandar Vellingiri, Abilash Valsala Gopalakrishnan
Structural abnormalities in female Wistar albino rats treated with doxorubicin with 3 mg/kg and 6 mg/kg. Various parameters, such as weight of ovaries, uterus was found to be decreased in a dose-dependent manner, elevated chromosomal abnormalities, the formation of micronuclei, and abnormalities in the morphology of mammary glands were observed after 24 h of the doxorubicin administration. Also, a reduced number of the estrous cycles, the diestrus phase, was found at a high dosage assessed after 28 days of doxorubicin administration (Nishi et al.2018). The diameter of the uterus and the thickness of the endometrium, myometrium, was decreased, which implicates fertility problems associated with endometrial receptivity (Richter et al.2007). Immature ICR female mice administered with 7.5 mg/kg doxorubicin mixed with saline via an intraperitoneal route of administration showed that the size of primary, secondary, primordial, and antral follicles was found to be reduced. The vascularity, thickness, and hyalinization of the ovarian cortex have increased. Shrinkage of the ovary characterized by the pre-ovarian edema has occurred due to the leakage of fluids into the peritoneal space (in humans) or bursal sac (in rodents) from the ovarian tissue (Ben-Aharon et al.2010). All these changes indicate that the doxorubicin-induced ovarian toxicity is via activation and release of apoptosis-inducing factors from the mitochondria into the cytosol through the damaged mitochondrial membrane (Zhang et al.2017a).