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Endocrine Disorders, Contraception, and Hormone Therapy during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Nonmalignant abnormalities, especially adenosis, are common among the daughters of pregnant women who were treated with diethylstilbestrol. Gross structural abnormalities of the cervix or vagina are identified in about one quarter and abnormalities of the vaginal epithelium in one-third to one-half of women whose mothers took diethylstilbestrol during gestation (Bibbo, 1979; Herbst et al., 1978; Robboy et al., 1984; Stillman, 1982). T-shaped uterus, constricting bands of the uterine cavity, uterine hypoplasia, or paraovarian cysts also occur with increased frequency among females exposed in utero (Kaufman et al., 1984). Among males exposed to DES in utero, epididymal cysts, hypoplastic testes, and cryptorchidism are reported with increased frequency (Stillman, 1982). Preterm delivery, spontaneous abortions, and ectopic pregnancy occurred with increased frequency in females whose mothers took diethylstilbestrol during gestation (Barnes et al., 1980; Herbst, 1981).
Effects on Female Offspring and Mothers After Exposure to Diethylstilbestrol
Published in Takao Mori, Hiroshi Nagasawa, Toxicity of Hormones in Perinatal Life, 2020
J. Rotmensch, K. Frey, A. L. Herbst
Structural changes of the female upper and lower genital tract have been seen in patients with in utero DES exposure (Figures 7 and 8). In 20 to 50% of DES-exposed females, transverse ridges, cervical collars, hoods, coxcombs, hypoplastic cervixes, and pseudopolyps have been described.25,27 Kaufman et al. reported on 267 exposed women who underwent hysterosalpingograms, 69% of which demonstrated some abnormality.26 The most frequently observed abnormalities were T-shaped uterus, small uterine cavity, and constriction rings. These upper genital tract abnormalities have not been confined to the uterine cavity; fallopian tube anomalies have also been described. At laparoscopy for infertility evaluation, DES-exposed females have been reported to have foreshortened tubes with pinpoint ostia and withered fimbriae, but these changes have not been commonly observed in DES-exposed women.28 Over time, some of the cervico-vaginal abnormalities have also regressed or disappeared.29,30 It has been reported that in 53% of patients with vaginal ridges there has been a decrease or disappearance of the abnormalities29 (Table 2).
Uterine Anomalies and Recurrent Pregnancy Loss
Published in Howard J.A. Carp, Recurrent Pregnancy Loss, 2020
Daniel S. Seidman, Mordechai Goldenberg
T-shaped uterus is characterized by an excess of myometrium in the uterine walls giving rise to a subcornual constriction ring which causes dysmorphism and hypoplasia of the uterine cavity [18]. The new classification of uterine anomalies by the European Society of Human Reproduction and Embryology and the European Society for Gynaecological Endoscopy working group of experts [19] introduced a new category defined as dysmorphic uterus. Dysmorphic uterus incorporates all cases with a normal uterine outline but with an abnormal shape of the uterine cavity excluding septa. Class U1a or T-shaped uterus is characterized by a narrow uterine cavity due to thickened lateral walls with a correlation 2/3 uterine corpus and 1/3 cervix. Class U1b, or uterus infantilis, is characterized by a narrow uterine cavity without lateral wall thickening and an inverse correlation of 1/3 uterine body and 2/3 cervix. Class U1c, or others, was added to include all minor deformities of the uterine cavity including those with an inner indentation at the fundal midline level of <50% of the uterine wall thickness [20]. In the ASRM classification, these anomalies are included in Class VII and are mainly related to in utero diethylstilbestrol (DES) exposure [3]. However, dysmorphic uteri are also found in RPL without DES exposure [20,21].
“One-stop shop” for the evaluation of the infertile patient: hystero-salpingo foam sonography combined with two and three dimensional ultrasound and sonohysterography
Published in Journal of Obstetrics and Gynaecology, 2022
Michal Zajicek, Eran Kassif, Boaz Weisz, Raz Berkovitz Shperling, Shlomo Lipitz, Tal Weissbach, Eran Barzilay, Raoul Orvieto, Jigal Haas
According to the classification published in 2013 by the European Society of Human Reproduction and Embryology/European Society for Gynaecological Endoscopy (ESHRE/ESGE), Dysmorphic uterus (class U1) is a uterus with normal uterine outline and an abnormal shape of the uterine cavity, excluding the septate uterus. This include t-shaped uterus (U1a), defined subjectively by a narrow uterine cavity due to thickened lateral walls with a correlation of 2/3 uterine corpus vs. 1/3 cervix, and uterus infantilis (U1b), characterised by a narrow uterine cavity without lateral wall thickening and an inverse correlation of 1/3 uterine body vs. 2/3 cervix (Grimbizis et al. 2013). Uterine dysmorphism was previously included in class VII, or diethylstilbestrol (DES) drug related müllerian anomalies, of the American Fertility Society (ASRM) classification (1988). It had been suggested that DES exposure in utero was associated with primary infertility, but a meta-analysis did not find a difference in pregnancy rates between DES-exposed women and controls (Goldberg and Falcone 1999). The use of DES is prohibited in pregnancy for more than 40 years and none of the women who were exposed to DES in utero are of reproductive age. In the post-DES era, dysmorphic uteri are rare and can be of primary origin or secondary to adenomyosis, intra-uterine adhesions or Tuberculosis. The clinical implication of dysmorphic uterus in women who were not exposed to DES is not clear.
Hysteroscopy and female infertility: a fresh look to a busy corner
Published in Human Fertility, 2022
Georgi Stamenov Stamenov, Salvatore Giovanni Vitale, Luigi Della Corte, George Angelos Vilos, Dimitar Angelov Parvanov, Dragomira Nikolaeva Nikolova, Rumiana Rumenova Ganeva, Sergio Haimovich
Infertility is estimated to affect 9% of all reproductive-aged couples, and female factors are responsible for 20–35% of all infertility cases (Boivin et al., 2007). Hysteroscopy is a valuable tool and is currently considered the “gold standard” approach in assessing the uterine cavity for diagnosis and treatment of female infertility (Bettocchi et al., 2004). Pathologies identified during hysteroscopy in infertile women include chronic endometritis, endometrial polyps, submucosal myomas, intrauterine adhesions, adenomyosis, thin endometrium, endometrial hyperplasia and/or cancer and uterine malformations such as the uterine septum, T-shaped uterus, arcuate uterus and unicornuate uterus (Practice Committee of American Society for Reproductive Medicine, 2012a).