Valeria Polli

The role of leiomyomas in infertility

STUDY OBJECTIVE To assess the role of leiomyomas and their surgical removal on pregnancy rates. DESIGN (Canadian Task Force classification II-1). Setting. Academic center. PATIENTS Two hundred twelve women who were investigated for infertility. INTERVENTION Laparoscopic myomectomy. MEASUREMENTS AND MAIN RESULTS Patients were divided according to case control criteria as those who underwent laparoscopic removal of myomas (106) and those who did not (106); both groups were compared with 106 women with unexplained infertility without myomas. Of the 318 women, 83 (26%) became pregnant and delivered live infants. The 44 (42%) who underwent surgical removal of leiomyomas had higher delivery rates than 12 (11%) who did not undergo surgery (p <0.001) and 27 (25%) who did not have myomas (p <0.001). Patients whose myomas were not surgically treated had fewer deliveries than women who did not have myomas (12 vs 27, p <0.002). Fifteen women had spontaneous abortions before week 12: 3 (3%) who had surgery, 10 (9%) who did not have surgery, and 2 (2%) who did not have myomas. CONCLUSION Laparoscopic myomectomy improved pregnancy rates over nonsurgical management of myomas.

Adhesion formation after laparoscopic myomectomy

STUDY OBJECTIVE To determine the frequency of adhesion formation after myomectomy performed by operative laparoscopy or laparotomy. DESIGN Case-control study. Setting. Academic womens hospital. PATIENTS Thirty-two premenopausal women scheduled for myomectomy by one of two techniques. INTERVENTIONS Surgical removal of myomata. MEASUREMENTS AND MAIN RESULTS Of the 32 women, 16 underwent laparotomy and 16 laparoscopy. Second-look laparoscopy was performed in 28 patients, at which time adhesions were lysed. Compared with laparotomy, laparoscopy resulted in adhesions in significantly fewer patients, and in significantly lower scores when adhesions were detected. CONCLUSION Laparoscopic removal of uterine myomata is associated with fewer adhesions than removal by laparotomy.

Characteristics of uterine contractility during menses in women with mild to moderate endometriosis

OBJECTIVE To establish the role of uterine contractions in retrograde menstruation with subsequent abdominal implantation of endometrial tissue. DESIGN Controlled prospective study. SETTING University hospital-based study. PATIENT(S) Infertile women with (n = 22) and without (n = 22) endometriosis. MAIN OUTCOME MEASURE(S) Frequency, amplitude, and basal pressure tone of uterine contractions; correlation of contractions with retrograde bleeding and presence of viable endometrial cells; and dysmenorrhea before and 3 and 24 months after surgery. RESULT(S) Compared with controls, patients with endometriosis had uterine contractions with higher frequency (22.73 +/- 5.66 osc/10 min vs. 11.09 +/- 3.26 osc/10 min), amplitude (20.83 +/- 3.94 mm Hg vs. 6.77 +/- 2.83 mm Hg), and basal pressure tone (50.14 +/- 16.30 mm Hg vs. 24.68 +/- 6.14 mm Hg). Dysmenorrhea was scored as 4.09 +/- 1.44 in patients with endometriosis and 0.86 +/- 1.42 in controls. Retrograde bleeding was found in 73% of patients with endometriosis vs. 9% of controls, and only 45% of patients with endometriosis had viable endometrial cells in the cul-de-sac. CONCLUSION(S) Endometriosis may result from abnormal myometrial contractility through tubal transportation, dissemination, and implantation of endometrial viable cells into the abdomen.

Myomas, Pregnancy Outcome, and In Vitro Fertilization

Abstract: Uterine fibroids have been reported in 27% of infertile women, and 50% of women with unexplained infertility become pregnant after myomectomy. The age at which a first pregnancy occurs is increasing from the thirties to the forties. This increase and the recurrence rate of leiomyomas from 15 to 30% points to the effect of myomas on the infertility. Mechanisms by which myomas may cause infertility are abnormal uterine contractility, elongation of the uterine cavity, and distortion of uterine vascularization. Surgery may have beneficial or adverse effects without clear data on its effect on the assisted reproductive technology (ART) procedures. The present study was undertaken to establish the impact of surgical removal of myomas on fertility and infertility of patients undergoing ART procedures. Patients who underwent surgical removal of myomas before in vitro fertilization (Group A) had a cumulative success rate of 33% for one to three procedures (28 clinical pregnancies in 84 patients) and delivery rate of 25% (21 live births in 84 patients). Patients who underwent in vitro fertilization without previous surgery (Group B) had a 15% clinical pregnancy rate (13 pregnancies in 84 patients) (P < 0.05) and 12% delivery rate (10 deliveries in 84 pregnancies) (P < 0.05). Abortion rates were 7% (8 deliveries in 84 patients) and 4% (3 deliveries in 84 patients) in Groups A and B, respectively. This study confirms the beneficial effect of surgical removal of fibroids before undergoing ART procedures.

The patterns of uterine contractility in normal menstruating women: From physiology to pathology

Abstract: The nonpregnant uterus shows uterine activity throughout the menstrual cycle. This uterine activity was detected both by single strep tissue and by using intrauterine pressure recordings in vitro and in vivo. Today, ultrasound has made it possible to study this activity with a noninvasive approach and to assess uterine contractions (UCs) in real‐time movements of the uterus. Throughout the menstrual cycle, wavelike activity patterns of the reproductive organ were established. These patterns are under control of steroid hormones. Adequate UCs may provide for gamete/embryo transportation throughout the uterotubal cavities and successful embryo implantation in spontaneous and/or assisted reproduction. Inadequate UCs may produce ectopic pregnancy, miscarriages, retrograde bleeding with dysmenorrhea, and endometriosis.

Vaginal Drug Delivery: The First Uterine Pass Effecta

In the past few years targeted drug delivery has been one of the prime objectives of pharmaceutical developers, who wish to maximize desired effects on a “target organ” while minimizing any adverse consequences linked to systemic activity. Recently, numerous independent investigators have reported higher accumulations of drugs in the uterus when they were administered vaginally. Higher concentrations were observed in the uterus even when levels in the blood were lower than those achieved by systemic administration (i.m., transdermal). Similar findings have been reported with substances other than progesterone, such as danazol’ and terbutaline.2 These observations support the hypothesis that there is a high degree of direct vagina-to-uterus transport or a “first uterine pass effect.” To test this hypothesis we used a human ex vivo uterine perfusion and we applied 3H-progesterone directly over the rim of vaginal tissue removed with the uterus at the time of surgery.

Transforming growth factor-β1 in the human endometrium

Transforming growth factor-β 1 (TGF-β1) is a polypeptide involved in a variety of important physiological and pathophysiological processes such as the implantation of the embryo into the endometrium. Many factors seem to be related to this event. TGF-β1 is involved in many mechanisms both in endometrial and in embryonic tissues: it induces proliferation and differentiation, it regulates proteolytic activity and it modulates the maternal immune response. Tins study evaluated the presence of TGF-β1 in the endometrium during normal menstrual cycles and in the uterine fluids during induction of ovulation in the framework of an in vitro fertilization program. Immuno-histochemistry was used to identify TGF-β1 in the endometrium and immunodot-blot to auantitate TGF-β1 in the uterine cavity fluid. The study shows that TGF-β1 is present in the endometrial tissue and its secretion is modulated during the menstrual cycle, as demonstrated immunohistochemically; its production seems to be controlled by ovarian steroid...

Financial impact in the Italian Health Service of laparoscopic versus laparotomic surgery for the treatment of ovarian cysts

To assess the cost of two procedures for the removal of ovarian cysts, 200 pre-menopausal women were recruited for the surgical removal of ovarian cysts by laparoscopy (n = 100) and laparotomy (n = 100) according to case-control criteria. Patients operated by laparoscopy (mean age +/- SD 32.22 +/- 9.98 years) and laparotomy (mean age +/- SD 29.57 +/- 6.62 years) for ovarian cysts (mean diameters +/- SD 4.98 +/- 3.62 and 4.83 +/- 2.78 cm) had a post-surgical hospital stay of 3.12 +/- 0.41 and 7.25 +/- 1.08 days (P < 0.001) respectively. The total rate of complications occurring in patients operated by laparoscopy was 9 versus 53% (P < 0.001) of those operated by laparotomy; body temperature > 38 degrees C was recorded in 52/100 of patients operated by laparotomy versus 6/100 of those operated by laparoscopy. The mean cost for each pure surgical treatment performed by laparoscopy was US

Influence of ovarian stimulation for IVF/ICSI on the antioxidant defence system and relationship to outcome.

498.17 versus US

Basement Membrane in Human Endometrium: Possible Role of Proteolytic Enzymes in Developing Hyperplasia and Carcinoma

642.47 when it was performed by laparotomy (P < 0.001). The laparoscopic surgical approach is more expensive in the first 36 operations, thereafter becoming cheaper. The mean of the entire overall expenditure was US