UTERUS AND INFERTILITY
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THIS SLIDE SET SHOWS CURRENT STATUS OF IMAGING IN 2019 AND EXPECT MANY MORE IN NEXT 5 YEARS WITH ARTIFICIAL INTELLIGENCE
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UTERUS AND INFERTILITY
- 1. Uterus in infertility DR G A RAMA RAJU
- 5. Evaluation: Uterine volume Myometrial architecture Junctional zone Endometrium cavity Endometrial architecture
- 11. Diagrammatic representation of uterine and placental vasculature
- 12. Diagrammatic representation of uterine and placental vasculature
- 13. Abnormal uterus Endometrial lining polyps Adhesions fibroids Adenomyosis Size and Shape # Absence of development absence of fusion Abnormal resorption Uterine Vascularization Doppler perfusion studies Normal uterus Junctional zone scar of csection Uterine Transplant current role issues surrogacy good the bad and ugly
- 14. Abnormal uterus Endometrial lining polyps Adhesions fibroids Adenomyosis Size and Shape #Absence of development Uterine Vascularization Normal uterus Uterine Transplant surrogacy
- 18. POLYPS
- 19. Mechanical Inflamatory Endocrine • receptor • IGFBP1 Cellular changes • apoptosis • proliferation Chromosomal abnormalities POLYP
- 22. ADHESION
- 24. Adenomyosis AND JUNCTIONAL ZONE
- 26. ADENOMYOMA
- 28. T2-weighted MRI. (a–h) T2-weighted MRI for Cases 1–8, respectively. Adenomyosis was diagnosed by the presence of either diffuse or focal thickening of the inner myometrium or an ill- defined myometrial nodule of low signal intensity on T2-weighted MRI. Multiple signal-hyperintense spots, representing ectopic endometrial tissue or micro-hemorrhage inside adenomyosis, were detected in Cases 1–3, 5 and 8, consistent with TAT elevation in these cases. In Cases 2, 3 and 5, signal-hyperintense spots were clear and numerous, levels of DD were elevated, and thrombotic disorders and menorrhagia were identified. Dysfunctional coagulation and fibrinolysis systems due to adenomyosis is a possible cause of thrombosis and menorrhagia Yamanaka, Akiyoshi, European Journal of Obstetrics & Gynecology and Reproductive Biology, Volume 204, 99-103 Copyright © 2016 Elsevier Ireland Ltd 3d will replace MRI
- 29. Fertility-Sparing Surgery for Focal and Diffuse Adenomyosis GNRH SURGERY
- 30. Schematic images of the adenomyomectomy procedure. (A) Uterine body viewed from above. (B) Saggital incision of the uterus; yellow areas in the myometrium are the adenomyoma tissues. (C) Coronal section. (D–G) Adenomyosis resection steps. (H) Suturing and repair of the uterus without entering the endometrial cavity. Treatment of adenomyomectomy in women with severe uterine adenomyosis using a novel technique Saremi, AboTaleb, Reproductive BioMedicine Online, Volume 28, Issue 6, 753-760 Copyright © 2014 Reproductive Healthcare Ltd.
- 32. FIBROID MAPPING
- 33. FIBROID MAPPING
- 34. FIGO classification system (PALM-COEIN) for causes of abnormal uterine bleeding in nongravid women of reproductive age Munro, Malcolm G., International Journal of Gynecology & Obstetrics, Volume 113, Issue 1, 3-13 Copyright © 2011
- 36. ROLE OF MYOMECTOMY The Effect of Intramural Myomas Without an Intracavity Component on in Vitro Fertilization Outcomes in Single Fresh Blastocyst Transfer
- 37. ENDOMETRITIS
- 38. How uterine microbiota a receptive, fertile endometrium MICRO POLPOSIS STRAW BERRY APPEARANCE
- 39. Abnormal uterus Endometrial lining polyps Adhesions fibroids Adenomyosis Size and Shape # Absence of development absence of fusion Abnormal resorption Uterine Vascularization Doppler perfusion studies Normal uterus Junctional zone scar of csection Uterine Transplant current role issues surrogacy good the bad and ugly
- 40. Size and Shape # Absence of development absence of fusion Abnormal resorption
- 42. MULLERIAN AGENESIS : FERTILITY OUR PUBLICATION 2006
- 44. Uterine peristalsis and fertility: current knowledge and future perspectives: a review and meta-analysis
- 45. KRISHNAIVF AND SAMSUNG KOREA WORK TOGETHER
- 46. Pregnancy outcomes of women with a congenital unicornuate uterus after IVF–embryo transfer
- 47. partial
- 48. Full septum
- 49. To do or not to do ?
- 50. Abnormal uterus Size and Shape # Uterine Vascularization Doppler perfusion studies Normal uterus Uterine Transplant surrogacy
- 52. Diagrammatic representation of uterine and placental vasculature
- 53. Diagrammatic representation of uterine and placental vasculature
- 55. AV MALFORMATAION
- 56. AV MALFORMATAION
- 57. DOPPLER
- 58. Abnormal uterus Size and Shape # Uterine Vascularization Normal uterus Junctional zone Scar of lscs Uterine Transplant surrogacy
- 60. Junctional zone
- 61. KRISHNA IVF WORKs WITH SAMSUNG
- 65. JUNCTIONAL ZONE IN PREGNANAT AND NON PREGNANT
- 66. JUNCTIONAL ZONE RAISE THROUGH OUT THE CYCLE Raises in ivf the cycle Different rate of raise in conception and non conception cycle
- 68. C SECTION SCAR :A CAUSE FOR INFERTILITY
- 71. Prerequisites for transplantation •Women who are born without a uterus (Rokitansky syndrome) •Women who are born with a deformed uterus, where surgery has not helped •Women who have been forced to have their uterus extracted (hysterectomy) because of for example cancer, myoma or life- threatening bleeding during childbearing •Women who have muscle tumors in their uterus (myoma), where an operation (myomectomy) has not helped •Women who have severe adhesions in the uterus
- 72. Professor Mats Brännström, University of Gothenburg /Sahlgrenska University Hospital.
- 73. Professor Mats Brännström, University of Gothenburg, talks about the world´s first child born after uterus transplantation. The successful birth is the result of more than 15 years of research.
- 74. The well-known research on uterine transplantation in Gothenburg is now supported by robotic surgery. This change has made operating on the donors considerably less invasive. After the technical modification, a first woman is now pregnant
- 77. STATUS OF LAW • MARCH 22 2018
- 78. To summarise D AND C IVF Surrogacy Uterine transplant
- 79. Thank you For the opportunity
- 83. PERFUSION DEFECTS IMPLICATED IN INFERTILITY
- 85. Effect of fibroids not distorting the endometrial cavity on the outcome of in vitro fertilization treatment: a retrospective cohort study Yan, Lei, M.D., Fertility and Sterility, Volume 101, Issue 3, 716- 721.e6
Editor's Notes
- , either or due to reduced endometrial receptivity, are the basis of uterine causes of infertility
- Diagrammatic representation of uterine and placental vasculature (red shading = arterial; blue shading = venous) in the non-pregnant, pregnant and immediate post-partum state. Normal pregnancy is characterized by the formation of large arterio-venous shunts that persist in the immediate post-partum period. By contrast pregnancies complicated by severe preeclampsia are characterized by minimal arterio-venous shunts, and thus narrower uterine arteries. Extravillous cytotrophoblast invasion in normal pregnancy (diamonds) extends beyond the decidua into the inner myometrium resulting in the formation of funnels at the discharging tips of the spiral arteries. Contrast with severe preeclampsia. (Prepared by Ms. Leslie Proctor, MSc.) Rheological and Physiological Consequences of Conversion of the Maternal Spiral Arteries for Uteroplacental Blood Flow during Human Pregnancy Burton, G.J., Placenta, Volume 30, Issue 6, 473-482 Copyright © 2009 Elsevier Ltd
- Ectopic endometrial glands and stroma present in the myometrium are seen as cyst/anechoic lacunae (f1), hyperintense foci of endometrial glands (f2), and irregular endometrial outline (f3), with linear striations and buds (g1). Adjacent myometrial hypertrophy is seen as an irregular myometrial mass with ill-defined borders (c1, d1, and e1), often with fan-shaped shading (d2) and globular (A) or asymmetrical uterus (B). Adenomyosis is characterized by diffusely spread vessels inside the lesions (e1) by Doppler, whereas circular flow along the pseudocapsule indicates leiomyomas. Structured imaging technique in the gynecologic office for the diagnosis of abnormal uterine bleeding Dueholm, Margit, MD, PhD, Best Practice & Research: Clinical Obstetrics & Gynaecology, Volume 40, 23-43
- Figure 3 Potential mechanism of direct action of GnRHa on adenomyotic lesions. GnRH agonist (GnRHa) decreases leading to an overexpression of aromatase cytochrome P450 (Kitawaki et al., 1997, 1999; Ishihara et al., 2003). Decreased enzymes involved in the synthesis of reactive oxygen species induce nitric oxide (NO) overexpression and oxidative stress through the generation of peroxynitrite (Ota et al., 1999, 2000, 2001a, b, 2002). GnRHa enhances the apoptosis index (Raga et al., 1998; Wang et al., 2002; Meresman et al., 2003; Ueki et al., 2004; Bilotas et al., 2007) and decreases the secretion of interleukin (IL)-1 and VEGF (Wu et al., 2009). GnRHa reduces the inflammatory reaction and suppresses cellular proliferation in adenomyotic tissue (Khan et al., 2010a, b). GnRHa induces the expression of the inhibitory Smad7, with a potential interruption of TGF-β receptor signaling mediated in the endometrium (Luo et al., 2003).
- Classification system including leiomyoma subclassification system. The system that includes the tertiary classification of leiomyomas categorizes the submucosal (SM) group according to the Wamsteker et al. system [31 ] and adds categorizations for intramural, subserosal, and transmural lesions. Intracavitary lesions are attached to the endometrium by a narrow stalk and are classified as type 0, whereas types 1 and 2 require a portion of the lesion to be intramural—with type 1 being less than 50% and type 2 at least 50%. The type 3 lesions are totally extracavitary but abut the endometrium. Type 4 lesions are intramural leiomyomas that are entirely within the myometrium, with no extension to the endometrial surface or to the serosa. Subserosal (types 5–7) leiomyomas represent the mirror image of the submucosal leiomyomas—with type 5 being at least 50% intramural, type 6 being less than 50% intramural, and Type 7 being attached to the serosa by a stalk. Classification of lesions that are transmural would be categorized by their relationship to both the endometrial and the serosal surfaces. The endometrial relationship would be noted first, with the serosal relationship second (e.g. 2-3). An additional category, Type 8, is reserved for leiomyomas that do not relate to the myometrium at all, and would include cervical lesions, those that exist in the round or broad ligaments without direct attachment to the uterus, and other so-called “parasitic” lesions. Adapted, with permission, from Ref. [11 ].
- Figure 2 Treatment of uterine intramural fibroids before attempting assisted reproduction technology (ART). Although the evidence is not strong, there is a common trend to remove fibroids ≥4 cm if they protrude on the serosal surface. Only stages 3–6 of the FIGO classification can fit these requirements (Munro et al., 2011). Whether laparoscopy (LPS) or laparotomy is performed depends on the total number of fibroids and the surgeon's skills, but LPS is initially recommended. New medical therapies that target estrogen receptor alpha (ER-α), progesterone (PR) or GnRH (GR) receptors and block the transforming growth factor (TGF)-β pathway may provide a non-invasive approach to reduce size and increase ART outcomes in the future. SPRM, selective progesterone receptor modulator.
- Embryology of the uterus. A: Müllerian (red) and Wolffian (green) ducts. B: Müllerian ducts fuse, Wolffian ducts regress. C: fused Müllerian ducts form the subendometrial myometrium (stratum subvasculare) and endometrium, Wolffian ducts have disappeared. D: Stratum vasculare and stratum supravasculare are formed. ( Noe et al., 1999 ) (See Supplementary Video S1 .).
- Diagrammatic representation of uterine and placental vasculature (red shading = arterial; blue shading = venous) in the non-pregnant, pregnant and immediate post-partum state. Normal pregnancy is characterized by the formation of large arterio-venous shunts that persist in the immediate post-partum period. By contrast pregnancies complicated by severe preeclampsia are characterized by minimal arterio-venous shunts, and thus narrower uterine arteries. Extravillous cytotrophoblast invasion in normal pregnancy (diamonds) extends beyond the decidua into the inner myometrium resulting in the formation of funnels at the discharging tips of the spiral arteries. Contrast with severe preeclampsia. (Prepared by Ms. Leslie Proctor, MSc.) Rheological and Physiological Consequences of Conversion of the Maternal Spiral Arteries for Uteroplacental Blood Flow during Human Pregnancy Burton, G.J., Placenta, Volume 30, Issue 6, 473-482 Copyright © 2009 Elsevier Ltd
- Schematic diagram of fibroids subclassification system. This figure shows the fibroid subclassification system that is adapted from Munro et al. (10) . All patients with tumors inside the endometrial cavity or causing intracavitary distortion were termed submucosal (SM). Lesions not distorting the cavity but residing within the myometrium were labeled intramural (IM). Those extending predominantly outside the myometrium were termed subserosal (SS). SM includes type 0, 1, and 2. Fibroids that are attached to the endometrium by a narrow stalk are classified as type 0, whereas types 1 and 2 require a portion of the lesion to be IM—with type 1 being less than 50% and type 2 at least 50%. IM includes types 3, 4, and 5. Type 3 lesions are totally extracavitary but abut the endometrium. Type 4 lesions are entirely within the myometrium, with no extension to the endometrial surface or to the serosa. We include type 5, which is at least 50% IM, in the IM subgroup. SS includes types 6 and 7. Type 6 is less than 50% IM, and type 7 is attached to the serosa by a stalk.