Table of Content

15 May 2017, Volume 36 Issue 3
Previous Issue    Next Issue

---

For Selected:

Download Citations EndNote Ris BibTeX

Toggle Thumbnails

Select

Cervical Cerclage after Cervical Conisation and Radical Trachelectomy XIA En-lan 2017, 36 (3):  181-184.  Abstract ( 1838 )   PDF (745KB) ( 8817 )   Cervical intraepithelial neoplasia treated by partial resection of cervix can effectively reduce the incidence of cervical invasive carcinoma. Early cervical carcinoma treated by radical trachelectomy can significantly reduce the mortality of cervical invasive carcinoma. However, these two types of operation are likely to lead to cervical insufficiency after surgery. Partial resection of cervix reduces the cervical supporting capacity due to the removed cervical tissue, which results in late abortion and premature delivery, and influences the reproductive outcome. Cervical cerclage can prolong the cervical length, and reduce the rates of premature delivery and midtrimester abortion. Therefore, the patients with fertility requirements need the preventive or therapeutic cervical cerclage. In order to prevent the cervical insufficiency caused by the radical trachelectomy, permanent cervical cerclage was performed with non-absorbable suture routinely. However, the second-trimester miscarriage or premature delivery is still encountered after surgery. Trachelorraphy is a safe, repeatable and easy to perform operation, to prevent the failed cervical cerclage. It is benefit to improve reproductive outcome for those women with the cervical insufficiency related to radical trachelectomy. Related Articles | Metrics

Select

The Application of Transvaginal Hydrolaparoscopy in Reproductive Medicine ZHANG Xin-yu, MA Cai-hong 2017, 36 (3):  185-188.  Abstract ( 1702 )   PDF (738KB) ( 8751 )   Transvaginal laparoscopy, one of the natural orifice transluminal endoscopic surgeries, can be used to discover and treat abnormal lesion in female pelvis. For infertile patients，transvaginal laparoscopy, especially transvaginal hydrolaparoscopy (THL), has been described as a more sensitive and minimally invasive technique to detect subtle lesions and causes of infertility. It was found that the curative effect and postoperative complication of THL are similar to laparoscopy. However, the incidences of adhesion and pain are much lower, the postoperative recovery is quicker, when compared with laparoscopy. THL was mainly used for the pelvic examination to detect the cause of infertility， pelvic adhesiolysis, treatment of endometriosis and hydrotubation. Ovarian drilling by THL could be a minimally invasive choice to treat polycystic ovary syndrome, which reduce LH level and improve metabolic syndrome, and achieve 30% of natural conception rate. This article focuses on the application and research progress of THL in the infertility diagnosis and treatment. Related Articles | Metrics

Select

Polycystic Ovarian Syndrome and Laparoscopic Ovarian Drilling TC Li, ZHAO Yu-ting 2017, 36 (3):  189-194.  Abstract ( 1702 )   PDF (822KB) ( 8845 )   Polycystic ovarian syndrome is a common endocrine disorder, and the most common cause of anovulatory infertility. In women presenting with anovulation associated with PCOS, clomifene citrate is the standard first line treatment for induction of ovulation. With the development of operative laparoscopy, laparoscopic ovarian drilling (LOD) is wildly used in treatment of anovulation. Patient，who is CC-resistance, can be offered LOD as the preferred second line treatment for ovulation induction. It is important to note that the puncture needle is applied to the ovary at right angle. The ovary is then ample irrigated to minimize adhesion formation. Most of the patients who underwent LOD, the ovarian function, menstruation and endocrine is improved significantly. The study found that marked obesity, marked hyperandrogenism and long duration of infertility seemed to predict resistance to LOD. High preoperative luteinizing hormone concentration in women who ovulated after LOD predict higher probability of pregnancy. LOD appears to offer several advantages over gonadotrophin therapy, like avoiding multiple pregnancies and ovarian hyper-stimulation syndrome. Related Articles | Metrics

Select

Evaluation of Tubal Mucosal Status Using Hysteroscopy in Patients with Hydrosalpinx ZHOU Qiao-yun，HUANG Xiao-wu 2017, 36 (3):  195-198.  Abstract ( 1439 )   PDF (725KB) ( 8872 )   Objective：To evaluate the tubal mucosal status using hysteroscopy as a succedaneum of salpingoscopy in those patients with hydrosalpinx. Methods：A total of 64 infertility patients who underwent laparoscopic tubal anaplasty due to unilateral or bilateral tubal hydrosalpinx were recruited between January 2013 to December 2015. Hysteroscopy was used as a succedaneum of salpingoscopy to evaluate the mucosa of the tubal ampulla, while the r-AFS staging system was also used. The patients were followed up for 6 to 42 months after surgery. Four cases were lost in follow-up. Results：Among the 60 patients, 18 cases got natural intrauterine pregnancy. Among them, 16 cases were classified as grade Ⅰ, with the pregnancy rate 66.7% (16/24); 2 cases were classified as grade Ⅱ, with the pregnancy rate 12.5% (2/16). There was a significant difference in the rate of natural intrauterine pregnancy between the grade Ⅰgroup and  the grade Ⅱgroup (P=0.003). There were 8, 4 and 6 patients who got their natural intrauterine pregnancy in the r-AFS′s grade Ⅰ, Ⅱ and Ⅲ group, respectively. There is no correlation between the rate of natural intrauterine pregnancy and the r-AFS′s score ( χ2=1.905, P=0.442). Conclusions：There is a significant correlation between the score evaluated by hysteroscopy as a succedaneum of salpingoscopy with the pregnancy outcome, suggesting that this is a alternative clinical method. Related Articles | Metrics

Select

Application of Hysteroscopic Tubal Occlusion in Patients with Hydrosalpinx before in vitro Fertillization and Embryo Transfer XU Wei，WENG Ning，HUANG Xiao-wu，LIU Ji 2017, 36 (3):  199-203.  Abstract ( 1634 )   PDF (830KB) ( 8960 )   Objective：To evaluate the application of hysteroscopic tubal occlusion in those patients with hydrosalpinx before in vitro fertilization and embryo transfer (IVF-ET). Methods：One hundred and seventy two cases of hydrosalpinx were retrospectively analyzed in our hospital from 2015 to 2016. A total of 100 cases were performed hysteroscopic tubal occlusion (the group A) before IVF-ET, with 67 cycles of fresh embryo transfer and 76 cycles of blastocyst embryo transfer. Seventy two cases were performed laparoscopic proximate tubal ligation (as the group B) before IVF-ET, with 72 cycles of fresh embryo transfer and 64 cycles of blstocyst embryo transfer. The operation time, fertilization rate, high quality embryo rate, clinical pregnancy rate and abortion rate were analyzed. Results：The operation time in the group A was less  than that in the group B [(21.18±7.89) min vs (44.56±20.30) min, P＜0.001]. There were no significant differences in the fertilization rate, high quality embryo rate, clinical pregnancy rate，abortion rate and miscarriage rate between the two groups (P＞0.05). Conclusions：The pregnancy outcome in those patients with hydrosalpinx who underwent the hysteroscopic tubal occlusion before IVF-ET was same as that in those laparoscopic proximate tubal ligation. Hysteroscopic tubal occlusion is a simple surgery with the advantages of minimal invasive, short operation time, no need of general anesthesia. and outpatient operation. References | Related Articles | Metrics

Select

Comparative Study on Endometrium Reepithelialization after Surgery of Uterine Septum Using Hysteroscopic Scissors and Resectoscope MA Ning，HUANG Xiao-wu，ZHOU Qiao-yun，YANG Ling-ling，XIA En-lan 2017, 36 (3):  204-207.  Abstract ( 2094 )   PDF (763KB) ( 8959 )   Objective: To evaluate the clinical outcomes of endometrial reepithelialization between hysteroscopic scissors and resectoscope in those patients underwent transcervical resection of septum (TCRS). Methods: This is a randomized controlled study  including 60 women with partial septate uterus, in our center from January 2015 to December 2016. Thirty cases underwent hysteroscopic metroplasty using hysteroscopic scissors (group A) and 30 cases had the procedure using the bipolar electrodes (group B). Main characteristics of the patients and operative parameters (operative time, blood loss, complications) were recorded. The hysteroscopic examination was performed after 1 and 2 months of surgery to evaluate the endometrial healing process including endometrial reepithelialization, intrauterine adhesions and residual suptum. Results: Although the operating time in the group A was significantly faster than that in the group B [(13.90±3.95) min vs. (23.13±5.15) min，P=0.00], there was no significant difference in the blood loss between the 2 groups [(8.67±2.25) mL vs. (8.83±2.15) mL，P=0.77]. There were not any intraoperative complications in two groups, and intrauterine adhesion or residual septum in two months follow-up visit. The poor reepithelialization in the group A was less than that in the group B [16.67% (5/30) vs. 93.33% (28/30), P=0.00], in the 1 month′s visit. However, the endometrium reepithelialization was completely satisfied in two groups after surgery. Conclusions: The endometrial reepithelialization is faster in the scissors group than that in the resectoscope group in the first month after surgery. However, the epithelialization status can be well satisfied in two groups within 2 months. Related Articles | Metrics

Select

Hysteroscopy Prior to the Assisted Reproductive Technology：A Review HUANG Rui，HUANG Xiao-wu 2017, 36 (3):  208-212.  Abstract ( 1729 )   PDF (734KB) ( 9363 )   With the extensive use of assisted reproductive technology (ART), it is more and more important to evaluate routinely the uterine cavity by hysteroscopy before the in vitro fertilization-embryo transfer (IVF-ET) cycle, particularly in those patients with repeated implantation failure (RIF). It has been confirmed that hysteroscopy in examination and treatment can improve the clinical outcomes of IVF-ET. The incidence of intrauterine abnormity is about 10% to 15% , such as polyps, submucous myoma, septum, adhesions and chronic endometritis. Vaginal sonography, hysterosalpingography, and saline infusion sonography can be used to evaluate the uterine cavity, while hysteroscopy examination is the golden standard for the diagnosis of intrauterine pathologies. However, the histological examination is the last standard for the diagnosis of endometritis. Hysteroscopy is also an effective tool for the treatment of intrauterine pathologies. The pregnant rate can be significantly increased in those women underwent hysteroscopic surgery, such as transcervical resection of the endometrial polyps (TCRP), transcervical resection of the myoma (TCRM), transcervical resection of the septum (TCRS), and transcervical resection of the intrauterine adhesions (TCRA). The duration after hysteroscopic surgery, for the IVF-ET treatment, depends on the kind of hysteroscopic surgery, ranged from 1 to 3 months. It is true that hysteroscopy plays an important role in the diagnosis and treatment of infertility. However, it is still under debate whether all of infertile women have a routine hysteroscopy before their IVF-ET treatment. Related Articles | Metrics

Select

Application of Falloposcopy: A Review CHEN Hang, HUANG Xiao-wu 2017, 36 (3):  213-218.  Abstract ( 2263 )   PDF (764KB) ( 10836 )   Falloposcope, a microendoscopy for the inspection of inner side of fallopian tube, can enter into fallopian tube with the guide of hysteroscopy, laparoscopy and fertiloscopy, or without the guide. Not only can falloposcope be used for the examination of tubal patency, including stenosis, obstruction, adhesions, hyperemia, hydrops, polyps, diverticulum, endometriotic lesions and so on, but also used for the biopsy of lesion and the dredge of fallopian tube. Falloposcope can be used to evaluate the function of fallopian tube, correcting the false positive and false negative results of the traditional test. It means that falloposcope can be employed for both diagnosis and treatment. Moreover, the causes of some tubal infertility can be clarified by falloposcope. The in vitro fertilization and embryo transfer (IVF-ET) is preferred for those patients with serious tubal lesions, while surgical treatment can increase the natural pregnancy chance for patients with mild tubal lesions. With the development of reproductive medicine technology and the deep study on fallopian tube, the advantages of falloposcopy have been showed, especially its irreplaceable role in the diagnosis and treatment of tubal disease. This review focuses on the progress of diagnosis and treatment of falloposcopy at home and abroad in recent years，and summarizes the clinical application value of it. Related Articles | Metrics

Select

Uterine Fibroids and Fertility YANG Hai-yan，HUANG Xiao-wu 2017, 36 (3):  219-225.  Abstract ( 1708 )   PDF (875KB) ( 8986 )   Uterine fibroids are the common tumors in women, twenty to thirty percents of reproductive women suffer from uterine fibroids. The prevalence of uterine fibroid in infertile women is about 5%-10%, while fibroids are the only cause of infertility in about 1.0%-2.4% of them. Fibroids can affect female fertility, which depends on the location and size of fibroids. Submucosal fibroids have an detrimental effect on fertility, subserosal fibroids had a little effects, while the effects of intramural myoma are controversial. The effects of uterine fibroids on female fertility are mainly involved to the alteration of local anatomy and function, immune and endocrine factors. Uterine fibroids in reproductive women may cause infertility, spontaneous  abortion, even   premature rupture of membranes, preterm birth and malpresentation. The treatment strategy of uterine fibroids in reproductive women should be comprehensively considered according to the size and location of fibroids, patients′ age, and fertility demand. The common treatments of uterine fibroids include transabdominal or laparoscopic myomectomy, hysteroscopic myomectomy and transvaginal myomectomy. The medicine treatment is usually used as the preoperative treatment in reproductive women. More attention should be paid to the effect of selected treatment strategy on the reproductive outcomes in those women with fertility demand. Related Articles | Metrics

Select

Research Progress of Fertility-Sparing for Early-Stage Cervical Cancer SUN Yu-xin，LIU Kai-jiang 2017, 36 (3):  226-229.  Abstract ( 1464 )   PDF (732KB) ( 8761 )   Many cases of cervical cancer are diagnosed in young woman who wish to preserve their fertility. As more and more women are delaying childbearing, and childbearing policy has been newly regulated in China, fertility preservation has become an important consideration in those patients with cervical cancer. It is an objective of gynecological oncology doctors, and a research hotspot, how to preserve fertility and improve living quality while treat their cancer. Radical trachelectomy (RT) can provide more fertile chance for those young patients with the cervical cancer at early stage. By reviewing literatures, we mainly discussed the selection criteria for fertility-sparing surgery, the specific surgery approach, and the oncological and pregnancy outcomes after fertility-sparing surgery. Related Articles | Metrics

Select

Effect of Endometrial Polyps on Reproductive Outcomes PENG Xue-bing，HUANG Xiao-wu，XIA En-lan 2017, 36 (3):  230-233.  Abstract ( 1468 )   PDF (696KB) ( 8853 )   Endometrial polyp is a common gynecological disease, which is a cause of abnormal uterine bleeding and infertility. Endometrial polyps may be related to enviromental estrogen exposure or chronic inflammatory response. Morbidity of endometrial polyps increased in infertility women. Three-dimensional ultrasound, SIS, hysterosalpingograms (HSG) and hysteroscopy are main diagnostic methods. SIS and hysteroscopy are two effective and reliable methods with higher sensitivity and specificity. Endometrial polyps less than 10 mm in diameter may undergo spontaneous regression. Blind dilation and curettage (D&C) is not recommended. Hysteroscopic polypectomy, as main treatment of conservative surgery with low complications, can improve reproductive outcome of infertility women. It is necessary to have more high-quality randomized controlled trials (RCT) to answer whether the hysteroscopic removal can be used as a conventional therapy in those infertile women with endometrial polyps. Related Articles | Metrics

Select

Hysteroscopic Diagnosis of Chronic Endometritis SONG Dong-mei，HUANG Xiao-wu 2017, 36 (3):  234-237.  Abstract ( 1726 )   PDF (723KB) ( 8801 )   Chronic endometritis was often overlooked because of its nonspecific symptoms. However, it has drawn more and more attention recently because of its influence on female reproductive prognosis, and abnormal uterine bleeding. Clinical features of chronic endometritis under hysteroscopy were as follows: ①focal or diffuse periglandular hyperemia; ②endometrial stromal edema, increased thickness of the endometrium, with whitish color and irregular surface, and out of phase; ③pedunculated micropolyps (less that 1 mm), stromal edema, or micropolyps with focal or diffuse periglandular hyperemia. The accuracy of hysteroscopic diagnosis of chronic endometritis is affected by the media and doctor′s experience. There is a great difference between the hysteroscopic diagnosis and the pathological diagnosis. The value of hysteroscopy in the evaluation of chronic endometritis has been recognized, but it is still controversial whether hysteroscopy can be used as an independent diagnostic criteria for chronic endometritis. The histopathological diagnosis should be advised if chronic endometritis is clinically suspected under hysteroscopy, so as to reduce the influence of the persistent chronic endometritis on female reproductive prognosis. Related Articles | Metrics

Select

Reproductive Problems after Laparoscopic Myomectomy YANG Qing，WANG Dan-dan 2017, 36 (3):  238-241.  Abstract ( 1350 )   PDF (691KB) ( 8794 )   Uterine myoma is the most common benign solid tumor of the genital system in women of reproductive age, which is related to infertility or spontaneous abortion in some women. Recently, laparoscopic myomectomy (LSM) has been the preferred treatment for those patients with fertility demand. However, up to now, there is no uniform conclusion about whether the location，size，number, penetrating endometium of uterine myoma affect the postoperative pregnant outcomes. Many issues, such as the negative influence of pelvic adhesion on fertility after LSM, the appropriate interval duration before pregnancy and the latent risk of utrine rupture during gestation period or labor stages, are still under clinical discussion. Related Articles | Metrics

Select

Ethical Dilemma of Advanced Couples: I Am Born when You Are Old GAO Qian, YANG Kun,ZHANG Yun-shan 2017, 36 (3):  246-250.  Abstract ( 1438 )   PDF (774KB) ( 8796 )   The rapid development of society leads to the change of people′s birth and life concept. Many women are delaying their age of childbearing to pursue educational and career goals, personal pursuit and others. With the full liberalization of two-child policy in China and the wide use of assisted reproductive technology (ART), the desire of the advanced couples to get their children has already been met as far as possible. The social phenomenon of the " I am born when you are old" will be a social concern in the next ten years. However, the implementation of ART for the advanced couples exists the reducing effectiveness, increasing cost, increasing health risks of the mother and the offspring, reducing quality of parents and even the  children′s interests are affected. Therefore, the setting age limit for ART is beneficial to society. It is a tricky problem for reproductive doctors and gynecologists how to face rationally and deal with the fertility require of those advanced couples. Related Articles | Metrics

Select

Proteomic Analysis on Villous Tissues Derived from Pregnant Women of Early Embryo Damage YAO Ting, LIU Guo-zhong, HOU Hai-yan, QIN Zhe, CHEN Juan, LIU Jian, CHEN Ya-qiong 2017, 36 (3):  251-255.  Abstract ( 1299 )   PDF (831KB) ( 8974 )   Objective: The differentially expressed proteins in the villous tissues derived from those women of fetal normal chromosome carly embryo damage(EED) and those women asked abortion with non-medical reasons were analyzed with the proteomic method, so as to search some clues of the pathogenesis of EED. Methods: Ten EED patients with fetal normal chromosome (the EED group) and 5 women who asked abortion with non-medical reasons (the control group) were included in this study. The LC-MS/MS, proteomic technology, was use to detect the protein map of villous tissues. The Maxquant software, Uniprot human reference protein database and DAVID Analysis were used to analyse the differential expression profile of proteins. Results: MS experiments identified 3 950 proteins, and qualified 3 879 proteins. A total of 220 proteins were found to be differently expressed including 162 up-regulated proteins and 58 down-regulated proteins in that profile. These proteins were involved in several biological process, such as immune response, reactive oxygen species metabolic process, angiogenesis and so on. The up-regulated C1R, C3, C4A, C4B and C7 were invoved in the activation of complement system, and the up-regulated TPSO was involved in the metabolism of reactive oxygen species. Conclusions: The differential expression profile of proteins was developed. The excessive activation of complement system, and the imbalance of redox reaction, could be related with the pathogenesis of EED. Related Articles | Metrics

Select

Measurement of Serum Irisin in Patients with Polycystic Ovary Syndrome ZHOU Li, LI Cheng-gang, LI Shuang, LI Xiao, XU Xiao-mei 2017, 36 (3):  256-259.  Abstract ( 1456 )   PDF (747KB) ( 8797 )   Objective: Irisin is a factor related to insulin sensitivity. In this study, the level of serum Irisin was measured in patients with polycystic ovary syndrome (PCOS), and its significance was discussed. Methods: Eighty patients with PCOS  (the PCOS group) and 60 healthy women (the control group) with regular menstrual cycle were included in our center from July 2014 to February 2016. PCOS patients were then divided into two subgroups: obese and non-obese groups, according to the body mass index (BMI). After physical examination, serum lipids, sex hormones and irisin level were measured, and compared between groups. Results: ① The levels of irisin, testosterone (T), luteinizing hormone (LH), total cholesterol (TC), BMI and waist-to-hip ratio (WHR) in the PCOS group were significantly higher than those in the control group, while the levels of high density lipoprotein cholesterol (HDL-c) and Estradiol (E2) were significantly lower (all P＜0.05). In patients with PCOS after excluding other indexes, there was a significant positive correlation between serum irisin level and T or BMI（r=0.476, P＜0.001; r=0.329, P=0.041, respectively）. ②The level of TG in the obese PCOS subgroup was higher than that in the non-obese PCOS subgroup（P=0.028）. However, the level of irisin in the obese PCOS subgroup was slightly higher than that in the non-obese PCOS subgroup, without significant difference（P=0.087）. Conclusions: The level of serum irisin in PCOS patients was significantly increased, and positively correlated with androgen and BMI, suggesting that irisin may be a factor related to PCOS. Related Articles | Metrics

Select

Research Progress on the Evaluation of Ovarian Reserve SU Xian-zhi, SHI Yun 2017, 36 (3):  260-264.  Abstract ( 1387 )   PDF (763KB) ( 8970 )    Ovarian reserve refers to the number and quality of follicles raised in the female ovaries, which reflects the fertility potential of women. Premature ovarian failure (POF) is one of the most important causes of infertility, which is defined as the ovarian dysfunction in women before the age of 40, accompanied by perimenopausal syndrome, infertility, low level of estrogen and high levels of gonadotropins, etc.. If the ovarian reserve can be correctly evaluated in the early stage of POF, and the POF patients can be treated timely, POF can be delayed. The perimenopausal symptoms can be reduced, and the possibility of pregnancy increased. In addition, the early and accurate evaluation of ovarian reserve is essential to forecast the fertility potential and to guide the drug regimen. Recently, there is a dispute over the estimate of ovarian reserve. Most researchers believe that for the limitation of single indicator for the evaluation of ovarian reserve, the multi-indicator combination is often preferred. The article summarizes the research progress on the evaluation of ovarian reserve, which provides us a reference for the evaluation of ovarian reserve, the treatment and study of POF, and for those POF patients to get timely diagnosis and appropriate treatment. Related Articles | Metrics