ASRM müllerian anomalies classification 2021.

There are many proposed classification systems for müllerian anomalies. The American Fertility Society (AFS) Classification from 1988 has been the most recognized and utilized. The advantages of this iconic classification include its simplicity, recognizability, and correlation with clinical pregnancy outcomes.

Uterine factor in recurrent pregnancy loss.

Objective: To review the current understanding of the role the uterus plays in recurrent pregnancy loss.

Findings: Congenital and acquired uterine abnormalities are associated with recurrent pregnancy loss in the first and second trimester. Relevant congenital Mullerian tract anomalies include unicornuate, didelphys, bicornuate and septate uteri.

Ovarian Morphology by Transabdominal Ultrasound Correlates With Reproductive and Metabolic Disturbance in Adolescents With PCOS.

Purpose: To determine whether ovarian morphology imaged using transabdominal ultrasonography reflects clinical and metabolic features in adolescents with polycystic ovary syndrome (PCOS).

Methods: A retrospective pilot study was conducted in 33 adolescents (12-18 years) with PCOS as defined by hyperandrogenism and irregular cycles. Adolescents underwent the following assessments at a random time during the menstrual cycle: transabdominal ultrasonography, physical examination (height, weight, and systolic and diastolic blood pressure), fasting hormonal tests (free, percent free, and total testosterone, androstenedione, follicle stimulating hormone, luteinizing hormone), and metabolic tests (including an oral glucose tolerance test, fasting and 2-hour insulin and glucose, homeostatic model assessment of insulin resistance, and whole-body insulin sensitivity index).

Deliberate practice improves obstetrics and gynecology residents' hysteroscopy skills.

Introduction: Development of surgical skills is an integral component of residency education in obstetrics and gynecology.

Objective: We report data from a supervised, deliberate, dry lab practice in hysteroscopy for junior obstetrics-gynecology residents, undertaken to evaluate whether simulation training improved hysteroscopy performance to a skill level similar to that of senior residents.

Methods: A prospective, comparative, multicenter trial compared Objective Structured Assessment Of Technical Skills (OSATS) performance of 2 groups: 19 postgraduate year (PGY)-1 and PGY-2 and 18 PGY-3 and PGY-4 Ob-Gyn residents.

Acute portal vein thrombosis complicating in vitro fertilization.

Objective: To describe a case of acute portal vein thrombosis after IVF treatment.

Design: Case report.

Setting: University teaching hospital.

Polycystic ovary syndrome in adolescence: impaired glucose tolerance occurs across the spectrum of BMI.

Context: Polycystic ovary syndrome (PCOS) is a chronic condition with metabolic manifestations spanning the reproductive years.

Objective: We sought to examine glucose metabolism, irrespective of the presence of obesity in a cohort of adolescent girls with PCOS.

Design: One hundred adolescents were assessed for PCOS in a multi-specialty adolescent PCOS program.

Polycystic ovary syndrome in adolescents.

Purpose Of Review: To highlight the new information in the field of polycystic ovary syndrome (PCOS) in adolescents and how it may pertain to current practice.

Recent Findings: The diagnosis of adolescent PCOS remains controversial, and experts continue to debate the appropriate criteria to be used. There is growing support for using Rotterdam criteria, but requiring the presence of all three criteria (oligoovulation or anovulation, hyperandrogenism and polycystic ovaries on pelvic ultrasonography), as the standard 'two of three' criteria may overdiagnose PCOS in adolescents.

Abnormal streak gonads in 46,XY complete gonadal dysgenesis.

Objective: To describe the surgical findings in two adolescents with 46,XY complete gonadal dysgenesis.

Design: Report of two cases.

Setting: University teaching hospital.

Hysteroscopic resection of a symptomatic uterine leiomyoma in an adolescent.

Background: Uterine leiomyomas or fibroids are rare in the adolescent population. Hysteroscopic resection is an ideal approach for adolescents with symptomatic intracavitary myomas.

Case: A 17-year-old female had a history of menometrorrhagia and symptomatic anemia, and had been hospitalized twice for acute management of heavy bleeding.

Endometrial polyps affect uterine receptivity.

This case-control study evaluated the effect of hysteroscopically identified endometrial polyps on endometrium by means of HOXA10 and HOXA11, known molecular markers of endometrial receptivity. Uteri with endometrial polyps demonstrated a marked decrease in HOXA10 and HOXA11 messenger RNA levels, which may impair implantation. These findings suggest a molecular mechanism to support the clinical findings of diminished pregnancy rates in women with endometrial polyps.

Interstitial cystitis is an etiology of chronic pelvic pain in young women.

Study Objective: The prevalence of interstitial cystitis (IC) in young women, especially in those 18 years old or younger, is not well defined. This case series was performed to investigate IC as a cause of chronic pelvic pain (CPP) in young women.

Design: Case series.

Cesarean scar ectopic pregnancy: case series and review of the literature.

Cesarean scar ectopic pregnancy is becoming increasingly common at tertiary care hospitals around the world. It is a condition in which the embryo implants within the myometrium at the site of a previous cesarean hysterotomy, and it can occur in women with only one prior cesarean delivery. We present four cases of cesarean scar ectopic pregnancy diagnosed within a 6-month period between 2007 and 2008.

Submucosal uterine leiomyomas have a global effect on molecular determinants of endometrial receptivity.

Objective: To evaluate the effect of uterine leiomyomas on the endometrium using molecular markers of endometrial receptivity: HOXA10, HOXA11, LIF, and BTEB1.

Design: Case-control study.

Setting: University medical center.

Training of residents in laparoscopic tubal sterilization: long-term failure rates.

Objectives: Laparoscopic tubal sterilization with bipolar coagulation is a common and effective method of contraception, and a procedure much used to teach laparoscopic surgical skills to Obstetrics and Gynaecology residents (trainees); but it has an inherent risk of failure. This study investigated the long-term failure rate of this procedure when performed by Obstetrics and Gynaecology residents on women treated in their teaching clinics.

Methods: From 1991 to 1994, Obstetrics and Gynaecology residents carried out 386 laparoscopic tubal sterilizations with bipolar coagulation at Yale-New Haven Hospital.

GnRH antagonists may affect endometrial receptivity.

Objective: HOXA10 is an essential regulator of endometrial receptivity. To determine the effect of GnRH antagonists on endometrial receptivity, we assessed endometrial HOXA10 expression in GnRH antagonist, GnRH agonist, and natural cycles.

Design: Prospective case-control study.

Reproductive performance of women with müllerian anomalies.

Purpose Of Review: This review discusses current diagnostic techniques for müllerian anomalies, reproductive outcome data, and management options in reproductive-age women.

Recent Findings: Multiple retrospective studies have investigated reproductive outcomes with müllerian anomalies, but few current prospective studies exist. Uterine anomalies are associated with normal and adverse reproductive outcomes such as recurrent pregnancy loss and preterm delivery, but not infertility.

Successful pregnancy complicated by early and late adnexal torsion after in vitro fertilization.

Objective: To report a case of unilateral adnexal torsion and subsequent contralateral adnexal torsion after in vitro fertilization.

Design: Case report and literature review.

Setting: Academic fertility center; university hospital.

Endometrial cancer and fertility.

Purpose Of Review: Endometrial cancer can affect reproductive-age women who may desire fertility preservation. This article discusses the current, available data about conservative management of endometrial cancer in young women.

Recent Findings: Reproductive-age women with well differentiated endometrial carcinoma have an overall favorable prognosis provided that the tumor is identified at an early, noninvasive stage; however, advanced disease can be present.

Options for medical treatment of myomas.

It is evident that complex biochemical interactions are involved in the regulation of myoma growth, and ovarian steroid hormones have significant influence on this process. Current myoma therapies manipulate the hormonal environment to achieve myoma regression and control of bleeding. Although several of these therapies achieve some level of success, further studies are necessary to evaluate the current and long-term effects of these therapies.

Second-trimester tubal pregnancy: a case report.

Background: Second-trimester tubal pregnancy is an infrequent diagnosis, as these pregnancies often present with symptoms during the first trimester.

Case: A previously asymptomatic woman presented with pelvic pain and vaginal bleeding at 4 months' gestation and was found to have a live, 14-week, tubal pregnancy.

Conclusion: Second-trimester symptoms, including nausea, vomiting, pelvic or abdominal pain, and vaginal bleeding, necessitate ultrasound to determine the pregnancy location, maintaining suspicion for a tubal or abdominal pregnancy.

Fibroids and in-vitro fertilization: which comes first?

Purpose Of Review: There is no consensus about the impact of uterine fibroids on fertility. This review explores past and recent studies that investigated the effects of submucosal, intramural, and subserosal fibroids on in-vitro fertilization (IVF) outcomes. We discuss the importance of proper evaluation of the uterus and endometrial cavity, and current options for optimal fibroid management in patients desiring fertility.