Systematic consideration of major risk factors for each component should be considered during history-taking. Examples of some of the principal dysfunctions for each component of the reproductive system are given: Review of Section I Be aware of the most important factors in society that have contributed to infertility as major health care concern. Realize that each anatomical component of the reproductive system must function appropriately for a successful pregnancy; and the easiest way to take a careful history is to consider each component systematically The goals of this section are to learn to look for clues on physical examination to common infertility causes. Also, the basic tests used to evaluate each component of the reproductive system will be reviewed. Physical Examination As with history taking, the physical examination is best directed toward uncovering manifestations of pathology involving each individual component of the reproductive system. In particular, attention is paid to the patient’s weight, thyroid palpation, evidence of acne, hirsutism and seborrhea, as well as a search for galactorrhea. The degree of development of secondary sexual characteristics is also noted. A nonmobile retroverted uterus may signify the presence of pelvic adhesions from previous PID, surgeries, appendicitis or endometriosis that are fixing the uterus in the pelvic cul-de-sac. Laboratory Investigation of Infertility Rubella immunity status, chlamydia and gonorrhea cultures are generally pursued on the initial visit.
Evaluation and Treatment of Infertility
Thus, estradiol produces breast development , and is responsible for changes in the body shape , affecting bones, joints, and fat deposition. It enhances growth of the myometrium. Estradiol appears necessary to maintain oocytes in the ovary.
The dating of the endometrium is best correlated with the timing of ovulation as detected by sonogram or LH testing, rather than by backdating from the subsequent menstrual cycle. A delay in maturation of a single endometrial biopsy is a common finding and therefore must be repeated in another cycle before it may be interpreted as indicative of and Management of the.
References Infertility is defined as the inability to achieve pregnancy after one year of regular, unprotected intercourse. Evaluation may be initiated sooner in patients who have risk factors for infertility or if the female partner is older than 35 years. Causes of infertility include male factors, ovulatory dysfunction, uterine abnormalities, tubal obstruction, peritoneal factors, or cervical factors. A history and physical examination can help direct the evaluation. Men should undergo evaluation with a semen analysis.
Abnormalities of sperm may be treated with gonadotropin therapy, intrauterine insemination, or in vitro fertilization. Ovulation should be documented by serum progesterone level measurement at cycle day Evaluation of the uterus and fallopian tubes can be performed by hysterosalpingography in women with no risk of obstruction.
The endometrium of the uterine body A consists of a single- layered prismatic surface epithelium, penetrating into the underlying connective tissue and thus forming tubular glands glandulae uterinae. The epithelium has 3 types of cells: The endometrium of the cervical canal B consists of a simple cylindrical surface epithelium with basal cells, cilia-carrying cells and secretory cells mucous- producing. This epithelium invaginates into the underlying connective tissue forming branched glands glandulae cervicales More info The uterus consists of two anatomically different sections: The mucosa of the uterine body, the endometrium, has a cell-rich connective tissue that surrounds the uterine glands The uterine epithelium consists of a single-layered prismatic epithelium that has three different types of cells: In each menstruation cycle the superficial functional layer of the endometrium is shed and reconstituted out of the underlying basal layer.
Histological “dating” of the endometrium (based on the development of endometrial glands and stroma) can assess maturation. It has become the principal means of diagnosing LPI. Optimally, an office biopsy performed with a disposable Pipelle R should sample endometrium from high in the uterus as soon before the onset of menses as ://
Product of conception Villi Decidua 25 Post-menopausal cystic atrophy: Swiss-cheese endometrium mimics simple hyperplasia: Swiss-cheese endometrium mimics simple hyperplasia 26 Aglandular endometrium: Submucosal leiomyoma 27 Common artifacts: Accurate dating not possible Contaminants: Common artifacts Telescoping artifact Artifactual compression 29 Artifacts can be misleading and thus repeat biopsy will be justified if proper evaluation ofendometrium is hampered. Artifacts can be misleading and thus repeat biopsy will be justified if proper evaluation ofendometrium is hampered.
Perforation Uterine perforation Lipoleiomyoma 31 Endometrial metaplasias: Endometrial metaplasias Epithelial Mullerian: Endometrial metaplasias Endometritis with squamous metaplasia Icthyosis uteri 33 Papillary syncytial metaplasia mimicking Serous carcinoma or EIC:
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Evaluation of the Couple as a Unit Infertility should be regarded as a two-patient disorder. Male and female partners must be thoroughly evaluated, counseled, and included in the therapeutic decision-making processes. Exclusion of the male partner may lead to feelings of isolation in the female and to disinterest and lack of cooperation of the male partner. A questionnaire is often helpful prior to the first visit and should include questions regarding prior conceptions, contraception, and coital frequency and techniques.
This document serves as a basis for review and in-depth questioning and does not replace the history. Both partners should be screened for the use of drugs or alcohol that may affect fertility.
Habitual implantation failure /RM,RIF/ S. Škrablin Successful implantation Materno-fetal dialogue Competent blastocyst receptive endometrium “Window of implantation”
Julio 24, a las 4: Marazzi cla Corbis Bettmann cr. Treat with ampicillin amoxicillin or oral cephalosporins for to days. The hippocampus is the keyboard to the computer that helps us enter in new memories. Immunemediated damage to the mitral valve due to rheumatic fever caused by crossreactivity between the streptococcal antigen and the valve tissue leads to scarring and narrowing of the mitral valve orifice. Because the rays of the sun come from one direction only at most half the body surface is exposed to solar radiation.
Hypokalemia KIschium inferior or lower part of the pelvis. It keeps large clots from traveling into the blood vessels of the lungs. Muscle myopathyComputerautomated medical history questionnaires help doctors use their time more efficiently and evidence shows that patients answer a machine more honestly than they do a human doctor especially on sensitive topics such as alcohol or drug intake and sexual relationships.
Journal of Cataract and Refractive Surgery. But its a bit like when youre flying.
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Abstract Human implantation is a complex process requiring synchrony between a healthy embryo and a functionally competent or receptive endometrium. Diagnosis of endometrial receptivity ER has posed a challenge and so far most available tests have been subjective and lack accuracy and a predictive value. Microarray technology has allowed identification of the transcriptomic signature of the window of receptivity window of implantation WOI.
bleeding disorders are ruled out.() Endometrial biopsy or curettage is usually done to determine if endometrial changes are consistent with DUB and to exclude other causes of bleeding, especially organic lesions in the perimenopausal ://
Learn more What is the endometrium? Endometrium is a tissue lining the interior of the uterus where the embryo implants and resides during pregnancy. Each month the endometrium prepares for the arrival of an embryo. When this does not occur, menstruation begins. What is endometrial receptivity? The endometrium is receptive when it is ready for embryo implantation What is the window of implantation WOI?
The period of receptivity, usually between days of the menstrual cycle, is called the window of implantation.
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Severity Stage 1 Endometriosis Minimal The first stage of endometriosis is characterized by superficial implants that are sometimes mistaken for cysts or ovarian cancer. They resemble small, flat patches or flecks on the pelvic surface. The presence of these implants causes irritation and inflammation in surrounding tissues, leading to the formation of adhesions.
Adhesions are bands of internal scar tissue that can bind tissues and organs that are normally mobile, causing pain and dysfunction. Stage 2 Endometriosis Mild Most women are diagnosed with minimal or mild endometriosis.
Insert sterile endometrial biopsy catheter tip into cervix to the fundus, or until resistance is felt, avoiding contamination from nearby tissues. 9. Ful y withdraw the internal piston on the catheter, creating suction at the catheter
Clean cervix with povidone-iodine solution. If needed, use tenaculum, grasping the anterior lip of cervix, for counter- traction. Pul outward with tenaculum to straighten the uterocervical angle. Insert sound to the fundus, using steady moderate pressure. Usual y measure cm. May need cervical dilators if sound wil not pass through internal os. Insert sterile endometrial biopsy catheter tip into cervix to the fundus, or until resistance is felt, avoiding contamination from nearby tissues.
INFERTILITAS Dr. PUTRI SRI LASMINI, SpOG (KFER).
Accessed November 18th, Diagrams Phases Proliferative phase: Early proliferative endometrium Mid proliferative days 8 – Mid proliferative endometrium and Ki67 staining Late proliferative days 11 – Day 10 – 12 endometrium shows glands that are more tortuous and crowded; intraglandular nuclear pseudo- stratification and mitotic activity are more prominent see inset and the stroma is edematous and mitotically active Ovulation:
24% (/) endometrial cancer patients were diabetic, of whom 54% used metformin. Metformin users were younger and heavier than non-users, though nearly all were postmenopausal and obese. 75% of both groups had endometrioid ://(
Embryo toxic serum Defective natural killer activity Endometriosis has been associated with ovulatory disorders such as luteal phase deficiency LPD , oligo-ovulation, and luteinized unruptured follicle LUF syndrome. In a prospective study of couples undergoing in vitro fertilization IVF , pregnancy rates were lower among couples in which the male had been exposed to high levels of the environmental pollutant bisphenol A BPA.
Such disorders include idiopathic hypogonadotrophic hypogonadism, prolactinomas, gonadotropin deficiencies, and Cushing syndrome. Testicular factors Testicular factors can be genetic or nongenetic in nature. Klinefelter syndrome is the most common chromosomal cause of male infertility and results in primary testicular failure. Nongenetic etiologies include drugs, radiation, infections, trauma, and varicoceles. Aging also affects male fertility.
As a man ages, testosterone levels decrease, gonadotropin levels increase, sperm concentration and semen volume change, and libido decreases. In addition, the incidence of birth defects increases. While age affects female fertility dramatically, males are not affected as much; anecdotal reports exist of men fathering children well into their 80s.
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Endometrial biopsies were collected from the uterine cavity with the use of Pipelle catheters from Gynetics on day P + 5 in an HRT cycle. The day of the EB in HRT cycle is after five full days of P impregnation that is on 6 th day morning. After the biopsy, the endometrial tissue was transferred to a cryotube containing mL RNA stabilizing agent (Qiagen), vigorously shaken for a few seconds, and .
Free cells of the connective tissue Fig. More info Vascular mechanisms basic to menstruation The mechanisms that regulate the menstruation phase 1rst-4th day result from the reduction in the estrogen and progesterone values, leading to a constriction of spiral arteries and consequent necrosis of the tissue. Only the functional layer of the endometrium is affected by these cyclic changes – the basal layer remains intact. The uterine vessel network scheme exhibits a selective sensibility with regard to the cyclic hormonal alterations.
The radial and basal arterioles do not react to the hormonal variations, whereas the spiral arteries of the functional layer are hormone sensitive and constrict when the progesterone concentration decreases. Together with blood, which does not coagulate due to a local fibrinolytic factor, the necrotic tissue is eliminated menstruation. The follicular or proliferative phase During the proliferative or follicular phase 4th to 14th day the secretion of estrogen through the growing ovarian follicle is responsible for the proliferation of the endometrium intensive mitosis in the glandular epithelium and in the stroma.
The uterus epithelium clothes the surface again.
This is an open access article distributed under the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Endometrial carcinoma is the most common cancer of the female reproductive tract. High GPER expression is predictive of poor survival in endometrial and ovarian cancer, but despite this, the estrogen-mediated signaling pathways and specific estrogen receptors involved in endometrial cancer remain unclear.
Furthermore, xenograft tumors of Hec50 cells yield enhanced growth with G-1 and estrogen, the latter being inhibited by GPER-selective pharmacologic antagonism with G Finally, our results provide the first demonstration that pharmacological inhibition of GPER activity in vivo prevents estrogen-mediated tumor growth. Introduction Carcinoma of the endometrium is the most common cancer of the female reproductive tract with over 40, new diagnoses and over 7, deaths per year in the United States.
· Infertility. Irregular endometrial cavity after myomectomy. Image courtesy of Jairo E. Garcia, MD. Therefore, histological dating of the endometrium does not discriminate between women of fertile and infertile couples and should not be used in the routine evaluation of ://
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