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Concept: Asherman's syndrome

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We sought to compare diagnostic values of two-dimensional transvaginal sonography (2D TVS) and office hysteroscopy (OH) for evaluation of endometrial pathologies in cases with repeated implantation failure (RIF) or recurrent pregnancy loss (RPL).

Concepts: Progesterone, Asherman's syndrome, Miscarriage, Uterus, Endometrium, Embryo, Obstetrics, Pregnancy

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We evaluated the outcome of treatment of uterine synechiae (or adhesions, also known as Asherman syndrome) by cervical dilatation and sequential estrogen and progestogen administration for three months. This retrospective cohort study examined records of 86 women with infertility or menstrual disorders or both and treated from October 2004 to November 2011 for synechiae diagnosed by hysterosalpingography. The data analyzed included age, presenting complaint, and treatment outcome. During the study period, 86 women were seen for uterine synechiae but only 81 files could be included. The patients' mean age was 25.52 (range: 19-40 years), with 37% in the age group of 25-29 years. Of these 82 women, 71 reported menstrual disorders and 60 infertility. After treatment, 11/60 (18%) became pregnant and 35/71(49%) recovered normal menstrual profiles. The reference treatment for uterine synechiae is hysteroscopy, which yields good results. In poor settings, however, hysteroscopy remains inaccessible, and the old method of cervical dilation and sequential estrogen and progestogen therapy is an acceptable alternative.

Concepts: Menstrual cycle, Childbirth, Estrogen, Uterus, Pregnancy, Cohort study, Endometrium, Asherman's syndrome

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This is a retrospective cohort study conducted in a national training centre for hysteroscopy between January 2012 and December 2014 to compare the clinical outcome of two doses of oestradiol valerate (4 mg and 10 mg daily) in the prevention of recurrence of adhesions after hysteroscopic adhesiolysis. A total of 176 women who suffered from Asherman syndrome with moderate to severe intrauterine adhesions were included: 91 subjects received a 10 mg daily dose of oestradiol and 85 subjects received a 4 mg daily dose of oestradiol in the postoperative period. Second look hysteroscopy was performed 4-6 weeks after the initial surgery. There was no difference in age and preoperative American Fertility Society (AFS) adhesion score between the two groups. The proportion of women in whom menstruation had returned to normal in the 10 mg group (49/91 = 53.8%) was significantly (p < 0.05) higher than that of subjects in the 4 mg group (35/85 = 41.2%). However, there was no difference in AFS scores at second look hysteroscopy between the two groups or in the conception rate and miscarriage rate between the two groups. The findings do not support the use of high-dose postoperative oestrogen therapy following hysteroscopic adhesiolysis.

Concepts: Pregnancy, Miscarriage, Menstrual cycle, Hysteroscopy, Endometrium, Uterus, Cohort study, Asherman's syndrome

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Equine mesenchymal stromal/stem cells (MSCs) are most commonly harvested from bone marrow (BM) or adipose tissue, requiring the use of surgical procedures. By contrast, the uterus can be accessed nonsurgically, and may provide a more readily available cell source. While human endometrium is known to harbor mesenchymal precursor cells, MSCs have not been identified in equine endometrium. This study reports the isolation, culture, and characterization of MSCs from equine endometrium.

Concepts: Asherman's syndrome, Adipocyte, Endometrium, Uterus, Stem cell, Embryo, Bone marrow, Mesenchymal stem cell

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To estimate the optimal order of office hysteroscopy and endometrial biopsy when performed successively for evaluation of abnormal uterine bleeding.

Concepts: Asherman's syndrome, Endometrial cancer, Randomized controlled trial, Gynecology

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Purulent disease of the uterus develops in 40% of dairy cows after parturition when the epithelium of the endometrium is disrupted to expose the underlying stroma to bacteria. The severity of endometrial pathology is associated with isolation of Trueperella pyogenes. In the present study, T. pyogenes alone caused uterine disease when infused into the uterus of cattle where the endometrial epithelium was disrupted. The bacterium secretes a cholesterol-dependent cytolysin, pyolysin (PLO), and the plo gene was identical and the plo gene promoter was highly similar amongst 12 clinical isolates of T. pyogenes. Bacteria-free filtrates of the T. pyogenes cultures caused hemolysis and endometrial cytolysis, and PLO was the main cytolytic agent because addition of anti-PLO antibody prevented cytolysis. Similarly, a plo-deletion T. pyogenes mutant did not cause hemolysis or endometrial cytolysis. Endometrial stromal cells were notably more sensitive to PLO-mediated cytolysis than epithelial or immune cells. Stromal cells also contained more cholesterol than epithelial cells, and reducing stromal cell cholesterol content using cyclodextrins protected against PLO. Although T. pyogenes or plo-deletion T. pyogenes stimulated accumulation of inflammatory mediators such as IL-1beta, IL-6 and IL-8 from endometrium, PLO did not stimulate inflammatory responses by endometrial or hematopoietic cells, or in vitro organ cultures of endometrium. The marked sensitivity of stromal cells to PLO-mediated cytolysis provides an explanation for how T. pyogenes acts as an opportunistic pathogen to cause pathology of the endometrium once the protective epithelium is lost after parturition.

Concepts: Asherman's syndrome, DNA, Bacteria, Embryo, Pregnancy, Gene, Uterus, Cervix

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Fertility depends on a receptive state of the endometrium, influenced by hormonal and anatomical adaptations, as well as the immune system. Local and systemic immunity is greatly influenced by microbiota. Recent discoveries of 16S rRNA in the endometrium and the ability to detect low-biomass microbiota fueled the notion that the uterus may be indeed a non-sterile compartment. To date, the concept of the ‘sterile womb’ focuses on in utero effects of microbiota on offspring and neonatal immunity. However, little awareness has been raised regarding the importance of uterine microbiota for endometrial physiology in reproductive health; manifested in fertility and placentation.

Concepts: Immunity, Innate immune system, Fetus, Asherman's syndrome, Menopause, Uterus, Pregnancy, Immune system

0

Uterine illnesses are the major problem in horse reproductive programs. The diagnosis of these pathologies is often neglected or does not provide enough information about the cause. The aim of this study was to evaluate different diagnoses to provide more accurate information about endometritis and the real endometrial profile at the beginning of a breeding season. Fifty-one mares with reproductive failure were evaluated. Two different uterine cytology diagnoses, culture of uterine flush material and biopsy assay, were performed. The data were analyzed by the Chi-squared test to compare different diagnostic methods for the same sample from each mare, and sensitivity and specificity tests were performed. Most of evaluations showed no association between cytology and other diagnostic methods, except with bacterial culture. The most common bacterium found was Escherichia colli, but it was not associated with neutrophil presence in cytology. The presence of β-hemolitic streptococcus was well characterized by positive cytology and cloudy lavage fluid aspect. Endometrial profile was affected by age and whether the mare was a donor or recipient. The most sensitive diagnostic method was gross aspect of lavage fluid. Endometritis should be diagnosed by at least two methods to increase accuracy. Endometritis is not the only uterine disease that causes embryo loss, since endometrial fibrosis can also be a cause.

Concepts: Asherman's syndrome, Positive predictive value, Type I and type II errors, Embryo, Diagnosis, Sensitivity and specificity, Pregnancy, Uterus

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Laparotomic myomectomy is often the only realistic solution for symptomatic women with multiple or large myomas who wish to retain their fertility. The aim of this study was to document the rate of uterine synechiae and their associated risk factors after laparotomic myomectomy. This prospective observational study took place in a teaching hospital from May 2009 to June 2014. It included all women aged 18-45 years who had laparotomic myomectomies (without diagnostic hysteroscopy at the time of surgery) for myomas and a postoperative diagnostic office hysteroscopy 6-8 weeks later. The study included 98 women with a laparotomic myomectomy and a postoperative hysteroscopic follow-up. Women with a laparotomic myomectomy for a subserosal myoma were excluded. The intrauterine adhesion rate after laparotomic myomectomy was 25.51% (25/98); 44% (11/25) of them were complex intrauterine adhesions. Opening the uterine cavity was a major risk factor for these complex adhesions, with an OR of 6.42 (95% CI 1.27 to 32.52). Office hysteroscopy could be carried out after surgery in such cases.

Concepts: Hospital, Internal orifice of the uterus, Hysteroscopy, Pregnancy, Observational study, Uterine fibroids, Asherman's syndrome, Uterus