LupinePublishers Open Access Journal of Reproductive System

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Advances in Adenomyosis Diagnosis Utilizing Transvaginal Ultrasonography-A Short Summary by
Kulvinder Kochar Kaur in Open Access Journal of Reproductive System and Sexual Disorders in Lupine_PUblishers.

Adenomyosis is a frequent condition, being present in 20% of general gynae population [1,2] and 30-40% of those attending assisted reproductive technology clinics, having a detrimental effect on cases of in vitro fertilization (IVF) [3,4]. Its main characteristics are presence of heterotopic endometrial glands and stroma within the myometrium, >2.5mm in depth of myometrium or more than one microscopic field at 10times magnification from the endometrium-myometrium junction, along with a variable degree of adjacent myometrial hyperplasia, causing globular and cystic enlargement of the myometrium, with some cysts filled with extravasated, hemolyzed red blood cells and siderophages [5]. Till now the main belief was that this could only get diagnosed with the use of histology only. As this disease gets commonly encountered in women over 40yrs, a belief got created that it was not a real disease. With the use of some imaging techniques like the magnetic resonance imaging and transvaginal ultrasound (TVS), it was found that adenomyosis had a typical appearance, which could be also detected in younger women, in the presence of symptoms or without, where it was found to have a typical appearance [6].
TVS is done in women of all ages and it showed typical sonographic findings, Different ultrasound imaging studies have been done to examine the diagnostic accuracy for finding adenomyosis as compared to that of histological examination of hysterectomy specimens. Also, the correlation of symptoms has been done. Biggest problem of using histology for adenomyosis diagnosis remains the big selection bias that has been observed. It had been seen that patients who had hysterectomy were usually in an advanced age and revealed heavy symptoms justifying surgery and thus do not represent the normal population. When a diagnosis of diffuse adenomyosis was done using TVS in younger fertile women who were with or without pain symptoms, a histological confirmation was found very occasionally of adenomyosis [7].
Inspite of this recently Tellum et al [8] tried to find the accuracy of TVS in diagnosis of adenomyosis. Using both 2D and 3D TVS, along with clinical symptoms, confirmed by histopathological examination they gave a predictive model, which showed a good test quality (area under curve [AUC]=0.86 [95% confidence interval=0.79-0.94], optimal cutoff 0.56, sensitivity of 85%, specificity78%). These 9 predictors were included ([sensitivity, specificity, β] or [AUCβ]; presence of myometrial cysts (51%,86%, β=0.86), fan shaped echo (36%, 92%, β=0.54), hyperechoic islets (51%, 78%, β=0.62), globular uterus (61%, 83%, β=0.2), normal uterine shape (83%, 61%, β=-0.75), thickest to thinnest ratio for uterine wall (0.61, β=0.26), maximum width of the junctional zone in sagittal plane (0.71, β=0.1), regular appearance of junctional zone (31%, 92%, β=-1.0) and grade of dysmenorrhea measured on a verbal numerical scaling (0.61, β=0.08). In view of various other studies, including that of Tellum et al. [8] showing a high accuracy of diagnosis, one can accept that one can make the diagnosis of adenomyosis just using ultrasonography (USG). One will be able to correlate the disease to real symptoms and fertility in the general population. Presence of one or more of USG features has often been observed in asymptomatic young ladies.

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https://lupinepublishers.com/reproductive-medicine-journal/fulltext/advances-in-adenomyosis-diagnosis-utilizing-transvaginal-ultrasonography-a-short-summary.ID.000128.php 

https://lupinepublishers.com/reproductive-medicine-journal/abstracts/advances-in-adenomyosis-diagnosis-utilizing-transvaginal-ultrasonography-a-short-summary.ID.000128.php 

https://lupinepublishers.com/reproductive-medicine-journal/pdf/OAJRSD.MS.ID.000128.pdf

Open Access Journal of Reproductive System How to Determine the Ideal Increased Progesterone Levels Cutoff During Fresh In Vitro Fertilization Cycles: Is it Time to Move Forward-A Short Commentary

LupinePublishers_How to Determine the Ideal Increased ProgesteroneLevels Cutoff During Fresh In Vitro Fertilization Cycles:Is it Time to Move Forward-A Short Commentary by Kulvinder Kochar Kaur in Open Access Journal of Reproductive System and sexual disorders in Lupine_Publishers.

That increased progesterone(P) that is present on the day of human chorionic gonadotropin (HCG)trigger has an effect on the probable chances of a pregnancy resulting following a fresh embryo transfer has been a point that can be debated over the last 25 years [1-3]. A meta-analysis conducted by Venetis et al in 2013, confirmed the negative effect of progesterone on pregnancy following an ET [3]. They Further confirmed that by using proper analytical approaches one can find this correlation [4]. How this effect is brought about is by changing endometrial receptivity, an approach tested both by basic along with clinical research. Most importantly this support comes from cycles in which increased P do not affect if the embryos are frozen and transferred in subsequent cycle of frozen-thawed embryos [3]. Hence a proposal of freeze all/ freeze only policy was suggested as an answer to manage increased P found by the end of follicular phase.
However, the biggest problem that arises is what is the threshold of increased P that has to be considered as abnormal and thus needing any intervening procedure. With multiple thresholds getting in the literature more confusion has got created. Hence clinicians are still not sure that on measuring P on the day of HCG what is the exact threshold which they will employ to decide that they have to cancel a fresh ET and get into freeze-only policy ? This question has been taken up by Hill et al in 2018 [5] by an intense analysis of 7608 ART transfer cycles for getting different P thresholds and found it varied from 0.4 -3.0 ng/ml .Using different methods which kept in mind the sensitivity as well as specificity of every threshold they proposed ,in addition to the cost factor that would result if they used a freeze only(they preferred the term freeze only over freeze all a term adopted by the journal club Global [6]) policy what would the result be. They analyzed that if they used a threshold in between 1.5-2.0ng/ml, it would prove to be the most cost effective to use the freeze only approach [5]. Although they did find a statistically significant negative effect of P on pregnancy rates getting found if a threshold of 0.7ng/ml although they found if they used this low cut off the number required to treat markedly increased which decreased to 13 with the 1.5-2.0ng/ml cutoff.


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https://lupinepublishers.com/reproductive-medicine-journal/abstracts/how-to-determine-the-ideal-increased-progesterone-levels-cutoff-during-fresh-in-vitro-fertilization.ID.000127.php 

  https://lupinepublishers.com/reproductive-medicine-journal/pdf/OAJRSD.MS.ID.000127.pdf

https://lupinepublishers.com/reproductive-medicine-journal/fulltext/how-to-determine-the-ideal-increased-progesterone-levels-cutoff-during-fresh-in-vitro-fertilization.ID.000127.php

Reproductive Journals-Lupine Publishers- Luteal Phase Support using Oral Dydrogesterone-a Prospective Treatment for Future Replacing Micronized Vaginal Progesterone: (OAJRSD)

Luteal Phase Support using Oral Dydrogesterone-a Prospective Treatment for Future Replacing Micronized Vaginal Progesterone by Kulvinder Kochar Kaur in Open Access Journal of Reproductive System and Sexual Disorders (OAJRSD) in Lupine Publishers

Although micronized vaginal progesterone is the accepted norm for use in luteal phase support (LPS) in controlled ovarian stimulation (COS) that is used for in vitro fertilization (IVF) cycles, recently importance of oral Dydrogesterone has got the importance in lieu of its oral availability, cheap, no cumbersome side effects and no definitive newer fetal side effects. After the LOTUS 1 trial with a multicenter double placebo, double dummy design it has proved an equal efficacy if not superiority of oral D, over micronized vaginal progesterone and it seems D might soon become the standard of care for LPS in conventional IVF cycles besides its routine indication for recurrent abortions.

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https://lupinepublishers.com/reproductive-medicine-journal/abstracts/luteal-phase-support-using-oral-dydrogesterone-a-prospective-treatment-for-future-replacing-micronized-vaginal-progesterone.ID.000119.php

https://lupinepublishers.com/reproductive-medicine-journal/pdf/OAJRSD.MS.ID.000119.pdf

https://lupinepublishers.com/reproductive-medicine-journal/fulltext/luteal-phase-support-using-oral-dydrogesterone-a-prospective-treatment-for-future-replacing-micronized-vaginal-progesterone.ID.000119.php

Recurrent Ovarian Cyst in Pregnancy, The Advantage of Laparoscopic Approach – A Case Report : (OAJRSD) - Lupinepublishers

Recurrent Ovarian Cyst in Pregnancy, The Advantage of Laparoscopic Approach – A Case Report by Wan Ahmad Hazim Wan Ghazali in Open Access Journal of Reproductive System and Sexual Disorders (OAJRSD) in Lupine Publishers

The incidence of recurrent ovarian cyst in pregnancy is rare. However, complications such as torsion, rupture, infection, haemorrhage and obstructed labour may occur. Thus, surgical removal is required to avoid such complications. A 27-year-old parity 1 with history of laparoscopic cystectomy during her first pregnancy presented with recurrent ovarian cyst in her second pregnancy at 13 weeks of gestation. Removal of ovarian cyst was done laparoscopically without significant complications. The remaining of her pregnancy was uncomplicated, and she delivered a healthy infant at term. Laparoscopic cystectomy is safe and should be the gold standard in pregnant women.

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https://lupinepublishers.com/reproductive-medicine-journal/abstracts/recurrent-ovarian-cyst-in-pregnancy-the-advantage-of-laparoscopic-approach-a-case-report.ID.000114.php

https://lupinepublishers.com/reproductive-medicine-journal/pdf/OAJRSD.MS.ID.000114.pdf

https://lupinepublishers.com/reproductive-medicine-journal/fulltext/recurrent-ovarian-cyst-in-pregnancy-the-advantage-of-laparoscopic-approach-a-case-report.ID.000114.php