A Study of Elevated Progesterone Level and Its Consequences on In-vitro Fertilisation (IVF) Outcomes | Chapter 4 | Medical Science: Recent Advances and Applications Vol. 9

 

Background: The embryo-endometrium dialogue remains incompletely understood. During conventional in vitro fertilisation cycles, progesterone elevation on the day of human chorionic gonadotropin administration refers to rising progesterone levels in the absence of either premature or a luteinizing hormone surge. Most research has reported that elevated progesterone had an adverse impact on the endometrial environment of fresh cycles, leading to a decrease in pregnancy rates. High progesterone levels on the day of Human Chorionic Gonadotropin trigger induce advanced endometrial histological maturation and differential endometrial gene expression, which lead to implantation failure.

 

Aim: The aim of the study is to investigate the impact of elevated progesterone levels on the clinical outcomes of in vitro fertilisation.

 

Methods: The current study was undertaken at Swagat Hospital and Research Centre, Bongaigaon, Assam (India). Fifty patients undergoing in vitro fertilisation (IVF) were selected for the study. Baseline estimation of follicle-stimulating hormone (FSH), luteinizing hormone (LH), anti-Mullerian hormone (AMH), (estrogen) E2 and (transvaginal sonography) TVS was done. The patients were grouped on the basis of their progesterone levels on the day of hCG trigger, with the cutoff for defining premature progesterone rise being (progesterone) P4≥ 3ng/ml. Final oocyte maturation was induced with hCG. Oocyte retrieval was performed 34-36 h after hCG. Two to three embryos of the day 3 cleavage stage were transferred under TVS guidance. The parameters obtained from each cycle were recorded. Statistical analysis was performed. A probability (P) value <0.05 was considered statistically significant. A sonographic confirmation of pregnancy was performed 2 weeks after a β-hCG positive. Statistical analysis was conducted using SPSS v23.0, with the Chi-square test for categorical data, ANOVA for quantitative variables, and significance set at P<0.05.

 

Results: On dividing the patients into two groups based on the cut-off of P4 as 3ng/ml, it was observed that the no of cases that conceived was significantly higher in the subjects whose P4 level was less than or equal to 3ng/ml than in the subjects whose P4 level was more than 3ng/ml.

 

Conclusions: The present study showed an adverse relationship between higher circulating serum concentration of P4 and clinical pregnancy rate. Elevated P4 level just before trigger is a reflection of endometrial maturity that can cause disparity between endometrial and embryonic ageing and therefore hamper implantation or cause failure in assisted reproductive technology (ART).

 

Author(s) Details

Sankar Kumar Das
Department of Obstetrics and Gynecology, Swagta Hospital and Research Center, Bongaigaon Assam, India and Department of Obstetrics and Gynecology, Gauhati Medical College and Hospital, Guwahati, Assam, India.

 

Priyanka Roy
Department of Obstetrics and Gynecology, Swagta Hospital and Research Center, Bongaigaon Assam, India and Department of Obstetrics, Assam Medical College and Hospital, Dibrugarh, Assam, India.

 

Krishna Kalita
Department of Obstetrics and Gynecology, Swagta Hospital and Research Center, Bongaigaon Assam, India and Department of Obstetrics and Gynecology, Assam Agricultural University, Jorhat, Assam, India.

 

Please see the book here:- https://doi.org/10.9734/bpi/msraa/v9/5481

Xanthogranulomatous Endometritis: A Rare Case with Infertility | Chapter 10 | Disease and Health: Research Developments Vol. 6

 Xanthogranulomatous inflammation is a distinguished histopathological entity affecting several organs, most commonly involving the kidney and gall bladder. The most common symptoms of xanthogranulomatous endometritis are irregular coporrhagia, discharge, cervical stenosis and pyometra. It is commonly mistaken for malignancy clinicoradiologically, and therefore, histopathological examination is of utmost importance. Only a small number of cases of xanthogranulomatous endometritis (XGE) have been reported in the literature so far. Microscopic examination shows sheets of foamy histiocytes along with other inflammatory cells on H&E stained sections. This study presents a case of a 31-year-old female with a complaint of inability to conceive for 3 years and having a history of previous 3 tubal pregnancies. Hysteroscopy examination reveals fluffy endometrium and patent bilateral fornices with normal cervical mucosa. Dilatation and curettage were done and sent for histopathological examination, and a diagnosis of Xanthogranulomatous Endometritis was made. As XGE is a rare inflammatory disease, awareness of this lesion is necessary for both the gynaecologist and pathologist and should be kept in differential diagnosis in the cases of infertility.

 

Author (s) Details

 

Rani E.
GGSMCH Faridkot, Punjab, India.

 

Please see the book here:- https://doi.org/10.9734/bpi/dhrd/v6/4655   

Impact of Ovarian Morphology on Endometrium Morphology, and Post Menopausal Bleeding | Chapter 15 | New Advances in Medicine and Medical Science Vol. 4

 This division evaluates and correlates presence of ovarian lesions accompanying endometrial morphology in females giving with post menopausal grieving. Postmenopausal ovaries are chiefly composed of stroma and stretch to have potential for hormonal synthesis. A total of 42 specimens of total intestinal hysterectomy with bilateral hysterectomy were examined. The patients' ages categorized from 45 to 80 years. The study did not find any statistically significant equivalence between high risk endometrial affliction and stromal hyperplasia/large ovary.

Author(s) Details:

Madhu Chaturvedi,
Department of Pathology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra-400022, India.

Khushboo S. Wadgaonkar,
Department of Pathology, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, Maharashtra-400022, India.

Please see the link here: https://stm.bookpi.org/NAMMS-V4/article/view/10718

A Brief Study about Menopause and Gynaecological Malignancy | Chapter 1 | Current Practice in Medical Science Vol. 7

 

 Untimely menopause can happen because of disease treatment. Cervical disease is the most well-known gynecological malignant growth. Constant HPV disease is more normal in postmenopausal ladies. In postmenopausal ladies, HPV immunization plays no part in essential cervical disease anticipation. Cervical disease side effects in postmenopausal ladies are tragically vague and related with co-morbidities. Thus, each indication of cervical malignant growth in a postmenopausal lady ought to be explored completely. Among every single gynecologic disease, ovarian malignant growth is the main source of death. Most of postmenopausal ladies with ovarian malignant growth present with questionable side effects and are in a high level phase of the illness at the hour of show. In the United States, endometrial disease is the most regular gynecologic danger. Most of endometrial carcinomas are identified early and have a positive visualization. However vulvar and vaginal malignant growths are unprecedented, they are normal in postmenopausal ladies. Any postmenopausal lady who has been tingling for quite a while, has a pervaginal release, or has a vulva or vaginal ulcer ought to be assessed completely. So principal objective of this composing is to mindful the gynecological oncologists about the extraordinary parts of gynecological diseases in menopausal lady.

Author(s) Details:

Sabera Khatun,
Department of Gynaecological Oncology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.

Jannatul Ferdous,
Department of Gynaecological Oncology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.

Please see the link here: https://stm.bookpi.org/CPMS-V7/article/view/7832

Histopathological Pattern of Endometrium in Abnormal Uterine Bleeding: A Prospective Study | Chapter 7 | Current Practice in Medical Science Vol. 3

By examining histological results in endometrial tissue samples, the current study establishes the most prevalent age group and frequent pathology producing abnormal uterine bleeding.

Abnormal uterine bleeding is one of the most common presenting symptoms in the gynaecology outpatient department (AUB). Unusual uterine bleeding for which there is no known cause is referred to as "dysfunctional uterine haemorrhage." For individuals who have abnormal uterine bleeding, it is essential to assess the endometrium's histological appearance. A beneficial initial step in the diagnosis of DUB may be an endometrial biopsy. This prospective research was conducted in the departments of pathology at Bhaskar Medical College and Satya Diagnostic Center in Hyderabad, Telangana State, on patients who presented with abnormal uterine haemorrhage. The research lasted for a total of two years, from June 2014 to November 2016. For the final analysis, 150 endometrial lesions with histopathological diagnoses were chosen. The dilatation and curettage (D&C) procedure was used to collect all of the endometrial samples included in the study. The patients' ages varied from 21 to 78 years old, with a mean of 49.5 years. Endometrial polyp, complex hyperplasia without atypia, endometrial cancer, pill endometrium, complex hyperplasia with atypia, endometritis, atrophic endometrium, and adenomatous hyperplasia were among the other patterns found. Age pattern and endometrial causes of DUB were statistically significant with a P value 0.05. In order to rule out cancer, a thorough histopathological examination of the endometrium should be performed on women who report with abnormal uterine bleeding, especially beyond the age of 40. In situations of dysfunctional uterine haemorrhage, it is helpful for diagnosis, to evaluate treatment response, and to understand the pathological incidence of organic lesions before surgery. In different types of AUB, D&C shows endometrial patterns and also aids in ruling out any organic disease. The endometrium should thus be histopathologically examined in women over 40 to rule out preneoplastic lesions and cancer.

Author(s) Details:

V. Vijay Sreedhar,

Department of Pathology, Bhaskar Medical College, Ranga Reddy District, Telangana State, India.

Ch. Jyothi,

Gandhi Medical College, Secunderabad, Telangana State, India.

M. Narsing Rao,

Department of Pathology, Bhaskar Medical College, Ranga Reddy District, Telangana State, India.

V. Sailaja,

Department of Pathology, Bhaskar Medical College, Ranga Reddy District, Telangana State, India.

M. N. P. Charan Paul,

Department of Pathology, Bhaskar Medical College, Ranga Reddy District, Telangana State, India.

G.Vijaya Lakshmi,

Department of Obg and Gynecology, Bhaskar Medical College, Ranga Reddy District, Telangana State, India.

Please see the link here: https://stm.bookpi.org/CPMS-V3/article/view/7385

New Bioengineering Strategies Based on Tissue-Specific Extracellular Matrices to Improve Human Endometrial Organoid Models | Chapter 9 | New Horizons in Medicine and Medical Research Vol. 11

 Multicellular, three-dimensional (3D) tissue models called organoids closely mimic in vivo tissue. Exact pre-clinical models of the human uterine endometrium are being used to conduct new studies of this vital tissue in response to the recent emergence of 3D structures from basic endometrial cells. We aimed to assess ECM hydrogels produced from decellularized pig endometrium (EndoECM) in producing and upgrading current human endometrial organoid culture systems in order to enhance these 3D models. To do this, we developed three lines of human endometrial organoids and expanded them under ideal and unfavourable circumstances while adding or omitting the soluble supplement EndoECM (0.1 mg/mL). The resultant organoids' epithelial genesis, long-term chromosomal stability, and stemness characteristics were all validated. Finally, we calculated their proliferative capacity under various culture conditions using proliferation rates and immunohistochemical methods. Our results show the importance of a bioactive environment for the upkeep and development of human endometrial organoids.

Author(s) Details:

Emilio Frances-Herrero,
Universitat de Valencia, 46010 Valencia, Spain and  Fundacion Instituto Valenciano de Infertilidad (FIVI), Instituto de Investigacion Sanitaria La Fe, 46026 Valencia, Spain.

Elena Juarez-Barber,
Fundacion Instituto Valenciano de Infertilidad (FIVI), Instituto de Investigacion Sanitaria La Fe, 46026 Valencia, Spain.

Hortensia Ferrero,
Fundacion Instituto Valenciano de Infertilidad (FIVI), Instituto de Investigacion Sanitaria La Fe, 46026 Valencia, Spain.

Irene Cervello,
Fundacion Instituto Valenciano de Infertilidad (FIVI), Instituto de Investigacion Sanitaria La Fe, 46026 Valencia, Spain.

Please see the link here: https://stm.bookpi.org/NHMMR-V11/article/view/7144

Evaluating the Role of Sildenafil on Endometrial Characters in Ovulation Induction Cycle | Chapter 19 | Recent Developments in Medicine and Medical Research Vol. 12

 Sildenafil increases endometrial growth by relaxing the smooth muscles of blood vessels, inducing vasodilation. One of the mainstays of infertility treatment is increasing endometrial thickness. The purpose of this study is to see how Sildenafil affects endometrial characteristics during the ovulation induction cycle.

Materials and Procedures: A total of 50 infertile women with thin endometrium were randomly assigned to one of two groups. 25 women in Group A received clomiphene citrate 50 mg daily from D2 to D6, as well as estradiol valerate 2 mg thrice daily from D2, and 25 women in Group B received clomiphene citrate 50 mg daily from D2 to D6, estradiol valerate 2 mg thrice daily from D2, and sildenafil citrate 25 mg vaginally thrice daily from D7 to the day of ovulation trigger. Trans-vaginal ultrasound was used to evaluate follicular development and endometrial features on alternate days beginning on day 8 of the cycle. An HCG trigger was given once the dominant follicle was >18 mm. In total, three ovulation cycles were investigated.

Endometrial character monitoring demonstrated a considerable improvement in Group B in all ovulation-induced cycles.

The mean endometrial thickness in Group B was 10.21.6 mm versus 8.531.4 mm in Group A; the tri laminar pattern was 93.54 percent in Group B versus 40.29 percent in Group A; the zone 4 endometrium was 79.03 percent in Group B versus 26.86 percent in Group A; and the clinical pregnancy rate per cycle was 20.96 percent in Group B versus 13.45 percent in Group A.

Conclusion: In ovulation induction cycles, the addition of vaginal Sildenafil to estradiol valerate has a substantial effect on endometrial features and clinical pregnancy rates.

Author(S) Details

Alla Satyanarayana Reddy
Department of Obstetrics & Gynaecology, Vinayaka Mission`s Research Foundation (DU), Vinayaka Mission`s Medical College, Karaikal, India.

A. Vikram Arun
Department of Radiology, Vinayaka Mission`s Research Foundation (DU), Vinayaka Mission`s Medical College, Karaikal, India.

View Book:- https://stm.bookpi.org/RDMMR-V12/article/view/4685

Study of Manual Liquid Based Cytology in Diagnosis of Gynecologic Pathology | Chapter 5 | New Frontiers in Medicine and Medical Research Vol. 2

 In the gynaecology department, abnormal uterine bleeding (AUB) is a common problem. In affluent countries, endometrial cancer is the fourth most prevalent cancer in women and the most common gynaecological cancer. Cervical cancer is the fourth most frequent cancer in women worldwide, following breast, colorectal, and lung cancers, with 5,28, 000 new cases per year. Despite the fact that cytological examination has been the gold standard for early identification of cervical cancer and has been found to be beneficial in the detection of endometrial cancer, its widespread application in underdeveloped countries has been impossible due to a lack of resources. personnel and other resources When there is concealing blood, inflammation, or thick patches of overlapping epithelial cells, its sensitivity drops to less than 50%. Manual Liquid Based Cytology (MLBC) is a low-cost method for suspending cells in a monolayer, which improves the detection of precursor lesions and specimen adequacy. Other tests, such as Cell block and immunocytochemistry, can be performed with the leftover sample.

1. To enhance the diagnosis of gynaecological cancers using a technique known as Manual Liquid Based Cytology (MLBC). 2. To investigate a low-cost strategy of researching both endometrial and cervical cancer using supplementary techniques such as cellblocking and immunocytochemistry. 3To compare the results of conventional pap smear (CPS) and MLBC in detecting endometrial and cervical gynaecological disorders.

Methodology: Ayres spatula was used to collect samples from the transition zone of the cervix, which included outpatients from the gynaecological department. The women were between the ages of 20 and 60, and 82 instances with a history of bleeding were chosen to examine endometrial pathology, while 100 cases of white discharge per vaginal were chosen to study cervix pathology. A total of 60 patients were then subjected to ancillary testing, such as cellblocking and immunocytochemistry. Wherever possible, histopathological correlation was performed on instances.

The endometruim investigation found that MLBC is more sensitive and specific than CPS in detecting malignant lesions. LBC/Histopathology vs CPS/Histopathology had a contingency coefficient of 0.572 vs 0.556. The enhanced detection rate for low grade intraepithelial lesion was found to be 150 percent for cervical lesion. The positive predictive value for diagnosing neoplastic lesions on cell blocks was 75%, and the CB/Histopathology Vs CPS/Histopathology Concordance Rate was 74% vs. 54%.

Conclusion: MLBC is a low-cost approach for detecting malignant endometrial and cervical lesions. It has been found to aid in the detection of infection and neoplastic diseases of the female genital tract in both endometrial and cervical cytology.

Author (S) Details

Nandini N. Manoli
Department of Pathology, Jagadguru Shri Shivarathreswara Medical College, Jagadguru Shri Shivarathreswara University, Mysore Karnataka, India.

Nandish S. Manoli
Department of OBG, JSS Medical College, JSS University, Mysore Karnataka, India.

Lopamudra Kakoti
Department of Pathology, Jagadguru Shri Shivarathreswara Medical College, Jagadguru Shri Shivarathreswara University, Mysore Karnataka, India.

Akshata Kamath
Department of Pathology, Jagadguru Shri Shivarathreswara Medical College, Jagadguru Shri Shivarathreswara University, Mysore Karnataka, India.

Shweta Kulkarni
Department of Pathology, Jagadguru Shri Shivarathreswara Medical College, Jagadguru Shri Shivarathreswara University, Mysore Karnataka, India.

View Book :- https://stm.bookpi.org/NFMMR-V2/article/view/2678

Histopathological Evaluation of Endometrial Tissue in Abnormal Uterine Bleeding: A Recent Study | Chapter 8 | Highlights on Medicine and Medical Science Vol. 17

 Background: Abnormal uterine bleeding can be caused by a number of conditions, and it is one of the most prevalent complaints that leads to endometrial sampling. It could be a natural physiological state, and just observation is necessary. Alternatively, the bleeding could be a symptom of a dangerous underlying illness that requires immediate attention.

Aim: To determine the varied patterns of endometrial curettings in abnormal uterine bleeding in different age groups and to evaluate the causes of abnormal uterine bleeding.

The research was carried out in the histopathology unit of the GMC Jammu Department of Pathology. All endometrial curettings and endometrial biopsy specimens obtained in the histology section were included in the study.

Results: Patients ranged in age from 14 to 75 years old. The age range 31-40 years had the highest number of cases in this study, with 188 cases (40.43 percent ). Secretory endometrium (170 instances) was the most prevalent pattern on histology, followed by proliferative endometrium (99 cases), endometrial hyperplasia (42 cases), and products of conception (27 cases). There were six cases of endometrial cancer and four occurrences of squamous cell carcinoma.

Conclusion: Endometrial tissue examined histopathologically in patients with atypical uterine bleeding reveals a wide range of alterations, ranging from normal endometrium during various hormonal cycles to cancer. As a result, it is a crucial diagnostic tool in the assessment of irregular uterine bleeding.

Author (S) Details

Ritu Bhagat
Demonstrator, Postgraduate Department of Pathology, GMC Jammu, India.

Chiterlekha Kundal
Demonstrator, Postgraduate Department of Pathology, GMC Jammu, India.

Subhash Bhardwaj
Demonstrator, Postgraduate Department of Pathology, GMC Jammu, India.

Vinod Kumar
Department of Medicine, GMC, Doda, India.

View Book :- https://stm.bookpi.org/HMMS-V17/article/view/2611

Experiment and Investigation on the Correlation of Histological Dating and Glycogen Content by Histochemical Stain during Various Phases of Menstrual Cycle in Primary Infertility | Chapter 3 | Current Topics in Medicine and Medical Research Vol.2

Glycogen and its products of metabolism are considered to be the most important and direct source of
nutrient for the early conceptus. The premenstrual biopsies were taken from 100 women with primary
infertility whose male partners had normal semenograms. The biopsies were then subjected to
Haematoxylin and Eosin (H & E) and Periodic Acid Schiff (PAS) staining with and without diastase to
study histological and histochemical changes particularly glycogen content in the endometrium
respectively. Histolomorphologic spectrum of endometrium on H & E stained sections revealed early
proliferative phase (4%), late proliferative phase (7%) and early secretory phase (7%), mid secretory
phase (33%) and late secretory phase (49%). PAS staining with or without diastase for glycogen was
performed and glycogen content, as demonstrated by magenta color, was graded from + to ++++.
Glycogen content was observed to be “+” to “++” in proliferative phase, where as in secretory phase, it
varied from “++” to “+++”. Glycogen was confirmed by treatment with diastase enzyme, after that PAS
stain gave negative staining, i.e. loss of magenta color as glycogen was digested by diastase.
Glycogen deficiency was observed in 24.7% of secretory phase endometrium of infertile women.
Depletion of glycogen results in inadequate preparation of endometrium at the time of implantation,
and hence, may be one of the causes of infertility.

Author(s) Details

Dr. Anshu Gupta
Department of Pathology, Institute of Human Behaviour & Allied Sciences (IHBAS), Delhi, India.

View Book :- http://bp.bookpi.org/index.php/bpi/catalog/book/220