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Panminerva Medica Jun 2016Endometriosis remains a very enigmatic and perplexing disease. The exact mechanism by which endometriosis causes infertility is still unclear. In the present paper, we... (Review)
Review
Endometriosis remains a very enigmatic and perplexing disease. The exact mechanism by which endometriosis causes infertility is still unclear. In the present paper, we will review possible mechanisms leading to subfertility or infertility in women with endometriosis and examine them according to location. Endometriosis in the pelvic cavity is a pathology associated with a general inflammatory response and should therefore be considered an inflammatory disease. Inflammatory changes affect the peritoneal fluid and hence the intratubal milieu, since the ampulla (where fertilization takes place) is exposed to peritoneal fluid through the fimbria. Any inflammatory change at this level may therefore impact fertilization and natural conception. The relationship between ovarian endometriomas and infertility may, of course, be explained by the presence of periovarian endometriosis. In the ovary, fibrosis observed in some cortical areas is induced by the inflammatory reaction caused by the presence of endometriomas. The association between fibrosis and a reduced ovarian reserve was demonstrated. Upregulated recruitment and the subsequent demise of early follicles may result in focal exhaustion of primordial follicles. Burn-out of early follicles by a local pelvic inflammatory environment caused by endometriomas may therefore be suggested. However, intraovarian inflammation, subsequent fibrosis and depletion of the ovarian reserve constitute another reason that should also be given due consideration. In addition, surgery should not be ruled out as a possible cause of ovarian reserve depletion. In conclusion, potential mechanisms leading to infertility are numerous, and while some of them remain hypothetical for now, others are supported by clear evidence. These possible mechanisms were reviewed in the present paper.
Topics: Endometriosis; Female; Humans; Infertility, Female; Iron Overload; NF-kappa B; Oocytes; Ovarian Diseases; Oxidative Stress; Pelvic Inflammatory Disease; Prostaglandins
PubMed: 26837776
DOI: No ID Found -
The Indian Journal of Medical Research Jan 2017
Topics: Abdomen; Adult; Azithromycin; Cephalosporins; Chlamydia Infections; Female; Hepatitis; Humans; Liver; Pelvic Inflammatory Disease; Peritonitis; Young Adult
PubMed: 28574030
DOI: 10.4103/ijmr.IJMR_1417_15 -
The American Journal of the Medical... Apr 2023
Topics: Female; Humans; Pelvic Inflammatory Disease; Hepatitis; Peritonitis; Chlamydia Infections; Chlamydia trachomatis
PubMed: 36549420
DOI: 10.1016/j.amjms.2022.12.017 -
Clinical Obstetrics and Gynecology Mar 2017Ultrasound is considered the first-line imaging modality in the evaluation of the fallopian tubes. This chapter reviews both the physiologic and pathologic sonographic... (Review)
Review
Ultrasound is considered the first-line imaging modality in the evaluation of the fallopian tubes. This chapter reviews both the physiologic and pathologic sonographic findings of the fallopian tubes and how to recognize characteristic entities. Specifically, it describes how to use ultrasound techniques to distinguish between pathologic processes including chronic versus acute pelvic inflammatory disease, as well as infertility, torsion, and malignancy. It also describes how to employ modern ultrasound techniques, such as color Doppler, three-dimensional imaging, and salpingocentesis in clinical practice.
Topics: Animals; Fallopian Tube Diseases; Fallopian Tubes; Female; Humans; Hysterosalpingography; Imaging, Three-Dimensional; Infertility, Female; Pelvic Inflammatory Disease; Ultrasonography; Ultrasonography, Doppler, Color
PubMed: 28005596
DOI: 10.1097/GRF.0000000000000262 -
Journal of Gynecology Obstetrics and... May 2020Pelvic inflammatory diseases (PID) must be suspected when spontaneous pelvic pain is associated with induced adnexal or uterine pain (grade B). Pelvic ultrasonography is... (Review)
Review
Pelvic inflammatory diseases (PID) must be suspected when spontaneous pelvic pain is associated with induced adnexal or uterine pain (grade B). Pelvic ultrasonography is necessary to rule out tubo-ovarian abscess (TOA) (grade C). Microbiological diagnosis requires endocervical and TOA sampling for molecular and bacteriological analysis (grade B). First-line treatment for uncomplicated PID combines ceftriaxone 1 g, once, IM or IV, doxycycline 100 mg ×2/day, and metronidazole 500 mg ×2/day PO for 10 days (grade A). First-line treatment for complicated PID combines IV ceftriaxone 1-2 g/day until clinical improvement, doxycycline 100 mg ×2/day, IV or PO, and metronidazole 500 mg ×3/day, IV or PO for 14 days (grade B). Drainage of TOA is indicated if the pelvic fluid collection measures more than 3 cm (grade B). Follow-up is required in women with sexually transmitted infections (STIs) (grade C). The use of condoms is recommended (grade B). Vaginal sampling for microbiological diagnosis is recommended 3-6 months after PID (grade C), before the insertion of an intrauterine device (grade B), and before elective termination of pregnancy or hysterosalpingography. When specific bacteria are identified, antibiotics targeted at them are preferable to systematic antibiotic prophylaxis.
Topics: Anti-Bacterial Agents; Bacteria; Bacterial Infections; Ceftriaxone; Doxycycline; Female; France; Genitalia, Female; Humans; Metronidazole; Pelvic Inflammatory Disease; Pelvic Pain; Practice Guidelines as Topic; Sexually Transmitted Diseases; Ultrasonography
PubMed: 32087306
DOI: 10.1016/j.jogoh.2020.101714 -
Abdominal Radiology (New York) Mar 2017Pelvic inflammatory disease (PID) is an ascending infection of the female genital tract caused by the spread of bacteria from the vagina to the pelvic reproductive... (Review)
Review
Pelvic inflammatory disease (PID) is an ascending infection of the female genital tract caused by the spread of bacteria from the vagina to the pelvic reproductive organs and occasionally the peritoneum. The most common causative organisms are sexually transmitted. PID is a significant source of morbidity among reproductive age women both as a cause of abdominal pain and as a common cause of infertility. Its clinical presentation is often nonspecific, and the correct diagnosis may first come to light based on the results of imaging studies. MRI is well suited for the evaluation of PID and its complications due to its superior soft tissue contrast and high sensitivity for inflammation. MRI findings in acute PID include cervicitis, endometritis, salpingitis/oophoritis, and inflammation in the pelvic soft tissues. Acute complications include pyosalpinx, tuboovarian abscess, peritonitis, and perihepatitis. Hydrosalpinx, pelvic inclusion cysts and ureteral obstruction may develop as chronic sequela of PID. The pathophysiology, classification, treatment, and prognosis of PID are reviewed, followed by case examples of the appearance of acute and subclinical PID on MR images.
Topics: Female; Humans; Magnetic Resonance Imaging; Pelvic Inflammatory Disease
PubMed: 27933478
DOI: 10.1007/s00261-016-1004-4 -
Gynecologie, Obstetrique, Fertilite &... 2021Chlamydia trachomatis (CT) is the most common sexually transmitted bacterial infection worldwide. It is asymptomatic in most cases and mainly affects young women, with... (Review)
Review
Chlamydia trachomatis (CT) is the most common sexually transmitted bacterial infection worldwide. It is asymptomatic in most cases and mainly affects young women, with potential long term sequelae (pelvic inflammatory disease, tubal infertility, obstetric complications). The impact on male fertility is controversial. Screening methods as well as antibiotics use have recently been reassessed due to resistance phenomena and the negative effect on the urogenital microbiota. Positive CT serology may be indicative of tuboperitoneal pathology, which may not be noticed on hysterosalpingography. New research on single-nucleotide polymorphisms (SNPs) aims to establish a patient profile at higher risk of infectious tubal damage due to CT. CT seropositivity is also associated with decreased spontaneous pregnancy rates and is a predictive factor for obstetrical complications.
Topics: Chlamydia Infections; Chlamydia trachomatis; Female; Humans; Hysterosalpingography; Infertility; Infertility, Female; Male; Pelvic Inflammatory Disease; Pregnancy
PubMed: 33434747
DOI: 10.1016/j.gofs.2021.01.003 -
Annals of Emergency Medicine Jul 2019
Topics: Female; Gynecological Examination; Humans; Pelvic Inflammatory Disease; Sexually Transmitted Diseases; Uterine Cervicitis
PubMed: 31248494
DOI: 10.1016/j.annemergmed.2019.01.046 -
Annals of Emergency Medicine Apr 2019
Topics: Female; Gynecological Examination; Humans; Pelvic Inflammatory Disease; Sexually Transmitted Diseases; Uterine Cervicitis
PubMed: 30902177
DOI: 10.1016/j.annemergmed.2018.11.027 -
Clinical Anatomy (New York, N.Y.) Jan 2019Pelvic pain is a common symptom that affects women worldwide and usually presents with variable range of severity, duration, and location. Several gynecological... (Review)
Review
Pelvic pain is a common symptom that affects women worldwide and usually presents with variable range of severity, duration, and location. Several gynecological conditions may result in pelvic pain, and may have a variable presentation among patients. Pelvic pain creates a significant challenge and frustration to both patients and clinicians, which also creates a significant burden on the economy. It is necessary to tailor the management of pelvic pain to each individual patient to achieve optimal outcomes. Endometriosis, adenomyosis, and fibroids result in pelvic pain and may occur simultaneously. This review highlights some of the common gynecological etiologies of pelvic pain with a focus on anatomy, diagnosis, and management. Clin. Anat. 9999:1-5, 2018. © 2018 Wiley Periodicals, Inc.
Topics: Adenomyosis; Endometriosis; Female; Humans; Leiomyoma; Pelvic Inflammatory Disease; Pelvic Pain; Uterine Neoplasms
PubMed: 30390350
DOI: 10.1002/ca.23270