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BMC Women's Health Jul 2022Cervical cancer is the most common indication for ovarian transposition in reproductive-age women. Ovarian transposition should be performed in premenopausal women... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Cervical cancer is the most common indication for ovarian transposition in reproductive-age women. Ovarian transposition should be performed in premenopausal women undergoing pelvic irradiation to preserve ovarian function, and prevent early menopause. As women become more knowledgeable about their fertility options, it is still unclear who will benefit from the intervention. We updated our previous meta-analysis of ovarian function preservation, symptomatic ovarian cysts, and metastases to the transposed ovaries following ovarian transposition in cervical cancer patients to further guide current clinical practice.
METHODS
A systematic search of Medline, Embase, Web of Science, and The Cochrane Library databases, dating from January 1980 to July 2021, was conducted. We computed the summary proportions of women who had ovarian function preservation, non-ovarian cyst formation and metastases to the transposed ovaries following ovarian transposition by random-effects meta-analysis and we explored study heterogeneity by type of radiotherapy.
RESULTS
There were 29 publications reporting on 1160 women with cervical cancer who underwent ovarian transposition. In the group that underwent surgery alone, 91% of the women had preserved ovarian function (95% CI 83-100), 89% (95% CI 80-99) of women who did not develop ovarian cysts, and 99% (95% CI 1-5) of women who did not suffer metastases to the transposed ovaries. In the surgery ± brachytherapy (BR) group, the proportion of women with the preserved ovarian function was 93% (95% CI 76-113), 84% (95% CI 69-103) of women who did not develop ovarian cysts, and 99% (95% CI 82-120) of women who did not suffer metastases to the transposed ovaries. In the external beam pelvic radiotherapy (EBRT) ± BR ± surgery group, the proportion of women with the preserved ovarian function was 61% (95% CI 55-69), and 95% (95% CI 85-107) of women who developed ovarian cysts. There were no metastases to the transposed ovaries in that group.
CONCLUSIONS
In women with cervical cancer, ovarian transposition offers a significant preservation of the ovarian function. Despite an expected incidence of ovarian cyst formation, it carries almost no risk for metastases to the transposed ovaries.
Topics: Brachytherapy; Female; Humans; Ovarian Cysts; Pelvis; Uterine Cervical Neoplasms
PubMed: 35869476
DOI: 10.1186/s12905-022-01887-8 -
Frontiers in Endocrinology 2023Increasing observational studies have indicated that hormonal reproductive factors were associated with ovarian cyst, a common gynecological disease. A two-sample...
BACKGROUND
Increasing observational studies have indicated that hormonal reproductive factors were associated with ovarian cyst, a common gynecological disease. A two-sample Mendelian randomization (MR) was carried out by investigating the causality of reproductive factors including age at first birth (AFB), age at natural menopause (ANM), and age at menarche (AAM), and the risk of ovarian cyst (OC).
METHOD
Summary statistics were collected from a large genome-wide association study (GWAS), and we used a two-sample MR study to clarify the causal association between the exposure of AFB ( = 542,901), ANM ( = 69,360), and AAM ( = 29,346) and the outcome of the OC ( = 20,750, = 107,564). We separately selected 51, 35, and 6 single-nucleotide polymorphisms (SNPs) as instrumental variables (IVs) for assaying the influence of AFB, ANM, and AAM on OC, respectively. Then, the causal relationship was tested through multiple approaches including an inverse-variance weighted method, an MR-Egger regression, and a weighted median method. In addition, the MR-PRESSO method was also used to verify the horizontal pleiotropy. Subsequently, we adjust the confounders for MR design.
RESULTS
The MR analysis results showed that AFB was negatively associated with the OC (IVW Beta: -0.09, OR: 0.91, 95% CI: 0.86-0.96, = 0.00185), and the greater AAM decreased the risk of OC (IVW Beta: -0.10, OR: 0.91, 95% CI: 0.82-0.99, = 0.0376). However, ANM has a positive correlation with the OC (IVW Beta: 0.05, OR: 1.05, 95% CI: 1.03-1.08, = 8.38 × 10). After adjusting BMI, alcohol intake frequency, and ever smoked, we also obtained a negative relationship between AFB and OC ( < 0.005). Meanwhile, we adjusted weight, alcohol intake frequency, and height, and then found a causal relationship between older AMN and an increased risk of OC ( < 0.005).
CONCLUSION
A causal effect of reproductive factors on the development of OC, affected by AFB, ANM, and AAM, was found convincingly. After adjusting the confounders, we also successfully found the substantial causal effect of younger AFB, younger AAM, and older ANM on an increased risk of OC.
Topics: Female; Humans; Birth Order; Genome-Wide Association Study; Mendelian Randomization Analysis; Ovarian Cysts; Menopause
PubMed: 38239975
DOI: 10.3389/fendo.2023.1279493 -
Reproduction, Nutrition, Development 2006Cystic ovarian follicles (COF) are an important ovarian dysfunction and a major cause of reproductive failure in dairy cattle. Due to the complexity of the disorder and... (Review)
Review
Cystic ovarian follicles (COF) are an important ovarian dysfunction and a major cause of reproductive failure in dairy cattle. Due to the complexity of the disorder and the heterogeneity of the clinical signs, a clear definition is lacking. A follicle becomes cystic when it fails to ovulate and persists on the ovary. Despite an abundance of literature on the subject, the exact pathogenesis of COF is unclear. It is generally accepted that disruption of the hypothalamo-pituitary-gonadal axis, by endogenous and/or exogenous factors, causes cyst formation. Secretion of GnRH/LH from the hypothalamus-pituitary is aberrant, which is attributed to insensitivity of the hypothalamus-pituitary to the positive feedback effect of oestrogens. In addition, several factors can influence GnRH/LH release at the hypothalamo-pituitary level. At the ovarian level, cellular and molecular changes in the growing follicle may contribute to anovulation and cyst formation, but studying follicular changes prior to cyst formation remains extremely difficult. Differences in receptor expression between COF and dominant follicles may be an indication of the pathways involved in cyst formation. The genotypic and phenotypic link of COF with milk yield may be attributed to negative energy balance and the associated metabolic and hormonal adaptations. Altered metabolite and hormone concentrations may influence follicle growth and cyst development, both at the level of the hypothalamus-pituitary and the ovarian level.
Topics: Animals; Cattle; Cattle Diseases; Energy Metabolism; Female; Gonadotropin-Releasing Hormone; Hypothalamo-Hypophyseal System; Luteinizing Hormone; Ovarian Cysts; Ovarian Follicle
PubMed: 16597418
DOI: 10.1051/rnd:2006003 -
Ultrasound in Obstetrics & Gynecology :... Jul 2017To explore the outcome of fetuses with a prenatal diagnosis of ovarian cyst. (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To explore the outcome of fetuses with a prenatal diagnosis of ovarian cyst.
METHODS
The electronic databases MEDLINE and EMBASE were searched using keywords and word variants for 'ovarian cysts', 'ultrasound' and 'outcome'. The following outcomes in fetuses with a prenatal diagnosis of ovarian cyst were explored: resolution of the cyst, change of ultrasound pattern of the cyst, occurrence of ovarian torsion and intracystic hemorrhage, need for postnatal surgery, need for oophorectomy, accuracy of prenatal ultrasound examination in correctly identifying ovarian cyst, type of ovarian cyst at histopathological analysis and intrauterine treatment. Meta-analyses using individual data random-effects logistic regression and meta-analyses of proportions were performed. Quality assessment of the included studies was performed using the Newcastle-Ottawa Scale.
RESULTS
Thirty-four studies (954 fetuses) were included. In 53.8% (95% CI, 46.0-61.5%) of cases for which resolution of the cyst was evaluated (784 fetuses), the cyst regressed either during pregnancy or after birth. The likelihood of resolution was significantly lower in complex vs simple cysts (odds ratio (OR), 0.15 (95% CI, 0.10-0.23)) and in cysts measuring ≥ 40 mm vs < 40 mm (OR, 0.03 (95% CI, 0.01-0.06)). Change in ultrasound pattern of the cyst was associated with an increased risk of ovarian loss (surgical removal or autoamputation) (pooled proportion, 57.7% (95% CI, 42.9-71.8%)). The risk of ovarian torsion was significantly higher for cysts measuring ≥ 40 mm compared with < 40 mm (OR, 30.8 (95% CI, 8.6-110.0)). The likelihood of having postnatal surgery was higher in patients with cysts ≥ 40 mm compared with < 40 mm (OR, 64.4 (95% CI, 23.6-175.0)) and in complex compared with simple cysts, irrespective of cyst size (OR, 14.6 (95% CI, 8.5-24.8)). In cases undergoing prenatal aspiration of the cyst, rate of recurrence was 37.9% (95% CI, 14.8-64.3%), ovarian torsion and intracystic hemorrhage were diagnosed after birth in 10.8% (95% CI, 4.4-19.7%) and 12.8% (95% CI, 3.8-26.0%), respectively, and 21.8% (95% CI, 0.9-40.0%) had surgery after birth.
CONCLUSION
Size and ultrasound appearance are the major determinants of perinatal outcome in fetuses with ovarian cysts. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
Topics: Female; Humans; Ovarian Cysts; Predictive Value of Tests; Pregnancy; Ultrasonography, Prenatal
PubMed: 27325566
DOI: 10.1002/uog.16002 -
Acta Obstetricia Et Gynecologica... Oct 2020Mitotane is an adrenolytic drug that is used as an adjuvant to treat adrenocortical carcinoma. This study aimed to evaluate the clinical course and pathogenetic...
INTRODUCTION
Mitotane is an adrenolytic drug that is used as an adjuvant to treat adrenocortical carcinoma. This study aimed to evaluate the clinical course and pathogenetic mechanisms underlying ovarian cyst formation in women of reproductive age diagnosed with adrenocortical carcinoma and being treated with mitotane as an adjuvant to surgery.
MATERIAL AND METHODS
Five women presented with stage III-IV adrenocortical carcinoma and ovarian cyst formation during mitotane treatment. The clinical course of the disease was followed during and after treatment. The effects of mitotane on progesterone production and cell proliferation were studied in cultured human ovarian granulosa cells.
RESULTS
Computed tomography and vaginal ultrasonography during mitotane treatment repeatedly demonstrated ovarian cysts of varying size without solid intralocular structures. Two women became amenorrheic during the treatment period. After mitotane cessation, the ovarian cysts disappeared and normal menstrual cycles resumed. One woman had an uncomplicated pregnancy two years after mitotane treatment. In one woman, who underwent salpingo-oophorectomy, histological analysis demonstrated benign ovarian cysts. Mitotane impeded the synthesis of progesterone, reduced the stimulatory effect of gonadotropins on progesterone formation, and reduced labeling with [ H]thymidine in cultured granulosa cells.
CONCLUSIONS
Therapeutic concentrations of mitotane are associated with the formation of benign ovarian cysts and amenorrhea. Mitotane-induced suppression of ovarian steroidogenesis and impediment of the proliferative capacity of steroid-producing cells are suggested potential pathogenetic mechanisms underlying mitotane-induced ovarian dysfunction and cyst development. Mitotane treatment does not compromise future ovarian function.
Topics: Adrenal Cortex Neoplasms; Adrenocortical Carcinoma; Adult; Amenorrhea; Antineoplastic Agents, Hormonal; Female; Humans; Middle Aged; Mitotane; Ovarian Cysts; Tomography, X-Ray Computed; Ultrasonography; Young Adult
PubMed: 32282928
DOI: 10.1111/aogs.13869 -
Journal of Infection and Public Health Jan 2021In order to explore the accuracy of computed tomography (CT) and type-B ultrasonography in the examinations infection of ovarian cyst, the computed tomography and type-B...
In order to explore the accuracy of computed tomography (CT) and type-B ultrasonography in the examinations infection of ovarian cyst, the computed tomography and type-B ultrasonography were used for the examinations of 50 patients with infection of ovarian cysts, whose results were analyzed to determine the accuracy. Results have shown that the misdiagnosis rates of CT for patients with infection of ovarian cyst reached 18%, in which the misdiagnosis rate of small lesion 2.1×1.5×1.8cm was relatively higher; in addition, the misdiagnosis rates of type-B ultrasonography reached 26%, in which the misdiagnosis rate of large lesion 2.6×1.6×1.5cm was relatively higher; however, the misdiagnosis rates of the joint examination of these methods were only 2%. In summary, the deficiencies of CT and type-B ultrasonography may lead to misdiagnosis; therefore, in the clinical practices, the examinations of patients with infection of ovarian cyst should combine CT and type-B ultrasonography together to avoid the misdiagnosis and obtain the most accurate results as much as possible, which is important to both the patients and the development of medical examinations.
Topics: Female; Humans; Ovarian Cysts; Tomography, X-Ray Computed; Ultrasonography
PubMed: 31455597
DOI: 10.1016/j.jiph.2019.08.003 -
The Journal of Veterinary Medical... Oct 2020Ovarian cysts are one of the most common ovarian dysfunctions in dairy cattle, which can lead to a considerable economic loss through its high incidence and can reduce... (Review)
Review
Ovarian cysts are one of the most common ovarian dysfunctions in dairy cattle, which can lead to a considerable economic loss through its high incidence and can reduce the reproductive performance. Anestrus is the most significant clinical sign observed in dairy cattle suffering from this condition. For diagnosis, most of the veterinarians use a combination of methods, from ultrasonography as an additional approach to trans-rectal palpation and symptomatology when assessing ovarian cysts. Although the Ovsynch treatment seems to be preferred, the pregnancy rate after this treatment is relatively low. Despite such reports on dairy cattle ovarian cysts, the data is insufficient to validate all the characteristics of this condition. This review summarizes what the literature has so far provided from definition to treatment of ovarian cysts in dairy cattle.
Topics: Animals; Cattle; Cattle Diseases; Diagnosis, Differential; Female; Incidence; Insemination, Artificial; Ovarian Cysts; Pregnancy; Pregnancy Rate; Reproduction; Risk Factors
PubMed: 32814749
DOI: 10.1292/jvms.20-0381 -
The Cochrane Database of Systematic... 2014Ten per cent to 15% of couples have difficulty in conceiving. A proportion of these couples will ultimately require assisted reproduction. Prior to controlled ovarian... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Ten per cent to 15% of couples have difficulty in conceiving. A proportion of these couples will ultimately require assisted reproduction. Prior to controlled ovarian hyperstimulation (COH) a baseline ultrasound is performed to detect the presence of ovarian cysts.Previous research has suggested that there is a relationship between the presence of an ovarian cyst prior to COH and poor outcome during IVF.
OBJECTIVES
The aim of this review was to determine the effectiveness and safety of functional ovarian cyst aspiration prior to ovarian stimulation versus a conservative approach in women with an ovarian cyst who were undergoing IVF or ICSI.
SEARCH METHODS
We searched the Menstrual Disorders and Subfertility Group (MDSG) Specialised Register, Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO, CINAHL, ClinicalTrials.gov, Google Scholar and PubMed. The evidence was current to April 2014 and no language restrictions were applied.
SELECTION CRITERIA
We included all randomised controlled trials (RCTs) comparing functional ovarian cyst aspiration versus conservative management of ovarian cysts that have been seen on transvaginal ultrasound (TVS) prior to COH for IVF or ICSI. Ovarian cysts were defined as simple, functional ovarian cysts > 20 mm in diameter. Oocyte donors and women undergoing donor oocyte cycles were excluded.
DATA COLLECTION AND ANALYSIS
Study selection, data extraction and risk of bias assessments were conducted independently by two review authors. The primary outcome measures were live birth rate and adverse events. The overall quality of the evidence for each comparison was rated using GRADE methods.
MAIN RESULTS
Three studies were eligible for inclusion (n = 339), all of which used agonist protocols. Neither live birth rate nor adverse events were reported by any of the included studies. There was no conclusive evidence of a difference between the group who underwent ovarian cyst aspiration and the conservatively managed group in the clinical pregnancy rate (OR 1.40, 95% CI 0.67 to 2.94, 3 studies, 339 women, I(2) = 0%, low quality evidence). This suggested that if the clinical pregnancy rate in women with conservative management was assumed to be 5%, the chance following cyst aspiration would be between 4% and 14%. There was no evidence of a difference between the groups in the mean number of follicles recruited (0.55 follicles, 95% CI -0.48 to 1.59, 2 studies, 159 women, I(2) = 0%, low quality evidence) or mean number of oocytes collected (0.41 oocytes, 95% CI -0.04 to 0.85, 3 studies, 339 women, I(2) = 0%, low quality evidence). Findings for the cancellation rate (two studies) were inconsistent but neither study reported a benefit for the aspiration group. The main limitations of the evidence were imprecision, inconsistency, questionable applicability, and poor reporting of study methods.
AUTHORS' CONCLUSIONS
There is insufficient evidence to determine whether drainage of functional ovarian cysts prior to controlled ovarian hyperstimulation influences live birth rate, clinical pregnancy rate, number of follicles recruited, or oocytes collected in women with a functional ovarian cyst. The findings of this review do not provide supportive evidence for this approach, particularly in view of the requirement for anaesthesia, extra cost, psychological stress and risk of surgical complications.
Topics: Adult; Embryo Transfer; Female; Fertilization in Vitro; Humans; Infertility, Female; Oocyte Retrieval; Ovarian Cysts; Ovarian Follicle; Ovulation Induction; Pregnancy; Pregnancy Rate; Randomized Controlled Trials as Topic; Suction; Ultrasonography, Interventional
PubMed: 25502626
DOI: 10.1002/14651858.CD005999.pub2 -
Fertility and Sterility Aug 2022To share our experience of intravenous indocyanine green (ICG) application during conservative ovarian surgery in a young patient with adnexal torsion, a large ovarian...
OBJECTIVE
To share our experience of intravenous indocyanine green (ICG) application during conservative ovarian surgery in a young patient with adnexal torsion, a large ovarian cyst, and apparent ovarian necrosis.
DESIGN
This confirmatory video of ovarian reperfusion uses footage from the laparoscopic treatment and ICG application in a young patient with adnexal torsion and apparent necrosis.
SETTING
Academic, multisite medical center.
PATIENT(S)
A 24-year-old patient with a 12-cm dermoid cyst, adnexal torsion, and apparent tissue necrosis.
INTERVENTION(S)
Five milligrams intravenous ICG, de-torsion, ovarian cystectomy, and ovarian reconstruction. The patient approved the ICG off-label use.
MAIN OUTCOME MEASURE(S)
Ovarian preservation and perioperative morbidity.
RESULT(S)
This video demonstrates the surgical treatment of a patient with adnexal torsion. The perfusion patterns before and after the surgical treatment, i.e., cyst de-torsion and cyst removal are documented using intravenous ICG. The perfusion patterns guided the surgeon to perform ovarian conservation despite apparent initial ischemia. The patient recovered well, and no postoperative 30-day morbidity occurred.
CONCLUSION(S)
Intraoperative subjective overestimation of the true ovarian ischemia may lead to unnecessary oophorectomy. Per the American College of Obstetrics and Gynecology recommendation, patients with adnexal torsion should be treated surgically with ovarian conservation regardless of the appearance of the ovary. As demonstrated, ovaries reperfuse despite multiple twists along the infundibulopelvic pedicle, apparent necrosis, and large cysts. Unilateral salpingo-oophorectomies are avoidable even in these cases.
Topics: Adnexal Diseases; Adult; Female; Humans; Indocyanine Green; Necrosis; Ovarian Cysts; Ovarian Torsion; Pregnancy; Retrospective Studies; Torsion Abnormality; Young Adult
PubMed: 35691717
DOI: 10.1016/j.fertnstert.2022.05.031 -
The Journal of International Medical... Jul 2019This study aimed to examine improvement and the effect of stress responses and ovarian reserve function in patients with ovarian cysts after laparoscopic surgery.
OBJECTIVES
This study aimed to examine improvement and the effect of stress responses and ovarian reserve function in patients with ovarian cysts after laparoscopic surgery.
METHODS
A retrospective analysis was performed on 117 patients with ovarian cysts. Fifty-one patients who were treated with abdominal ovarian cyst dissection were in the control group. Sixty-six patients who were treated with laparoscopic ovarian cyst dissection were in the experimental group.
RESULTS
Operative conditions and recovery in the experimental group were better than those in the control group. After surgery, changes in most ovarian reserve function indices in the experimental group were significantly less than that in the control group. The maximum diameter of the ovary and the number of antral follicles after surgery were less in the experimental group than in the control group. Changes in stress response indices after surgery were significantly less in the experimental group than in the control group.
CONCLUSIONS
Laparoscopic ovarian cyst surgery may have a relatively small adverse effect on multiple related indices of ovarian reserve function. The patient’s stress response level is also lower after this surgery. Therefore, laparoscopic ovarian cyst surgery is suitable for treating patients with ovarian cysts.
Topics: Adult; Case-Control Studies; Female; Follow-Up Studies; Humans; Laparoscopy; Ovarian Cysts; Ovarian Reserve; Prognosis; Retrospective Studies; Stress, Physiological
PubMed: 31187659
DOI: 10.1177/0300060519851333