INFERTILITY

New male fertility test offers clarity for couples struggling to conceive

New male fertility test offers clarity for couples struggling to conceive

Infertility affects 10% to 15% of couples globally, and while often viewed as a women’s health problem, men contribute to around half of the cases.

A new male fertility test based on Cornell research could help predict which men might need treatment and which couples might have success with different forms of assisted reproduction.

“The ‘Cap-Score test is designed to provide information on the man’s fertility that they never had before,” said Dr. Alexander Travis, professor of reproductive biology at the Baker Institute for Animal Health and the test’s inventor.

“Now, doctors can discuss these results with the couple, and help them choose the personalized treatment pathway that is right for them to try to get pregnant, including how to improve the man’s fertility.”

The research was published in Reproductive BioMedicine Online. Travis is senior author.

The Cap-Score is a diagnostic test approved for use by medical doctors in all 50 states; the technology has been licensed to Androvia LifeSciences, LLC, a fertility research company co-founded by Travis, its chief science officer, in 2015. Travis holds equity in the company.

Cap-Score quantifies the ability of sperm to undergo a process called “capacitation,” which enables the sperm to fertilize an egg. Only sperm that capacitate are capable of fertilizing. By contrast, traditional male fertility exams rely primarily on semen analysis, which counts sperm and assesses whether they swim and look normal.

“Fertility exists in degrees; as long as a man produces some sperm that swim, he has some level of fertility,” Travis said. “But it is the functional ability of those sperm to fertilize an egg that influences the odds that a couple will become pregnant.”

The new research included prospective clinical pregnancy outcomes data from six fertility clinics. Prospective tests are important when evaluating a new diagnostic procedure because they show the ability to predict what will happen for patients.

Travis said Cap-Score‘s predictive ability “held true across different age ranges for the female partner.” This is important because there are many well-known impacts of maternal age on a couple’s fertility. The new data shows that the man’s fertility plays a key role in whether a couple will be able to conceive, even if they might have delayed having children and are older.

The researchers also compared Cap-Score results from more than 2,000 men having fertility exams at 22 clinics against results from a control group of fertile men with a pregnant partner or young baby. Cap-Scores from the fertile men showed an expected bell-shaped curve. In contrast, the vast majority of men questioning their fertility had scores below the mean of the fertile population.

Additionally, the researchers examined the relationship between traditional semen analysis results and impaired capacitation. “Men are often assumed to be fertile if they have enough normal-looking sperm that swim,” Travis said, “but we found that almost two-thirds of the men who had low Cap-Scores passed the traditional semen analysis.”

Infertility and most male infertility cases remain unexplained due to a lack of diagnostic testing. Not only does this place the onus of expensive and often invasive testing on women, it also may prompt couples to try expensive procedures that might be inappropriate for their situation. The Cap-Score can now provide crucial missing information to help guide their choices.

“Couples and doctors have had to make important decisions about their fertility without all the information they needed. This has caused a lot of anxiety and pain — physically, financially and emotionally,” Travis said.

Using the Cap-Score, doctors and couples can make informed decisions about whether to try to conceive unassisted or choose one of several medical approaches. The results can also be used to identify which men might benefit from treatment to improve their fertility, including changes in lifestyle, nutritional supplements or surgery.

Read more: https://www.rbmojournal.com/article/S1472-6483(20)30162-0/pdf

Bioengineering repairs uterus resulting in live births in rabbits

Bioengineering repairs uterus resulting in live births in rabbits

Researchers looking for an alternative to uterus transplants successfully restored uterine structure and function in rabbits using bioengineered uterine tissue.

The research, published in Nature Biotechnology, showed that the engineered tissue developed native tissue-like structures and was able to support pregnancies leading to live births.

‘The study shows that engineered uterine tissue is able to support normal pregnancies, and fetal development was normal,’ said author Professor Anthony Atala from the Wake Forest Institute for Regenerative Medicine in North Carolina. ‘With further development, this approach may provide a pathway to pregnancy for women with an abnormal uterus‘.

In the study, 78 rabbits were randomly assigned to four different groups: groups one to three had most of their uterine tissue removed. Group four was a normal control group, where animals underwent a sham surgery but no tissue was removed.

In group one the excision was repaired with a synthetic polymer scaffold containing cells collected from the tissue that was removed; group two underwent repair with the polymer scaffold only; in group three no extra material was added and the remaining edges were stitched together.

The polymer scaffolds degraded after three months. At six months the group that had repair with the scaffold only developed a thin uterine wall, but the group that received the scaffold seeded with cells had developed native tissue-like structures including distinct endometrium and myometrium tissue layers, and were expressing progesterone and oestrogen hormone receptors. The excision-only group formed scar tissue.

The rabbits were mated naturally with fertile males six months after the procedures. Four out of ten rabbits from the tissue-engineered group had normal PREand gave birth to healthy offspring with normal body weights. No fetal development occurred in the scaffold-only or excision-only groups.

‘This is a highly significant finding with great potential for future human application. For women who suffer infertility due to a severely damaged uterus or because of a hysterectomy then adaptations of this approach may well find clinical application,’ said Professor Darren Griffin from the University of Kent, who was not involved in the study.

Uterus transplantation became a viable treatment following the first successful transplant which led to a live birth in 2014. However, this treatment is associated with a range of issues including lack of donors, transplant rejection and the risk of disease transmission. Bioengineered uteri could be an alternative treatment method for women with uterine infertility; however, more preclinical studies need to be carried out before clinical trials can be performed in humans.

Read more: https://www.nature.com/articles/s41587-020-0547-7

Embryo vitrification is safe but longer storage reduces chances of pregnancy success

Embryo vitrification is safe but longer storage reduces chances of pregnancy success

Freezing and storing embryos during fertility treatment using a technique called vitrification is safe, although women are less likely to become pregnant and have a live birth the longer the embryos are stored, according to new research published in Human Reproduction, one of the world’s leading reproductive medicine journals.

There have been concerns that vitrification technology could be unsafe for the embryo, leading to complications at the time of birth and later, including preterm birth, low or high birthweight and birth defects.

Until now, it was also unclear whether storage time after vitrification affected embryo viability, pregnancy outcomes or neonatal outcomes. The study, which is the largest to investigate these questions, found that the chances of becoming pregnant and giving birth to a live baby significantly decreased with longer storage time.

The researchers from the Shanghai Ninth People’s Hospital (Shanghai, China) analysed outcomes from 24,698 patients who had vitrified embryos transferred for the first time between January 2011 and December 2017.

They compared patients who had vitrified embryos stored for up to three months (group one) with patients whose embryos were stored for 3-6 months (group two), 6-12 months (group three) and 12-24 months (group four). They found that the implantation rate fell from 40% in group one to 26% in group four; the clinical pregnancy rate fell from 56% in group one to 26% in group four; and the live birth rate fell from 47% in group one to 26% in group four.

This means that among women who had embryos stored for less than three months, 47 out every 100 women would achieve a live birth. Whereas among women who had embryos stored for between 12-24 months, 34 out of every 100 women would achieve a live birth.

The rate of miscarriages and ectopic pregnancies also increased with longer storage time. However, these associations were not statistically significant after taking into account factors that could affect the results such as the mother’s age, mother’s body mass index, the cause of infertility, parity and embryo quality and stage of development. There was no evidence that storage time affected neonatal outcomes.

Groups three and four had a greater proportion of older women or patients with a poor prognosis due to smaller numbers of available eggs than groups one and two; so the researchers carried out a second analysis to investigate whether it could be the women’s ages and the amount of viable eggs they had in their ovaries at the time of vitrification and embryo transfer that led to the lower pregnancy and birth rates.

They analysed a subset of 7,270 women who were younger than 36 years and whose infertility was caused by blocked or damaged fallopian tubes. This produced similar results; there was a 50% live birth rate among women in group one, compared to a 38% live birth rate in group four.

Dr Qianqian Zhu is a research assistant who led the study. She said: “We think the results from this sub-analysis support our main results about the relationship between the duration of storage with pregnancy and neonatal outcomes.”

Co-author, Professor Qifeng Lyu is deputy director of the department of assisted reproduction at the hospital. He said: “Our study suggests that although the storage time of vitrified embryos negatively affected pregnancy outcomes, including clinical pregnancy and live birth rates, it did not affect neonatal outcomes. Concerns have arisen over the safety of prolonged storage time of vitrified embryos worldwide following the wide application of vitrification, and neonatal health is related to growth, development and health in childhood, adolescence and adulthood. Our study demonstrated the safety of using long-stored embryos after vitrification on neonatal health.

This is reassuring news for couples seeking fertility treatment. The reduction in live birth rates can be overcome through additional embryo transfer cycles. If we had found that neonatal health was adversely affected by vitrification, it would impose a heavy burden on individuals, family and society.”

The study is unable to show the effect of storing embryos for longer than 24 months, and the researchers did not undertake long-term follow-up of babies, so do not have information about their growth and development. As the study was retrospective, the researchers say that prospective studies with long-term follow-up are needed to investigate the safety of vitrification for longer periods of time.

Dr Zhu said: “Our results suggest that clinicians should consider the effect of storage duration before making decisions about the numbers of embryos to freeze and store. This is especially important for cancer patients, who may have their ovaries destroyed by cancer therapies and who have to delay fertility treatment until they have recovered from their disease.”

Vitrification involves placing embryos briefly in a solution to dehydrate them before they are rapidly frozen into a glass-like state. Chemicals called cryoprotectants are used during this process to prevent ice crystals forming, which could damage the embryos. Then the embryos are immediately exposed to liquid nitrogen to freeze them rapidly, ready for storage. When needed, this process is reversed to thaw and warm the embryos quickly. Vitrification is a simple, fast and inexpensive technique, which has become a fundamental tool in fertility treatments in recent years because of its higher embryo survival rates and better clinical outcomes.

Read more: https://academic.oup.com/DocumentLibrary/humrep/PR_Papers/deaa136.pdf

Is endometriosis hereditary?

Is endometriosis hereditary?

Women with endometriosis may be more likely to have a close relative with the disease. However, research into the potential link is still developing.

Endometriosis is a complex condition. Many factors beyond heredity may increase a person’s risk of developing it.

Is endometriosis hereditary?

More research is necessary to determine if endometriosis has a hereditary component.

Preliminary research suggests that endometriosis may have a hereditary component. However, it is unlikely that genetics are the only or the most influential risk factor.

A 2010 study included 80 participants with endometriosis and 60 without it. Those with endometriosis were more likely to have a relative with the condition.

About 5.9% of participants with endometriosis had a first-degree relative with the condition, compared with just 3% of those without the disease.

While the likelihood of having a relative with the condition was almost doubled in the endometriosis group, the absolute risk was very low.

The study did not find significant differences in symptoms when they compared women with endometriosis and a family history of the disease and those with endometriosis but no family history.

There are many complicating factors. For example, many doctors were ill-informed about endometriosis until recently, and they often missed the diagnosis. Research indicates that as many as 70% of cases in the 1970s were undetected.

This means that mothers and other relatives of people with endometriosis may have had the condition but never received a diagnosis.

Is there an endometriosis gene?

Researchers continue to look for specific genetic causes of endometriosis.

One potential target is a variant of a gene called transforming growth factor β1 gene-509C/T. However, a 2012 meta-analysis of prior research did not find a significant link between this gene and the condition.

A 2019 review has listed more than two dozen genes that various studies have linked to endometriosis. The researchers have failed to demonstrate that any specific gene inevitably causes the condition.

Instead, researchers suggest that interactions between genes and the environment may play a role. According to a 2016 review, epigenetic factors may play a role in endometriosis. These are factors that regulate gene expression.

A person with a gene that increases the risk of endometriosis may not develop the disease without exposure to certain epigenetic risk factors, such as stress or pollution.

Because family members often live in similar environments, epigenetic risk factors may be shared within a family.

Other endometriosis risk factors

A woman with endometriosis may experience periods that occur unusually frequently and last longer than 7 days.

Women with endometriosis may be more likely to have had their first periods before the age of 11 and more likely to experience infertility.

Beyond the potential genetic link, a range of factors may increase the risk of developing endometriosis, including:

  • alcohol use

  • advanced age

  • lifestyle and environmental factors, such as stress, exposure to pollution, and exposure to hormone-disrupting chemicals

The risk of endometriosis increases with age. This may stem from accumulating effects of lifestyle and environmental factors. Or, it could be that genes linked with endometriosis change with age.

Male fertility got no boost from zinc, folic acid in study

Male fertility got no boost from zinc, folic acid in study

A rigorous U.S. government-led study found that zinc and folic acid supplements don’t boost men’s fertility, despite claims that they do.

The mineral and the vitamin are important for sperm production and are found in many common foods. Previous studies on whether over-the-counter supplements might boost sperm health have had conflicting results.

There were a few small trials that showed a benefit, but we needed some definitive evidence that this would work,” said lead author Enrique Schisterman, a researcher at the National Institute of Child Health and Human Development. The study published in the Journal of the American Medical Association showed it didn’t.

Schisterman called the results disappointing. Supplements cost about $60 a month compared with tens of thousands of dollars many couples spend on invasive medical treatment for infertility.

People who go through fertility treatment are really, really desperate to find something that works,” he said.

The institute paid for the study, which involved almost 2,400 men planning fertility treatments with their partners at four U.S. clinics.

The researchers avoided using over-the-counter supplements, which aren’t strictly regulated and may contain ingredients other than those listed on the label. Instead they created tablets that combined 5 milligrams of folic acid, similar to previous studies, and 30 mgs of zinc, a lower dose than in some studies to avoid potential side effects.

Half the men studied swallowed one tablet daily for six months; the other men took dummy pills. Several semen tests were performed during the study.

Over 18 months of follow-up, 820 babies were born, about equal numbers in each group. Sperm quality also was similar in both groups.

Sperm DNA changes linked with infertility were slightly more common in the supplement users and those men had more digestive side effects, which have been linked previously with zinc pills.

Infertility affects at least 50 million couples worldwide. It’s usually defined as not being able to conceive after a year of trying. Male infertility including low sperm counts or poor-quality sperm contributes to about 1 in 3 cases. Research suggests sperm counts in western countries have been declining for decades, for unknown reasons.

Read more: https://jamanetwork.com/journals/jama/fullarticle/2758450?guestAccessKey=47179784-451b-4342-aadd-5f74ea3f79b1&utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_content=tfl&utm_term=010720

New discovery may help women pause biological clock

New discovery may help women pause biological clock

From the moment a girl reaches puberty, her eggs begin maturing and gradually losing quality.

Genetic researchers at the Hebrew University of Jerusalem helped discover a biological switch that delays egg aging without losing egg quality – in worms.

They’re hopeful this breakthrough may lead to a way for women to extend their fertility windows and maintain high egg quality into their 30s and 40s.

Hebrew University scientists Yonatan Tzur and Hanna Achache, along with Tzur’s lab team and an associate at Harvard Medical School, studied egg maturation in C. elegans (roundworms) and published their findings in the scientific journal Genetics.

They chose these tiny worms because they have been helpful in shedding light on human genetics. Roundworms contain the same number of genes as humans do and their eggs mature in about one day.

Tzur and his team monitored the changes in each of the worm’s 20,000 genes during egg formation and were able to pinpoint an exact gene (ogr-2) that controls the rhythm of egg maturation. Delving further, the team studied MAP Kinase (“MAPK”), the biochemical switch that turns egg development on and off.

When they removed the ogr-2 gene with CRISPR gene-editing technology, MAPK went into overdrive and the worms’ eggs aged very quickly.

“We tested the gene’s role by removing it from the worm’s gene sequence. Instantly, these ‘edited’ worms became less fertile and their eggs more closely resembled those of an older worm,” said Tzur.

These findings are significant because aging egg cells are the main cause of birth defects, miscarriages and infertility. As human eggs age, abnormalities develop.

While in-vitro fertilization (IVF) allows doctors to select the best eggs, women above the age of 35 have less chance of producing a healthy baby with their own eggs. For women 42 and older, those chances are close to zero.

These statistics, along with the fact that the average age of first-time mothers in the Western world is increasing sharply, means finding the key to slowing down egg maturation is crucial and has spurred scientists like Tzur to discover the mechanisms that control ovarian development and oocyte aging.

Though still in its early stages, the discovery could have two possible applications for humans. One is to gently increase the equivalent of ogr-2 in girls via a food additive. This may allow girls to maintain the high quality of young eggs until they’re ready to use them.

Another potential tactic would be to suppress MAPK during IVF cycles. This would help older eggs complete their development and improve women’s chances of having a healthy baby as they get older.

Source: https://www.israel21c.org/new-discovery-could-help-women-pause-the-biological-clock/

Levels of thyroid hormones affect chronic pain and severity of endometriosis

Levels of thyroid hormones affect chronic pain and severity of endometriosis

Endometriosis patients with thyroid dysfunction may have increased risk of more intense chronic pain and increased disease severity, a study suggests.

The underlying disease mechanism of endometriosis is still unclear.

Autoimmune thyroid disorders are associated with endometriosis, but the mechanism by which the two diseases are linked is unknown.

Each cell in the body carries protein markers called antigens that allow a cell to be identified as “self” or “non-self” by the immune system. In autoimmune thyroid disorders, the body’s own immune system attacks and damages the thyroid gland. These diseases are characterized by the production of autoantibodies against thyroid-specific antigens, including the thyroid itself and the thyroid-stimulating hormone receptor.

Now, researchers at the Université Paris Descartes looked at the relationship between endometriosis and autoimmune thyroid disorders, specifically at how thyroid disorders affect the progression of endometriosis.

They first found that both the levels of RNA and proteins involved in thyroid metabolism were altered in the biopsied endometrium of patients with endometriosis compared to healthy people. RNA molecules act as templates to make proteins, which perform key functions in the cell.

Moreover, in endometriotic cells, the amount of thyroid hormones was altered compared to that of control cells. The thyroid hormone T4 (thyroxine) is converted into T3 (triiodothyronine), which is much more active than T4. In the endometriotic cells, T4 production was increased while that of T3 was reduced.

The thyroid-stimulating hormone regulates the production of T3 and T4. In vitro (lab) studies using cells from the endometrium of endometriotic patients and healthy controls showed that thyroid-stimulating hormone increased cells’ proliferation. But the researchers saw no differences in the increase of proliferation rate between endometriotic cells and control cells.

Mouse studies confirmed the data gained in vitro since endometriotic implants were found to be bigger when thyroid hormones increased. A retrospective analysis of endometriosis patients with or without a thyroid disorder revealed an increased chronic pelvic pain and disease score in endometriotic patients with a thyroid disorder.

The study, “Role of thyroid dysimmunity and thyroid hormones in endometriosis” was published in the journal PNAS

Read more: https://www.pnas.org/content/116/24/11894

Laparoscopic surgery especially benefits endometriosis patients with pelvic pain

Laparoscopic surgery especially benefits endometriosis patients with pelvic pain

Patients with severe endometriosis and pelvic pain show the most pronounced improvements in quality of life within one year after undergoing laparoscopic surgery, a new study reports.

Laparoscopic surgery is the current gold standard to treat endometriosis. A small incision is made to allow a tool called a laparoscope, coupled with a small camera, to go inside the abdomen to guide the removal of endometriosis lesions.

Although surgery has the potential to reduce pain and improve patients’ quality of life, it is crucial to evaluate how surgery is affecting physical and mental health as well as patients’ social well-being.

Endometriosis often causes chronic pelvic pain, severe pain during menstruation (dysmenorrhea), and pain during sex (dyspareunia). Other non-gynecologic symptoms include constipation, diarrhea, and rectal bleeding. Together, these symptoms have a significant impact on patients’ quality of life.

In order to investigate which factors led to changes in patients’ quality of life, a team of researchers analyzed 981 patients from five districts in the Auvergne region of France who underwent laparoscopic treatment between 2004 and 2012.

Enrolled participants, ages 15-50, had received laparoscopic surgery or been newly diagnosed with a histological confirmation of endometriosis.

The team compared quality of life prior to surgery and one year after surgery using the 36-Item Short Form (SF-36) questionnaire, data on presence or absence of specific symptoms, and intensity of pain. Improvement in quality of life was measured using effect size method (ES), in which a value of 0.8 or higher corresponds to a significant improvement.

The SF-36 consists of eight sections covering physical functioning, energy/fatigue, bodily pain, role limitations due to physical health, general health perception, social functioning, role limitations due to emotional problems, and emotional well-being. The lower the score in the questionnaire, the greater the disability.

In total, 44% of patients with endometriosis and chronic pelvic pain had an improvement in quality of life equal to or above 0.8 ES compared to 23% of patients without pain who had similar ES scores.

Moreover, 47% of patients with stage 4 endometriosis had an ES score above 0.8, whereas only 26%, 31%, and 27.5% of patients in stage I, II, and III respectively had a similar improvement in quality of life.

Researchers observed that patients with chronic pelvic pain were more likely to improve their quality of life after surgery compared to those without it. Fertile patients also were more likely to improve quality of life compared to infertile patients.

Mental health of patients with chronic pelvic pain was also improved after surgery compared to patients without pain.

Similarly, patients with anxiety also showed better mental score compared to non-anxious patients.

Overall, researchers found that chronic pelvic pain was the most significant factor in predicting patients’ improvement in quality of life after surgery.

Patients presenting with severe endometriosis and who experience higher levels of pain are more likely to show improvement in [quality of life] after surgery,” researchers said.

[Chronic pelvic pain] is the most significant independent predictive factor for changes in QoL scores,” the study concluded.

The study, “Identification of predictive factors in endometriosis for improvement in patient quality of life,” was published in the Journal of Minimally Invasive Gynecology.

Read more: https://www.sciencedirect.com/science/article/pii/S1553465019302274?via%3Dihub

 

Endometriosis diagnosis takes 7 to 12 years

Endometriosis diagnosis takes 7 to 12 years

Endometriosis may affect all aspects of a woman’s life, including sexual relations, social activities, emotional well-being and work productivity.

The disease is costly. Claims data show that average annual health care costs (medical and prescription) are more than three times higher for women with endometriosis compared to patients without endometriosis, even five years pre- and five years post-diagnosis. Τhe cost can increase in cases of greater severity of the disease, presence of pelvic pain and infertility.

However, endometriosis is still underfunded and under-researched, thus limiting scientific progress and the number of available diagnostic and treatment options, according to a new review study.

Aiming to address these concerns, the Society for Women’s Health Research (SWHR) brought together a group of researchers, clinicians, and patients as well as industry and government officials, who evaluated barriers affecting endometriosis diagnosis and treatment, reviewed current practice, and highlighted research priorities.

Multidisciplinary approaches addressing all patient needs and greater disease awareness are needed to improve care, diagnosis and development of treatments for people with endometriosis, showed the resutls of the research “Assessing Research Gaps and Unmet Needs in Endometriosis,” which was published in the American Journal of Obstetrics and Gynecology.

According to the expert group, the current lack of knowledge and awareness about the causes of endometriosis contributes to the significant delays (7 to 12 years) from first experiencing symptoms to diagnosis. These delays are even worse for women with pelvic pain and for younger women, and may cause physical and emotional damage, as well as increase costs associated with the disease.

Another contributing factor is that the current gold standard for diagnosis requires surgery (laparoscopy), warranting the development of accurate, noninvasive and less costly diagnostic tools, such as biomarkers. Also, current guidelines only recommend assessing endometrial lesions, despite reports of a questionable association between the number of lesions and disease severity, symptoms and impact on women’s quality of life.

Campaigns to educate patients, healthcare providers, and the public may also help achieve more timely and accurate diagnosis and treatment, the team noted.

Additional barriers are difficulties with insurance coverage, and the stigma around menstrual issues and society’s normalization of women’s pain, which may make patients reluctant to discuss symptoms or seek care.

“In addition, women who do bring up their symptoms may fall victim to the well-documented clinical gender bias that has resulted in some women’s pain being dismissed or inadequately treated,” Rebecca Nebel, PhD, the study’s senior author and director of scientific programs at SWHR, said.

Standardized screenings, such as those used in cases of potential violence against women, could be used as a model in endometriosis, the experts said.

Other barriers are related to healthcare providers, as women need to make an average of seven visits to their primary provider before being referred to specialists, and often are misdiagnosed.

As for current practice in treatment, most medical and surgical approaches — including hysterectomy and uterus removal — focus on managing pain and associated symptoms by suppressing or removing endometrial lesions, but may not be effective.

Physical therapy, acupuncture, and yoga are examples of non pharmacological strategies that may help ease pain. Mental health professionals may help treat depression and grieving associated with endometriosis, while also providing coping and relaxation strategies.

Available medical therapies may induce side effects such as bone loss, hot flashes, and weight gain. Also, many cannot be used when women are trying to get pregnant, often forcing them to decide on whether to minimize pain or time their attempts to conceive while off medication.

Overall, “future treatments and care should shift toward a patient-centric, multidisciplinary approach that focuses on the patient as a whole, rather than one symptom at a time,” the experts said.

Centers of expertise taking an interdisciplinary approach with experts in “laparoscopy, medical management, pain education, physical therapy, and psychological care” may help implement treatment strategies “that address all the needs of the patient, including quality-of-life issues,” the team stated.

Read more: https://www.ajog.org/article/S0002-9378(19)30385-0/pdf

https://www.ajog.org/article/S0002-9378(19)30385-0/fulltext

Source: https://endometriosisnews.com/2019/02/28/multidisciplinary-approach-awareness-will-most-benefit-endometriosis-patients-experts-say/

Early life sexual and physical abuse dramatically increases risk of endometriosis

Early life sexual and physical abuse dramatically increases risk of endometriosis

By I.Soussis MD

A prospective cohort study found that women reporting severe and/or chronic abuse of multiple types during childhood and adolescence had a 79% higher risk of laparoscopically confirmed endometriosis.

Severe abuse was defined as being kicked, bitten, punched or physically attacked more than once, or choked or burned ever, whereas severe sexual abuse was considered forced sexual activity during both childhood and adolescence.

“We saw stronger associations among women whose endometriosis was most likely diagnosed as a result of pelvic pain symptoms,” said lead author Holly Harris, ScD, an assistant professor of epidemiology at the Fred Hutchinson Cancer Research Center in Seattle, Washington.

Previous studies led by members of Dr. Harris’ research team had shown a connection between early life abuse and both uterine fibroids and hypertension. “Given recent links found between endometriosis and hypertension, one of the next logical steps was to examine the association between abuse and risk of endometriosis,” Dr. Harris told Contemporary OB/GYN.

For the study, which appeared in the journal Human Reproduction, data were collected from 60,595 premenopausal women from 1989 to 2013 as part of the Nurses’ Health Survey II cohort.

Participants completed a questionnaire on exposure to violence.

A total of 3,394 cases of endometriosis were diagnosed during 24 years of follow-up.

Overall, 34% of study participants reported moderate or severe physical abuse during early life and 11% of study participants reported forced sex, while 14% of women diagnosed with endometriosis had severe sexual abuse history.

“It is extremely important for readers, clinicians and women with or those who care about women with endometriosis to understand that these results absolutely do not imply that all women who have endometriosis have been abused,” Dr. Harris said. “Abuse in early childhood and adolescence is common among both women with and without endometriosis.”

The associations between abuse and endometriosis were stronger in women presenting without infertility. This group was also more likely to report pelvic pain.

“Sadly, childhood abuse is real, is a major public health issue, and can have long-lasting impacts on health,” Dr. Harris said. “In addition, for women with pelvic pain with or without endometriosis, it is important that they know that these symptoms are not normal.”

When these women raise concerns about their pain with clinicians, they should not be dismissed, no matter their age or history, according to Dr. Harris. “There is a growing body of evidence that pain sensitization can result from a physiologic response to the stress and trauma of abuse,” she said. “This occurs not only among women with endometriosis but also among women with other pain conditions.”

 

Read more: https://academic.oup.com/humrep/article-abstract/33/9/1657/5055017?redirectedFrom=fulltext

 

Source: http://www.contemporaryobgyn.net/endometriosis/does-abuse-affect-risk-endometriosis?rememberme=1&elq_mid=4894&elq_cid=607376&GUID=69980457-AFA5-43B0-B217-28D67525EA6C

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