In spite of efforts to preserve fertility, some patients have severe complications after trachelectomy, such as Asherman's syndrome, resulting in infertility. Clinicians should pay careful attention to the status of the endometrial cavity after trachelectomy.
Aging of the uterine endometrium is a critical factor that affects reproductive success, but the mechanisms associated with uterine aging are unclear. In this study, we conducted a qualitative examination of age-related changes in endometrial tissues and identified candidate genes as markers for uterine aging. Gene expression patterns were assessed by two RNA sequencing experiments using uterine tissues from wild type (WT) C57BL/6 mice. Gene expression data obtained by RNA-sequencing were validated by real-time PCR. Genes expressing the pro-inflammatory cytokines Il17rb and chemokines Cxcl12 and Cxcl14 showed differential expression between aged WT mice and a group of mice composed of 5 and 8 week-old WT (young) animals. Protein expression levels of the above-mentioned genes and of IL8, which functions downstream of IL17RB, were analysed by quantitative immunohistochemistry of unaffected human endometrium tissue samples from patients in their 20 s and 40 s (10 cases each). In the secretory phase samples, 3,3’- diaminobenzidine (DAB) staining intensities of IL17RB, CXCL12 and CXCL14 for patients in their 40 s were significantly higher than that for patients in their 20 s, as detected by a Mann Whitney U test. These results suggest that these genes are candidate markers for endometrial aging and for prediction of age-related infertility, although confirmation of these findings is needed in larger studies involving fertile and infertile women.
A 37-year-old woman, gravida 1, para 0, was referred to our hospital because of uterine malformation. Pelvic examination revealed a longitudinal vaginal septum and doubled uterine cervix. Magnetic resonance imaging revealed no external fundal indentation, a complete uterine septum, and cervical duplication. We performed vaginal septectomy and hysteroscopic metroplasty. After the resection of the vaginal septum, we inserted the Hegar dilator into the right cervical os and pushed it against the wall to reveal the position of the septum.
A premenarcheal 11-year-old girl with no experience of sexual intercourse had repeated lower abdominal pain since she was 7 years old. Imaging and blood tests on her first visit to our hospital showed no abnormal findings. However, she continued to experience intermittent right lower quadrant abdominal pain, and a year and a half later, presented with severe right lower abdominal pain. Transabdominal ultrasound examination and pelvic contrast MRI showed a pelvic mass of 10cm diameter with no blood flow to the right adnexal area. We suspected torsion of ovarian cyst, and performed laparoscopic surgery to obtain a definitive diagnosis. Laparoscopic surgery showed that her uterus and bilateral ovaries were normal in appearance, but only a stump of the left fallopian tube remained, and the right fallopian tube was twisted 1440 degrees. We performed right salpingectomy, and she was discharged three days after the surgery. Case reports of fallopian tube torsion or oviduct edema in women with no experience of sexual intercourse can be found in the literature, and laparoscopic examination should be considered for minors with repeated lower abdominal pain.
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