May 17th 2024
A recent study suggests that higher CASP8 expression in embryos is associated with successful implantation outcomes in women of advanced maternal age, as presented at ACOG 2024.
23rd Annual International Congress on the Future of Breast Cancer® East
July 19-20, 2024
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15th Annual International Symposium on Ovarian Cancer and Other Gynecologic Malignancies™
May 11, 2024
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Community Practice Connections™: 14th Annual International Symposium on Ovarian Cancer and Other Gynecologic Malignancies
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4th Annual International Congress on the Future of Women’s Health™
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Patient, Provider, and Caregiver Connection™: Exploring Unmet Needs In Postpartum Depression – Making the Case for Early Detection and Novel Treatments
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Identifying Health Care Inequities in Screening, Diagnosis, and Trial Access for Breast Cancer Care: Taking Action With Evidence-Based Solutions
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Endometriosis is still poorly understood despite a high and still increasing publication rate of over 500 articles a year, i.e. 455 426, 448, 504 and 534 in the last 5 years respectively. It is considered to be one of the most important causes of pelvic pain and of infertility. The exact prevalence is not known since a laparoscopy is required to make the diagnosis and since the recognition varies with the training and the interest of the laparoscopist. Moreover the pathophysiology is poorly understood, which makes it difficult to formulate and test simple hypotheses.
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Great Debate: Laparoscopic Myomectomy is a Safe Procedure
June 23rd 2011Dr. Dubuisson stated that there is is a great demand from patients for minimally invasive surgery and it is important that the surgeon apply certain conditions to the selection of patients for successful treatment of leiomyomas by laparoscopy. Dr. Dubuisson said that the indications for a safe laparoscopic myomectomy include the following:
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Laparoscopic Resection of Sigmoid Endometrioma
June 23rd 2011Mackendrodt performed the first colonic resection for sigmoid endometriosis in 1909. Research has revealed that approximately 10 percent of menstruating women have endometriosis and up to 34 percent may have intestinal involvement.
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OBGYN.net Conference CoverageFrom American Association of Gynecological LaparoscopistsOrlando, Florida, November 2000. "AAGL The Founding Years" Jordan Phillips, MD, OBGYN.net Editorial Advisor and General Chairman andFounder of AAGL with Dr. Louis Keith, MD OBGYN.net Editorial Advisor
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An ectopic pregnancy is a pregnancy implanted in an abnormal location (outside of the uterus). During the past 40 years its incidence has been steadily increasing concomitant with increased STD rates and associated salpingitis (inflammation of the Fallopian tubes). Such abnormalities of the tubes prevent normal transport of the fertilized egg to the uterus.
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Advanced Operative Hysteroscopy & Laparoscopy
June 22nd 2011Whenever the surgery that is considered can be performed equally well and equally safely by either laparoscopy or laparotomy, the decision as to the type of incision to be used can (and in my opinion really should) include the patient.
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A Patient's Guide to Adhesions and Related Pain
June 22nd 2011Chronic pelvic pain and/or associated intestinal disturbance are a major cause of misery for thousands of patients. Often in constant pain, the patient experiences loneliness, hopelessness, frustration and desperation with thoughts of suicide. Family and work relationships are strained to the limit. Although ADHESIONS are often (but not always) the cause of this pain, treatment for adhesions is not performed either because the surgeon does not believe that adhesions can cause the problem, or because lysis of adhesions is considered too difficult or futile.
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A significant number of women experience infertility due to surgically correctable causes. Most cases are a result of endometriosis and/or adhesions (scar tissue) from previous surgery or pelvic infection. Endometriosis and adhesions cause distortion and blockage of the fallopian tubes, thus causing infertility. Infertility surgery tries to unblock, release and restore normal anatomy of the fallopian tube.
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Around 153 million women around the world have chosen to be sterilized for contraceptive purposes, of these 138 million are in the developing countries. 1 Approximately fifty percent of all female sterilization is performed during the puerperal period or a cesarean section, and the other fifty percent is called “interval sterilization” when there has been no pregnancy for the previous six weeks.
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The dilemma of endometriosis: is consensus possible with an enigma?
Because endometriosis is a common disease entity among infertile patients with a prevalence of up to 50%, one could argue that without laparoscopy clinical work-ups can not completely rule out all of the causes of infertility. The decision to perform laparoscopy on patients with infertility is very complex owing to a number of factors, such as maternal age, semen parameters, tubal patency, pelvic symptoms, insurance coverage, surgical risks, and availability of surgical expertise.
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Laparoscopic treatment of endometriosis in patients with failed in vitro fertilization cycles
Endometriosis is one of the most common gynecologic disorders and is significantly more prevalent in the setting of infertility. The prevalence of endometriosis in infertile women ranges from 25% to 50% compared to 5% in fertile women. Successful laparoscopic management of all stages of endometriosis was reported as early as 1986. This has revolutionized the management of endometriosis. The benefits of surgical therapy for infertility associated with endometriosis have been well documented.
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For the past three decades, gynecologists have been utilizing the hysteroscope in the office to diagnose a variety of conditions that can be responsible for symptoms such as abnormal uterine bleeding, recurrent miscarriage, infertility, and post menopausal bleeding. The most common lesions found during diagnostic office hysteroscopy include cervical and uterine polyps, submucous myomata, uterine septae, intrauterine adhesions, endometrial hyperplasia and endometrial cancer.
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Robotic Myomectomy with da Vinci Surgical Robot
June 22nd 2011It is advantageous to perform surgery in the least invasive way possible while still getting optimal results. Although I usually prefer to do surgery through a laparoscope rather than through a larger incision, I have felt limited by the lack of wrist-like movements of the instruments. I felt that deeper myomas (that couldn’t be removed by a hysteroscope) were better removed through a regular incision.
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Diagnosing Abnormal Uterine Bleeding
June 22nd 2011It is usually quite simple to find the cause of abnormal menstrual bleeding, although occasionally the cause may not be found. Since abnormal uterine bleeding can be caused by disorders of the uterus, hormone imbalance (usually not ovulating), and pregnancy, it is helpful to look at each area separately. When I see someone for abnormal bleeding, I ask the following questions.
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Fibroids are non-cancerous (benign) growths of the muscle wall of the uterus. They are probably responsible for more unnecessary gynecologic surgery than any other condition. Every year a staggering 600,000 American women have a hysterectomy. And about 30 percent of those hysterectomies, 180,000 in all, are performed because of fibroids. For many years gynecologists have surgically removed these growths, often because of fear of the problems they might cause in the future. And those problems are often overstated.
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Laparoscopic Assisted Vaginal Myomectomy
June 22nd 2011Laparoscopic myomectomy (LM) is a minimally invasive surgical procedure for the removal of uterine myomas. It was first described in the late 1970s by Semm. Subsequently, equipment has been developed to enhance the procedure. LM requires advanced laparoscopic skill and expertise in suturing and tissue removal. Laparoscopic assisted myomectomy (LAM), a procedure that combines operative laparoscopy and minilaparotomy, was described by Nezhat et al in 1994.
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Difficulties in Recruitment for a Randomized Controlled Trial Involving Hysterosalpingography
June 22nd 2011The usefulness of hysterosalpingography (HSG) as routine investigation in the fertility work-up prior to laparoscopy and dye had been assessed in a randomized controlled trial. Recruiting subjects to the study was more difficult than anticipated. The objective of this study was to explore possible reasons for non-participation in the trial.
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Intracytoplasmic sperm injection (ICSI) is a component of infertility treatment often employed when conventional in vitro fertilization is unlikely to be successful. Despite good clinical results with ICSI, the procedure is typically associated with degeneration of a significant percentage (approximately 10%) of the treated oocytes. The cause of this degeneration remains unclear. Speculation that damage caused by oocyte compression during the injection procedure may be responsible has led to the development of a novel technique known as laser-assisted ICSI.
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Diagnosis of abnormal uterine bleeding, fibroids, and adenomyosis
June 21st 2011It is usually quite simple to find the cause of abnormal menstrual bleeding, although occasionally the cause may not be found. Since abnormal uterine bleeding can be caused by disorders of the uterus, hormone imbalance (usually not ovulating), and pregnancy, it is helpful to look at each area separately.
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Myomectomy is the only surgical treatment of myomas that preserves fertility. The safety of pregnancy after uterine artery embolization has not been established, and pregnancy is impossible after hysterectomy. The average reduction in volume of fibroids after a UAE is 50%, where fibroids that have removed are completely gone.
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Endometrial ablation is the removal or destruction of the endometrium (lining of the uterus). Endometrial ablation is an alternative to hysterectomy for women with heavy uterine bleeding who are wish to avoid hysterectomy. Most women who have had a successful endometrial ablation will have little or no menstrual bleeding.
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The most important question to ask is whether or not the fibroids need to be treated at all. The vast majority of fibroids grow as a woman gets older, and tend to shrink after menopause. Obviously, fibroids that are causing significant symptoms need treatment. While it is often easier to treat smaller fibroids than larger ones, many of the small fibroids never will need to be treated. So just because we can treat fibroids while they are small, it doesn't follow that we should treat them. The location of the fibroids plays a strong influence on how to approach them. A gynecologist experienced in the treatment of fibroids can help you determine if they need to be treated.
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Fibroids are non-cancerous (benign) growths of the muscle wall of the uterus. They are probably responsible for more unnecessary gynecologic surgery than any other condition. It is a staggering number, but about 600,000 American women have a hysterectomy every year. And about 30% of those hysterectomies, 180,000 in all, are performed because of fibroids. For many years these growths have been surgically removed, often because of fear of the problems they might cause in the future. And, those problems are often overstated. While approximately 30% of all women will have fibroids during their lifetimes, the vast majority of these women will never have symptoms and will never require treatment. And, for the rare patient that does have problems, there are a number of sound and effective options available. Hysterectomy should be the solution of last resort.
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