Magnetic resonance (MR) imaging has extended the usefulness of imaging in evaluation of pelvic disorders associated with female infertility. The causes of female infertility include ovulatory ...disorders (ie, pituitary adenoma and polycystic ovarian syndrome), disorders of the fallopian tubes (ie, hydrosalpinx and pelvic inflammatory disease), uterine disorders (ie, müllerian duct anomaly, adenomyosis, and leiomyoma), and pelvic endometriosis. Although laparoscopy, hysteroscopy, hysterosalpingography, and transvaginal ultrasonography are the most effective techniques for evaluation of pelvic disorders related to female infertility, MR imaging is used in a variety of clinical settings in diagnosis, treatment, and management. The applications of MR imaging include evaluation of the functioning uterus and ovaries, visualization of pituitary adenomas, differentiation of müllerian duct anomalies, and accurate noninvasive diagnosis of adenomyosis, leiomyoma, and endometriosis. In addition, MR imaging helps predict the outcome of conservative treatment for adenomyosis, leiomyoma, and endometriosis and may lead to selection of better treatment plans and management. Finally, MR imaging may serve as an adjunct to diagnostic laparoscopy and hysterosalpingography in patients with hydrosalpinx, peritubal adhesions, or pelvic adhesions related to endometriosis.
Female genital mutilation (FGM) includes procedures involving the partial or total removal of the external female genitals for non‐therapeutic reasons. They can have negative psychosexual and health ...consequences that need specific care. In this paper, we review some key knowledge gaps in the clinical care of women with FGM, focusing on obstetric outcomes, surgical interventions (defibulation and clitoral reconstruction), and the skills and training of healthcare professionals involved in the prevention and management of FGM. We identify research priorities to improve the evidence necessary to establish guidelines for the best multidisciplinary care, communication, and prevention, and to improve health‐promotion measures for women with FGM.
Background
Subfertile women are highly motivated to try different adjunctive therapies to have a baby, and the widespread perception is that dietary supplements such as myo‐inositol (MI) and ...D‐chiro‐insoitol (DCI) are associated with only benefit, and not with harm. Many fertility clinicians currently prescribe MI for subfertile women with polycystic ovary syndrome (PCOS) as pre‐treatment to in vitro fertilisation (IVF) or for ovulation induction; however no high‐quality evidence is available to support this practice. This review assessed the evidence for the effectiveness of inositol in subfertile women with a diagnosis of PCOS.
Objectives
To evaluate the effectiveness and safety of oral supplementation of inositol for reproductive outcomes among subfertile women with PCOS who are trying to conceive.
Search methods
We searched the following databases (to July 2018): Cochrane Gynaecology and Fertility Group (CGFG) Specialised Register, CENTRAL, MEDLINE, Embase, PsycINFO, CINAHL, and AMED. We also checked reference lists and searched the clinical trials registries.
Selection criteria
We included randomised controlled trials (RCTs) that compared any type, dose, or combination of oral inositol versus placebo, no treatment/standard treatment, or treatment with another antioxidant, or with a fertility agent, or with another type of inositol, among subfertile women with PCOS.
Data collection and analysis
Two review authors independently selected eligible studies, extracted data, and assessed risk of bias. The primary outcomes were live birth and adverse effects; secondary outcomes included clinical pregnancy rates and ovulation rates. We pooled studies using a fixed‐effect model, and we calculated odds ratios (ORs) with 95% confidence intervals (CIs). We assessed the overall quality of the evidence by applying GRADE criteria.
Main results
We included 13 trials involving 1472 subfertile women with PCOS who were receiving myo‐inositol as pre‐treatment to IVF (11 trials), or during ovulation induction (two trials). These studies compared MI versus placebo, no treatment/standard, melatonin, metformin, clomiphene citrate, or DCI. The evidence was of 'low' to 'very low' quality. The main limitations were serious risk of bias due to poor reporting of methods, inconsistency, and lack of reporting of clinically relevant outcomes such as live birth and adverse events.
We are uncertain whether MI improves live birth rates when compared to standard treatment among women undergoing IVF (OR 2.42, 95% CI 0.75 to 7.83; P = 0.14; 2 RCTs; 84 women; I² = 0%). Very low‐quality evidence suggests that for subfertile women with PCOS undergoing pre‐treatment to IVF who have an expected live birth rate of 12%, the rate among women using MI would be between 9% and 51%.
We are uncertain whether MI may be associated with a decrease in miscarriage rate when compared to standard treatment (OR 0.40, 95% CI 0.19 to 0.86; P = 0.02; 4 RCTs; 535 women; I² = 66%; very low‐quality evidence). This suggests that among subfertile women with PCOS with an expected miscarriage rate of 9% who are undergoing pre‐treatment to IVF, the rate among women using MI would be between 2% and 8%; however this meta‐analysis is based primarily on one study, which reported an unusually high miscarriage rate in the control group, and this has resulted in very high heterogeneity. When we removed this trial from the sensitivity analysis, we no longer saw the effect, and we noted no conclusive differences between MI and standard treatment.
Low‐quality evidence suggests that MI may be associated with little or no difference in multiple pregnancy rates when compared with standard treatment (OR 1.04, 95% CI 0.63 to 1.71; P = 0.89; 2 RCTs; 425 women). This suggests that among subfertile women with PCOS who are undergoing pre‐treatment to IVF, with an expected multiple pregnancy rate of 18%, the rate among women using inositol would be between 12% and 27%.
We are uncertain whether MI may be associated with an increased clinical pregnancy rate when compared to standard treatment (OR 1.27, 95% CI 0.87 to 1.85; P = 0.22; 4 RCTs; 535 women; I² = 0%; very low‐quality evidence). This suggests that among subfertile women with PCOS who are undergoing pre‐treatment to IVF, with an expected clinical pregnancy rate of 26%, the rate among women using MI would be between 24% and 40%. Ovulation rates were not reported for this comparison.
Other comparisons included only one trial in each, so for the comparisons MI versus antioxidant, MI versus an insulin‐sensitising agent, MI versus an ovulation induction agent, and MI versus another DCI, meta‐analysis was not possible.
No pooled evidence was available for women with PCOS undergoing ovulation induction, as only single trials performed comparison of the insulin‐sensitising agent and the ovulation induction agent.
Authors' conclusions
In light of available evidence of very low quality, we are uncertain whether MI improves live birth rate or clinical pregnancy rate in subfertile women with PCOS undergoing IVF pre‐treatment taking MI compared to standard treatment. We are also uncertain whether MI decreases miscarriage rates or multiple pregnancy rates for these same women taking MI compared to standard treatment. No pooled evidence is available for use of MI versus placebo, another antioxidant, insulin‐sensitising agents, ovulation induction agents, or another type of inositol for women with PCOS undergoing pre‐treatment to IVF. No pooled evidence is available for use of MI in women undergoing ovulation induction.
The Perfect Vagina highlights the complexities involved with Female Genital Cosmetic Surgery, its role in Western beauty culture, and the creation and control of body image in countries where ...self-care is valorized and medicine is increasingly harnessed for enhancement as well as health.
Offending Womenis an eye-opening journey into the lived reality of prison for women in the United States today. Lynne Haney looks at incarcerated mothers, housed together with their children, who are ...serving terms in alternative, community-based prisons-a type of facility that is becoming increasingly widespread. Incorporating vivid, sometimes shocking observations of daily life, she probes the dynamics of power over women's minds and bodies that play out in two such institutions in California. She finds that these "alternative" prisons, contrary to their aims, often end up disempowering women, transforming their social vulnerabilities into personal pathologies, and pushing them into a state of disentitlement. Uncovering the complex gendered underpinning of methods of control and intervention used in the criminal justice system today,Offending Womenlinks that system to broader discussions on contemporary government and state power, asks why these strategies have arisen at this particular moment in time, and considers what forms of citizenship they have given rise to.
Bolokoli,khifad,tahara,tahoor,qudiin,irua,bondo,kuruna,negekorsigin, andkene-keneare a few of the terms used in local African languages to denote a set of cultural practices collectively known as ...female circumcision. Practiced in many countries across Africa and Asia, this ritual is hotly debated. Supporters regard it as a central coming-of-age ritual that ensures chastity and promotes fertility. Human rights groups denounce the procedure as barbaric. It is estimated that between 100 million and 130 million girls and women today have undergone forms of this genital surgery.Female Circumcisiongathers together African activists to examine the issue within its various cultural and historical contexts, the debates on circumcision regarding African refugee and immigrant populations in the United States, and the human rights efforts to eradicate the practice. This work brings African women's voices into the discussion, foregrounds indigenous processes of social and cultural change, and demonstrates the manifold linkages between respect for women's bodily integrity, the empowerment of women, and democratic modes of economic development. This volume does not focus narrowly on female circumcision as a set of ritualized surgeries sanctioned by society. Instead, the contributors explore a chain of connecting issues and processes through which the practice is being transformed in local and transnational contexts. The authors document shifts in local views to highlight processes of change and chronicle the efforts of diverse communities as agents in the process of cultural and social transformation.
An updated World Health Organization (WHO) classification of female genital tumours was published in autumn 2020. We discuss the major new additions to and changes from the prior 2014 classification ...with a discussion of the reasons underlying these. A feature of the new classification is the greater emphasis on key molecular events with integration of morphological and molecular features. Most of the major changes from the prior classification pertain to uterine (corpus and cervix) and vulval tumours, but changes in all organs are covered.
We review the major new additions and changes in the new 2020 WHO Classification of Female Genital Tract Tumours. The updated 2020 Classification places a greater emphasis on key molecular events and on the integration of morphological and molecular features and represents a major step‐forward from the prior Classification.
Female genital tuberculosis is a disease caused by Mycobacterium tuberculosis infection in the female reproductive tract. The disease burden among women leads to infertility is significant, ...especially in developing countries. The bacteria can spread from the lung into the reproductive organ through lymphatic or hematogenous. Many patients present with atypical symptoms, which mimic other gynecological conditions. Several investigations are needed to establish the diagnosis. Almost all cases of genital TB affect the fallopian tube and cause infertility in patients and endometrial involvement. Current treatment still relies on antituberculosis therapy with a combination of tubal surgery. The present review describes the epidemiological data, clinical presentation, diagnosis, and currently available treatment to cure the disease and for in vitro fertilization.
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