March Grand Rounds: Restorative Reproductive Surgery

Dr. Kongoassa, Medical Director, and Restorative Reproductive Surgeon, at the Centre for Reproductive Health Medicine and Gynecology, and the Center for Restorative Reproductive Surgery, runs through the diagnosis of abnormal physiology and pathology as well as different surgical approaches to restoring and optimizing reproductive function.  With extensive video, this 1-hour presentation outlines the identification, and surgical options for a number of conditions including endometriosis, adenomyosis, fallopian tube blockages/damage, fibroids, uterine polyps, low ovarian reserve, isthmocele, chronic endometritis, and ovarian cysts.

November Grand Rounds: Unusual Endometriosis

Dr. Yong presents unusual clinical presentations of endometriosis, including unusual locations, histological changes and approaches to treatment and management. Paul Yong, MD, PhD, FRCSC is a gynaecologist with fellowship training in advanced laparoscopic surgery, and a researcher in endometriosis located in Vancouver, Canada.

Research Updates: Endometriosis Severity and Pregnancy Complications: Findings from the ENDO Study

Learn how endometriosis, in both an operative and population cohort, is associated with pregnancy complications (including early pregnancy loss, ectopic pregnancies, hypertensive disorders of pregnancy, gestational diabetes, small-for-gestational age, and preterm birth). The ENDO Study is a collaborative epidemiologic study whose goal is to assess the relation between exposure to environmental chemicals and lifestyle factors that may affect womens reproductive health. Particular focus will be on the relation between hormonally active chemicals and risk of developing endometriosis considering womens lifestyles.

Journal Nook

Elevated prenatal anti-Müllerian hormone reprograms the fetus and induces polycystic ovary syndrome in adulthood
This study created a fair bit of buzz in the news and across social media in May suggesting hormone exposure in the womb may be a cause of PCOS, and a gonadotrophin-blocking treatment, cetrorelix, could be used to treat and prevent PCOS . New research from France suggests PCOS may develop in women who were exposed to elevated levels of AMH in-utero. They found pregnant women with PCOS had higher levels of AMH than normal. The elevated AMH seems to trigger a maternal neuroendocrine driven testosterone excess and decreases the placental metabolism of testosterone to estradiol, leading to masculinization of the exposed female fetus. Given PCOS tends to run in families, this explanation could make sense. In this study, pregnant mice were injected with the antimüllerian hormone (AMH), to mimic the hormonal imbalance they observed in the women with PCOS. Sure enough, after injection of the mothers, the next generation of female mice developed symptoms that are very similar to PCOS – such as elevated testosterone levels and disrupted ovulation. The team noted it is planning on looking at how hormones such as testosterone, regulated during pregnancy, affect their offspring.

Of course this study was done on mice, so we don’t yet know the same thing happens in women, and although we know gonadotrophin hormones are often raised in women with PCOS, blocking these hormones can help manage some symptoms but may not necessarily mean a cure. The drug suggested, which is commonly used in IVF, would prevent ovulation altogether so we don’t know the affect this would have on fertility.

Grand Rounds: HSG and Lipiodol

This Grand Rounds Dr Neil Johnson explores the use of HSG with Lipiodol which has shown fertility benefit particularly in endometriosis patients. Minimally-invasive and well tolerated by women the outcomes of a recent multi-centre randomized controlled trial was also published and presented last year at the WCE2017 (World Congress on Endometriosis).