A practical guide to the evaluation of benign endometrial conditions in biopsy and curettage material

Sampling of the endometrium, via biopsy or dilation and curettage, is an important diagnostic tool in a wide variety of clinical scenarios, ranging from infertility and abnormal uterine bleeding to cancer surveillance in high-risk populations. This review describes the most common methods for endometrial sampling used currently and discusses the issue of specimen adequacy from an evidence-based perspective. It also focuses on select benign conditions involving the endometrium in the setting of abnormal uterine bleeding, ranging from anatomic/structural lesions to patterns indicative of a dysfunctional menstrual cycle. The topic of endometrial sampling evaluation in the context of recurrent pregnancy loss is also discussed, with insights on documentation of endometrial changes during the ovulatory phase and the diagnosis of endometritis.     

输卵管疾病的生育力保护

输卵管因素不孕症占不孕人群的30%～35%。随着腹腔镜技术及微创手术原则的应用，生殖相关输卵管性疾病的微创手术治疗受到关注。手术治疗输卵管性不孕在评估输卵管功能，保留生育功能，改善患者自然妊娠或辅助生殖技术助孕的结局方面具有重要作用。文章主要对有生育要求的输卵管病变患者，腹腔镜手术保留及恢复生育功能的处理及临床结局进行阐述。     

对比四维子宫输卵管超声造影与子宫输卵管造影评估输卵管通畅性效能:Meta分析

目的 采用Meta分析对比四维子宫输卵管超声造影（4D-HyCoSy）与子宫输卵管造影（HSG）评估输卵管通畅性的效能。方法 系统搜索PubMed、Cochrane Library、Embase、Web of Science、中国生物医学文献数据库、中国知网、万方医学网及维普数据库中建库至今有关4D-HyCoSy和/或HSG评估输卵管通畅性的文献。由2名研究人员依据纳入标准和排除标准筛选文献并提取信息；分别计算4D-HyCoSy和HSG评估输卵管通畅性的合并敏感度（SEN）、特异度（SPE）及诊断比值比（DOR），绘制综合受试者工作特征（SROC）曲线，获得曲线下面积（AUC），并以Medcalc 19.1.1统计软件比较AUC。结果 最终纳入19篇文献、1 358例疑似输卵管因素导致不孕患者，其中4篇同时采用4D-HyCoSy及HSG评估输卵管通畅性，10篇仅以4D-HyCoSy评估，5篇仅以HSG评估。Meta分析结果显示，4D-HyCoSy评估输卵管通畅性的合并SEN、SPE及DOR分别为0.92[95%CI（0.91，0.94）]、0.91[95%CI（0.89，0.93）]及115.06[95%CI（54.23，224.10）]；HSG评估输卵管通畅性的合并SEN、SPE及DOR分别为0.84[95%CI（0.81，0.87）]、0.80[95%CI（0.76，0.83）]及28.64[95%CI（10.08，81.35）]。4D-HyCoSy评估输卵管通畅性的AUC为0.98[95%CI（0.96，0.99）]，HSG为0.93[95%CI（0.90，0.95）]，差异有统计学意义（Z=6.97，P<0.01）。结论 4D-HyCoSy评估输卵管通畅性的效能高于HSG。     

Schistosomiasis (bilharziasis) and male infertility

Schistosomiasis (bilharziasis) is an endemic parasitic disease of a major source of morbidity and mortality for developing countries. It is caused by different species of blood flukes (trematode worms) of the genus Schistosoma, the most important of which are S. haematobium which infests the genitourinary tract and S. mansoni and S. japonicum which infest the gastrointestinal tract. The incidence of schistosome‐induced male infertility is not known and probably underestimated being overshadowed by the more severe and often fatal urinary and gastrointestinal complications. Several causes may contribute to schistosomiasis‐induced male infertility, such as hormonal imbalance, testicular tissue damage and genital ductal system obstruction, in addition to decreased libido and erectile dysfunction due to associated hormonal imbalance and prostatic infestation. Demonstration of the schistosome ova in seminal plasma or testicular tissue confirms the diagnosis. Treatment of schistosomiasis‐induced male infertility depends on clinical evaluation and includes, besides anthelmintic treatment, hormonal replacement and assisted reproduction (IVF/ICSI) in cases of severe oligozoospermia and or obstructive and nonobstructive azoospermia.     

Spermatogenesis disorder is associated with mutations in the ligand‐binding domain of an androgen receptor

Androgens play a key role in spermatogenesis, and their functions are mediated by the androgen receptor (AR). Some mutations in the AR gene have the potential to alter the primary structure and function of the protein. The aim of this study was to investigate the AR gene mutations in a cohort of males with idiopathic azoospermia referred to Royan Institute. Fifty‐one biopsy samples were obtained for routine clinical purposes from 15 men with hypospermatogenesis (HS), 17 patients with maturation arrest (MA) and 19 patients with Sertoli cell‐only syndrome (SCOS). The AR cDNAs were prepared from tissue mRNAs and were sequenced. One synonymous variant and three nonsynonymous protein coding single nucleotide polymorphisms (nsSNPs) were detected. Protein structure prediction demonstrated that the S815I and M746T nonsynonymous variants would affect protein structure and its normal function. Our study suggests that mutations in the AR gene would change or disturb the receptor's normal activity. Although these variations may influence spermatogenesis, it is difficult to say that they lead to a lack of spermatogenesis.