Background and Objectives: Fallopian tubal pathology is a primary risk factor for female infertility, with simple proximal disease and proximal disease extending more distally being more common than pure distal occlusion. Proximal tubal occlusion is often attributed to ascending events, such as pelvic inflammatory disease. Conversely, while distal occlusion can also be attributable to ascending pelvic inflammatory disease, it can also have a pelvic origin, such as through endometriosis and ruptured appendicitis. The aim of this study was to identify certain causes of infertility and their association with tubal occlusion. The focus was on the location of tubal occlusion, uni- versus bilateral occlusion, and other causes of infertility, including male factors. Methods: In a retrospective study cohort study, 373 women aged between 18 and 40 years, treated from 1 January 2017 to 31 December 2022, were included. Fallopian tube patency was tested using either hysterosalpingography, hysterosalpingo-contrast sonography, or laparoscopic chromopertubation. Results: In total, 95 of 373 women (25.5%) revealed at least one occluded tube, with unilateral occlusion being more common than bilateral occlusion (60/95, 63.2% vs. 35/95, 36.8%). The majority of tubal occlusions occurred proximally (86.2%). According to the adjusted multivariate regression models, the presence of hydrosalpinx (odds ratio, OR, 13.323, 95% confidence interval, CI: 2.679-66.253, p = 0.002), myomas (OR 2.108, 95%CI: 1.008-4.409; p = 0.048), and an abnormal sperm test result of the male partner (OR 2.105, 95%CI: 1.156-3.833; p = 0.015) were statistically significant associated factors for tubal occlusion. Conclusions: Fallopian tube patency testing is still of major relevance in fertility evaluation. The presence of uterine myomas, hydrosalpinges, and a male factor significantly increase the risk.

BACKGROUND: Uterine leiomyoma is one of the most common benign tumors in females. High-intensity focused ultrasound (HIFU) has been widely used in the therapy of uterine leiomyomas. However, HIFU method has a prolonged duration of operation and poor patient tolerance, which need improvement. This study sought to explore the efficacy and safety of add-on use of oxytocin in uterine leiomyomas patients who received HIFU and ultrasound-guided percutaneous anhydrous ethanol injection.
METHODS: This is a randomized controlled trial. A total of 60 patients with uterine leiomyomas were included and randomly divided into study group and control group. The patients in the control group were treated with HIFU and ultrasound-guided percutaneous anhydrous ethanol injection, while the study group received oxytocin injection in addition to the treatment measures of the control group. The efficacy and safety of the treatments were assessed by using the volume ablation rate of the tumor and the Society of Interventional Radiology (SIR) Practice Guidelines, respectively.
RESULTS: Finally, all of the 60 patients (30 in the study group and 30 in the control group) completed the treatments. There were no statistically significant differences between the 2 groups in terms of leiomyoma volume ablation rate (94.48%±2.07% vs. 94.91%±2.53%, P=0.36), crumb gray time (150.70±57.51 vs. 165.77±77.13 s, P=0.37), total treatment energy (556,835.0±202,583 vs. 512,610.0±158,004 J, P=0.19), and total treatment time (116.70±28.61 vs. 107.40±23.22 mins, P=0.14). The pain score of the oxytocin group was significantly greater than that in the control group (4.53±1.55 vs. 3.60±1.19, P=0.008). At 3 months and 1-year post-therapy, no statistically significant differences were observed in the residual necrotic leiomyoma volume between the 2 groups.
CONCLUSIONS: The add-on use of oxytocin in uterine leiomyomas patients undergoing HIFU and ultrasound-guided intratumoral ethanol injection could not improve treatment effect.
BACKGROUND: Chinese Clinical Trial Registry identifier: ChiCTR2200058584.

Objective: Although polymorphisms of adiponectin gene (ADIPOQ) in obesity-related conditions have been the target of research efforts, little is known about this genetic marker in uterine leiomyomas. The aim of this pilot study was to analyze the frequencies of alleles and genotypes of Single Nucleotide Polymorphism ADIPOQ (NM_004797.4):c.214+62G>T (rs1501299) and to correlate it with the risk of uterine fibroids. Study Design: The Test Group comprised 90 women treated surgically for uterine leiomyomas in the Department of Operative Gynecology, Endoscopy and Gynecologic Oncology, Polish Mother\'s Memorial Hospital-Research Institute. 90 disease-free individuals were used as Controls. Patients within both groups were additionally stratified into lean, overweight and obese, according to Body Mass Index. Statistical analysis was performed between the two major groups and, furthermore, within the abovementioned subgroups. Results: The study revealed no statistically significant differences in the distribution of alleles and genotypes of SNP ADIPOQ (NM_004797.4):c.214+62G>T (rs1501299) between the two main groups. A weak correlation within distributions of alleles was observed between obese Test Patients and lean Controls. Conclusion: This pilot study has revealed no association between SNP ADIPOQ (NM_004797.4):c.214+62G>T (rs1501299) and uterine fibroids. Further studies on larger groups are warranted to elucidate whether this SNP may be correlated with uterine leiomyomas.

Objective: This study seeks to evaluate the feasibility to conduct clinical studies on the treatment of uterine fibroids (UFs) and related symptoms with a 7-point Tung\'s acupuncture protocol. Methods: Nine participants who met the study criteria were recruited into 2 treatment groups, a 6-week and a 12-week group, with 5 and 4 participants, respectively, in each group. Acupuncture was given twice a week. Ultrasound examination was performed before and after the program to evaluate uterine size, number of fibroids, and volume. Symptom Survey Questionnaire (SSQ) for 14 symptoms was given to the participants every time receiving acupuncture. Results: All 9 participants completed the program. No adverse response nor concerns or complaints to the program was reported. The result from 1 subject was excluded from the study due to age limit. All 8 subjects reported improvement in SSQ after the 6-week acupuncture treatment. The reduction of the scores for 10 of the 14 surveyed symptoms was statistically significant. The average score showed reduction for both the 6- and 12-week groups, whereas the 12-week group appeared to have higher percentage reduction than the 6-week group. After 12 weeks of treatment, 9 of the 14 surveyed symptoms were completely eliminated. Ultrasound result for uterine size, number of fibroids, and volume was discussed. Subject recruitment, referrals, long-term follow-up, and challenges in the study were also addressed. Conclusion: It is possible to conduct clinical trial with larger sample size for the treatment of UFs with acupuncture. The study also suggests that acupuncture might reduce symptoms related to UFs. Larger trials with negative control groups and long-term follow-up may help to confirm the result. The changes in uterine size and UF volume cannot be adequately determined due to technical issues for ultrasound examination in the study.

Atypical leiomyomas are histopathologically recognized by moderate to severe pleomorphic atypical tumor cells showing low mitotic counts without coagulative tumor cell necrosis. The histopathological features and clinical behavior of these tumors are unclear. The surgical management of these lesions includes myomectomy and hysterectomy. The current study presents 5 cases of women with atypical leiomyomas that were managed surgically. The clinicopathological characteristics of the patients and recurrences were analyzed. The median age of the patients was 43 years old. While 3 out of 5 patients were treated by hysterectomy (with or without salpingo-oophorectomy), the remaining 2 patients were treated by myomectomy. The median mitotic index was 3 mitotic figures/10 high-power fields. The post-operative course of all patients was uneventful, and there was no evidence of local or distant recurrence in a median follow-up time of 72 months. The treatment of choice for atypical leiomyomas is hysterectomy. However, myomectomy may be an option for fertility sparing cases. A thorough consultation with regard to the uncertain behavior of such tumors and a rigorous follow-up must be offered in such patients.

Currently, no reliable data are available concerning the prevalence of uterine myomas in Germany. In this prospective study, we examined the prevalence of myomas in women older than 30 years by means of vaginal ultrasound.
2296 women, who consented to the procedure, were examined by means of vaginal ultrasound for the presence of myomas in seven gynaecological outpatient departments in Germany.

myomas were detected in 41.6 % of all women. Age dependence: With increasing age, the prevalence of uterine myomas rose from 21.3 % (30-35 years) to 62.8 % (46-50 years). Later, the number of myomas decreased again from 56.1 % (51-55 years) to 29.4 % in women older than 55 years. Menarche/BMI: no correlation could be found between the age at first menstrual period or the body mass index and the occurrence of myomas. Parity: since the group of nulliparous women and the group of women with more than four deliveries stand out by increased occurrence of myomas, a non-linear correlation seems to exist, necessitating more in-depth discussion with regard to age dependency.
The results of this study suggest that more than 40 % of women over 30 years of age suffered from myomas and more than 50 % of all women in Germany may develop uterine myomas at some time in their life.

Uterine leiomyomas are the most common gynecologic benign tumors of the female genital tract that cause a variety of health problems including, abnormal menstrual bleeding, pelvic pain, placenta displacement, premature labor, and miscarriages. Recently, studies showed that recurrent somatic mutations in MED12 exon 2 are the major cause of uterine leiomyomas in different ethnic groups. In order to validate these results in Iranian population, we performed mutational analysis of exon 2 and the flanking intronic regions by using single-strand conformational polymorphism (SSCP) and sequencing analyses in a series of 103 uterine leiomyomas samples. MED12 gene was mutated in 31.07 % of the uterine leiomyomas. Mutations were consisted of 20 missense (62.5 %) and 12 in-frame deletion (37.5 %) mutations and were not detected in normal myometrial tissue. Although this is the lowest mutation frequency reported so far, MED12 mutations are associated with fibroid pathogenesis in the studied population. Understanding the molecular mechanisms responsible for the pathogenesis of uterine leiomyoma will play an important role in designing new therapeutic strategies.

OBJECTIVE: To elucidate the clinical profile of a concomitant diagnosis of adenomyosis in women with leiomyomas.
METHODS: Retrospective questionnaire-based study.
METHODS: Academic medical center.
METHODS: The study sample comprised a total of 560 women: 159 women with adenomyosis and leiomyomas and 401 women with leiomyomas alone.
METHODS: Mailing of a symptom questionnaire.
METHODS: Comparison of women undergoing hysterectomy with adenomyosis and leiomyomas and women with leiomyomas alone.
RESULTS: Women with a concomitant diagnosis of adenomyosis and leiomyomas had significantly higher scores for disease burden during the menstrual period before surgery: heavy bleeding episodes and passing blood clots. Furthermore, women with adenomyosis and leiomyomas reported higher scores of distress regarding pelvic pain occurring during the menstrual period and pelvic pain not associated with the menstrual cycle. Moreover, in multivariate analysis, older age (odds ratio [OR] 1.10, 95% confidence interval [CI] 1.04-1.18), gravidity (OR 1.44, 95% CI 1.12-1.74), and pelvic pain occurring during the menstrual period (OR 1.27, 95% CI 1.06-1.54) increase the odds of having adenomyosis and not only leiomyomas.
CONCLUSIONS: Adenomyosis contributes to symptomatology in women with concomitant adenomyosis and leiomyomas.