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Aim: To evaluate the usefulness of transabdominal sonographic confirmation of placental detachment in preventing uterine inversion. Methods: This was 14‐year retrospective cohort study that included women who had transvaginal deliveries in our hospital. We introduced routine transabdominal ultrasonography during placental delivery to prevent uterine inversion. Followed by the confirmation of placental detachment by ultrasonography, we started placental delivery procedure. The frequency of uterine inversion during placental delivery was compared before and after the ultrasonography was introduced. Moreover, the duration of the third stage of labor and bleeding volume during labor were compared between the ultrasonography performing group (USG group) and the non‐performing group (non‐USG groups). Results: Five thousand and eighty‐one women, including 1724 and 3357 women who delivered before and after the ultrasonography was introduced, respectively. The frequency of uterine inversion after the introduction of the ultrasonography system was significantly reduced compared to that before the introduction (0.03% vs. 0.23%, p = 0.03). Even after the introduction of ultrasonography, the actual rate of performing ultrasonography remained 54.1% due to various restrictions. The mean duration of the third stage of labor in the USG group was slightly longer than that in the non‐USG group (8.4 ± 5.0 vs. 6.8 ± 3.6, p < 0.01). The mean bleeding volume during labor in the USG group was higher compared with the non‐USG group (457 ± 329 vs. 418 ± 285, p < 0.01). Conclusions: Transabdominal sonographic confirmation of placental detachment may be useful in preventing uterine inversion. [ABSTRACT FROM AUTHOR]

Aim: The abnormal secretion of luteinizing hormone (LH) is one of the typical features of polycystic ovary syndrome (PCOS) and adopted in the diagnostic criteria of the Japan Society of Obstetrics and Gynecology (JSOG). We investigated cut‐off values for LH and the LH/follicle‐stimulating hormone (FSH) ratio in resent two measurement systems for the diagnosis of PCOS. Methods: Ninety‐nine controls and 106 patients with PCOS were enrolled. Serum LH and FSH levels were measured using an electrochemiluminescence immunoassay (ARCHITECT) and chemiluminescence immunoassay (ECLusys). We examined the distribution of the measured levels, selected the conversion closest to the standard normal distribution in the control group, and calculated mean + 1 SD values for LH and the LH/FSH ratio as candidates. Cut‐off values coincided with the medians of the candidates in the two assay systems using a regression equation. We calculated the endocrinological abnormality rate in PCOS according to the JSOG criteria by abnormal LH secretion and elevated T. Results: Cut‐off values for LH (mIU/mL) and the LH/FSH ratio were 7.1 and 1.21, respectively, in ARCHITECT, and 9.9 and 1.51, respectively, in ECLusys. The detection rates of endocrinological abnormalities in PCOS were 72.2% and 70.6% in the nonoverweight/obese PCOS group and overweight/obese PCOS group, respectively, in ARCHITECT, and 69.4% and 73.5%, respectively, in ECLusys. Conclusion: We obtained cut‐off values of LH and the LH/FSH ratio for diagnostic criteria of JSOG criteria for PCOS, that were highly compatible between two major assay systems. These cut‐off values will contribute to the diagnosis of PCOS in Japan and presumably in women of Asian ethnicities. [ABSTRACT FROM AUTHOR]

Aim: The actual status of fertility preservation treatments in the startup phase in Japan was investigated as a basis for discussing future directions. Methods: This study was conducted as "Research project to promote support of children and parenting 2016" which was supported by Ministry of Health in Japan with the approval of the institutional review board at St. Marianna University. Subjects of the survey were facilities registered with the Japan Society of Obstetrics and Gynecology as fertility preservation facilities, and facilities belonging to the Japan Association of Private Assisted Reproductive Technology Clinics and Laboratories. We provided questionnaires to survey both the medical care system and cases for which fertility preservation was implemented between 2006 and 2016. Results: Responses were obtained from 68 facilities (of the 64, 59 [92.2%] responded to the questionnaire and 9 clinics cooperated). Many facilities limited the cryopreservation of oocytes and ovaries to patients 40–41 years old and the use of eggs to patients 44–45 years old. In the patient survey, 812 cases of oocyte cryopreservation and 201 cases of ovarian tissue cryopreservation were performed during study period. Breast cancer was the most indicated disease, with oocyte cryopreservation in the late 30s and ovarian tissue cryopreservation in the early 30s. Very few babies were born from fertility preservation, and no live birth cases of ovarian tissue cryopreservation were identified. Conclusions: Even from the early days, fertility preservation was implemented according to certain standards in Japan, but was characterized by a large variety of facilities. [ABSTRACT FROM AUTHOR]

Imperforate anus (IA) requires urgent treatment after birth, which is dependent on the type of IA, and is also frequently associated with other congenital abnormalities. Most patients with IA have an accompanying fistula, whose location is strongly associated with the type of IA. The fistula location can be a key factor in defining appropriate treatment, especially in neonates presenting with severe associated abnormalities. Herein, we report three cases of IA in which fistulas were detected and localized prenatally. Examination of the fetal pelvis through the sagittal or coronal view, using high‐frequency transducers, revealed the location of the fistulas. In particular, the sagittal view obtained using the fetal infracoccygeal or perineal approach allowed us to determine the precise anatomy of the fistulas. Neonatal assessment confirmed the fistula locations. We recommend using the sagittal view obtained using the fetal infracoccygeal or perineal approach with high‐frequency transducers to assess fistulas in fetuses with IA. [ABSTRACT FROM AUTHOR]

Many transgender men receive testosterone therapy to achieve virilization. The therapy is often mistaken for having a contraceptive effect because it causes amenorrhea. However, some treated patients become pregnant, which is not well known. A 25‐year‐old transgender man who had received testosterone for 3 years had an unplanned pregnancy during discontinuation of treatment. He was unaware of his pregnancy, resumed testosterone, and continued treatment until pregnancy was confirmed. His female child was exposed to androgens during the fetal period; thus, careful, long‐term observation was required. He developed insomnia and depression during the postpartum, and giving birth made it difficult for him to change his family register to male. Transgender men can become pregnant through sexual intercourse with biological men, even during hormone replacement therapy, so correct contraception is necessary to avoid unwanted pregnancies. Transgender sex education is important to increase awareness of this issue among individuals and medical professionals. [ABSTRACT FROM AUTHOR]

Aim: The survival rates of cancer patients have greatly improved owing to the advances in oncology. The preservation of fertility in cancer patients is an important task. To determine the reality of cryopreservation of embryos, oocytes and ovarian tissue in cancer patients, large‐scale survey analysis was performed in Japan. Methods: We sent 613 Japan Society of Obstetrics and Gynecology‐certified assisted reproductive technology institutions a questionnaire about their experience of performing cryopreservation for cancer patients between January 2011 and December 2015. Subsequently, the institutions that conducted cryopreservation for cancer patients were sent a second questionnaire. Results: We received replies from 481 (78.5%) institutions. Among them, 126 (26.2%) conducted cryopreservation for cancer patients. These 126 institutions were sent a second questionnaire. Of these, 108 (85.7%) institutions responded. At the 108 institutions, 1085 embryo or oocyte cryopreservation procedures and 122 ovarian tissue cryopreservation procedures were conducted for cancer patients. Cryopreservation was mainly performed for breast cancer patients (~70%), followed by patients with hematological malignancy. A total of 361 and 19 embryo transfer cycles were performed for patients whose embryos and oocytes were cryopreserved, respectively, and 42 and seven institutions reported pregnancy outcomes after embryo transfer in patients that underwent embryo and oocyte cryopreservation, respectively. However, pregnancy was not observed in the seven cases that underwent ovarian tissue transfer. Conclusion: Indications, age limits and ovarian stimulation protocols for cryopreservation widely varied between the institutions. A national registration system for oncofertility must be established to evaluate the safety and efficacy of the current system. [ABSTRACT FROM AUTHOR]

The Japan Society of Obstetrics and Gynecology Reproductive Endocrinology Committee summarizes the activities of each subcommittee below from April 2017 to March 2019.Current important issues regarding reproductive medicine were examined and discussed from social, political, ethical and scientific viewpoints.A nation‐wide survey targeted at OB/GYN facilities revealed the usual procedure in diagnosis and management of fertility‐desiring POI patients and fertility outcomes of the patients.How to introduce and adapt FIGO AUB systems to obstetric and gynecologic practices in Japan was examined and discussed. [ABSTRACT FROM AUTHOR]

Abstract: Aim: We aimed to evaluate the effect of prolonged hospitalization for threatened preterm labor (TPL) on maternal and fetal vitamin D status. Methods: This was a retrospective cohort study, spanning 4 years, including 18 women with TPL and 36 women with normal pregnancy who received prenatal care for a singleton pregnancy at our center. TPL cases were women who were admitted to our hospital after the second trimester test for at least 28 days, during which time the third trimester test was also performed. Controls were randomly sampled from women matched for age as well as the season during which the third trimester test was performed. Serum 25‐hydroxyvitamin D (25(OH)D) concentration in maternal blood was compared between the two groups at second trimester, third trimester and in the umbilical cord blood at delivery. Results: The mean ± SD of maternal serum 25(OH)D concentration in the TPL group (14.0 ± 3.0 ng/mL) was significantly lower than that in the control group (17.8 ± 5.9 ng/mL) (P < 0.01) in the third trimester, although there was no significant difference in the second trimester (P = 0.30). There was a significant reduction (P < 0.01) in the maternal serum 25(OH)D from the second to third trimester in the TPL group, compared to the control group (P = 0.60). There was no significant difference between the two groups in umbilical cord blood 25(OH)D concentrations at delivery (P = 0.41). Conclusion: Prolonged hospitalization for TPL reduced the maternal vitamin D status but did not influence the neonatal status at delivery. [ABSTRACT FROM AUTHOR]

Abstract: Aim: We conducted a self‐administered survey on the perception of teachers toward human papillomavirus (HPV) vaccine to determine the ways to increase their willingness to encourage its use. Methods: Answers were obtained both prior to and after having the teachers read five brief information articles: (i) cervical cancer knowledge, (ii) vaccine knowledge, (iii) result of a survey in Nagoya, (iv) news report of the World Health Organization statement and (v) articles written by Dr Muranaka, a journalist. Results: Most of the respondents (180/247) did not know about the natural history of cervical cancer. Only 36% knew that HPV is the cause of cervical cancer, although 63% knew that HPV vaccine would prevent cervical cancer. Few respondents had knowledge regarding adverse events following immunization and the survey results from Nagoya. Among those who were initially negative for the HPV vaccine, only 43% revealed that they fully understood its safety and only 29% reversed their opinion to recommend vaccination to their daughters and/or students, even after reading our informational material. The most useful information for changing their attitudes was to increase their understanding of vaccines and informing them about Nagoya city survey results. They mostly wanted a proof of the preventive effects of the vaccine on cervical cancer in Japan. Conclusion: Gynecologists and pediatricians must proactively communicate accurate scientific information to the government and the media to spread awareness among people in Japan. Also, we must try to demonstrate the capabilities of this vaccine to prevent cervical cancer and/or its precancerous lesions. [ABSTRACT FROM AUTHOR]

Abnormal coronary artery (CA) anatomy is common in cases of D-transposition of the great arteries (TGA) and can be a significant risk factor during the arterial switch operation. Here, we report three cases of TGA in which CA anatomy was assessed prenatally using color Doppler imaging. All CA, except the left circumflex CA in one case, were identified. CA anatomy was completely correctly diagnosed in one of our three cases. In the two remaining cases, the left circumflex CA could not be visualized in one patient, and the origin of the left anterior descending CA was not correctly diagnosed in the other. We found that prenatal assessment of CA anatomy using color Doppler in TGA was feasible, but the diagnostic accuracy was limited. We anticipate that more experience with the advancing technology will improve accuracy. [ABSTRACT FROM AUTHOR]

We report a case of non-mosaic trisomy 20 detected prenatally by amniocentesis during the 16th week of pregnancy. Fetal blood sampling showed a normal karyotype and no fetal, neonatal or infant abnormalities were observed. Amniotic fluid cell karyotyping revealed a trisomy 20 (47, XY,+20) with 100% trisomic cells (38/38); however, a subsequent cordocentesis revealed a normal male karyotype. Moreover, a follow-up ultrasonographic examination did not reveal any major congenital malformations, and a healthy male infant was delivered subsequently at an appropriate gestational age without obvious anomalies. Cytogenetic analysis of blood lymphocytes from the infant revealed a normal karyotype, but cultured cells from the term placenta showed a mosaic karyotype 47, XY,+20/46, XY with 88% trisomic cells (44 of 50). Furthermore, no anomalies or developmental delays were observed in the neonatal period, thus suggesting two possibilities: confined placental mosaicism with the presence of normal and abnormal cell lineages, or generalized mosaicism affecting a limited number of tissues in both the placenta and fetus. [ABSTRACT FROM AUTHOR]

Aim The aim of this study was to assess the efficacy of assisted hatching ( AH) in assisted reproductive technology ( ART) treatment. Material and Methods In this retrospective observational study, the data of patients who were registered in the National ART Registry System of Japan between January and December 2010 were analyzed. The descriptive statistics and validity of AH in fresh embryo transfer ( ET) and frozen-thawed ET were assessed by using multiple logistic regression analyses. Results From a total of 105 450 single ET, 46 029 (43.7%) cycles underwent AH. A total of 9737 (21.3%) and 36 292 (60.9%) cycles underwent AH from 45 818 fresh single ET and 59 632 frozen-thawed single ET, respectively. In the fresh ET patients that underwent AH, the clinical pregnancy and live birth rate were significantly decreased in patients of all ages compared with that of the non- AH group. In the frozen-thawed ET patients, there was no significant difference in pregnancy and live birth rate between the AH group and the non- AH group. Conclusion AH treatment was more frequently performed in frozen-thawed ET patients than in fresh ET patients, and in the blastocyst stage than in the early cleavage stage. A significantly decreased pregnancy and live birth rate was observed in the fresh ET patients who underwent AH. In the frozen-thawed ET patients who underwent AH, improvement in the clinical pregnancy and live birth rate was not observed. Further studies on the indication and application of AH in ART treatment are required. [ABSTRACT FROM AUTHOR]

Aim: The objective of this study was to verify the impact of systematic retroperitoneal lymphadenectomy on survival in patients with ovarian cancer. Material & Methods: During 2001-2005, clinical records of 118 patients with epithelial ovarian cancer were collected in Tokushima prefecture. From a number of hospitals, patients in one group were treated without systematic lymphadenectomy, and in another group, patients were treated with routine systematic lymphadenectomy. Clinical records were reviewed retrospectively and progression-free survival (PFS) and overall survival (OS) were compared. Results: Sixty-two patients were staged as I-II according to the macroscopic findings at surgery. Forty of these patients received systematic lymphadenectomy and 22 patients did not. The 5-year OS was 100 and 80%, respectively ( P = 0.07). The 5-year PFS was 94 and 71%, respectively ( P = 0.04). In patients with clear cell adenocarcinoma, 3-year OS and PFS were significantly better in the lymphadenectomy group ( P = 0.01, P = 0.046, respectively). The 56 patients staged as III-IV according to the macroscopic findings at surgery were optimally debulked. Twenty-eight of these patients received systematic lymphadenectomy and 28 patients did not. There is no difference in the 5-year OS (65 and 66%, respectively; P = 0.71) or the 5-year PFS (30 and 52%, respectively; P = 0.48). Conclusion: This study has demonstrated that the systematic lymphadenectomy had benefit only in patients with ovarian cancer macroscopically confined to the pelvis. In patients with clear cell adenocarcinoma, systematic lymphadenectomy was beneficial. To the contrary, systematic lymphadenectomy had no benefit on OS or PFS in patients with advanced ovarian cancer if optimally debulked. [ABSTRACT FROM AUTHOR]

Aim: We evaluated the reproducibility of an elevated luteinizing hormone (LH) level or elevated LH/follicle-stimulating hormone (FSH) ratio in different phases of the menstrual cycle in patients with polycystic ovary syndrome (PCOS). Furthermore, we evaluated the influence of cycle days and body mass index on LH levels using different days from menses or withdrawal bleeding. Methods: Forty-three patients with PCOS and 37 controls were enrolled. All patients with PCOS had elevated LH levels and LH/FSH ratio, polycystic ovarian morphology and chronic anovulation at diagnosis. After their diagnoses, we measured serum LH and FSH in the early period and/or late period of the follicular phase. Results: The rate of patients with elevated LH levels and LH/FSH ratio were significantly higher in the late phase than in the early phase in PCOS. In the early phase, only 52% of patients had elevated LH levels and LH/FSH ratio. We failed to demonstrate an inverse relationship between the LH level and BMI. Conclusions: LH levels of patients with PCOS were strongly influenced by the days from menses or withdrawal bleeding. In the early period, the reproducibility of elevated LH levels or LH/FSH ratio was poor even in patients previously diagnosed with them. [ABSTRACT FROM AUTHOR]

Aim: To investigate whether laparoscopic proximal tubal division for the treatment of hydrosalpinges could preserve ovarian function. Methods: From June 2002 to October 2006, before assisted reproductive treatment (ART), a total of 17 infertile patients with bilateral hydrosalpinges were studied – 11 patients underwent laparoscopic proximal tubal division (PTD group), and six underwent laparoscopic salpingectomy (salpingectomy group). In both groups, the basal follicle-stimulating hormone (FSH) values before and after surgery, the operation time and outcome of ART treatment were retrospectively evaluated. Results: The mean FSH value before laparoscopic PTD was similar to that after surgery. The FSH value before laparoscopic salpingectomy significantly increased after surgery (6.8 ± 1.1 vs 14.1 ± 9.3). The operation time in the PTD group was significantly shorter than in the salpingectomy group. The outcomes of ART were similar in both groups. The pregnancy rate per patient in the PTD and salpingectomy groups were 45.5% and 50%, respectively. Conclusions: Laparoscopic proximal tubal division preserved ovarian function and was an optimal operation method for infertility patients with hydrosalpinges. The basal FSH values after laparoscopic proximal tubal division were comparable to those before surgery. [ABSTRACT FROM AUTHOR]

Aim: To clarify the effect of laparoscopic cystectomy for ovarian endometrioma in infertility patients, the pregnancy outcome was evaluated. Methods: This was a retrospective study. From August 2002 to February 2006, 33 infertility patients with ovarian endometrioma underwent laparoscopic cystectomy at our center. According to the laparoscopic findings 33 were divided into two groups; 10 were evaluated as the patients who need assisted reproductive technologies (ART) treatment (IVF subgroup) and 23 were evaluated as the patients who do not need ART treatment but conventional infertility treatment (non-IVF subgroup). During the same period, 70 patients who were age-matched and received ART treatment without laparoscopy were defined as control (control group). Following up to 12 months after laparoscopy, the cumulative pregnancy rate in the non-IVF subgroup was calculated. Results: The patients age, duration of infertility and size of endometrioma were equal in the IVF and the non-IVF subgroups. The revised-American Society of Reproductive Medicine (r-ASRM) score in the IVF subgroup was significantly higher than that in the non-IVF group ( P < 0.05). The pregnancy rates after laparoscopic cystectomy in IVF and non-IVF subgroups were 50.0% and 60.9%, respectively. These rates in the IVF and the non-IVF groups were slightly higher than that in control group (41.4%), but these differences were not significant. The cumulative pregnancy rate in the non-IVF group reached 52.2%, 12 months after laparoscopic surgery. Conclusions: Laparoscopic surgery should be performed prior to ART treatment not only for making a decision about the treatment course but also for establishing a good pelvic condition to induce a pregnancy during ART treatment in infertility treatment with ovarian endometrioma. [ABSTRACT FROM AUTHOR]