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RESEARCH QUESTION: Do different subtypes of superficial peritoneal endometriotic lesions exist, based on the presence and morphology of smooth muscle, collagen fibres and immune cell populations? DESIGN: A retrospective cohort study of 24 patients, from across the menstrual cycle, with surgically and histologically confirmed endometriosis. Immunofluorescence was used to delineate the CD10 stromal area of lesions (n = 271 lesions from 67 endometriotic biopsies), and then smooth muscle actin (SMA) positive tissue and immune cell populations (CD45+ and CD68+) were quantified within and adjacent to these lesions. Second harmonic generation microscopy was used to evaluate the presence and morphology of type-1 collagen fibres within and surrounding lesions. RESULTS: Overall, immune cell numbers and the area of SMA and collagen within endometriotic lesions tended to be low, but a spectrum of presentations significantly varied, particularly in the adjacent tissue microenvironment, based on lesion locations, the morphology of endometriotic gland profiles, or both. Lesions in which collagen fibres formed well aligned capsules around the CD10+ stromal border were identified compared with lesions in which collagen fibre distribution was random. Considerable inter- and intra-patient variability in the morphology of SMA and collagen was observed within and surrounding lesions. CONCLUSION: These data demonstrate considerable diversity in the presence of immune cells and morphology of SMA and collagen within, but even more so, surrounding endometriotic lesions, even within individual patients. This heterogeneity, especially within individual patients, presents a challenge to incorporating these cell and tissue types into any new endometriosis classification systems or prognostic approaches.

Natural variability in menstrual cycle length, coupled with rapid changes in endometrial gene expression, makes it difficult to accurately define and compare different stages of the endometrial cycle. Here we develop and validate a method for precisely determining endometrial cycle stage based on global gene expression. Our 'molecular staging model' reveals significant and remarkably synchronised daily changes in expression for over 3400 endometrial genes throughout the cycle, with the most dramatic changes occurring during the secretory phase. Our study significantly extends existing data on the endometrial transcriptome, and for the first time enables identification of differentially expressed endometrial genes with increasing age and different ethnicities. It also allows reinterpretation of all endometrial RNA-seq and array data that has been published to date. Our molecular staging model will significantly advance understanding of endometrial-related disorders that affect nearly all women at some stage of their lives, such as heavy menstrual bleeding, endometriosis, adenomyosis, and recurrent implantation failure.

OBJECTIVE: To prospectively compare long-term lower gastrointestinal function before and after laparoscopic surgery for deep endometriosis (DE). METHODS: In this prospective observational study we followed 149 patients with confirmed DE who were treated surgically. Patients completed the International Consultation on Incontinence Questionnaire Anal Incontinence Symptoms and Quality of Life Module (ICIQ-B) before surgery, and 6 weeks, 6 months, and 12 months after surgery. Bowel pattern, bowel control, and bowel impact on quality of life summary scores were compared before and after surgery. RESULTS: Bowel pattern score showed an increasing improvement at all time points after surgery, from a mean pre-operation score of 4.8 ± 2.0 to 4.4 ± 1.8 at 6 weeks, 4.2 ± 1.8 at 6 months, and 4.2 ± 1.2 at 12 months. Bowel impact on quality of life significantly improved from pre-surgery mean score of 5.5 ± 6.0 to 4.2 ± 5.5 at 6 weeks and 4.4 ± 5.4 at 6 months. Direct lower gastrointestinal endometriosis involvement and worse initial function were associated with larger improvements in scores following surgery. CONCLUSIONS: Lower gastrointestinal function significantly improved after surgical treatment of DE. Further research is needed to confirm our findings and to better characterize the sub-groups of patients for whom surgery will have a beneficial effect on their bowel function.

Endometriosis is a common condition associated with debilitating pelvic pain and infertility. A genome-wide association study meta-analysis, including 60,674 cases and 701,926 controls of European and East Asian descent, identified 42 genome-wide significant loci comprising 49 distinct association signals. Effect sizes were largest for stage 3/4 disease, driven by ovarian endometriosis. Identified signals explained up to 5.01% of disease variance and regulated expression or methylation of genes in endometrium and blood, many of which were associated with pain perception/maintenance (SRP14/BMF, GDAP1, MLLT10, BSN and NGF). We observed significant genetic correlations between endometriosis and 11 pain conditions, including migraine, back and multisite chronic pain (MCP), as well as inflammatory conditions, including asthma and osteoarthritis. Multitrait genetic analyses identified substantial sharing of variants associated with endometriosis and MCP/migraine. Targeted investigations of genetically regulated mechanisms shared between endometriosis and other pain conditions are needed to aid the development of new treatments and facilitate early symptomatic intervention.

OBJECTIVE: We aim to demonstrate a clinical difference in pregnancy outcomes in IVF cycles undergoing blastocyst-stage embryo biopsy and preimplantation genetic screening (PGS) in comparison to patients undergoing standard (non-PGS) IVF treatment. DESIGN: We conducted a retrospective cohort analysis of a private IVF clinic in Melbourne, Australia. MATERIALS AND METHODS: Details of patients undergoing PGS utilising blastocyst biopsy and next-generation sequencing from January 2015 to March 2018 were extracted from the clinic's database and compared to patients receiving standard IVF treatment and a blastocyst transfer from January 2010 to March 2018. Our analysis compared 719 PGS cases to 2920 non-PGS cases of single, frozen embryo transfer. Statistical analysis was conducted using Windows SPSS Version 25 and STATA 15. Demographic and stimulation cycle details were compared between groups using a combination of the Mann-Whitney-U test, Welch's t-test and student's ttest. Outcomes were analysed using logistic and linear regressions. RESULT(S): Statistically significant differences in some demographic factors, notably age and previous pregnancy/IVF history were apparent in PGS cycles. Our primary outcome was an ongoing and delivered pregnancy, with secondary outcomes of clinical pregnancy, twin delivery, gestation at delivery and birthweight. Adjustment regression models utilised almost all demographic and stimulation variables (except gravidity, parity and number of embryos biopsied). PGS had a statistically significant superior rate of ongoing and delivered pregnancies compared to non-PGS cases (OR 1.86, 95% CI 1.50-2.29, p=<0.001), with an associated superior clinical pregnancy rate (OR 1.66, 95% CI 1.36-2.04, p=<0.001). PGS produced superior ongoing and delivered pregnancy rates for women above 35 years (p=<0.001), but no difference under 35 years (p=0.92). Of note, there was no statistically significant difference between PGS and non-PGS groups related to twin del

OBJECTIVE: To evaluate whether GnRH-agonist (GnRHa) triggering improves embryo quality and live birth rates in 'freeze-all' cycles compared to human chorionic gonadotrophin (hCG). DESIGN: Retrospective cohort study. MATERIALS AND METHODS: This retrospective cohort study from January 2012 and December 2014 compared GnRHa and hCG-triggered 'freeze-all' cycles. Limiting for first cycle per patient, 396 GnRHa and 1,868 hCG-triggered cycles were included. Only cycles where embryos were available and thawed for transfer were included for live birth rates (LBR). 217 GnRHa and 509 hCG-triggered cycles were analysed for LBR. A multiple imputation approach was used to account for missing data. The primary outcome was LBR. Secondary outcomes included number of oocytes collected, embryo grade and quality, clinical pregnancy rates and the incidence of ovarian hyperstimulation syndrome (OHSS). Regression analysis was performed to adjust for confounders. P-values <0.05 were considered statistically significant. RESULT(S): The singleton LBR after one embryo transfer was higher in GnRHa triggered 'freeze-all' cycles compared to hCG (38.4% vs. 24.6%, p=0.001), as well as a non-significantly higher cumulative LBR (57.4% vs. 41.1%, p=0.18). There was no difference in the number of embryos thawed or transferred, and there was no difference in embryo grade or expansion. The incidence of OHSS was significantly lower in GnRHa triggered cycles (0.5% vs. 1.9%, p=0.008). CONCLUSION(S): GnRHa triggering resulted in a superior LBR compared to hCG in 'freeze-all' cycles, even after adjusting for confounders. GnRHa triggering did not compromise embryo quality and significantly reduced the risk of OHSS compared to hCG. Given these findings, GnRHa triggering appears to be the way of the future for 'freeze-all' cycles.

Background: The Northwestern Pacific is a data-poor region for studies into the movements and habitat use of open ocean and pelagic sharks. However, this region experiences considerable pressure from commercial fishing. Therefore, shark movement data from this region carry significant implications for conservation and management, particularly for threatened species. Here, we provide the first data on seasonal residency and movements of scalloped hammerhead (Sphyrna lewini) and Galapagos sharks (Carcharhinus galapagensis), using acoustic and satellite telemetry, and dive logbooks, off Japan. Results: Eight female sharks, four of each species, were tagged around a coastal seamount off southeastern Japan (Mikomoto Island) in August 2015, and monitored for a period of up to 363 days using an array of six receivers around the island. Analyses of the more abundant scalloped hammerhead acoustic data suggest high seasonal residency predominantly from August to November associated with lower chlorophyll-a concentrations, before sharks then leave the island and return the following summer. Residency for scalloped hammerhead sharks were highest among those receivers closest to the Kuroshio Current, which produces strong coastal upwelling, however SST was not found to be predictive of occurrence at Mikomoto. Shark presence was corroborated by analysis of dive-log data from a local ecotourism operator. We also produced two unique satellite tracks, whereby a scalloped hammerhead exhibited a 200-km dispersal into a coastal embayment west of the tagging location and a Galapagos shark migrated over 800 km offshore into the high seas. Conclusion: This study provided some of the first behavioral and movement data for scalloped hammerhead and Galapagos sharks in Japan. Our findings suggest varying spatial and temporal visitation of two shark species to a coastal seamount, underscored by some degree of seasonal residency and site fidelity and linked, for scalloped hammerhead sharks at l

BACKGROUND: Management of ovarian torsion ranges from de-torsion to oophorectomy and is dependent on various factors. Oophorectomy can have significant implications for fertility and general health, thus requiring careful consideration. AIMS: We evaluate the management of ovarian torsion at a tertiary hospital over a ten-year period and identify the predictors of oophorectomy in ovarian torsion cases. MATERIALS AND METHODS: Inpatient notes of patients who underwent surgical management for acute ovarian torsion at a tertiary hospital in Victoria, Australia, were reviewed, from January 2008 to June 2018. We reported the incidence and predictors of oophorectomy and ovarian ischaemia and current practices in oophoropexy. RESULTS: Our analysis included 159 patients. The incidence of oophorectomy was 47%. After confounders were adjusted, increasing age was the only significant predictor for oophorectomy. The adjusted odds ratio of having an oophorectomy based on age alone was 1.10 for each year increase in age between the ages of 15 and 68 (P = 0.001, 95% confidence interval 1.04-1.16). Of those with oophorectomy, 57% had ischaemia confirmed histologically. There were no significant predictors for ischaemia. CONCLUSION: The incidence of oophorectomy in this audit is comparable to reported incidences in current literature. However, with increasing evidence to support ongoing ovarian function even in cases where ischaemia is histologically confirmed, this incidence could be lowered. Age was the only variable that was found to have a significant effect on the incidence of oophorectomy.

BACKGROUND: To better understand the potential role of social media (SM) as a self-management tool for individuals with endometriosis and to assess its current use by endometriosis patients. AIMS: The primary outcome was use of SM for health in patients with endometriosis. Secondary outcomes included preferred SM platforms for health information sharing and factors that influenced use, positive and negative experiences and reported impacts on health. MATERIALS AND METHODS: A single-centre, cross-sectional study performed within benign gynaecology units at a tertiary hospital in Melbourne, Australia. One hundred patients with a confirmed diagnosis of endometriosis participated. Individuals did not have to be users of SM. Data were collected through an electronic third-party survey tool (SurveyMonkey® ). Analysis methods included descriptive statistical analysis, frequency counts, as well as cross-tabulation to examine statistical association between variables. Free-text responses were qualitatively analysed using deductive-inductive semantic thematic analysis. RESULTS: Social media was used for health by 76% of patients with endometriosis in this study. SM users were younger, had pelvic pain for more than six months and reported higher rates of psychosocial impact and symptoms from endometriosis. Respondents reported overall positive impacts on psychological, social and cognitive health outcomes (76%) from SM use. CONCLUSION: In our cohort, a high number of people with endometriosis are using SM for health. These individuals are more likely to suffer both physical and psychosocial impacts from endometriosis. Hospitals and health organisations may consider support of the endometriosis community through SM.

BACKGROUND: Adenomyosis is a benign disorder defined by ectopic endometrial glands within the uterine myometrium. A study by Mooney et al reported the myometrial-cervical ratio (MCR), a novel ultrasound measurement that was found to improve the preoperative diagnosis of adenomyosis. AIMS: To validate the association between sonographic MCR and adenomyosis confirmed on histopathology in an independent patient group. MATERIALS AND METHODS: Single-centre retrospective cohort study including women who underwent hysterectomy between 1 January 2016 and 31 December 2018 for a benign, non-obstetric indication with an ultrasound at the study centre prior to surgery. Clinical details and histopathology were extracted. Ultrasound images were reviewed by a gynaecology ultrasound subspecialist blinded to histological findings. RESULTS: Eight hundred eighty-seven patients underwent hysterectomy in the study period for eligible indications; 317 had an ultrasound at the study centre and were included. There was no statistically significant association between the MCR and adenomyosis on histology when all patients were included; however, increased MCR was associated with adenomyosis when those with fibroids on ultrasound were excluded. The area under the receiver operating characteristic for this model was 0.614 (95% CI: 0.53 to 0.69). The optimal MCR cut-point in this subgroup was 1.79, which achieved 55.6% sensitivity and 62.8% specificity, with 58.5% correctly classified. There was no significant difference in MCR compared to traditional ultrasound markers of adenomyosis. CONCLUSIONS: In a population undergoing hysterectomy for benign and non-obstetric indications, the MCR applied to preoperative ultrasound was only weakly associated with a histological diagnosis of adenomyosis.