Jason A. Abbott

Background Microvascular scarring compromises the functionality of the endometrium, and vascular flow at the junctional zone (JZ) may be the key to understanding poor reproductive outcomes in women with Asherman syndrome (AS). Aims To investigate whether vascular perfusion of the uterus, measured by dynamic contrast‐enhanced magnetic resonance imaging (DCE‐MRI) is impaired in women with intrauterine adhesions (IUA) and AS. Materials and Methods A prospective observational cohort pilot study of 23 women with IUA treated with hysteroscopic synecholysis and a control group of two patients with cervix cancer were subject to DCE‐MRI with gadolinium to assess uterine vascularity. Twelve regions of interest (ROIs) were allocated on the DCE‐MRI image incorporating the JZ, with control ROI placed at the psoas muscle. Individual ROIs were compared to the mean total perfusion (TP) in the same uterus. Pre‐ and post‐operative perfusion analyses were performed on five women. Receiver operator curves (ROC) were used to analyse MRI as a predictor of IUA. Results There was no significant difference in perfusion; a trend toward reduced perfusion was observed in women with IUA compared to the controls. The ROC was predictive of higher‐grade and inoperable IUA. Conclusions Reduced perfusion on DCE‐MRI as assessed by ROC predicted higher‐stage AS. The results of this study support further investigation of DCE‐MRI as a prognostic tool for AS prior to surgical intervention to assist in providing prognostic guidance for women suffering from AS.

Background Uterus transplantation is an emerging treatment option for uterine factor infertility. Most uterus transplantation research programs use living donors, although this comes with considerable surgical and psychological risks and not all women desiring uterus transplantation will have an available living donor. A deceased donor program eliminates donor risks; however, the availability of deceased uterus donors is currently unknown in Australia. Aims To establish the feasibility of a deceased donor uterus transplantation program in Australia and consider expanded inclusion criteria for this model. Materials and Methods A retrospective review of the New South Wales (NSW) Organ and Tissue Donation Service database was undertaken to identify potential deceased uterus donors, with comparison to the broad deceased donor inclusion criteria from three international uterus transplantation trials including female, brain‐dead, multi‐organ donation, no major abdominal surgery, and <60 years of age. Results Between January 1, 2018, and December 31, 2022, 648 deceased donors were available in NSW. Of these, 43% (279/648) were female and 67% of the women (187/279) were also multi‐organ donors. When the brain‐dead donor‐only and age criteria (<60 years) were applied, a total of 107 deceased donors met the available criteria for uterus transplantation, with an average of 21 deceased donors per year in NSW. Conclusions There appears to be adequate deceased donor organ availability to establish a deceased uterus transplantation program in NSW, Australia. Should interest in uterus transplantation increase, including criteria such as older and nulliparous donors could increase organ availability for a uterus transplantation program.