Structure and function of the fallopian tubes following exposure to diethylstilbestrol during gestation

Fuzzy-womb-for-E
DES Daughters were found to have unique tubal morphologic features consisting of a foreshortened, convoluted tube with “withered” fimbria with a pinpoint os at laparoscopy. Fuzzy womb for E.

Abstract

Structure and function of the fallopian tubes following exposure to diethylstilbestrol (DES) during gestation, Fertility and sterility, NCBI PubMed PMID: 7308519, 1981 Dec.

The association between the use of diethylstilbestrol (DES) and vaginal and cervical adenocarcinoma and adenosis in the progeny was first reported by Herbst et al. in 1971. This progeny will reach a peak as far as reproduction is concerned in this decade. It is estimated that 2 million women may be involved to varying degrees.

Changes in uterine and cervical contour and structure have been detailed. Thus DES exposure and anatomic changes in the Müllerian system have been documented.

In this report 16 women in the reproductive age group who were exposed to DES in utero and presented with infertility are discussed. On workup for infertility they were found to have unique tubal morphologic features consisting of a foreshortened, convoluted tube with “withered” fimbria with a pinpoint os at laparoscopy.

The diagnosis could not be made at the time of hysterosalpingogram. Three patients had surgery in an attempt to correct this condition; and in all cases the surgery was unsuccessful.

No statistical data is offered as to epidemiologic factors or incidence rates, but the suspected increase in infertility and ectopic pregnancy rates in patients with DES exposure may corroborate these findings.

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Reproductive and gynecologic surgical experience in diethylstilbestrol-exposed daughters

trying-to-rest
Spontaneous abortion, ectopic pregnancy, incompetent cervix, and premature labor occurred significantly more often in the DES-exposed population than in the normal controls. trying to rest.

Abstract

Reproductive and gynecologic surgical experience in diethylstilbestrol-exposed daughters, American journal of obstetrics and gynecology, NCBI PubMed PMID: 7315913, 1981 Dec.

Information on reproductive history, gynecologic operations, and examinations was analyzed for 338 diethylstilbestrol (DES)-exposed and 298 unexposed women whose mothers participated in an evaluation of DES use in pregnancy 28 years ago.

  • A history of infrequent menses (less often than every 36 days) was reported more commonly by the exposed women (32%) than by the unexposed women (15%) and the mean duration of menstrual flow was also less.
  • A greater number of exposed women than unexposed women experienced primary infertility (53 versus 19). The reasons for these differences are not currently known.
  • Comparison of the outcomes of first pregnancies showed a higher proportion of premature births, spontaneous abortions, and ectopic pregnancies in the exposed women (P less than 0.001).
  • The difference in the occurrence of ectopic pregnancies was statistically significant (8 versus 0; P less than 0.005).
  • An adverse pregnancy outcome was more likely in DES-exposed women with cervicovaginal ridges.
  • However, when the outcome of all pregnancies were considered, 81% of the exposed women had at least one living child.
  • More exposed women than unexposed women had gynecologic surgical procedures, which may, in part, be due to the increased medical surveillance of the exposed group.
  • The spectrum of diseases at operation in both groups was similar.
  • Adnexal masses and pelvic inflammatory disease were more commonly reported among the exposed women while the occurrence of endometriosis in both groups was similar.
  • For the exposed women who had been examined at the Chicago Lying-In Hospital over a 4-year period, epithelial changes in the vagina had disappeared in 32% and cervicovaginal ridges had disappeared in 57%.
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Pregnancy outcome in women exposed to DES in utero, their mothers, and unexposed siblings

Pregnancy Outcome in 98 Women Exposed to Diethylstilbestrol In Utero.

Abstract

Pregnancy Outcome in 98 Women Exposed to Diethylstilbestrol In Utero, Their Mothers, and Unexposed Siblings, Obstetrics and gynecology, Volume 59 – Issue 3, July 1981.

The reproductive capability and labor complications of 98 women exposed to diethylstilbestrol (DES) in utero were compared with those of three separate control groups. The controls consisted of:

  1. 167 age-matched, normal women,
  2. 20 siblings not exposed to DES who had achieved pregnancy,
  3. and their mothers.

Spontaneous abortion, ectopic pregnancy, incompetent cervix, and premature labor occurred significantly more often in the DES-exposed population than in the normal controls.

The controls also achieved a higher percentage of desired pregnancies overall; this was statistically significant (89.6 versus 75.0%, P less than .001).

When compared with their mothers, however, the DES-exposed population achieved a greater percentage of desired, viable pregnancies (75.6 versus 67.0%, P less than .001).

The unexposed siblings of the DES women achieved a higher percentage of desired, viable pregnancies than did their exposed sisters (86.9 versus 73.6%, P = .274), but less than the normal population (86.9 versus 89.6%).

Click to download the full study.

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Pregnancy outcome in women exposed to diethylstilbestrol in utero

image of pregnant-woman
The outcomes of the pregnancies of DES-exposed women registered in the Stilbestrol Clinic at the Stanford University Medical Center were examined in 1981. Pregnant Woman.

Abstract

American journal of obstetrics and gynecology, NCBI PubMed PMID:7234915, 1981 May.

The presence of anomalies in vagina, cervix, and uterine body of women exposed to diethylstilbestrol in utero has provoked interest and concern regarding the reproductive potential of these women. To expand and to evaluate better better the current knowledge in this matter, the outcomes of the pregnancies of exposed women registered in the Stilbestrol Clinic at the Stanford University Medical Center were examined.

The results were combined with the published results of similar examinations of other institutions and a summation of all available data is presented.

  • Although it is evident that the majority (79%) of exposed women who have become pregnant and not regularly sought abortion have obtained at least one living infant, the incidence of spontaneous abortion and preterm delivery has consistently been found to be greater in exposed women than in unexposed control women.
  • One of every 30 pregnancies reported in exposed patients has been ectopically located.
  • Additionally, there is suggestive evidence that exposed women with teratologic changes have a higher incidence of pregnancy loss than those without such changes.

However, few of these observations can boast statistical validity and statistical validation of the same observation by separate investigators has not been obtained. Moreover, none of the teratologic changes in exposed patients has been seen to preclude normal pregnancy and term delivery.

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Reproductive performance of DES-exposed female progeny

image of empty-couffin
This 1981 study showed that fetal wastage is high in DES Daughters.

Abstract

Obstetrics and gynecology, Volume 58 – Issue 1, July 1981.

The reproductive performance of 106 patients exposed in utero to diethylstilbestrol by maternal ingestion is described.

Fetal wastage is high, apparently because of spontaneous abortion during the first and second trimesters.

Recommendations – see image below – are made for preconception counseling of exposed progeny to increase fetal salvage.

Obstetrics and gynecology, Volume 58 – Issue 1, July 1981.

Click to download the full study.

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Reproductive Outcome of Women exposed to Diethylstilbestrol In Utero

image of dark-candle
In this 1980 survey, among pregnancies that progressed beyond 20 weeks’ gestation, the incidence of premature delivery was significantly increased and associated with an increased perinatal mortality. Those risks are even bigger for DES Daughters with gross cervicovaginal changes. dark candle light.

Abstract

Obstetrics and gynecology, Volume 56 – Issue 1, July 1980.

Diethylstilbestrol DES exposure in utero produces histologic and gross anatomic abnormalities in the lower and upper female genital tract. The authors investigated the reproductive history of 71 DES-exposed women by comparing their questionnaire data with those of 69 demographically matched non-DES-exposed control subjects.

  • The study group’s menstrual indices were comparable with those of the control group except in menstrual flow, which was significantly shorter in duration (P < .001), and in dysmenorrhea, which was reported more often (P<.05).
  • Fertility, as indicated by incidence of pregnancy, mean gravidity, and frequency of infertility problems, did not differ between groups.
  • The incidence of early (less than 20 weeks) pregnancy complications, ectopic pregnancy, and spontaneous abortion was comparable between groups. However, the incidence of late (after 20 weeks) pregnancy complications, premature delivery (40%, P<.001), and perinatal death (25%, P<.05) was significantly increased in the study group. Among DES-exposed subjects with gross cervicovaginal changes, premature delivery was even more frequent (71.4%, P<.0005), and consequently it was associated with a higher perinatal mortality (43%, P<.001).

The authors conclude that DES exposure in utero in this study group was not associated with increased difficulty in conceiving or early pregnancy complications. However, among pregnancies that progressed beyond 20 weeks’ gestation, the incidence of premature delivery was significantly increased and associated with an increased perinatal mortality. The mechanism(s) for these premature deliveries remains to be elucidated.

Click to download the whole study.

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Reproductive problems in the DES-exposed female

image of pregnancy
Reproductive problems in the DES-exposed female, 1980 findings. Pregnant-25-weeks.

Abstract

Obstetrics and gynecology, NCBI PubMed, PMID:7366902, 1980 Apr.

The records of 25 diethylstilbestrol-exposed women under treatment for reproductive dysfunction were reviewed.

A tendency toward:

  • pregnancy wastage (5 of 10 patients),
  • ectopic pregnancy (2 of 8 patients),
  • cervical factor infertility (15 of 20 patients),
  • hysterographic abnormalities (15 of 19 patients),
  • and ovulatory dysfunction (10 of 25 patients) was noted.

With the exceptions of ovulation induction and cervical cerclage, no means of treatment can be recommended.

Click to download the full study.

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Comparison of Pregnancy Experience in DES-Daughters and unexposed Women

pregnant image
In this 1980 study, the difference in pregnancy outcomes between the DES daughters and the unexposed is highly significant. Pregnant.

Abstract

A comparison of pregnancy experience in DES-exposed and DES-unexposed daughters

The Journal of reproductive medicine, NCBI PubMed,  PMID:7359503, 1980 Feb.

Reproductive histories were compared for 226 DES-exposed and 203 -unexposed daughters whose mothers participated in a double-blind evaluation 27 years before.

  • Irregular menstruation was slightly more common among the exposed (10%) than among the unexposed (4%).
  • Nineteen of the exposed and only four of the unexposed had primary infertility.
  • Among those at risk, 86% of the unexposed and 67% of the exposed had become pregnant. The reasons for these differences are not known.
  • Comparison of evaluable first pregnancy outcome revealed full-term live birth to be more common among the unexposed (85%) than the exposed (47%).
  • Premature live birth was experienced by 22% of the exposed but only 7% of the unexposed.
  • Nonviable outcomes of stillbirth, neonatal death, miscarriage and ectopic pregnancy occurred in 31% of the exposed and 8% of the unexposed.

The difference in pregnancy outcomes between the groups is highly significant. The DES-exposed with transverse cervicovaginal ridges were more likely to experience a nonviable outcome. Overall 82% of the exposed and 93% of the unexposed had at least one live offspring.

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My DES Daughter Journey – Interview with June Stoyer

 

Recorded radio interview by The Organic View, with host, June Stoyer joined by DES Daughter DES Daughter Google+ icon Domino talking about her journey.

Part 1

Part 2

Part 3

Alternatively, click here to listen to the show, and/or download the iTunes podcast.

The Organic View Radio Show logo Host June Stoyer interviews the top CEO’s, experts, movers and shakers that affect the organic industry as well as our environment. The Organic View show explores all of the issues impacting the organic industry, proposed regulations, the environment, politics, living green and sustainability.

Read more about my DES Daughter journey : Introduction and Doctors.

DES Daughters

What is a DES Daughter? Who are they?

DES Daughters are all the women born between 1938 and 1978 who have been exposed in utero to the anti miscarriage drug and man-made estrogen Diethylstilbestrol (or DES in short) Diethylstilbestrol DES Google+ Page icon.

They live in the U.S.A., Canada, Australia, Europe and all corners of the world where the drug was prescribed decades ago during pregnancy.

DES Daughters during a DES Symposium image
DES Daughters during the MGH Boston 2011 DES Symposium – Andrea Goldstein, Caitlin McCarthy, Cheryl Roth.