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DES Exposure in Utero
By Eric Daiter, M.D.


Maternal diethylstilbestrol (DES) ingestion during pregnancy was intended to reduce the likelihood for spontaneous abortion (miscarriage). DES was the first orally active commercially available estrogen compound and as it gained popularity it was widely used from the 1940s to 1971. In 1971, the association between DES exposure in utero and the subsequent development of a rare vaginal cancer (in the female offspring) named "clear cell adenocarcinoma" was established. The FDA promptly removed the pregnancy related indications for DES when these findings were revealed. Therefore, females born in 1971-1972 are the youngest to be exposed to this medication. In 1997, these women are 25 years old so reproductive consequences of the medication for this population of women is still important.

The abnormalities associated with DES of reproductive importance include:

  • structural abnormalities of the upper vagina, including transverse vaginal ridges or a vaginal hood over the cervix
  • structural abnormalities of the cervix, including cervical collars, a cervical cockscomb appearance, and inadequate development of the cervix
  • abnormal size and shape of the endometrial cavity, generally including a small uterine cavity with possibly a T shape (due to incomplete resorption of the lateral walls of the cavity), constricted regions at the ostia (entrance of the tubes into the cavity) to give an hourglass like image on HSG, and an irregular contour of the cavity.

The risk of spontaneous abortion in women who were exposed to DES in utero is far greater than normal, especially when the abnormalities listed above are present.

No currently available treatment for any of these DES changes in terms of spontaneous abortion has been convincingly shown to be effective in the available literature. A common practice is placement of a cerclage into the cervix, since the abnormally developed cervix may have a strong association with pregnancy loss. The literature on the techniques and benefits of this treatment do not allow for a uniform recommendation. Another treatment that has been proposed but of unclear benefit is the hysteroscopic transsection of the lateral walls of the uterus to increase the size of the cavity. This surgery is potentially dangerous since the incisions are close to major uterine blood vessels.

Dr. Eric Daiter graduated from the University of Pennsylvania, where he was awarded an academic scholarship and was enlisted into the University Scholar's Program and the Benjamin Franklin Scholar's Program.

Dr. Daiter graduated medical school at Temple University Medical School in Philadelphia and completed the Obstetrics and Gynecology residency program at Albert Einstein College of Medicine in New York. He completed his Reproductive Endocrinology and Infertility fellowship at the Hospital of the University of Pennsylvania. He has considered a career as a physician scientist in research medicine and has published several articles on molecular events that occur during the human embryo's implantation into the uterus. Dr. Daiter entered private practice in 1994, where he joined a successful referral based infertility practice and further developed his clinical skills. Dr. Daiter emphasizes the basic principles of infertility patient care, including the importance of highly personalized, cost considerate, state of the art, one on one care for his patients. He specializes in all aspects of In Vitro Fertilization, with a patient success rate among the highest in the state. He has performed several hundred advanced operative laparoscopic and hysteroscopic surgeries, utilizing the most modern laser techniques.

Dr. Daiter opened his Edison, NJ office in 1997. The office continues to support the highest level of professional care for infertile couples. Extended office hours are available for patient convenience.

Eric Daiter, M.D.
34-36 Progress Street
Suite B-4
Edison, New Jersey, 08820

Web Site URL: http://www.drdaiter.com/index.html
E-Mail: info@drdaiter.com
Phone: (908) 226-0250
Fax: (908) 226-0830



The information presented in these articles are offered for informational purposes only. These pages have been written by Dr. Eric Daiter, yet are not intended to replace the medical advise offered by your personal physicians or healthcare professionals.

All rights reserved. No part of the material protected by this copyright notice may be reproduced or utilized in any form, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without written permission from the copyright owner.

  


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