During the past decade, cryopreservation of oocytes and embryos has become one of the most exciting areas in human-assisted reproduction. Improvement of the old techniques and introduction of alternative procedures have radically increased the overall efficiency and extended applicability. In parallel, the development of other laboratory techniques (embryo culture and preimplantation diagnostics) as well as medical, social, legal and cultural demands required the rapid and widespread exploitation of the new possibilities. This review summarizes the main features of the technical development, including both achievements and controversies, and outlines the emerging assisted reproductive technique strategies based partially or predominantly on cryopreservation. Application of these new achievements may substantially modify our approach in many fields and increase the overall efficiency of infertility or fertility preservation treatments.
{"title":"From a backup technology to a strategy-outlining approach: the success story of cryopreservation","authors":"G. Vajta, A. Reichart, F. Ubaldi, L. Rienzi","doi":"10.1586/EOG.12.80","DOIUrl":"https://doi.org/10.1586/EOG.12.80","url":null,"abstract":"During the past decade, cryopreservation of oocytes and embryos has become one of the most exciting areas in human-assisted reproduction. Improvement of the old techniques and introduction of alternative procedures have radically increased the overall efficiency and extended applicability. In parallel, the development of other laboratory techniques (embryo culture and preimplantation diagnostics) as well as medical, social, legal and cultural demands required the rapid and widespread exploitation of the new possibilities. This review summarizes the main features of the technical development, including both achievements and controversies, and outlines the emerging assisted reproductive technique strategies based partially or predominantly on cryopreservation. Application of these new achievements may substantially modify our approach in many fields and increase the overall efficiency of infertility or fertility preservation treatments.","PeriodicalId":12242,"journal":{"name":"Expert Review of Obstetrics & Gynecology","volume":"16 1","pages":"181-190"},"PeriodicalIF":0.0,"publicationDate":"2013-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75436453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"The original minimally invasive hysterectomy: no hospitalization required","authors":"Colleen P McNicholas, B. Levy","doi":"10.1586/EOG.13.6","DOIUrl":"https://doi.org/10.1586/EOG.13.6","url":null,"abstract":"","PeriodicalId":12242,"journal":{"name":"Expert Review of Obstetrics & Gynecology","volume":"34 1","pages":"103-105"},"PeriodicalIF":0.0,"publicationDate":"2013-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77405164","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Within our society, despite peak fertility occurring during a woman’s 20s, many women are choosing to delay childbearing for a variety of reasons. Furthermore, the timeline of female fertility is not readily understood among the general population. Assisted reproductive technologies are being viewed by many as a strategy for coping with age-related infertility. Yet, assisted reproductive technology is limited in its ability to overcome age-related infertility. Fertility preservation strategies, such as egg and ovarian tissue cryopreservation, initially designed for woman receiving gonadotoxic therapies are being offered to a broader audience. Despite these strategies being investigational, according to the American Society of Reproductive Medicine, a majority of clinics in the USA are making egg freezing available to women of all ages for ‘social reasons’. While new technologies are sometimes quick to be embraced, their benefits may not always outweigh the costs. This article seeks to examine the true cos...
{"title":"Cost implications to society of delaying childbearing","authors":"J. Hirshfeld-Cytron","doi":"10.1586/EOG.12.68","DOIUrl":"https://doi.org/10.1586/EOG.12.68","url":null,"abstract":"Within our society, despite peak fertility occurring during a woman’s 20s, many women are choosing to delay childbearing for a variety of reasons. Furthermore, the timeline of female fertility is not readily understood among the general population. Assisted reproductive technologies are being viewed by many as a strategy for coping with age-related infertility. Yet, assisted reproductive technology is limited in its ability to overcome age-related infertility. Fertility preservation strategies, such as egg and ovarian tissue cryopreservation, initially designed for woman receiving gonadotoxic therapies are being offered to a broader audience. Despite these strategies being investigational, according to the American Society of Reproductive Medicine, a majority of clinics in the USA are making egg freezing available to women of all ages for ‘social reasons’. While new technologies are sometimes quick to be embraced, their benefits may not always outweigh the costs. This article seeks to examine the true cos...","PeriodicalId":12242,"journal":{"name":"Expert Review of Obstetrics & Gynecology","volume":"96 1","pages":"9-14"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88108895","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The five main subtypes of ovarian surface epithelial carcinoma (high-grade serous, low-grade serous, endometrioid, clear cell and mucinous) are different diseases, with differences in genetic and environmental risk factors, precursor lesions, molecular events during oncogenesis, patterns of spread and response to treatment. With recent advances in surgical pathology, it is possible to reproducibly diagnose these subtypes in routine surgical pathology practice. This review examines these subtypes of ovarian carcinoma, focusing on differential diagnosis, molecular features and current treatment strategies. The increasing understanding of the molecular abnormalities associated with each subtype is leading to exploration and introduction of more subtype-specific treatment of ovarian carcinoma.
{"title":"Differential diagnosis and clinical relevance of ovarian carcinoma subtypes","authors":"Chris MJ Conklin, C. Gilks","doi":"10.1586/EOG.12.72","DOIUrl":"https://doi.org/10.1586/EOG.12.72","url":null,"abstract":"The five main subtypes of ovarian surface epithelial carcinoma (high-grade serous, low-grade serous, endometrioid, clear cell and mucinous) are different diseases, with differences in genetic and environmental risk factors, precursor lesions, molecular events during oncogenesis, patterns of spread and response to treatment. With recent advances in surgical pathology, it is possible to reproducibly diagnose these subtypes in routine surgical pathology practice. This review examines these subtypes of ovarian carcinoma, focusing on differential diagnosis, molecular features and current treatment strategies. The increasing understanding of the molecular abnormalities associated with each subtype is leading to exploration and introduction of more subtype-specific treatment of ovarian carcinoma.","PeriodicalId":12242,"journal":{"name":"Expert Review of Obstetrics & Gynecology","volume":"36 1","pages":"67-82"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75297480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Does maternal obesity change cardiomyocyte endowment","authors":"J. Morrison, C. Suter, K. Botting, J. Nyengaard","doi":"10.1586/EOG.12.74","DOIUrl":"https://doi.org/10.1586/EOG.12.74","url":null,"abstract":"","PeriodicalId":12242,"journal":{"name":"Expert Review of Obstetrics & Gynecology","volume":"2 1","pages":"1-3"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88561651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Worldwide, the rate of delivery by cesarean section is increasing, such that the cesarean section rate is often greater than 30%. The reasons for this increase are many, but a major reason for this change is related to our relatively poor ability to manage labor. This review attempts to cover the issues that contribute to this. Issues regarding definition, assessment and management of labor progress as well as critical times in labor will be examined. Types of partograms are discussed as well as the maternal and fetal factors that influence progress of labor. To be able to care for women in labor, it is important to be aware of limitations of management and how best to overcome these.
{"title":"Assessment of labor progress","authors":"M. Higgins, D. Farine","doi":"10.1586/EOG.12.73","DOIUrl":"https://doi.org/10.1586/EOG.12.73","url":null,"abstract":"Worldwide, the rate of delivery by cesarean section is increasing, such that the cesarean section rate is often greater than 30%. The reasons for this increase are many, but a major reason for this change is related to our relatively poor ability to manage labor. This review attempts to cover the issues that contribute to this. Issues regarding definition, assessment and management of labor progress as well as critical times in labor will be examined. Types of partograms are discussed as well as the maternal and fetal factors that influence progress of labor. To be able to care for women in labor, it is important to be aware of limitations of management and how best to overcome these.","PeriodicalId":12242,"journal":{"name":"Expert Review of Obstetrics & Gynecology","volume":"6 1","pages":"83-95"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89934805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2013-01-01DOI: 10.1586/17474108.2013.825476
C. Maher, N. Haya
During the transvaginal mesh era some women have suffered unexpectedly poor outcomes following the insertion of transvaginal mesh for the surgical management of pelvic organ prolapse. To minimize the risk of these events repeating, we support changes to approval process of new devices including premarket demonstration of safety and efficacy. Clinicians should demonstrate greater vigilance in the introductory phase of new technologies including incorporating ethics committee approval for procedures without adequate safety and efficacy data. Formalization of an ‘arm’s length’ relationship between clinicians and industry would help minimize conflicts of interest which may unduly bias the introduction of new technologies and create improved transparency and confidence. Colleges and educational societies where the elected representatives are free of any relationship with industry could facilitate the ‘arm’s length’ relationship between clinician and industry that our community demands. These changes to regulat...
{"title":"The transvaginal mesh decade","authors":"C. Maher, N. Haya","doi":"10.1586/17474108.2013.825476","DOIUrl":"https://doi.org/10.1586/17474108.2013.825476","url":null,"abstract":"During the transvaginal mesh era some women have suffered unexpectedly poor outcomes following the insertion of transvaginal mesh for the surgical management of pelvic organ prolapse. To minimize the risk of these events repeating, we support changes to approval process of new devices including premarket demonstration of safety and efficacy. Clinicians should demonstrate greater vigilance in the introductory phase of new technologies including incorporating ethics committee approval for procedures without adequate safety and efficacy data. Formalization of an ‘arm’s length’ relationship between clinicians and industry would help minimize conflicts of interest which may unduly bias the introduction of new technologies and create improved transparency and confidence. Colleges and educational societies where the elected representatives are free of any relationship with industry could facilitate the ‘arm’s length’ relationship between clinician and industry that our community demands. These changes to regulat...","PeriodicalId":12242,"journal":{"name":"Expert Review of Obstetrics & Gynecology","volume":"1 1","pages":"485-492"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82386683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Surgeons dealing with female pelvic organ prolapse and female stress urinary incontinence have been using mesh implants for at least six decades. This practice has become very widespread since around 1995 due to the development of highly biocompatible synthetic suburethral slings. Over the last 10 years this trend has also extended to similar materials being used in prolapse surgery, causing major controversy. Anchored meshes seems to be effective in reducing prolapse recurrence when used for cystocele repair, but they do not guarantee a cure and complications are not uncommon. Imaging has a major, largely unrealized role to play in patient selection, the optimization of implant design, in surgical audit and in the management of complications and recurrence. In this article, the author will summarize the current role of imaging in the context of mesh surgery, both in incontinence and prolapse.
{"title":"Mesh implants in incontinence and prolapse surgery: an ultrasound perspective","authors":"H. Dietz","doi":"10.1586/EOG.12.76","DOIUrl":"https://doi.org/10.1586/EOG.12.76","url":null,"abstract":"Surgeons dealing with female pelvic organ prolapse and female stress urinary incontinence have been using mesh implants for at least six decades. This practice has become very widespread since around 1995 due to the development of highly biocompatible synthetic suburethral slings. Over the last 10 years this trend has also extended to similar materials being used in prolapse surgery, causing major controversy. Anchored meshes seems to be effective in reducing prolapse recurrence when used for cystocele repair, but they do not guarantee a cure and complications are not uncommon. Imaging has a major, largely unrealized role to play in patient selection, the optimization of implant design, in surgical audit and in the management of complications and recurrence. In this article, the author will summarize the current role of imaging in the context of mesh surgery, both in incontinence and prolapse.","PeriodicalId":12242,"journal":{"name":"Expert Review of Obstetrics & Gynecology","volume":"16 1","pages":"15-27"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73609909","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Molly B. Carnahan, Jennifer Fedor, A. Agarwal, Sajal Gupta
Ovarian endometrioma is a benign, estrogen-dependent cyst found in women of reproductive age. Infertility is associated with ovarian endometriomas; although the exact cause is unknown, oocyte quantity and quality are thought to be affected. The present research aims to analyze current treatment options for women with ovarian endometriomas, discuss the role of fertility preservation before surgical intervention in women with ovarian endometriomas and present guidelines for the selection of cases for surgery or expectant management. This review analyzed the factors of ovarian reserve, cyst laterality, size and location, patient age and prior surgical procedures. Based on these factors, the authors recommend three distinct treatment pathways: reproductive surgery to achieve spontaneous pregnancy following treatment, reproductive surgery to enhance IVF outcomes and expectant management with IVF.
{"title":"Ovarian endometrioma: guidelines for selection of cases for surgical treatment or expectant management","authors":"Molly B. Carnahan, Jennifer Fedor, A. Agarwal, Sajal Gupta","doi":"10.1586/EOG.12.75","DOIUrl":"https://doi.org/10.1586/EOG.12.75","url":null,"abstract":"Ovarian endometrioma is a benign, estrogen-dependent cyst found in women of reproductive age. Infertility is associated with ovarian endometriomas; although the exact cause is unknown, oocyte quantity and quality are thought to be affected. The present research aims to analyze current treatment options for women with ovarian endometriomas, discuss the role of fertility preservation before surgical intervention in women with ovarian endometriomas and present guidelines for the selection of cases for surgery or expectant management. This review analyzed the factors of ovarian reserve, cyst laterality, size and location, patient age and prior surgical procedures. Based on these factors, the authors recommend three distinct treatment pathways: reproductive surgery to achieve spontaneous pregnancy following treatment, reproductive surgery to enhance IVF outcomes and expectant management with IVF.","PeriodicalId":12242,"journal":{"name":"Expert Review of Obstetrics & Gynecology","volume":"25 1","pages":"29-55"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79829990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Lichen sclerosus is a non-neoplastic chronic inflammatory dermatosis that can affect any cutaneous body surface, showing particular predilection for the anogenital area in females. It is clinically characterized by progressive and worsening degeneration of the dermal/epidermal layers, which determines hyperkeratinization, and a thick scar-like appearance of the external genitalia. Very often, atrophic changes of the genital structures – labia majora and minora, clitoris and vulvar vestibule – are evident with architectural alterations of the genitalia that cause significant sexual discomfort. Chronic and severe vulvar itching, especially at night, is the predominant symptom reported by almost all patients. Diagnosis is often delayed by long-term self-administered topical preparations, or by the clinician’s unawareness of the disease. Indeed, the condition is often misdiagnosed as an aspecific vulvitis. Postmenopausal women are more frequently affected, but young girls and even children may also suffer fro...
{"title":"Lichen sclerosus of the vulva","authors":"M. Origoni, C. Gelardi, S. Salvatore, M. Candiani","doi":"10.1586/EOG.12.71","DOIUrl":"https://doi.org/10.1586/EOG.12.71","url":null,"abstract":"Lichen sclerosus is a non-neoplastic chronic inflammatory dermatosis that can affect any cutaneous body surface, showing particular predilection for the anogenital area in females. It is clinically characterized by progressive and worsening degeneration of the dermal/epidermal layers, which determines hyperkeratinization, and a thick scar-like appearance of the external genitalia. Very often, atrophic changes of the genital structures – labia majora and minora, clitoris and vulvar vestibule – are evident with architectural alterations of the genitalia that cause significant sexual discomfort. Chronic and severe vulvar itching, especially at night, is the predominant symptom reported by almost all patients. Diagnosis is often delayed by long-term self-administered topical preparations, or by the clinician’s unawareness of the disease. Indeed, the condition is often misdiagnosed as an aspecific vulvitis. Postmenopausal women are more frequently affected, but young girls and even children may also suffer fro...","PeriodicalId":12242,"journal":{"name":"Expert Review of Obstetrics & Gynecology","volume":"16 1","pages":"57-65"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84778880","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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