Gynecological Endocrinology最新文献

Polycystic ovary syndrome (PCOS) is a common endocrine disorder characterized by hyperandrogenism and ovulatory dysfunction. Women with PCOS are at an increased risk for adverse pregnancy outcomes, such as miscarriage and preterm birth. Endometrial receptivity plays a pivotal role in embryo implantation. However, there has been limited review or discussion regarding potential alterations in endometrial receptivity in PCOS patients, the nature of these changes, and their underlying mechanisms. In this review, we aim to summarize the alterations in endometrial receptivity associated with PCOS, highlight the impact of PCOS on endometrial receptivity, and explore the underlying mechanisms. Abnormal expression of key receptivity markers has been observed in both PCOS patients and animal models, which may contribute to reduced endometrial receptivity. The factors leading to impaired endometrial receptivity in PCOS are multifaceted, including hormonal imbalances, metabolic disturbances, chronic inflammation, and microbiota alterations. However, the intricate mechanisms behind PCOS-related endometrial dysfunction remain poorly understood. Further research is essential to unveil these complex mechanisms and improve fertility outcomes for women with PCOS.

Background: Genitourinary syndrome of menopause (GSM) is characterized by vulvovaginal dryness, irritation, dyspareunia, and elevated vaginal pH due to estrogen deficiency-related changes of the lower genital tract. Non-hormonal therapies, including hyaluronic acid (HA)-based vaginal gels, are increasingly used to improve local tissue hydration and symptoms.

Objective: To assess short-term clinical outcomes and local tolerability associated with a hyaluronic acid-based vaginal gel (Gynexelle Hyalo-Duo) in women with GSM.

Methods: This retrospective, single-center observational study included 60 women aged 18-65 years (30 reproductive-age and 30 postmenopausal) managed at Studio Medico Capasso, Naples, Italy. The gel was applied daily for 7 days, followed by three applications per week for 3 weeks. Outcomes included the Vaginal Health Index (VHI), Vulvar Health Index (VuHI), Subjective Evaluation of Specific Symptoms (SESS), and vaginal pH, assessed at baseline (T₀), after 1 week (T₁), and after 4 weeks of treatment (T₂).

Results: At T₂, mean VHI increased from 12.7 ± 3.3 to 19.3 ± 4.0 (p < 0.001), VuHI decreased from 5.3 ± 3.8 to 2.5 ± 3.5 (p < 0.001), and SESS improved from 11.8 ± 3.3 to 2.4 ± 3.9 (p < 0.001). Vaginal pH decreased from 6.1 ± 1.0 to 4.7 ± 0.8 (p < 0.001). Improvements were observed in both reproductive-age and postmenopausal women. No adverse events were documented.

Conclusion: Short-term use of a hyaluronic acid-based vaginal gel was associated with improvements in vulvovaginal symptoms and vaginal health parameters, with good local tolerability, in a real-world observational setting.

Objective: This study aimed to determine if there was a change in serum G protein-coupled receptor 120 (GPR120) level and develop a nomogram model that accurately predicted the risk of preeclampsia (PE) in the first trimester.

Methods: A total of 250 pregnant women were included in our prospective cohort study from January 2023 to July 2024. We measured the level of GPR120, and maternal demographics and clinical features were retrieved. Optimization of variable selection was achieved. We developed a nomogram based on multivariate logistic regression to predict the risk of pulmonary embolism (PE), incorporating eight selected predictive indicators. The AUC and calibration plots were utilized to assess the discrimination and calibration of the nomogram. For assessing the clinical advantages and usefulness of the two prediction models, the DCA, IDI, and NRI were utilized.

Results: The GPR120 expression level in the first trimester was significantly elevated in women who later developed PE (P < 0.001). The nomogram demonstrated excellent discriminatory power in predicting PE in both the training and validation cohort. Calibration of the nomogram remained satisfactory in both the training and validation cohorts. The NRI values and IDI demonstrated that the performance of the developed nomogram was remarkably superior to that of the Model 2 (P < 0.05). The nomogram's clinical usefulness was validated by the DCA.

Conclusions: GPR120 expression is significantly increased in early pregnancy of PE patients. The nomogram exhibited predictive capability for PE development but needs larger, multicenter cohorts for validation.

Objective: To evaluate the effect of intrauterine infusion of platelet-rich plasma (PRP) on luteal support and pregnancy outcomes in patients with thin endometrium undergoing frozen-thawed embryo transfer (FET).

Methods: A total of 160 patients with thin endometrium undergoing FET from March 2023 to March 2024 were assigned to the observation group (PRP infusion, n = 80) or the control group (conventional treatment, n = 80). All patients underwent hormone replacement therapy cycles,with PRP infused on days 9, 11, and 13 in the observation group. Outcomes included endometrial thickness, uterine hemodynamic parameters (PI, RI), PBAC-assessed menstrual volume, pregnancy outcomes, and embryology-related variables. Logistic regression identified independent factors associated with clinical pregnancy. Adverse events were also recorded.

Results: Post-treatment, the observation group had greater endometrial thickness and lower PI and RI values than the control group. PBAC scores, clinical pregnancy rate (36.25% vs. 21.25%), and live birth rate (25.00% vs. 12.50%) were significantly higher, while preterm birth rate did not differ. Embryo transfer-related variables were comparable between groups. Multivariate analysis identified PRP infusion and endometrial thickness at transfer as independent protective factors for clinical pregnancy, whereas advanced age was an unfavorable factor. No obvious adverse events occurred.

Conclusion: PRP infusion enhances endometrial receptivity by improving thickness and blood perfusion, thereby increasing pregnancy and live birth rates in thin endometrium patients undergoing FET. It is safe and may be used as an effective adjunct in endometrial preparation.

Objective: To compare dydrogesterone versus levonorgestrel-releasing intrauterine system (LNG-IUS) for abnormal uterine bleeding (AUB) management with long-term follow-up and etiology-stratified analysis.

Methods: This single-center retrospective cohort study analyzed reproductive-aged women with International Federation of Gynecology and Obstetrics (FIGO)-classified AUB receiving dydrogesterone (n = 131) or LNG-IUS (n = 118). Propensity score matching balanced baseline covariates between groups (n = 104 pairs). Primary outcomes were bleeding control rates (composite: hemoglobin increase ≥ 1.5 g/dL, ≥ 50% Pictorial Blood Loss Assessment Chart [PBAC] reduction, no rescue interventions) at 3 and 12 months. Secondary outcomes included 24-month recurrence and adverse events (AEs).

Results: LNG-IUS demonstrated superior 3-month bleeding control versus dydrogesterone (82.7% vs. 65.4%; relative risk [RR] 1.26, 95% confidence interval [CI] 1.08-1.48; p = 0.002). At 12 months, bleeding control rates were comparable between groups (78.8% vs. 72.1%; RR 1.09, 95% CI 0.96-1.24; p = 0.17). LNG-IUS significantly reduced 24-month recurrence risk (hazard ratio [HR] 0.48, 95% CI 0.32-0.72; p < 0.001), particularly for structural AUB (HR 0.39, 95% CI 0.24-0.64). Subgroup analysis revealed LNG-IUS superiority in adenomyosis at 12 months (88.2% vs. 60.0%; RR 1.47, 95% CI 1.24-1.74; p < 0.001) but comparable efficacy in nonstructural AUB (76.6% vs. 72.9%; RR 0.95, 95% CI 0.78-1.16; p = 0.63). Dydrogesterone exhibited higher systemic AEs (28.2% vs. 13.6%; p = 0.003), while LNG-IUS had device-related events including expulsion (5.1%).

Conclusion: LNG-IUS offers superior short-term bleeding control and sustained long-term recurrence prevention, especially for structural AUB. Dydrogesterone effectively manages nonstructural etiologies but carries higher systemic adverse event rates. Treatment selection should be etiology-guided, balancing immediate symptom control versus recurrence prevention and individualized safety considerations.

Objective: Uterine peristalsis, which originates from sub-endometrial zone of myometrium, is observed at ultrasonography as a wave-like activity of endometrium. Increased uterine peristalsis is suggested to be related to decreased pregnancy rates in both fresh and frozen embryo transfer cycles. The aim of this study is to compare the effects of two different frozen embryo transfer preparation protocols on the frequency of uterine peristalsis and to evaluate the effect of peristalsis on pregnancy rates.

Methods: In this observational cohort study, 3-min transvaginal ultrasound videos were recorded one hour before embryo transfer in frozen embryo transfer cycles prepared by either artificial hormone treatment or aromatase inhibitor stimulation. Peristalsis frequency was assessed by reviewing videos at triple speed. Consequent pregnancy outcomes were also analyzed.

Results: During the study period of four months, a total of 147 patients with 99 artificial hormone treatments and 48 aromatase inhibitor-stimulated frozen embryo transfer cycles were included. The absence of uterine peristalsis was observed in 27.1% of the aromatase inhibitor-stimulated patients and 23.2% of the artificial hormone-treated patients (p = 0.68). Among those with peristalsis, the frequency was similar between groups (0.95 ± 0.59 and 0.98 ± 0.68 for the aromatase inhibitor-stimulated and artificial hormone treatment protocols, respectively; p = 0.97). Peristalsis presence or frequency was not associated with pregnancy or live birth rates.

Conclusions: In this study, uterine peristalsis frequency at frozen embryo transfer cycles did not differ between endometrial preparation protocols and showed no significant association with pregnancy outcomes. Further randomized studies are warranted.

Background: Although assisted reproductive technology (ART) may increase the incidence of ectopic pregnancy (EP), the risk of EP and its associated risk factors in polycystic ovary syndrome (PCOS) patients, one of the target populations for ART, remain poorly understood.

Methods: This retrospective study analyzed 377 PCOS patients undergoing IVF/ICSI (2010-2017). Standard ART protocols were applied, including controlled ovarian stimulation, oocyte retrieval, and embryo transfer. LASSO regression with 10-fold cross-validation selected 13 predictive features from 26 variables. Univariate and multivariate logistic regression analyses were performed for the overall cohort. A predictive nomogram was developed and internally validated using bootstrap resampling.

Results: Among 377 PCOS patients analyzed, LASSO regression identified 13 potential predictors including age, IVF cycles, and endometrial thickness (EMT). In women <35 years (n = 333), multivariate analysis revealed three independent EP predictors: increased IVF cycle number (aOR = 4.592, 95%CI 1.48-14.21, p = 0.008), thinner EMT (aOR = 0.587, 95%CI 0.40-0.86, p = 0.007), and frozen embryo transfer (aOR = 0.044, 95%CI 0.01-0.22, p < 0.001). The developed nomogram incorporating these factors showed good discrimination (AUC 0.82) and calibration. Notably, clinical factors like abortion history and prolactin levels, while significant in univariate analysis, lost predictive value after multivariate adjustment in younger women.

Conclusion: This study identifies three key predictors of ectopic pregnancy in younger PCOS (<35 year) patients undergoing ART: IVF cycle number, endometrial thickness, and frozen embryo transfer. The developed nomogram provides a validated assessment tool, particularly for younger patients. These findings highlight the need for personalized risk stratification and further research into underlying mechanism.

Objective: To review the mechanism of action, epidemiology, clinical efficacy, factors influencing treatment outcomes, and limitations of clomiphene citrate (CC).

Methods: A systematic literature search was conducted using electronic databases. The search strategy employed a combination of relevant MeSH terms and keywords. The final selection was limited to complete, peer-reviewed articles.

Results: Clomiphene citrate (CC) is the first-line oral ovulation induction agent for WHO Group II anovulation, most commonly polycystic ovary syndrome. It acts primarily at the hypothalamus, depleting estrogen receptors to increase gonadotropin-releasing hormone pulsatility and stimulate gonadotropin release. Although effective in restoring ovulation in approximately 73% of treated women, pregnancy rates remain significantly lower (~36%), highlighting a pronounced ovulation‒pregnancy gap. This discrepancy is largely attributed to CC's peripheral anti-estrogenic effects, which can cause endometrial suppression and hostile cervical mucus, thereby impairing implantation. Treatment success is influenced by factors such as obesity, insulin resistance, and hyperandrogenism, which are key predictors of CC resistance. While generally well-tolerated, side effects include hot flashes, mood swings, headaches, visual disturbances, and a notable risk of multiple pregnancies (8%-10%).

Conclusions: While CC remains a cornerstone for inducing ovulation, its peripheral anti-estrogenic effects and significant rate of resistance necessitate adjunctive strategies, careful patient selection, and a transition to advanced therapies when needed to improve live birth outcomes.