Gynecologic and Obstetric Investigation最新文献

Objectives: To investigate the ovarian response in different phases of the menstrual cycle in breast cancer women candidates for fertility preservation.

Design: A retrospective study was carried out, including women with breast cancer undergoing oocyte cryopreservation at the Fertility Preservation Unit of the University of Naples Federico II between 2017 and 2023.

Participants/materials, setting, methods: Women who started ovarian stimulation during the follicular phase (FP) were compared with those who started during the luteal phase (LP). The two study groups were further stratified according to the phase of the menstrual cycle at ovarian stimulation initiation: early (day 1-5, EFP) or late follicular phase (day 6-14, LFP), early (day 15-21, ELP) or late luteal phase (day 22-32, LLP). The primary outcome was oocyte recovery.

Results: A total of 113 women who underwent fertility preservation for breast cancer were included. No differences in oocytes retrieved and ovarian sensitivity were observed when comparing follicular and luteal phases. No differences were observed regarding oocytes retrieved and ovarian sensitivity among the four groups divided according to the menstrual cycle phase. Ovarian stimulation was significantly shorter in the early follicular phase (9 days; 8-10) than in the other menstrual phases (LFP: 10 days, 9-11, p <0.04; ELP: 11, 9-11, p <0.004 and LLP: 11 days, 10-12, p <0.001).

Limitations: Our study's limitations are its small sample size and retrospective design.

Conclusions: The phases of the menstrual cycle at which OS was started did not affect oocyte yield and ovarian sensitivity in women with breast cancer undergoing a random start protocol with letrozole.

Background: Vitamin D deficiency during pregnancy has been linked to adverse maternal-fetal outcomes. However, it remains unclear whether standard supplementation mitigates risks equally in patients with differing baseline 25-hydroxyvitamin D [25(OH)D₃] levels.

Objectives: Determine whether differences exist in obstetric outcomes and pregnancy-related disorders among patients with different levels of 25(OH)D₃ in the first trimester who receive standard supplementation.

Design: This retrospective comparative cohort study involves pregnant women aged 16-50 years who received prenatal care at a semi-private hospital in Northeastern México between January 2022 and December 2024.

Participants/materials, setting, methods: Participants were grouped based on first trimester serum 25(OH)D₃ levels (≥30 ng/mL vs. <30 ng/mL), all receiving standard 25(OH)D₃ supplementation (4000 IU/day). For comparisons between groups, we performed independent samples t-tests or Mann-Whitney U tests for quantitative variables and chi-square tests for qualitative variables. A multivariate logistic regression analysis was conducted to identify predictors of adverse obstetric outcomes. Results A total of 303 women [mean (SD) age 29.3 (5.4) years] were analyzed, divided almost equally between first trimester 25(OH)D₃ deficient group (n=151) and the sufficient group (n=152), with similar baseline characteristics. Although insufficient 25(OH)D₃ women reached sufficiency during the second and third trimesters, sufficient women maintained significantly higher serum 25(OH)D₃ levels throughout pregnancy (p<0.001) and had lower rates of preeclampsia (1.3% vs. 10.6%, p<0.001), gestational diabetes (8.6% vs. 24.5%, p<0.001), preterm labor (0% vs. 5.3%, p=0.003), urinary tract infections (4.6% vs. 14.6%, p=0.003), and bacterial vaginosis (3.9% vs. 13.2%, p=0.004). Logistic regression confirmed first-trimester 25(OH)D₃ sufficiency as independently protective against adverse outcomes (OR=0.21, 95% CI: 0.10-0.43, p<0.001). Conclusions First-trimester 25(OH)D₃ sufficiency was associated with reduced risk of obstetric complications, compared with women with insufficiency, even when the last achieved sufficiency in the second and third-trimester. These findings highlight the importance of early screening and support the need for personalized supplementation strategies before conception to optimize maternal-fetal outcomes.

Background: The nature and functions of the innermost layer of the myometrium, which is located immediately below the endometrium, coined the "junctional zone" (JZ), continue to be the subject of debate. The role and significance of the JZ have attracted little attention beyond its relation to the diagnosis of adenomyosis.

Objectives: This review was conducted to update our current understanding of the role of the JZ as a specific uterine region.

Methods: This is a comprehensive review of literature that was published in PubMed and MEDLINE platforms till April 2025 and that addresses the uterine JZ, excluding articles concerned with uterine adenomyosis.

Outcome: It is not possible to reconcile JZ appearance on imaging with embryological or functional correlates. There are clear histological and immunohistological differences between the inner and outer myometrium, but the change is gradual with no demarcation of the transition. Whether the JZ has a different origin remains controversial because of the lack of supportive embryological evidence. There is evidence that JZ appearance on MRI is hormonally dependent, but it is not always recognizable and is often indistinct before puberty and after menopause. JZ seems to increase in thickness in the secretory and menstrual phases.

Conclusion: While increased thickness is often considered a sign of adenomyosis, considerable uncertainty remains. We have not been able to identify studies that related features of the JZ per se to clinical outcomes. This supports the need for caution when interpreting the relevance of the JZ.

Background In the field of polycystic ovary syndrome, metformin and myo-inositol are frequently employed to treat the endocrine-metabolic aspects of the condition. Accordingly, myo-inositol is sometimes considered as a nutraceutical alternative for metformin. Both compounds have undergone repurposing efforts to identify new applications; however, the mechanisms of both these compounds differ considerably, as does their potential in conditions outside of polycystic ovary syndrome. Objectives This paper discusses contrasts both molecules in terms of mechanism, possible adverse effects, and novel indications, with an aim of detangling the unique properties of each molecule. Methods A narrative review was conducted independently by the authors using the search platforms PubMed, Google Scholar, and Web of Science between August and November 2024. Outcome Myo-inositol has a more acceptable safety profile than metformin, which is known to be associated with gastrointestinal adverse effects and, in rare cases, lactic acidosis. Both myo-inositol and metformin may improve pregnancy outcomes and fertility care; however, the long-term safety of metformin use in pregnancy is unknown. Myo-inositol and metformin have been investigated in the fields of thyroid care, mental health, and cancer, but further research is required to understand their mechanism and potential applications in these disease spaces. Conclusions and Outlook Myo-inositol is a naturally present molecule in physiological conditions, which underlines its importance in a variety of biological functions, as opposed to the strict pharmacological action of metformin. Further study is required to fully understand the potential of each of these molecules, specifically within the fields of mental health and oncology.

Objective: The aims of this study were to investigate influence of placental position and type on occurrence of placenta accreta spectrum (PAS) and to analyze their correlation with adverse perinatal outcomes.

Methods: This retrospective study included 270 pregnant women who delivered at the Affiliated Hospital of Guangdong Medical University and Huizhou Central People's Hospital between January 2021 and December 2023. Placental position, type, and related imaging features were assessed using magnetic resonance imaging (MRI) and compared with PAS and perinatal outcomes. Logistic regression was used to analyze the associations between placental position, type, and PAS, as well as adverse outcomes.

Results: There were significant differences between the PAS group and the non-PAS group in terms of pregnancy history, cesarean section history, delivery history, history of placenta previa, antepartum hemorrhage, and intraoperative blood loss. Lateral wall/fundus placenta location (OR = 4.984, 95% CI: 1.376-18.050, p = 0.014) and complete placenta previa (OR = 3.160, 95% CI: 1.321-7.558, p = 0.010) were significantly associated with the occurrence of PAS.

Conclusion: Placental location and the type of placenta previa were significantly associated with the occurrence of PAS and adverse perinatal outcomes. In future clinical management, particular attention should be paid to placental location and type, especially in cases of lateral wall/fundus placenta and severe placenta previa. Individualized monitoring and intervention strategies should be implemented to improve both PAS-related and overall perinatal outcomes.

Introduction: Triggering final oocyte maturation is a critical step in in vitro fertilization-embryo transfer (IVF-ET), especially for optimizing outcomes in patients with poor ovarian response or low oocyte maturation. The double trigger protocol, combining a GnRH agonist with human chorionic gonadotropin (hCG), has been proposed to enhance oocyte quality and improve reproductive outcomes compared to hCG alone. Our review aimed to evaluate the efficacy of the double trigger compared to hCG-only trigger on reproductive outcomes in patients undergoing IVF-ET.

Methods: A systematic review and meta-analysis were conducted using PubMed, Scopus, and Google Scholar up to June 15, 2025. Studies comparing double trigger to hCG-only trigger were included. Outcomes such as the number of oocytes retrieved, MII oocytes, 2PN embryos, and day-3 top-quality embryos (TQEs) were analyzed using mean difference (MD), while clinical pregnancy rate was evaluated using odds ratio (OR). Risk of bias was assessed using RoB-2 and ROBINS-I tools. Meta-analysis was performed with a random-effects model in RevMan, and certainty of evidence was evaluated using GRADE. The review was registered with PROSPERO (CRD420251071480).

Results: Six studies involving a total of 352 patients were included. In poor ovarian responders, the double trigger protocol significantly increased the number of oocytes retrieved (MD 0.49; p = 0.02) and MII oocytes (MD 0.62; p = 0.005). Among normo-responders with low oocyte maturation, the double trigger significantly improved MII oocytes (MD 5.08; p = 0.03), 2PN embryos (MD 4.70; p < 0.0001), TQEs (MD 1.46; p = 0.01), and clinical pregnancy rate (OR 5.75; p = 0.009).

Conclusion: The double trigger protocol may improve certain reproductive outcomes compared to hCG-only triggering, particularly among poor ovarian responders and normo-responders with low oocyte maturation. These findings suggest that double trigger could be considered a potential personalized strategy in selected IVF populations, although further high-quality studies are needed to confirm its effectiveness.