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.
Introduction: Lymphocele is one of the complications after lymphadenectomy for female pelvic malignancies. In recent years, some studies indicated that the use of biomedical materials during surgery for gynecological malignancies may help to reduce the occurrence of lymphatic cysts, but results were inconsistent. The aim of the study was to evaluate the correlation between the use of biomedical materials intraoperatively and formation of lymphocele after lymph node dissection in patients with gynecological malignancies.
Methods: We conducted a systematic search of 4 electronic databases (PubMed, Web of science, EMBASE, Cochrane Library) for articles published before April 14, 2025. We included randomized controlled clinical trials (RCTs) on the results of lymphatic cysts after the application of biomedical materials for gynecological malignant patients undergoing lymph node dissection. Statistical analyses were conducted using the RevMan 5.3 software.
Results: Ten randomized controlled studies were finally included in the present study. A total of 879 patients (from 10 studies) with gynecological cancer who underwent pelvic lymph node dissection and/or para-aortic lymph node dissection were included in the meta-analysis. Pelvic lymphoceles were diagnosed in 249 (28.3%) patients. The symptomatic lymphocele incidence proportion was 6.4% (47/731). The lymphocele incidence of biomedical material group was significant lower compared with control group (432 vs. 447 cases, OR 0.68, 95% CI: 0.50-0.93, p = 0.02, data derived from 10 studies), while symptomatic lymphocele incidence was not significantly different between the two groups (358 vs. 373 cases, OR 0.66, 95% CI: 0.39-1.10, p = 0.11, data derived from 9 studies). In the subgroup analysis, the incidence difference of lymphoceles between the biomedical material group and control group showed significant association with extension of nodes dissection (p = 0.02) and diagnosis time after surgery (p = 0.02).
Conclusions: The present meta-analysis supports that the use of biomedical materials is effective in reducing the incidence of lymphocele after lymphadenectomy due to gynecologic cancer, and subgroup analysis found the reduction was more significant in the group without para-aortic lymph node dissection, and in the short term after surgery. Further well-designed clinical studies are required to confirm our conclusions.
Objectives: This prospective cohort study aimed to identify key factors influencing the success rate of external cephalic version (ECV) and to evaluate its impact on the mode of delivery and maternal-neonatal outcomes.
Design: A prospective cohort study was conducted. Participants/Materials: The study enrolled 62 pregnant women with singleton breech presentations at or beyond 37 weeks of gestation who consented to undergo ECV. A convenience sample of 12 women with cephalic presentations was also enrolled as a control group for outcome comparison.
Setting: The study was conducted at the Department of Obstetrics and Child Health Hospital, Jinniu District Maternal and Child Health Hospital, Chengdu, China.
Methods: Participants were divided into ECV success (n = 51) and failure (n = 11) groups based on procedural outcome. Baseline characteristics were compared, and predictors of ECV success were analyzed using univariable logistic regression. Maternal and neonatal outcomes were compared between the success group and the control group.
Results: Five independent predictors of ECV success were identified: lower maternal body mass index (BMI) at delivery (odds ratio [OR] = 0.816, 95% confidence interval [CI]: 0.662-0.991; p = 0.042), prior spontaneous vaginal delivery (OR = 8.250, 95% CI: 1.879-58.080; p = 0.012), non-posterior placental location (OR = 0.171, 95% CI: 0.034-0.678; p = 0.017), higher amniotic fluid index (OR = 1.442, 95% CI: 1.053-2.185; p = 0.048), and fewer ECV attempts (OR = 0.174, 95% CI: 0.059-0.375; p = 0.001). The ECV success group had a significantly higher vaginal delivery rate (81% vs. 0%; p = 0.012) and a lower cesarean delivery rate (19% vs. 100%) compared to the failure group. Neonates in the success group exhibited higher birth weights (3,266.4 ± 352.54 g vs. 3,063.2 ± 202.93 g; p = 0.017). Outcomes in the success group were comparable to the cephalic-presentation control group, except for a higher rate of labor induction (33.3% vs. 0%, p = 0.050).
Limitations: The main limitations of this study include its modest sample size, single-center design, and the lack of long-term follow-up data on maternal and neonatal outcomes post-ECV.
Conclusions: ECV is an effective intervention for reducing cesarean delivery rates in breech presentations. Success is associated with lower maternal BMI, a history of vaginal delivery, favorable placental location, adequate amniotic fluid, and fewer procedural attempts. These findings support the integration of patient-specific factors into clinical protocols to optimize ECV success and improve perinatal outcomes.
Introduction: Natural orifice transluminal endoscopic surgery (NOTES) is a minimally invasive technique that accesses the abdominal cavity through natural orifices, eliminating the need for abdominal incisions. While this approach holds significant promise, particularly with its adaptation as vaginal NOTES (vNOTES), long-term safety data remain limited, especially beyond benign indications and hysterectomy. This review aims to evaluate the feasibility and outcomes of vNOTES in gynaecological oncology procedures that do not involve concurrent hysterectomy.
Methods: This systematic review, registered with PROSPERO (CRD42022380581) and conducted per PRISMA guidelines, searched MEDLINE, Embase, CINAHL, SCOPUS, and CENTRAL up to March 31, 2023. Using MeSH, Emtree, and keywords including "vaginal natural orifice transluminal endoscopic surgery," "vNOTES," and "gynaecological surgery," studies were selected if they included women undergoing vNOTES for oncological indications without hysterectomy.
Results: Of 5,367 records screened, 58 underwent full-text review; four articles (n = 6) were included for oncological procedures without hysterectomy. These involved staging of peritoneal (n = 3), endometrial (n = 2), and cervical cancers (n = 1). Mean age was 54.3 years, BMI 30 kg/m2, and operative time 93.5 min. Mean estimated blood loss was 17.2 mL. No conversions occurred. One patient developed a postoperative fever (12.5%), managed conservatively.
Conclusion: This review highlights the limited but promising evidence for vNOTES in gynaecological oncology beyond hysterectomy. It offers a potential minimally invasive alternative for complex pelvic procedures requiring retroperitoneal access, including obturator pathology, sentinel lymph node dissection, and mesh excision. Careful patient selection and use within a research setting, mirroring protocols for transanal total mesorectal excision, are recommended. Prospective case registration via the International NOTES Society is advised to support safe implementation.
Objectives: Vaginitis is an inflammatory condition of the vagina, which often manifests with symptoms like discharge, foul odor, and pruritus. The most commonly recognized forms are candidiasis, bacterial vaginosis (BV), and trichomoniasis, but conditions like cytolytic vaginosis (CV) remain under-recognized and frequently misdiagnosed in clinical practice despite its notable prevalence. This study aims to evaluate the prevalence of CV in patients with vaginitis, assess the specificity of the diagnostic criteria for CV, and investigate the efficacy of CV treatments.
Design: This study is a prospective diagnostic study. Participants/Materials, Setting: A total of 81 patients (aged 20-55 years) with symptoms of vaginitis, and 30 control participants without these symptoms were enrolled.
Methods: Vaginal samples were analyzed for Trichomonas vaginalis, vulvovaginal candidiasis (VVC), and BV and CV. Vaginal samples were evaluated using Gram staining, pH measurement, and microbiological culture to identify causative agents. CV was diagnosed based on the low vaginal pH, presence of abundant lactobacilli, cytolysis of the vaginal epithelium, false clue cells, and naked nuclei in Gram staining.
Results: The study found that CV was the most prevalent diagnosis, accounting for 32.1% of cases. This was followed by BV (22.2%) and VVC (14.8%). The most common symptoms among CV patients were vaginal discharge, pruritus, and dysuria. Vaginal discharge characteristics did not significantly distinguish CV from other forms of vaginitis. A recurrence rate of 61.5% was observed in CV patients, highlighting the recurrent nature of the condition. Sodium bicarbonate sitz baths effectively relieved symptoms in many patients (58.8%).
Limitations: The number of patients receiving treatment is low, and the treatment follow-ups could have been conducted over a longer period, considering the menstrual cycle.
Conclusions: The study highlights the diagnostic challenge of CV, where common symptoms overlap with other forms of vaginitis, leading to potential treatment failures. CV treatment, including NaHCO3 sitz baths, showed moderate efficacy, but further research is needed to establish more effective therapeutic strategies. Our findings underscore the importance of considering CV in the differential diagnosis of vaginitis as it remains an overlooked condition that significantly contributes to recurrent vaginitis. Further studies with larger sample sizes and better treatment protocols are needed to enhance the management of this condition.
Objective: This study aimed to evaluate whether having only one blastocyst-stage embryo on Day 5/6 rectify the live birth rate (LBR) when various number of oocytes had been collected.
Design: A retrospective cohort study from two in vitro fertilization (IVF) centers has been conducted. Participants/Materials: The study included women undergoing IVF treatment whose cycles resulted in only one blastocyst-stage embryo available for frozen transfer on Day 5/6. Cases with no oocyte retrieval, no blastocyst development, or missing clinical data were excluded. There were no restrictions based on female age or BMI to reflect real-world clinical conditions.
Setting: A multi-center study was conducted.
Methods: This retrospective cohort study included 2,125 single blastocyst frozen embryo transfer cycles performed between November 2018 and February 2023. All patients had only one blastocyst-stage embryo available for transfer on Day 5/6, regardless of the number of oocytes retrieved during controlled ovarian stimulation. Patients were stratified into quartiles based on their blastocyst-to-oocyte ratio. Baseline demographic, ovarian stimulation, and embryological parameters were compared across quartiles. The primary outcome was the LBR. Binary logistic regression was used to identify independent predictors of the LBR, including female age, embryo quality, BMI, and blastocyst-to-oocyte ratio.
Results: The mean blastocyst-to-oocyte ratio was 18.6%. Patients in the lowest quartile had significantly younger mean age and higher AMH levels compared to the highest quartile. Although blastocyst development rates increased across quartiles, the LBR was lower in the highest quartile from all other groups (24.5% vs. 31.9 to 29.9%). When the LBR was analyzed as dependent variable, binary logistic regression identified female age (β = 0.93, 95% CI: 0.92-0.95, p < 0.001) and embryo quality (β = 2.35, 95% CI: 1.62-3.39, p < 0.001, compared with moderate-quality embryos; β = 4.22, 95% CI: 2.91-6.11, p < 0.001, compared with poor-quality embryos) as independent predictors. However, the blastocyst-to-oocyte ratio did not demonstrate a significant association with the LBR.
Limitations: The retrospective design and absence of genetic testing for embryo ploidy might limit the ability to establish causality. Variability in laboratory conditions and stimulation protocols may also have introduced confounding factors.
Conclusions: The blastocyst-to-oocyte ratio does not significantly impact the LBR when only one blastocyst is available for transfer. Instead, female age and embryo quality remain the most critical factors in determining the LBR. These findings emphasize the importance of embryo selection over numerical ovarian response parameters in clinical decision-making to obtain live birth.
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