Gynecologic and Obstetric Investigation最新文献

Objectives: The aim of the study was to report the first cases of surgical staging for apparently early-stage endometrial cancer performed using the Versius® next-generation robotic surgical system (Cambridge Medical Robots [CMR] Surgical, Cambridge, UK).

Design: The study used a prospective case series. Participants/Materials: Women who underwent surgical staging, including total hysterectomy, bilateral adnexectomy, and sentinel lymph node (SLN) biopsy, for apparently early-stage endometrial cancer using the Versius® next-generation robotic surgical system (CMR Surgical, Cambridge, UK) were included.

Setting: The study was conducted at a Gynecologic Oncology Referral Center.

Methods: We prospectively recorded data of all consecutive women who underwent the investigated surgical procedure.

Results: Fourteen endometrial cancer patients were treated between March and August 2024 at the Azienda Ospedaliera Universitaria Integrata of Verona. The mean age was 69.4 ± 8.7 years, and the average body mass index was 27.2 ± 4.8. SLN biopsy was performed on all patients: 5 patients had unilateral and 9 bilateral successful SLN detection; 6 women underwent systematic pelvic lymphadenectomy in the unmapped areas. The median operative time was 122 (min-max, 77-185) minutes, and the median hysterectomy time was 34 (min-max, 18-68) minutes. None of the surgical procedures required conversion to conventional laparoscopic or open surgery for technical reasons, and no intraoperative complications were recorded. No readmissions, reoperations, or deaths were observed during the follow-up (median 102 days, min-max 39-249).

Limitations: The limitations of the study are the first experience in a limited study population and the use of methylene blue for SLN mapping.

Conclusions: Our preliminary results with the Versius® platform appear encouraging regarding surgical time, blood loss, rate of completion of the robotic procedures, and complications risk. Further studies will confirm the indications, feasibility, and safety of the Versius® surgical robot system for treating apparently early-stage endometrial cancer.

Introduction: Primary ovarian insufficiency (POI) that caused infertility could decrease the quality of life in women. Therefore, an effective treatment is needed. Adipose-derived stem cells (ADSCs) have been reported to have therapeutic benefits in POI. This review aims to evaluate the therapeutic effect of ADSCs in POI.

Methods: Literature studies were searched according to PRISMA 2020 guidelines in the following databases: PubMed, ProQuest, Wiley, Emerald, and JSTOR (until July 10th, 2024). The study inclusion criteria are original articles, in vivo study with adipose-derived stem cell therapy towards POI with ovarian function as the outcome. SYRCLE's risk of bias tool was used to evaluate the quality of the studies.

Results: We retrieved 9 from 292 articles published in English between 2013 and 2024. Animals used in this study were mice (n = 5) and rats (n = 4). ADSCs were administered either systematically or directly by injection into the ovaries. Decreased apoptosis, increased follicle survival, and hormone levels were observed. These showed that ADSCs implantation could improve ovarian function in rats and mice. Overall, ADSCs in POI showed satisfactory results.

Conclusion: ADSCs showed benefits in increasing ovarian function in POI. Further studies, especially human studies, are needed to evaluate the efficacy and side effects of the ADSCs treatment before reaching general conclusions.

Objectives: The aim of the study was to evaluate current practices among gynecologists in managing large endometriomas before in vitro fertilization (IVF).

Design: A cross-sectional online survey was conducted. Participants/Materials: The survey was distributed to an estimated 410 gynecologists, with 111 specialists completing the survey (response rate: 27.8%). Among respondents, 73% practiced in academic settings, and 61% had more than 15 years of clinical experience.

Setting: Gynecologists involved in IVF treatments or endometrioma surgery were recruited via email through professional societies across multiple countries.

Methods: An online survey consisting of 18 questions covering clinical experience, surgical thresholds, techniques, hormonal protocols, and timing of ovarian stimulation post-surgery was distributed through professional societies. Responses were collected anonymously and analyzed using SPSS version 29.0.2.0.

Results: Laparoscopic cystectomy was the most common procedure (48.2%). The median threshold size for surgery was 50 mm (interquartile range [IQR] 40-60). Despite the same median threshold, surgeons performing laparoscopic surgery as their main clinical activity had a significantly different distribution of thresholds (IQR 40-60 vs. 47-89, p = 0.006), with a tendency to recommend surgery for smaller endometriomas. Techniques like CO₂ laser ablation and plasma energy were less commonly used. Notably, 40.5% of participants indicated they would change their practice if a CO₂ laser or plasma energy device were available in their surgical armamentarium. Most participants (67.9%) adjusted their strategy based on preoperative anti-Müllerian hormone levels. The average timing for IVF stimulation post-surgery was 6 weeks (IQR 4-8) with no difference across different experiences.

Limitations: The survey-based design may introduce response bias and reflect only the opinions of those who chose to participate. Additionally, the study may not capture regional or institutional differences comprehensively.

Conclusion: Managing large endometriomas before IVF involves balancing surgical benefits with risks to ovarian reserve. The survey highlights significant variability in practices, with a median surgical threshold size of 50 mm. Laparoscopic cystectomy, while common, is associated with ovarian tissue loss, whereas emerging techniques like CO₂ laser ablation show promise in preserving ovarian reserve. The need for up-to-date evidence-based guidelines is essential to standardize practices and optimize outcomes for IVF patients.

Introduction: Variants of the luteinizing hormone/chorionic gonadotropin receptor (LHCGR) gene have been investigated for their close associations with assisted reproductive technology (ART) outcomes. However, available data are controversial. This meta-analysis aimed to elucidate the associations of LHCGR N312S polymorphism (rs2293275) with ART outcomes.

Methods: A thorough search was performed in the databases of PubMed, EMBASE, Web of Science, and Cochrane Library from their inception to July 19, 2024. The analysis included five studies, encompassing 2,692 patients with infertility and subfertility. RevMan 5.4 was used for further comprehensive data analysis.

Results: In this study, A allele homozygotes encoded asparagine (N/N), and G allele homozygotes encoded serine (S/S). The number of oocytes retrieved was higher in AA homozygotes than in GG homozygotes (mean difference [MD] 1.07, 95% confidence interval [CI] 0.09-2.05, I2 = 7%, p = 0.03) or AG heterozygotes (MD 1.26, 95% CI 0.32-2.20, I2 = 45%, p = 0.008). The number of mature oocytes and the distribution of the LHCGR (rs2293275) genotype (MD 0.60, 95% CI -0.25 to 1.45, I2 = 49%, p = 0.17; MD 0.85, 95% CI 0.02-1.68, I2 = 76%, p = 0.05; MD -0.36, 95% CI -1.20 to 0.49, I2 = 56%, p = 0.41) were not significantly different. G allele homozygotes and heterozygotes exhibited an increasing trend in the number of clinical pregnancies compared with A allele homozygotes (odds ratio [OR] 1.69, 95% CI 1.21-2.36, I2 = 0%, p = 0.002; OR 1.30, 95% CI 1.09-1.54, I2 = 0%, p = 0.003).

Conclusion: This study revealed associations of LHCGR polymorphism with ART outcomes, implying that the LHCGR N312S polymorphism (rs2293275) may serve as a predictor of certain ART outcomes.

Background: Endometriosis is a chronic gynecological condition that affects approximately 10% of women of reproductive age globally. It is associated with significant morbidity due to symptoms such as pelvic pain and infertility. Current knowledge suggests that endometriosis impacts oocyte quality, a critical factor for successful fertilization and pregnancy. Despite extensive research, the exact mechanisms remain unclear, and further updates are necessary to optimize treatment strategies.

Objectives: This review aims to summarize current evidence regarding the impact of endometriosis on oocyte quality and its subsequent effects on fertility outcomes, particularly in the context of in vitro fertilization (IVF).

Methods: A comprehensive search was conducted in PubMed using the terms "endometriosis AND oocyte quality," "endometriosis AND infertility, and "endometriosis AND IVF." The review included studies published up to July 2024.

Outcome: The review findings indicate that endometriosis may be associated with decreased oocyte quality, characterized by impaired morphological features and molecular abnormalities. These defects potentially lead to lower fertilization rates, impaired embryo development, and reduced pregnancy outcomes. However, some studies suggest that with controlled factors such as age and ovarian reserve, IVF outcomes may be comparable to those without endometriosis.

Conclusions and outlook: For clinicians and scientists working in medically assisted reproduction, understanding the impact of endometriosis on oocyte quality is crucial for improving fertility treatment outcomes. Advances in assisted reproductive technologies and personalized treatment approaches may mitigate these adverse effects. The potential for using artificial intelligence to assess oocyte quality presents a promising avenue for future research, as currently there is no direct and objective measure to assess this parameter.

Objectives: This study aimed to explore potential differences in efficacy between vaginal progesterone (VPG) and VPG + oral progesterone (OPG) for luteal-phase support in hormone replacement therapy-frozen embryo transfer (HRT-FET) cycles.

Design: A single-centre, open-label, randomized controlled, phase IV pilot study was conducted.

Participants/materials, setting, methods: Infertile women aged 20-38 years undergoing HRT-FET cycles were included. Participants were randomized to VPG (n = 86) or VPG + OPG (n = 86). The primary efficacy endpoint was ongoing pregnancy at 10-12 weeks. Secondary efficacy endpoints included β-human chorionic gonadotropin (β-hCG) positivity, implantation rate, and clinical-pregnancy rate. Safety analyses included adverse events (AE) and vital signs.

Results: A higher ongoing pregnancy rate was observed with VPG + OPG (29.1%) versus VPG (18.8%); treatment difference 8.4% (90% confidence interval [CI] -2.2%, 19.0%). Numerical differences also favoured VPG + OPG over VPG for β-hCG positivity (0.9% [90% CI: -10.8%, 12.7%]), implantation (10.4% [90% CI: 0.5%, 21.3%]), and clinical pregnancy (10.1% [90% CI: -0.8%, 21.1%]). Incidences of treatment-emergent AEs were comparable.

Limitations: The single-centre study was limited by a relatively small sample size which could have impacted the reported outcomes. Another limitation was the open-label design, which might have increased the risk of bias for subjective endpoints, such as AE reporting.

Conclusions: A higher ongoing pregnancy rate was observed with VPG + OPG vs VPG; however, a statistical conclusion cannot be reached considering the small sample size. These data suggest that a minimum daily progesterone dose, such as VPG 90 mg + OPG 20 mg reported here, or VPG 180 mg reported in other studies, may be required for successful outcomes following HRT-FET cycles.

Objectives: Retained products of conception (RPOC) can occur after delivery, abortion, or uterine evacuation, presenting diagnostic challenges. This study aimed to assess the diagnostic accuracy of transvaginal ultrasound (TVS) endometrial thickness measurements for identifying RPOC and propose tailored hysteroscopic management strategies.

Design: This is a retrospective cohort study.

Participants and setting: A total of 226 women with suspected RPOC underwent hysteroscopy between 2018 and 2021 at the Galilee Medical Center.

Methods: Endometrial thickness was measured by TVS, and diagnostic metrics, including sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV), were calculated.

Results: The mean endometrial thickness was 1.6 cm (0.7-6 cm). The overall PPV for RPOC was 79.2%, with a false-positive rate of 20.7%. A cut-off of 1.49 cm yielded a sensitivity of 69.8%, specificity of 59.6%, PPV of 86.8%, and NPV of 34.1%. Women with thickness >1.49 cm had a threefold increased likelihood of RPOC. Stratifying by endometrial thickness showed PPVs of 54.5% (<10 mm), 76.5% (10-20 mm), and 98.0% (>20 mm).

Limitations: Retrospective design may introduce selection bias, and findings require validation in larger, prospective studies.

Conclusions: An endometrial thickness above 1.49 cm significantly increases the likelihood of RPOC confirmation. RPOC can occur in asymptomatic women with associated risk factors. TVS endometrial thickness measurements are effective for diagnosing and managing these cases, and stratification further enhances diagnostic accuracy.