Minerva obstetrics and gynecology最新文献

Introduction: Considering the prevalence and the importance of low ovarian response, it is important to update the evidence base on whether using higher compared to lower starting doses of gonadotrophins during ovarian stimulation of patients expected to exhibit low ovarian response is beneficial.

Evidence acquisition: A systematic review and meta-analysis of randomized controlled trials (RCTs) was performed by performing literature search until December 2024 in MEDLINE, Embase, Cochrane CENTRAL, Scopus, Web of Science and Clinicaltrials.gov. The primary outcome was live birth. Secondary outcomes included clinical and ongoing pregnancy, cumulative live birth, clinical and ongoing pregnancy, number of oocytes retrieved and number of usable embryos.

Evidence synthesis: Six eligible RCTs were identified (N.=2262). No significant difference was observed in live birth rates (RR: 0.96, 95% CI: 0.80-1.15; I²=0%, 2 studies, N.=1171), ongoing pregnancy rates (RR: 0.99, 95% CI: 0.81-1.19; I²=0%, 3 studies, N.=775), clinical pregnancy rates (RR: 1.04, 95% CI: 0.89-1.21; I²=0%, 5 studies, N.=1179) and the number of oocytes retrieved (WMD: -0.61, 95% CI: -2.52 to +1.31; I²=86.6%, 4 studies, N.=1286) between the groups compared. A lower number of usable embryos was observed (WMD: -0.38, 95% CI: -0.63 to -0.13; I²=0%, 3 studies, N.=1223) when using a lower compared to a higher starting dose of gonadotrophins in expected low responders undergoing ovarian stimulation for IVF/ICSI.

Conclusions: The available evidence is currently insufficient to conclude whether the use of a higher starting dose of gonadotrophins is beneficial in terms of live birth rates for patients expected to exhibit low response after ovarian stimulation.

Background: Patient education materials (PEMS) are not always available in a patients' written language. Google Translate, using artificial intelligence (AI), provides a cost-effective, widely available translation option. We evaluated understandability and actionability of Google AI translations of International Urogynecological Association (IUGA)'s midurethral sling (MUS) leaflet with the Patient Education Materials Assessment Tool (PEMAT). We also evaluated translation equivalence using the comparability of language (CL) and similarity of interpretability (SI) assessments. We hypothesized no differences between back-translated and original version's PEMAT scores, CL, or SI and that PEMAT back-translated version scores would be non-inferior to original versions.

Methods: IUGA's MUS leaflet was translated into Mandarin Chinese and Swahili, then back-translated into English using Google Translate. Participants scored original and back-translated versions using the PEMAT (0-100, better scores are higher) and CL and SI (1-7 scale, lower scores better). Participants were randomized whether they evaluated the original or back-translated version first to decrease bias.

Results: No significant differences were found on understandability or actionability between the original English and back-translated Mandarin Chinese or Swahili versions. However, neither met the pre-specified non-inferiority margin of 5-points on the PEMAT. CL (mean: 4.4±0.9) and SI (mean: 4±1.2) scores for both indicated moderate comparability and similarity.

Conclusions: Original and back-translated versions of Mandarin Chinese or Swahili MUS IUGA leaflets did not score differently on the PEMAT although we did not meet the non-inferiority margin. CL and SI support Google translate as a moderately useful tool in providing IUGA leaflets in languages not commonly available.

Background: The Italian Medically Assisted Reproduction Registry (ItMARR) was established by a Decree of the Minister of Health issued on October 7^th, 2005. ItMARR has a crucial role in clearly and publicly disseminating epidemiological information on MAR activities and outcomes.

Methods: ItMARR data are collected in aggregate form and their submission is mandatory as stipulated by Law 40/2004. The aim of this article is to make a comprehensive overview of the activity of authorized centers that perform IUI and ART in Italy. Data used in this article refer to MAR treatments started between January 1^st and December 31^st, 2021.

Results: MAR techniques were performed by 340 centers. In total, 92,407 ART cycles and 15,660 IUI cycles were performed in 2021. Gametes donation cycles represent 14.6% of ART activity and 4.2% of IUI. ART cycles performed per million women of childbearing age were 9077. In 2021, 3.8% of births in the general population in Italy were a result of ART application. In 2021, MAR activity had a strong increase compared to the previous year in which there were strong limitations on reproductive treatments due to the COVID-19 pandemic. Pregnancy rates per transfers were 29.4% with fresh techniques, 35.2% with FER, 26.3% with FO, 41.2% with OD and 37.9% with SD. The decreasing trend of multiple deliveries continues.

Conclusions: The ItMARR has become a great asset in the reproductive health scenario promoting a better MAR information dissemination. ItMARR is working on the implementation towards a "cycle-by-cycle" data collection system. This will bring the Italian monitoring system in line with others European countries.

Introduction: Female fertility is influenced by a complex interplay of lifestyle factors. They may include weight, diet, supplementation, physical activity, sleep and substance use. Understanding these factors, in combination with a thorough understanding of strategies to support effective behavior change is essential to develop effective lifestyle interventions for women who wish to enhance their fertility. This review aimed to summarize the evidence on female fertility and lifestyle, and to discuss intervention considerations which may affect implementation of the evidence.

Evidence acquisition: Electronic databases (PubMed, Google Scholar) were searched to identify relevant peer-reviewed studies and evidence-based guidelines.

Evidence synthesis: The following lifestyle factors are associated with improved female fertility: maintaining a healthy weight, following a healthy dietary pattern (e.g. Mediterranean diet) with appropriate supplementation, participating in regular physical activity, attaining 7-8.5 hours of high-quality nocturnal sleep and avoiding or limiting substance use (caffeine, alcohol and smoking). Considering the factors affecting lifestyle management in both consumers (e.g. emotional eating and financial barriers) and health professionals (e.g. time constraints and concerns about patient expectations of care) is essential to optimize success of lifestyle interventions to improve fertility.

Conclusions: Lifestyle management has an important role in improving reproductive health and overall health for women who wish to conceive. A patient-centered approach which incorporates behavioral science, individual preferences, and healthcare delivery considerations is essential. There is a need for further research to inform optimal intervention components and behavior change strategies for this population.

Endometriosis is a frequent chronic estrogen-dependent condition that can significantly impair fertility and reduce the quality of life in affected individuals. Women with endometriosis face a 30-50% risk of infertility. Multifactorial factors such as peritoneal inflammation, altered ovarian reserve, impaired tubal function and modified endometrial receptivity have been proposed to contribute to infertility. Endometriosis has been highlighted as a condition that may require a fertility preservation to safeguard reproductive potential. This review aims to provide a comprehensive update on fertility preservation for women with endometriosis. A comprehensive literature search was conducted using PubMed, focusing on peer-reviewed studies. Key words included "endometriosis," "fertility preservation," "oocytes," and "cryopreservation." Studies in English and French that delve into FP techniques, success factors, and risks were included. Several fertility preservation techniques are available, but oocyte cryopreservation following ovarian stimulation is the most common and effective option for women affected by endometriosis. Success rates depend on factors such as age and prior surgical history. Surgery for ovarian endometriomas may reduce ovarian reserve, underscoring the importance of considering fertility preservation before surgery. All of ovarian stimulation protocols can be used and may not increase the risk of disease progression or recurrence however the use of an antagonist protocol with GnRH agonist triggering could be particularly beneficial in this context, as it may help reduce pain and minimize the risk of ovarian hyperstimulation syndrome. The number of cryopreserved oocytes is directly correlated with pregnancy success. Multiple stimulation cycles can be performed to obtain a sufficient number of oocytes, increasing the chances of achieving a successful live birth in case of reuse. FP should be routinely discussed with women with endometriosis, particularly those who may undergo surgery, however, its implementation is not systematic and should be considered on a case-by-case basis. Further research is essential to tailor FP strategies for women with endometriosis optimizing both clinical outcomes and cost-effectiveness.

Introduction: Identifying eligible studies is a foundational component of systematic reviews, requiring careful interpretation of complex inclusion and exclusion criteria. Given the rapid integration of large language models (LLMs) into evidence synthesis, their reliability in autonomously performing this task necessitates timely evaluation. This study intends to assess whether general-purpose LLMs can accurately perform the study identification phase of a published systematic review in obstetrics using only predefined eligibility criteria.

Evidence acquisition: Six publicly accessible LLMs were given a standardized prompt, without iterative refinement or human oversight, to identify eligible studies from a 2023 JAMA Network Open meta-analysis. Each model's output was compared with the 14 studies included in the reference review. Primary outcomes were precision, recall, F1 score, and hallucination severity.

Evidence synthesis: Claude 3.7 achieved the highest accuracy, correctly identifying 5 of 14 reference studies (precision 71.4%, recall 35.7%, F1 score of 0.48). In comparison, all other models exhibited substantially lower performance with minimal variation in F1 scores (ranging between 0.08-0.12), indicating a poor balance of precision and recall. Precision was generally inversely related to the number of false positives, and LLMs that returned more total studies tended to produce more hallucinations.

Conclusions: Current general-purpose LLMs are unreliable for autonomous study identification in clinically relevant systematic reviews and human oversight remains essential. The low F1 scores highlight major limitations in current LLMs' ability to accurately and comprehensively identify relevant studies. These findings underscore the need for fine-tuning and hybrid AI-human workflows before safe integration into evidence synthesis in obstetrics and gynecology.

Background: We evaluated the common histopathological characteristics of preeclampsia (PE) and fetal growth restriction (FGR), and demonstrated the major differences of the three groups of 1/ PE with FGR, 2/ PE without FGR and 3/ FGR without PE.

Methods: Placental slides were studied retrospectively. Predominantly FGR- and PE-associated lesions were identified. Gestational age at the time of delivery (GATD) and diagnosis-to-delivery time (DTDT) were also examined.

Results: Decidual arteriopathies, maternal hypertension and obesity were more common in PE, and villous capillarization was significantly lower in FGR. We found that only villous infarction and chorangiosis had a connection with GATD. Villous infarction and chorangiosis were associated with DTDT >80 days, while placental changes leading to decreased villous capillarization was associated with DTDT <30 days.

Conclusions: Despite several common histopathological characteristics, placental histopathological profile of PE with FGR, PE without FGR and FGR without PE have remarkable differences, indicating histological background of their distinguished prognosis. Inadequate vascular development and decidual vasculopathies are characteristic in PE, while the undercapillarization of placental villous tree and villitis of unknown etiology leading to placental damage are characteristic of FGR. The dynamic equilibrium of different entities determines global placental function, and manifestation of FGR and/or PE.

Background: Cytomegalovirus (CMV) is the leading cause of congenital infection in pregnancy and non-genetic infant hearing loss. Evidence showed that antenatal education about hygiene practices might decrease infection acquisition. We aimed to assess pregnant women's awareness of CMV infection and knowledge of preventive behaviors and to identify associated factors.

Methods: A prospective cross-sectional survey study was conducted at a single academic maternity center between May and November 2023. Data were gathered via a self-administered paper questionnaire from pregnant women aged 18 or older.

Results: Out of 384 participants, 65.4% were aware that CMV infection could pose risks during pregnancy. CMV awareness was significantly linked to university education (OR 7.18, 95% CI 2.79-18.44), preconceptional provision of information (OR 1.98, 95% CI 1.17-3.36), folic acid intake (OR 2.75; 95% CI 1.53-4.95, P=0.0007), and pregnancy vaccination uptake (OR 1.64; 95% CI 1.06-2.52, P=0.0249). Women starting folic acid when already pregnant and smoking during pregnancy, were 55% and 72% less aware of CMV, respectively (OR 0.45, 95% CI 0.23-0.86; OR 0.28, 95% CI 0.14-0.59). Only 28.1% of women had adequate CMV preventive behaviors knowledge, rising to just 33.1% among those aware of CMV and its risks in pregnancy. Mass-media use positively influenced awareness of CMV (OR 2.57, 95% CI 1.44-4.60).

Conclusions: Although we identified a moderately high rate of CMV infection awareness, appropriate knowledge of its specific preventive measures was low. Mass-media use to inform before conception and the adoption of effective communication methods early in pregnancy might represent feasible ameliorating interventions.