Minerva obstetrics and gynecology最新文献

Introduction: Embryo implantation is a crucial step in pregnancy that requires interaction between the embryo and the endometrial lining, facilitated by cytokines, growth factors, and adhesion molecules. Failures in this process are a leading cause of implantation failure and miscarriage in in-vitro fertilization (IVF) treatments. Heparin has shown potential to improve outcomes by enhancing endometrial receptivity, promoting angiogenesis, and modulating inflammatory responses. This study aims to provide an overview of the main characteristics of existing research on the role of heparin adjuvant therapy in IVF cycles.

Evidence acquisition: A comprehensive bibliographic search was systematically conducted from inception to 2024, focusing on studies that evaluated the impact of heparin adjuvant therapy in IVF cycles and compared clinical outcomes between case and control groups.

Evidence synthesis: A total of 31 studies were included. Most of the studies have focused on patients with recurrent implantation failure, defined using highly heterogeneous criteria across studies, as well as patients with both congenital and acquired thrombophilic disorders. Additionally, most of the studies involved small sample sizes.

Conclusions: Current evidence does not adequately support the routine use of heparin in IVF cycles. To date, the research is plagued by methodological inconsistencies, which undermine both the reliability and the applicability of the findings.

Introduction: Clinical characteristics of polycystic ovary syndrome (PCOS) (menstrual irregularities, obesity, anovulation, etc.), occur together with a series of conditions at skin level like seborrhea, acne, hirsutism, and androgenetic alopecia. Estroprogestins (EPs) are recognized as the most powerful therapy to treat hyperandrogenism and/or hyperandrogenemia and regularize menstrual cycle.

Evidence acquisition: This review includes the most relevant publications about the effects of EPs in PCOS women published between 1995 and 2025.

Evidence synthesis: According to the available data, EPs composed by an anti-androgenic progestin appear the most suitable to reduce the hyperandrogenic manifestations of PCOS. More specifically, cyproterone acetate (CPA), drospirenone (DRSP) and dienogest (DNG) associated with 20-30 μg of ethinylestradiol (EE) seem to be the most effective compounds for the management of androgen excess. As the benefit risk/ratio of the association EE/CPA is less favorable, the use of EPs with other antiandrogenic progestins could be more appropriate to treat PCOS patients, also from a metabolic point of view.

Conclusions: In conclusion, an aware choice of the most adequate and tolerable EP formulation according to the pharmacological profile and individual characteristics of PCOS patient is essential to opportunely customize the treatment of androgen excess.

Background: Polycystic ovary syndrome (PCOS) is an endocrine/metabolic condition. Hyperandrogenism and insulin-resistance with compensatory hyperinsulinemia are important features of PCOS. The aim of this paper is to review the rationale of antiandrogens and insulin-sensitizers use in PCOS management.

Evidence acquisition: We include in our research the most relevant scientific literature about the impact of antiandrogens and insulin sensitizers in PCOS between 1976 and 2025.

Evidence synthesis: According to the most recent recommendations, antiandrogens can be a possible therapeutic option to reduce the impact of hyperandrogenism and treat hirsutism in PCOS patients after a period of 6 months of estroprogestins and/or cosmetic therapy without adequate results. Insulin-sensitizers can decrease the levels of insulin in subjects affected by hyperinsulinemia, improving metabolic and hormonal alterations observed in PCOS patients.

Conclusions: Antiandrogens and insulin sensitizers represent fundamental pharmacological therapies for PCOS management.

Polycystic ovary syndrome (PCOS) is a prevalent endocrine-metabolic disorder characterized by hyperandrogenism, chronic anovulation, and polycystic ovarian morphology, affecting 6-10% of women during their reproductive years. It is a leading cause of female infertility, impacting up to 40% of cases. First described in 1935, PCOS manifests with various clinical features, including hirsutism, amenorrhea, and metabolic disturbances. Additionally, PCOS patients exhibit hormonal imbalances and ovarian dysfunction, contributing to the overall clinical picture. Notably, PCOS is linked to metabolic comorbidities like hepatic steatosis, glucose intolerance, dyslipidemia, type 2 diabetes mellitus (T2DM), and hypertension. This review explores the key aspects of PCOS, providing an overview of ovulation induction strategies, including lifestyle modifications, pharmacological interventions, and emerging approaches. The review synthesizes findings from relevant studies. Effective management of PCOS necessitates early detection and intervention to prevent progression to severe health conditions. Evidence underscores the importance of addressing oxidative stress and low-grade inflammation in treatment plans. A holistic approach, including individualized medication, diet, and lifestyle modifications, is crucial for improving insulin resistance, promoting weight loss, enhancing ovulation rates, and addressing broader metabolic concerns. Key therapeutic strategies include insulin sensitizers like metformin, ovulation induction agents like clomiphene citrate (CC) and aromatase inhibitors (AIs) such as letrozole, and the use of gonadotropins for resistant cases. Combining these treatments with dietary and lifestyle interventions, such as an anti-inflammatory diet, nutritional education, and personalized exercise programs, can enhance treatment outcomes. Through an integrated approach, significant improvements in metabolic health and reproductive function for women with PCOS are possible.

The management of assisted reproductive technology (ART) in predicted hyper-responders to ovarian stimulation represents a complex and challenging clinical scenario, whereby the benefits of higher oocyte yield must be balanced against the drawbacks and risks of ovarian hyperstimulation syndrome. This review explores advances in ART for hyper-responders, focusing on adapted stimulation protocols, ovulation triggering, cryopreservation, and personalized strategies to optimize outcomes. In-vitro maturation of oocytes, an emerging alternative, is gaining traction for increasing live birth rates in selected cases and expert centers. A comprehensive review of the literature was conducted. Articles were selected based on relevance, rigor, and contributions to advancing the management of hyper-responders in assisted reproductive technology. Key findings were synthesized to provide an overview of evidence and emerging trends. Findings suggest a paradigm shift from indiscriminate oocyte retrieval towards achieving a target range, with 15-19 oocytes per cycle correlating with an optimal balance between live birth rates and complication risks. However, challenges remain in predicting ovarian response accurately, particularly in patients with elevated Anti-Müllerian Hormone levels or specific clinical profiles. The variability of ovarian response in these categories underscores the need for individualized protocols, incorporating patient-specific factors of age, Body Mass Index, and ovarian reserve markers. Strategies like tailored gonadotropin dosing and advances in cryopreservation techniques, such as embryo and oocyte vitrification, have shown promise but still require refinement. Future research should aim to refine dosing algorithms, explore genetic contributions, and enhance personalized, patient-centered approaches that prioritize safety, comfort, and improved outcomes in managing hyper-responders.

Introduction: Polycystic ovary syndrome (PCOS) is a heterogeneous endocrine-metabolic syndrome mainly characterized by ovarian dysfunction, which is only one manifestation of a more complex syndrome with a significant systemic impact.

Evidence acquisition: We review scientific literature on the pathophysiology and diagnosis of PCOS evaluating the most relevant data from original articles, reviews and meta-analyses published until June 2024.

Evidence synthesis: From a pathophysiological point of view, the concurrence of both metabolic aspects, such as insulin resistance and obesity, and hormonal alterations, such as hyperandrogenemia, might produce the most relevant clinical signs and/symptoms of this syndrome, for instance menstrual irregularities, hair loss, acne and hirsutism. In the latest years, many pieces of evidence highlighted the importance of family history and genetics in the development of the syndrome during adolescence and adult life. According to the available data, hypovitaminosis D could play a detrimental role in the pathogenesis and clinical manifestations of PCOS.

Conclusions: PCOS is a challenging endocrine and metabolic dysfunction, due to its different expression among women and to the difficulty in obtaining an accurate diagnosis. The most appropriate approach to women affected by PCOS should involve a multi-step strategy, taking into account the characteristics of each patient, in order to identify the best non-pharmacologic and pharmacologic approach to manage both short- and medium-, and long-term sequelae.

Episiotomy is a common surgical procedure during childbirth that involves incising the woman's perineum to facilitate the passage of the fetus. This procedure is used to speed up the delivery, but only in emergencies. It has been reported that explicit consent is unnecessary when the woman in labor is subresponsive or unresponsive. This manuscript analyzes and describes ethical issues regarding the need for explicit consent to use this procedure. The analysis has been made from two perspectives: applying the principlist approach, a system of biomedical ethics that uses the four bioethical principles formulated by Childress and Beauchamp and the principle of vulnerability in its complex relationship with the concepts of dependence and care as articulated in the Barcelona Declaration of 1998. Based on our analysis, we conclude that explicit consent is a fundamental prerequisite in medical practice that should always be sought, even in complex situations such as performing an episiotomy. A table reporting recommendations to enhance communication with the woman throughout the prenatal phase and during labor has also been provided to improve informed consent processes and ensure more effective patient engagement and decision-making.

Introduction: Polycystic ovary syndrome (PCOS) is a multifactorial endocrine-metabolic disease that requires pharmacological and non-pharmacological treatments. The aim of this paper is to review the major evidence about current lifestyle and dietary approaches to manage this syndrome.

Evidence acquisition: We include in our research the most relevant publications about lifestyle and diet in PCOS published between 1995 and 2025.

Evidence synthesis: According to the most recent recommendations, regular physical activity is crucial to ameliorate hormonal and metabolic parameters as well as to maintain and/or reduce weight in PCOS women. As for the foods, although there is not agreement on a specific diet, low-glycemic index nutrients associated with high fiber intake should be generally preferred in hyperinsulinemic patients.

Conclusions: In conclusion, suggestions about lifestyle and diet should represent a cornerstone of the personalized multi-step therapy of PCOS.

Introduction: Polycystic ovary syndrome (PCOS) is a common endocrine disorder affecting reproductive-aged women, which is associated with a significantly higher risk of developing cardiometabolic abnormalities. The present review is aimed to understand the different mechanism related to the cardiometabolic alteration of women with PCOS.

Evidence acquisition: A literature search was made on terms encompassing PCOS, hyperandrogenism, obesity, lipid metabolism, insulin resistance, inflammation, oxidative stress, gut microbiota, cardiovascular event, and mortality.

Evidence synthesis: Hyperandrogenism is the key signature of women with PCOS. Androgens by reducing the intracellular signal of insulin, induce an insulin resistance that is compensated by hyperinsulinemia. Hyperinsulinemia and insulin resistance are the key determinants of the metabolic syndrome and therefore of the cardiovascular risk. Obesity, oxidative stress and chronic inflammation further increase insulin resistance and represent adjunctive pejorative risk factors. Modification of gut microbiota is common in women with PCOS, and it is consequent to hyperandrogenism and obesity. Gut dysbiosis contributes to induce metabolic alterations. In women with PCOS the cardiovascular risk depends upon syndrome manifestation. The risk is maximal in hyperandrogenic obese anovulatory women, milder in hyperandrogenic non obese women, and is not increased in non-hyperandrogenic PCOS women.

Conclusions: Among PCOS women, phenotypes characterized by hyperandrogenism, anovulation and obesity are at high risk of cardiometabolic alterations. In general, a careful investigation on the presence of cardiovascular risk factors, and the use of appropriate remedies to reduce them, is useful in all PCOS women with hyperandrogenism, and in particular in those with associated anovulation and obesity.