Minerva obstetrics and gynecology最新文献

Introduction: To date, the application of platelet-rich plasma (PRP) to women in assisted reproductive technologies is a potential therapeutic method that has been developed. This umbrella review is designed to summarize the best evidence regarding the treatment potential of PRP in infertile patients.

Evidence acquisition: A systematic literature search was conducted on the main database (PubMed, the Cochrane Library and Web of Science) for systematic reviews and meta-analyses describing the effect of PRP on fertility outcomes. The retrieved data was extracted, and the quality of the included studies was assessed using the Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR-2) tool.

Evidence synthesis: Seven systematic reviews were finally included. The quality of evidence was high in one review, moderate to low in five, and low in one. In terms of ovarian PRP, antral follicular count (AFC) and the number of retrieved oocytes were shown to have significant differences. Nonetheless, the livebirth rates did not demonstrate a clinically relevant improvement. Concerning endometrial PRP, an improvement in the clinical pregnancy rate both in cases of repeated implantation failure and thin endometrium was suggested; nonetheless, no effect on live birth rates and miscarriage rates was detected. Results of laboratory tests showed transient rises of AMH and fall in FSH with ovarian PRP, but this effect was not consistent over time.

Conclusions: This umbrella review showed that PRP infusion was a potential technique for improving particular reproductive outcomes according to the available literature, particularly on premature ovarian insufficiency, poor ovarian response and recurrent implantation failure patients. However, the overall quality of the studies is low, and future studies should concentrate on more robust methodologies and higher standards of evidence and on the standardization of PRP protocols and the evaluation of both short- and long-term results to establish more clear recommendations for its use in assisted reproductive technologies.

Robotic-assisted surgery (RAS) has revolutionized the treatment of endometrial cancer (EC), providing a less invasive alternative to traditional open methods. In early-stage EC, RAS has shown similar oncological results compared to conventional techniques while offering notable improvements in perioperative outcomes, such as shorter hospital stays, less post-operative pain, and faster recovery times. Additionally, the robotic platform has seen widespread adoption in gynecologic oncology due to its ability to address the limitations of conventional laparoscopy, especially reduced conversion rate from minimally invasive surgery (MIS) to open/laparotomy. This approach is particularly beneficial for high-risk groups, including obese and elderly patients, where it has proven to be both safe and effective, presenting a favorable risk-benefit profile. Furthermore, robotic-assisted sentinel lymph node (SLN) mapping, utilizing the FireFly^® fluorescence imaging system with indocyanine green (ICG) dye, offers exceptional accuracy in detecting SLNs, enhancing the precision of nodal mapping, thereby decreasing the need for more invasive lymphadenectomy and reducing associated morbidity. It is essential to recognize physiological challenges that can arise during RAS, particularly when steep Trendelenburg position combined with pneumoperitoneum (increased intra-abdominal pressure due to CO2 insufflation), can significantly affect both cardiovascular and respiratory systems. Although the upfront costs of robotic surgery are relatively higher, the long-term benefits, such as fewer complications and faster recoveries, make it a cost-effective solution. This review examines current evidence supporting the use of RAS as a standard option for managing patients with EC and its positive impact on their outcomes across diverse risk categories.

Today, the rate of cesarean sections is increasing worldwide. An underlying important phenomenon is cesarean section on maternal request (CSMR). CSMR is an elective cesarean section without medical and/or obstetric indications. The CSMR rate is often unknown but increasing. Women claim their right to choose how to give birth. Forcing a woman to undergo a vaginal delivery can affect not only her physical well-being but also her psychological well-being, and therefore her health. Over the last 20 years, various countries have developed national and international guidelines for the recognition of the woman's right to choose childbirth, although clear guidelines in this direction have not been established. In Italy, the rate of CSMR is about 9% of all cesarean sections, but it is underestimate. In Italy, CSMR is currently contrary to good care practice, so the doctor has no professional obligations and is entitled to refuse the request for a cesarean section. However, the legislation does not explicitly state that the doctor must refuse such a request. As a result, choice is not available to all the women. In a perspective where women claim their right to health, not only physical but also psychological, the need to develop informed consent for childbirth in general and a guideline on CSMR are unavoidable. This is important both to ensure equal opportunities for all women and to clarify the medical responsibilities and the legal consequences of this choice.

Background: In Italy from 2015 to 2022, couples undergoing ART treatment with gamete donation are steadily increasing. This choice may have a negative impact on their personal and relational well-being. The aim of this study was to explore the emotional experience of couples undergoing gamete donation assisted reproduction treatment (ART).

Methods: An online ad-hoc survey with 25 questions (1 open-ended) was emailed to the physicians in charge of Italian ART centers. Physicians and psychologists invited patients undergoing ART with gamete donation to complete it. The survey ran from May to December 2023.

Results: A total of 256 questionnaires were completed. Among respondents, 87.5% underwent an egg donation cycle, while the remainder used sperm donation or double donation. About 90% reported being informed about psychological support services at the ART center, yet only half attended at least one session. Women more often reported emotions such as "sadness," "fear," and "anger," while men expressed more "joy." "Sadness" was more pronounced in individuals trying to conceive for less than 3 years. The emotional complexity of patients emerges from the writings.

Conclusions: Some patients' characteristics appear to influence their emotional state. Being female, not receiving psychological counseling at the ART center, and spending less time attempting to conceive are conditions associated with greater negative emotions toward oneself or one's partner. A thematic qualitative analysis of patient narratives reveals several topics that reflect the emotional complexity of these patients. The emerging results may inspire the design of future psychological interventions focusing on the emotional needs of ART patients undergoing ART treatment with gamete donation.

Introduction: Recurrent implantation failure (RIF) occurs when pregnancy is not achieved after multiple embryo transfers. The lack of standardized diagnostic criteria among clinicians makes RIF a particularly challenging condition, leading to the use of various procedures, including immunological ones, often without robust evidence. This study aims to provide an overview of the main characteristics of existing research on the role of interventions in relation to in vitro fertilization (IVF) outcomes in patients with RIF.

Evidence acquisition: A comprehensive bibliographic search was systematically conducted from inception to November 2024, focusing on studies that evaluated the impact of immunological treatments in RIF cases, comparing IVF outcomes between case and control groups.

Evidence synthesis: A total of 77 studies were included. The diagnostic criteria for RIF were heterogeneous, with only 36 studies (47%) defining RIF as three or more failed embryo transfers. Moreover, the studies generally had small sample sizes.

Conclusions: There is not yet sufficient evidence to support the routine use of immunological interventions in clinical practice for RIF. The existing research is marked by methodological inconsistencies, which limit the reliability and generalizability of the results.

Colposcopy has traditionally played a crucial role in the assessment and management of abnormal cervical cytology and human papillomavirus (HPV) -related lesions. However, with the reduction in high-risk (HR) HPV types due to vaccination, the role of colposcopy in the HPV vaccination era is being questioned. The aim of this narrative review was to highlight the latest evidence from the world of HPV vaccination and the future role of colposcopy in the HPV vaccination era. PubMed, MEDLINE, Scopus, Web of Science were searched for relevant articles up to June 2024. HPV vaccination may influence colposcopic practice by reducing HR-HPV vaccine type, colposcopy referrals, colposcopic positive predictive value for CIN 2+, and by changing referral patterns, colposcopic performance, and procedures. The relative incidence of HPV-negative adenocarcinoma and its precursors may be increasing, presenting a new challenge that may increase the difficulty of colposcopic assessment. The role of colposcopy in the management of cervical abnormalities will vary according to vaccination status, vaccine type and timing of vaccination. As this evolves, colposcopy will need to adapt to provide optimal care tailored to individual risk profiles and to maintain the key role in cervical cancer prevention that it has acquired over the past decades. There will certainly be a need to improve the quality and performance of colposcopy by reducing inter- and intra-observer variability in colposcopic practice, including more objective patient selection, greater knowledge, expertise and skill, with the aim of achieving reproducible, sensitive and less biased assessment of cervical appearance.

Introduction: The diminished ovarian reserve (DOR) relates to a condition in which the ovary experiences a decline in its typical reproductive capacity. Despite notable advancements in understanding the pathophysiology of reduced ovarian reserve in recent years, significant unresolved challenges remain, particularly concerning the optimal therapeutic approaches for this complex condition. The main aim of this study was to investigate the potential of platelet-rich plasma (PRP) in enhancing ovarian follicle numbers by assessing changes in ovarian reserve markers.

Evidence acquisition: A comprehensive literature search was conducted on the following databases: PubMed/MEDLINE, SCOPUS, The Cochrane Library, Science Direct and Web of Science. All the relevant studies published till October 2023 were screened. After removing duplicates, and full-text evaluation, 9 articles were eventually included in the present review.

Evidence synthesis: The pregnancy rate (PR) among patients with poor ovarian reserve (POR) ranged from 13% to 40%, indicating the potential effectiveness of PRP as a rejuvenating treatment. The live birth rate (LBR) ranged from 13% to 20%, comparable to or not lower than the LBR of a matched healthy population aged between 38 and 42 years. Furthermore, the data presented thus far support the notion that PRP may lead to an average clinical PR of 10% in women affected by premature ovarian insufficiency (POI) and perimenopause.

Conclusions: PRP can not be regarded as a gamete replacement therapy, but rather as an 'additional' therapeutic tool in the management of women with DOR or POR, as well as in peri-menopausal women. Additional qualitative studies are required to validate the existing evidence, as the literature currently lacks randomized controlled trials (RCTs) in this regard.

Endometriosis is a chronic gynecological condition which can lead to infertility in women during reproductive age. Endometriosis influences the assisted reproductive technology (ART) outcomes by its impact on oocyte and embryo quality, oocyte numbers and subsequently the embryo numbers and endometrial receptivity. There has been clinical dilemma as to whether it is predominantly the oocyte, or the endometrium which affects the pregnancy outcomes in women with endometriosis. In this review we provide an overview of the effect of endometriosis on the oocyte molecular mechanism, the overall effect of endometriosis and its various stages as well as the effect of endometrioma on the oocyte quality in autologous study models. We have also provided a review of the donor oocyte models to study the effect of endometriosis on the endometrium. While initial small donor oocyte-based model studies suggested a possible major detrimental impact of oocyte quality on ART outcomes in women with endometriosis, the more recent studies have found minimal or no impact of oocyte quality on treatment outcomes. There is growing evidence to suggest an important contributory role of reduced oocyte yield on ART success in women with endometriosis. There is a need to explore whether oocyte yield and not the oocyte quality or endometrial receptivity, is the main reason for lower success in women with endometriosis following ART.