Obstetrics and Gynecology Science最新文献

Objective: To investigate 2-year overall survival (OS) after progression in patients with uterine carcinosarcoma (UCS).

Methods: This retrospective descriptive cohort study included patients diagnosed with progressive UCS at all stages, who underwent surgical staging with or without adjuvant therapy between January 2002 and December 2022. Clinicopathological characteristics, including recurrence patterns, were assessed using descriptive statistics, Fisher's exact test, and the chi-squared test. Prognostic factors and OS after progression were analyzed using the Cox proportional hazards model and Kaplan-Meier method, respectively.

Results: Fifty-four patients (mean age, 61 years) were eligible for analysis. During primary treatment, 40 patients underwent optimal surgery, 44 received adjuvant chemotherapy with or without radiotherapy, and 43 developed progressive disease within the first 2 years (median progression-free interval: 10.5 months). Overall, 74.07% of patients developed distant or combined metastases. During salvage treatment, 22 patients received chemotherapy, 11 received a combination of chemotherapy and radiotherapy, and five underwent radiotherapy alone. The median follow-up period was 18 months, with a 2-year OS rate of 20% post-progression. Multivariate analysis revealed that leukocytosis at progression was associated with decreased survival (hazard ratio [HR], 5.98; 95% confidence interval [CI], 2.33-15.3; P<0.001). Notably, optimal primary surgery (HR, 0.31; 95% CI, 0.13-0.72; P=0.006) and chemoradiotherapy as salvage treatment (HR, 0.23; 95% CI, 0.08-0.7; P=0.009) significantly improved survival.

Conclusion: Patients with progressive UCS have poor OS. Optimal surgery as primary treatment combined with salvage chemoradiotherapy improves post-progression survival. Leukocytosis during disease progression significantly affects survival outcomes.

Objective: To assess the impact of time since treatment on the quality of life (QOL), neurotoxicity, sexual function, lymphedema, and utility in ovarian cancer survivors.

Methods: This secondary analysis of a cross-sectional study examined the QOL, neurotoxicity, sexual function, lymphedema, and utility in 172 epithelial ovarian cancer survivors treated with first-line platinum-based chemotherapy without recurrence. Associations between time since treatment and overall QOL (National Comprehensive Cancer Network/functional assessment of cancer therapy ovarian symptom index-18 [NFOSI-18]), neurotoxicity (neurotoxicity subscale, version-4 [NTX-4]), sexual function (female sexual function index, 6-item Korean version [FSFI-6K]), lymphedema (gynecologic cancer lymphedema questionnaire [GCLQ]), and utility (EuroQol 5-dimension [EQ-5D]) were visualized using jittered box plots.

Results: Overall QOL (NFOSI-18) improved up to 3 years post-treatment (scores: 29.3 at 1 year, 28.6 at 2 years, and 26.6 at 3 years), followed by minor fluctuations over time. NTX-4 scores improved until 5 years (8.2, 7.7, 6.2, and 5.8), but remained above normal (score 0). Sexual function (FSFI-6K) increased until 3 years of age (4.6, 6.9, and 10.4 years), stabilizing at a level indicative of dysfunction (score <21). The lymphedema (GCLQ) scores fluctuated over time (4.9, 5.6, 3.3, 4.3, 5.2, and 3.8). Utility (EQ-5D index) improved up to 3 years (0.8250, 0.885, and 0.925), whereas the EQ-5D visual analog scale score increased gradually up to 5 years (71.5, 72, 73, 76, and 74), indicating ongoing recovery.

Conclusion: In ovarian cancer survivors, QOL, symptom burden, and utility gradually improved over time post-treatment but did not fully return to pre-treatment levels.

Objective: This study aimed to assess the beliefs, barriers, and attitudes towards oocyte cryopreservation in Jordanian females. Understanding these aspects in our region can help healthcare providers identify similarities and differences compared to other geographic areas, which could facilitate a proper approach and informed counseling.

Methods: We conducted a cross-sectional online survey using Google® forms (Google, Mountain View, CA, USA). The questions were designed to target a convenience sample of single women (never married, divorced, or widowed) aged 18-64 years in Jordan. Of the 400 women approached, 345 completed the questionnaire voluntarily. Responses were collected and analyzed using the software program SPSS® 23.0 (IBM, Armonk, NY, USA).

Results: The.

Results: highlight notable deficiencies in women's understanding of the expenses, procedures, and success rates of oocyte freezing as a feasible method for fertility preservation. Most participants stated that the main barriers to oocyte cryopreservation were cost (87.5%), future husband rejection (76.8%), and social exclusion (72.2%). However, a significant number of participants admitted that this procedure would encourage late marriage and increase the chance of pregnancy in cases of late marriage and fertility problems.

Conclusion: Women in this study had poor knowledge, but generally had positive attitudes toward oocyte cryopreservation. Educational campaigns are warranted to enhance knowledge and positive attitudes.

Objective: Polycystic ovary syndrome (PCOS) is a gynecological, endocrine condition characterized by ovulatory disorders, clinical or biochemical hyperandrogenism, and polycystic ovarian morphology. PCOS has significant metabolic and reproductive implications that affect the quality of life of women. This PCOS guideline summary is based on the Indonesian Reproductive Endocrinology and Fertility Association guidelines for PCOS. This guideline is expected to guide the diagnosis and long-term management of PCOS.

Methods: We searched scientific evidence on the Cochrane and PubMed databases using the keyword "polycystic ovary syndrome". This evidence was reviewed by experts in the field of obstetrics and gynecology, and recommendations were made based on scientific evidence while considering patient values, costs, and resources.

Results: A total of 127 recommendations and practice points were made regarding the diagnosis and management of PCOS. The levels of available health services and management algorithms for PCOS in Indonesia are also included.

Conclusion: The first-line treatment for managing hyperandrogenism and menstrual disorders in patients with PCOS is combined oral contraceptives. The first-line treatment for ovulation induction is letrozole, while clomiphene citrate, metformin, gonadotropins, and ovarian surgery serve as the second-line treatment. The third-line treatments included in vitro fertilization, with or without in vitro maturation.

Objective: The World Health Organization recognized infertility as a disease and emphasized universal access to high-quality treatment. Nevertheless, inequality and inequity in infertility care are pervasive in Morocco, access to care is hindered by multiple potential barriers delaying treatment seeking and management. This study aimed to explore factors and barriers to assisted reproductive technology (ART) among infertile women in Morocco.

Methods: This is a cross-sectional analytical study relies on prospective data collected through a standardized questionnaire, was carried out in January-June 2023. The target population concerned 110 infertile women attending a private clinic in Morocco.

Results: Women who experienced infertility in Morrocco have demonstrated several barriers including: cost and lack of financial means (90%) and distance from fertility care (80%). On bivariate analysis findings suggest there are multifactorial factors that influence access to ART: the age, marriage span, monthly household income, duration of infertility, and education level and profession. On multivariable logistic analysis, age over 35 years old (odds ratio [OR], 3.36; 95% confidence interval [CI], 1.07-10.65; P=0.004) and the duration of infertility over 10 years (OR, 5.59; 95% CI, 1.24-25.24; P=0.003) remained significantly associated with women who had undergone ART.

Conclusion: This study has demonstrated that infertile women confront economic barriers, social pressure, and constraints related to health systems. Women over the age of 35 with the duration of infertility exceeding 10 years are certainly making more considerable economic efforts to access ART. Policy-makers must to take into account these barriers and factors to ensure efficient access to ART.

Objective: This study aimed to systematically evaluate potential causal relationships between nine cathepsins and female infertility using Mendelian randomization (MR).

Methods: .

Methods: A bidirectional MR analysis was conducted utilizing single nucleotide polymorphisms as instrumental variables to investigate the potential causal effects between nine cathepsins and female infertility. Genetic data on female infertility were sourced from the FinnGen study, and cathepsin-related data were obtained from genome-wide association studies datasets of European ancestry.

Results: Elevated levels of cathepsin E were significantly and inversely associated with the risk of female infertility, suggesting a potential protective role. This finding was further supported by multivariable MR analysis. However, no significant associations were observed between the other eight cathepsins and female infertility.

Conclusion: This study represents the first systematic MR analysis to identify a potential protective effect of cathepsin E on female infertility.

Objective: To analyze the relationship between pelvic organ prolapse (POP) and menopausal hormone therapy (MHT).

Methods: This retrospective cohort study used Korean National Health checkup and insurance data from 2002 to 2019. Women who used MHT for more than 6 months between 2002 and 2011 were included in the MHT group; postmenopausal women with no MHT use comprised the non-MHT group.

Results: In the non-MHT group, there were 1,001,350 women, while the MHT group had 353,206 women. Tibolone (adjusted hazard ratio [aHR], 0.87; 99% confidence interval [CI], 0.818-0.926) and combined estrogen plus progestin by the manufacturer (CEPM) (aHR, 0.821; 99% CI, 0.758-0.89) were associated with reduced POP risk. The other oral MHT groups and the transdermal estrogen group showed no significant difference in POP risk compared with the non-MHT group (other oral MHT: aHR, 1.045; 99% CI, 0.941-1.161) (transdermal estrogen: aHR, 1.252; 99% CI, 0.731-2.145). Lower body mass index (BMI) (<18.5) was associated with reduced POP risk (aHR, 0.822; 99% CI, 0.698-0.968), while a BMI between 23 and 29.9 was associated with increased risk (BMI 23-24.9: aHR, 1.143; 99% CI, 1.088-1.2) (BMI 25-29.9: aHR, 1.173; 99% CI, 1.12-1.228). All parities had a higher POP risk than parity 1 (parity 0 or no response: aHR, 1.785; 99% CI, 1.589-2.005; parity 2: aHR, 1.434; 99% CI, 1.292-1.592; parity ≥3: aHR, 1.916; 99% CI, 1.712-2.144).

Conclusion: Tibolone and CEPM use were associated with reduced POP risk in postmenopausal women. Other MHT types showed no significant association with POP.

Objective: The objective of our study was to characterize the sperm parameters of men consulting for infertility in our fertility center.

Methods: The study included 3,025 patients investigated from September 2021 to July 2023. Demographic data, infertility risk factors, and the primary or secondary nature of infertility were recorded for each patient. The sperm parameters were analyzed according to World Health Organization (WHO) criteria (2021).

Results: The average age of the patients was 40 years. The average duration of infertility was 5.5 years. Primary infertility was noted in 2,736 patients (88.97%). The most common risk factors for infertility were occupational exposure, followed by varicocele. Lifestyle factors associated with male infertility included smoking (24.29%), alcohol consumption (12.49%), and high temperature exposure (30.08%). Spermogram abnormalities were observed in 78.71% of cases. Spermocytogram abnormalities were found in 63.1% of cases. Sperm count, morphology, total motility, and vitality below WHO (2021) reference values were found in 25.60%, 34.13%, 32.29%, and 62.46% of the analyzed samples, respectively. Seminal fluid analysis revealed oligozoospermia in 29.07% of cases, asthenozoospermia in 24.68%, and azoospermia in 17.56%. Oligo-astheno-necrospermia was the most frequently observed combined abnormality (10.0%).

Conclusion: This study showed a high rate of abnormal semen quality in male partners of infertile couples. Male infertility is often multifactorial and results in quantitative and/or qualitative sperm abnormalities.

Hysteroscopy is particularly valuable for the diagnosis of uterine cavity abnormalities through direct visualization. The development of office hysteroscopy has expanded the range of diagnostic and surgical procedures available. These detailed guidelines include patient counseling and the selection and setting of office hysteroscopy, including room, equipment, and medical staff. Analgesia or local anesthesia is often required in selective office hysteroscopy cases. Cervical dilation and preparation using medical or mechanical methods are required for most diagnostic hysteroscopic procedures. Methods for optimizing visualization and choosing suitable distension media are important for a successful office hysteroscopy. It is crucial to adhere to guidelines to prevent complications, such as vasovagal syncope, cervical trauma, uterine perforation, fluid overload, and embolism. Vaginoscopy can be a good alternative option for alleviating pain, especially in cases where the insertion of a vaginal speculum is expected to be challenging.