Minerva obstetrics and gynecology最新文献

Background: Supracervical hysterectomy (SCH), commonly performed during sacrocolpopexy, involves removal of the uterine corpus, leaving the cervix in-situ. Significant anatomic variation exists in remnant tissue, which may develop into a uterine malignancy. No prior studies have sought to describe the future risk of developing de novo uterine cancer after SCH with benign pathology. This study aims to describe the incidence rate of uterine cancer following SCH performed for benign indication.

Methods: Retrospective cohort study of patients who underwent SCH between June 2000 and December 2022 using the Premier Healthcare Database. Demographics and covariates were compared between patients who did and did not develop malignancy. Primary outcome was incidence rate of uterine cancer after benign SCH. Kaplan-Meier estimates were used to assess uterine cancer risk following SCH.

Results: Among 25,126 benign SCHs, 92 patients (0.37%) were found to have incidental malignancy at the time of hysterectomy, and 35 (0.14%) patients subsequently developed de novo malignancy despite benign pathology at index surgery with an incidence rate of 0.44 per 1000 person-years (95% CI 0.31-0.61). Patients with uterine cancer were older (54.7 vs. 48.8 years, P<0.001) with lower rates of pelvic organ prolapse (17.3% vs. 35.7%, P<0.001) and higher rates of postmenopausal bleeding (19.7% vs. 3.0%, P<0.001), endometrial hyperplasia (11.2% vs. 1.2%, P<0.001), and cervical abnormalities (16.5% vs. 5.6%, P<0.001).

Conclusions: Incidence of incidental and de novo uterine cancer after benign supracervical hysterectomy are low, occurring in 0.51% of patients, and can augment counseling regarding hysterectomy approach.

Background: Luteal phase E2 priming is commonly used in patients with DOR to 30 synchronize follicular development before controlled ovarian hyperstimulation (COH). Some protocols 31 incorporate a GnRH antagonist during the luteal phase to further suppress endogenous gonadotropins, 32 though data on its added benefit are limited.

Methods: This retrospective cohort study analyzed 1555 IVF cycles from 1212 patients with AMH <1 ng/mL undergoing COH for oocyte cryopreservation or IVF with PGT-A between 2012 and 2024 at an urban academic center. Patients received either luteal E2 priming alone (Group A, N.=280) or with a GnRH antagonist (Group B, N.=932). The primary outcome was the number of mature oocytes retrieved. Secondary outcomes included total oocytes, cycle cancellation, fertilization, blastocyst conversion, high-quality blastocysts, euploidy, implantation, clinical pregnancy, and live birth.

Results: Baseline characteristics were similar between groups. No significant differences were observed in median total (6 [4-9] vs. 6 [4-9]) or mature oocytes retrieved (4 [3-6] vs. 5 [3-7]) between Group A and Group B. Fertilization rates, blastocyst development, quality, and euploidy outcomes were also comparable. Among 227 patients who underwent single euploid embryo transfer, implantation, clinical pregnancy, and live birth rates did not differ significantly between groups.

Conclusions: The addition of a GnRH antagonist to luteal E2 priming did not improve oocyte yield or IVF outcomes in patients with DOR. Given similar efficacy and potential cost savings, luteal E2 priming alone may be a sufficient approach. Prospective trials are needed to validate these findings.

Background: It is known that 17-beta estradiol, administered in the postmenopausal period, is able to positively influence blood glucose concentration, as well as the incidence of DM over time. Postmenopausal hypertensive women are a group of patients at high risk of developing diabetes mellitus. The aim of this prospective matched cohort study was to evaluate whether estrogen influences the glycometabolic profile also in postmenopausal hypertensive women.

Methods: The present study selected hypertensive postmenopausal women, treated with 17-beta estradiol administered transdermally at a dose of 50 µg per 24 hours. Hypertensive patients who were never treated with hormones served as control group.

Results: We compared HbA1c among 1418 postmenopausal hypertensive women: 709 treated with 17-beta estradiol, and 709 age-matched never treated with hormones. Length of the follow-up resulted in a median time of 4.5 years (25^th-75^th percentiles=3.0-5.5 years). At baseline, the concentration of HbA1c was 5.6% in both groups. HbA1c (mean±SEM) was significantly lower at 6-months in patients treated with 17-beta estradiol (5.0±0.05%) compared with no-hormones group (5.5±0.04%); absolute decline from baseline was -0.6±0.06% with 17-beta-estradiol, compared with -0.1±0.04% (P<0.0001). New-onset DM was significantly reduced in the group of 17-beta estradiol (adjusted relative risk=2.04; 95%CI: 1.03-3.05; P=0.01).

Conclusions: 17-beta estradiol significantly improved HbA1c and reduced the long-term incidence of new-onset diabetes mellitus in the postmenopausal hypertensive population.

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: Endometriosis is an inflammatory disorder characterized by ectopic endometrial-like tissue, affecting approximately 10% of women. It significantly impairs quality of life through symptoms such as dysmenorrhea, pelvic pain, and infertility. Conventional treatments often inadequately manage the complex pain associated with the disease. Complementary, alternative, and integrative medicine (CAIM) approaches are proposed as supplementary strategies addressing broader symptomatology.

Evidence acquisition: This scoping review employed a comprehensive search of PubMed and PsycINFO databases from inception through April 25^th, 2025. Studies assessing CAIM treatments on endometriosis-associated pain or quality of life were included. Screening and data extraction were performed independently by multiple reviewers, following PRISMA-ScR guidelines.

Evidence synthesis: A total of 107 studies across diverse CAIM domains were analyzed, including acupuncture, Chinese and natural medicine, nutritional supplements, physical therapy, dietary interventions, relaxation techniques, psychotherapy, and combined therapies. Acupuncture, Chinese and natural medicine, and nutritional supplements had the most substantial evidence base, featuring randomized controlled trials and meta-analyses indicating significant pain relief and quality of life improvements. However, significant heterogeneity in study designs, diagnosis confirmation methods, intervention specifics, and outcome measures limited direct comparability and generalizability.

Conclusions: CAIM therapies demonstrate potential as adjunctive treatments for endometriosis-associated pain and quality of life enhancement. Future research should examine additive benefits of CAIM therapies combined with conventional treatments, supporting integrative care addressing endometriosis-related pain, sensitization, mental health, inflammation, and myofascial dysfunction.

Introduction: Artificial intelligence (AI) is revolutionizing healthcare by enhancing diagnostics, optimizing treatment plans, and improving patient outcomes through data analysis and predictive modeling. Within the field of reproductive endocrinology and infertility, machine learning algorithms trained on large datasets can analyze images, laboratory results, and genetic information to optimize in vitro fertilization outcomes.

Evidence acquisition: A comprehensive search of the electronic databases PubMeD and MEDLINE was conducted, and search results were narrowed to publications after the year 2020 yielding 54 publications included in this review; select seminal publications from before the year 2020 were also included.

Evidence synthesis: This review summarizes the most recent evidence demonstrating the design, implementation, and validation of AI in assisted reproductive technologies. The summarized findings are categorized by application of AI to the embryology laboratory and to clinical workflows as well as highlighting ethical concerns regarding the use of such tools.

Conclusions: AI-powered tools have been deployed in fertility clinics and embryology laboratories to enhance gamete selection and as drivers of quality improvement. Despite the promise of AI, challenges such as data bias, ethical concerns, and regulatory hurdles persist. As AI continues to evolve, its integration into reproductive medicine holds the potential to improve success rates and expand the accessibility of infertility treatments.

Background: This study aimed to confirm the association between hypertension and the onset of menopause in Koreans.

Methods: For this retrospective cross-sectional study, data for women aged 40 to 80 years with natural menopause were extracted using the Korea National Health and Nutrition Examination Survey (IV~VIII) (2007~2019). Women with hypertension before menopause were included in the case group, and women without hypertension before menopause were included in the control group. The relationship between hypertension and onset of menopause was evaluated through multivariate linear regression analysis.

Results: Of the 105,732 participants, we selected 23,441 women aged 40 to 80 years who had no history of cancer and had undergone natural menopause. This cohort comprised 16,839 women without a history of hypertension and 6,602 women with hypertension. The median age at menopause was 52 [50; 54] and 50 [47; 52] years in the hypertension and control groups, respectively. Hypertension (Beta coefficient [BC]±standard error [SE], 1.93±0.13) increased menopausal age. In the subgroup analysis, there was no significant difference in menopausal age according to the gap between menopausal age and age at hypertension diagnosis.

Conclusions: This study found an association between hypertension and the onset of menopause, such that women diagnosed with hypertension before menopause had a higher menopausal age. However, the timing of the diagnosis of hypertension was not related to the onset age of menopause.

Background: Different gonadotropins (Gn) have been developed to stimulate the ovaries as part of in-vitro fertilization (IVF). Studies comparing these formulations in poor responders are limited. The objective of this study was to evaluate clinical outcomes comparing follitropin-δ to follitropin-α in expected poor responders.

Methods: Retrospective analysis of IVF cycles in expected poor responders, identified based on the POSEIDON criteria (women with low ovarian reserve - POSEIDON groups 3 and 4) that reached the oocyte collection between January 2020 to December 2022. Clinical outcomes were compared between those using follitropin-δ or follitropin-α and a sub analysis based on POSEIDON subgroup was performed. Chi-square, Student's t-test, and Mann-Whitney Test were used.

Results: In total, 279 cycles were included. While those using follitropin-δ (N.=49) compared to follitropin-α (N.=230) had more oocytes collected (P=0.002), the number of good quality embryos was similar and clinical outcomes including fresh (24.5% vs. 18.2%, P=0.31) and cumulative live birth rate (30.6% vs. 23.0%, P=0.26) were comparable. Among POSEIDON 3 patients utilizing follitropin-δ, while the number of good quality embryos was higher (P=0.04), pregnancy outcomes were comparable. Among POSEIDON 4 patients using follitropin-δ, there were more MII oocytes (P<0.001) and embryos (P=0.007), however pregnancy outcomes were comparable.

Conclusions: The treatment of poor responders is often challenging. Among POSEIDON 3-4 patients undergoing IVF, follitropin-δ appears to result in similar pregnancy outcomes as follitropin-α. Future studies should compare different drug doses and the potential benefits of combination regimens in these well-defined poor ovarian response patients.