Fertility and sterility最新文献

{"title":"The role of hysteroscopy in patients with adenomyosis and infertility: bringing out the submerged.","authors":"Attilio Di Spiezio Sardo, Giuseppe Gabriele Iorio, Serena Guerra, Keith Isaacson, Dimitrios Kafetzis, Alessandro Conforti, Maria Chiara De Angelis, Brunella Zizolfi, Carlo Alviggi","doi":"10.1016/j.fertnstert.2025.02.003","DOIUrl":"10.1016/j.fertnstert.2025.02.003","url":null,"abstract":"<p><strong>Objective: </strong>To describe how hysteroscopic treatment of adenomyotic cystic lesions of the inner myometrium (IM), persisting after pharmacologic treatment, can improve reproductive outcomes in patients with multiple in vitro fertilization (IVF) failures.</p><p><strong>Design: </strong>Video case series demonstrating the infertility workup and the hysteroscopic treatment of adenomyotic cystic lesions of the IM in patients with infertility with multiple IVF failures.</p><p><strong>Setting: </strong>University tertiary care hospital-Fertility Center.</p><p><strong>Patient(s): </strong>Out of a large experience of patients with infertility and IM/junctional zone cystic adenomyosis undergoing IVF in the Fertility Center of our university hospital, we selected 3 patients for this case series. All 3 patients had a personal history of repeated implantation failure and sonographic evidence of adenomyosis (myometrial cysts).</p><p><strong>Exposure: </strong>Patients underwent initial pelvic 2-dimensional and 3-dimensional sonographic assessment, according to the protocol of the Fertility Center of our university hospital. All patients were diagnosed with adenomyosis (myometrial cysts). The patients were treated with gonadotropin-releasing hormone (GnRH) agonists 3.75 mg for at least 2 months to achieve hypoestrogenism (serum estradiol level, <40 pg/mL) and lesions shrinkage. If hypoestrogenism was not achieved, letrozole 2.5 mg/daily was added. In case of lesions persistence at ultrasound (i.e., cysts refractory to pharmacologic treatment), patients underwent hysteroscopy, and identified lesions were treated under sonographic guidance. One month after hysteroscopy, embryo transfer was performed.</p><p><strong>Main outcome measure(s): </strong>Achievement of pregnancy in women with infertility with multiple IVF failures and adenomyotic cystic lesions, undergoing medical and surgical treatment for adenomyosis.</p><p><strong>Result(s): </strong>Not all cystic adenomyotic lesions of the IM regress after hypothalamic-pituitary-ovarian axis-suppressive treatment (GnRH agonist). When GnRH agonist treatment is not sufficient to achieve satisfactory hypoestrogenism, letrozole is an effective add-on. In cases of refractory lesions at ultrasound, hysteroscopic treatment can improve reproductive outcomes. Patients undergoing combined hysteroscopic and medical treatment achieved pregnancy.</p><p><strong>Conclusion(s): </strong>The optimal management of adenomyotic cystic lesions in patients undergoing IVF is debated. This case series suggests the usefulness of hysteroscopic treatment of adenomyotic cystic lesions persistent after medical therapy, in patients with infertility with a personal history of multiple IVF failures. We propose a combined medical and surgical treatment strategy. Further studies are required to validate the proposed protocol.</p>","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143381979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Standardization of robot-assisted living donor hysterectomy for uterus transplantation.","authors":"Masato Tamate, Laura Divine, Giuliano Testa, Liza Johannesson","doi":"10.1016/j.fertnstert.2025.02.006","DOIUrl":"10.1016/j.fertnstert.2025.02.006","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;To present a standardized surgical technique of robot-assisted living donor hysterectomy for uterus transplantation with preservation of the donor ovaries.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Step-by-step description of surgical technique and live-action narrated surgical footage showing uterus donor hysterectomy.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Subjects: &lt;/strong&gt;Nineteen robot-assisted living donor hysterectomies for uterus transplantation have been performed at Baylor University Medical Center at Dallas (September 2024). This video shows the surgical procedure in a 33-year-old previously healthy woman. She had a history of a unilateral laparoscopic ovarian cystectomy, and her obstetric history included three term vaginal deliveries. She independently contacted our institution expressing interest in becoming a nondirected uterus donor and underwent comprehensive evaluation by a multidisciplinary transplant team, including medical and psychological assessment for suitability to donate. She explicitly stated desire for no further children.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Intervention: &lt;/strong&gt;Robot-assisted living donor hysterectomy using the da Vinci Xi robotic system. Surgery was performed with the patient in Trendelenburg position (15°), using CO&lt;sub&gt;2&lt;/sub&gt; pneumoperitoneum (&lt;12 mm Hg), with a four robotic-arm arrangement. Ureteric stents were placed bilaterally, and indocyanine green was injected retrograde to facilitate ureter identification using firefly mode during dissection. Retraction of the uterus was performed with a uterine manipulator. The operative steps performed were as follows: ligation of the round ligaments and exposure of the retroperitoneal space; dissection of the superior uterine veins; dissection of the uterine arteries and the inferior uterine veins; dissection of the ureters, bladder, and rectum; vaginotomy and transection of the vessels; transvaginal uterine graft extraction using a Endo Catch retrieval system and closure of the vaginal cuff. Anatomical terms are used in the video and narration with reference to common gynecological practice. After removal of the uterus from the donor, the uterus was placed on ice on the back-table and flushed with cool preservation fluid. The back-table is a sterile area used in transplantation surgery where the organ is prepared for transplantation. Preparation includes trimming and potential reconstruction of the vessels that will be used. It is on the back-table where the final decision to go ahead with the transplant surgery is made by the uterus transplant team. The back-table procedure and implantation surgery can be seen in separate videos.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Main outcome measures: &lt;/strong&gt;Hospital stay, perioperative and long-term complications, uterine graft viability, and recipient pregnancy outcome.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;No surgical complications occurred. The postoperative course was uneventful, with early mobilization. The length of hospital stay was 2 days. At a 1-year fol","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143381972","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Can we please connect the dots on climate and health?","authors":"Micaela Stevenson Wyszewianski, Ruben Alvero","doi":"10.1016/j.fertnstert.2025.02.002","DOIUrl":"10.1016/j.fertnstert.2025.02.002","url":null,"abstract":"","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-02-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143374051","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A commentary on: “Preovulation body mass index and pregnancy after first frozen embryo transfer in patients with polycystic ovary syndrome and insulin resistance”","authors":"Mei Yang ,&nbsp;Jiahe Wu ,&nbsp;Xinyue Zhang","doi":"10.1016/j.fertnstert.2024.09.040","DOIUrl":"10.1016/j.fertnstert.2024.09.040","url":null,"abstract":"","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":"123 2","pages":"Page 379"},"PeriodicalIF":6.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142344454","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Noninvasive neovagina creation using vaginal dilation therapy in ninety-seven patients with Mayer-Rokitansky-Küster-Hauser syndrome","authors":"Na Chen M.D. ,&nbsp;Jiali Duan M.D. ,&nbsp;Qianqian Gao M.D. ,&nbsp;Roujie Huang M.M. ,&nbsp;Jia Kang M.D. ,&nbsp;Shuang Song M.D. ,&nbsp;Xia Liu M.M. ,&nbsp;Xiangyu Gu B.S. ,&nbsp;Lei Li M.D. ,&nbsp;Ran Chen M.D. ,&nbsp;Shan Deng M.D. ,&nbsp;Lan Zhu M.D.","doi":"10.1016/j.fertnstert.2024.09.048","DOIUrl":"10.1016/j.fertnstert.2024.09.048","url":null,"abstract":"","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":"123 2","pages":"Pages 364-366"},"PeriodicalIF":6.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142377836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Early embryo ontogeny and parental genetic legacy: from developmental mechanisms to diagnosis and treatment","authors":"Giovanni Coticchio Ph.D. ,&nbsp;Danilo Cimadomo Ph.D. ,&nbsp;Antonio Capalbo Ph.D. ,&nbsp;Laura Rienzi B.Sc., M.Sc.","doi":"10.1016/j.fertnstert.2024.10.043","DOIUrl":"10.1016/j.fertnstert.2024.10.043","url":null,"abstract":"","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":"123 2","pages":"Pages 208-210"},"PeriodicalIF":6.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142617712","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reply of the authors: from breast cancer to fertility outcomes: increasing understanding of urgent fertility preservation","authors":"Maëliss Peigné M.D., Ph.D. ,&nbsp;Michaël Grynberg M.D., Ph.D. ,&nbsp;Charlotte Sonigo M.D., Ph.D.","doi":"10.1016/j.fertnstert.2024.10.013","DOIUrl":"10.1016/j.fertnstert.2024.10.013","url":null,"abstract":"","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":"123 2","pages":"Page 376"},"PeriodicalIF":6.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142461574","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"(Not) My body, my choice?","authors":"Eve C. Feinberg M.D.","doi":"10.1016/j.fertnstert.2024.11.012","DOIUrl":"10.1016/j.fertnstert.2024.11.012","url":null,"abstract":"","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":"123 2","pages":"Pages 199-200"},"PeriodicalIF":6.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142827697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evidence-based guideline: Premature Ovarian Insufficiency† ‡","authors":"Nick Panay ,&nbsp;Richard A. Anderson ,&nbsp;Amy Bennie ,&nbsp;Marcelle Cedars ,&nbsp;Melanie Davies ,&nbsp;Carolyn Ee ,&nbsp;Claus H. Gravholt ,&nbsp;Sophia Kalantaridou ,&nbsp;Amanda Kallen ,&nbsp;Kimberly Q. Kim ,&nbsp;Micheline Misrahi ,&nbsp;Aya Mousa ,&nbsp;Rossella E. Nappi ,&nbsp;Walter A. Rocca ,&nbsp;Xiangyan Ruan ,&nbsp;Helena Teede ,&nbsp;Nathalie Vermeulen","doi":"10.1016/j.fertnstert.2024.11.007","DOIUrl":"10.1016/j.fertnstert.2024.11.007","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Study Question&lt;/h3&gt;&lt;div&gt;How should premature/primary ovarian insufficiency (POI) be diagnosed and managed, based on the best available evidence from published literature?&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Summary Answer&lt;/h3&gt;&lt;div&gt;The current guideline provides 145 recommendations on symptoms, diagnosis, causation, sequelae and treatment of POI.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;What is Known Already&lt;/h3&gt;&lt;div&gt;Premature ovarian insufficiency (POI) presents a significant challenge to women's health, with far-reaching implications, both physically and emotionally. The potential implications include adverse effects on quality of life; fertility; and bone, cardiovascular and cognitive health. Although hormone therapy (HT) can mitigate some of these effects, many questions still remain regarding the optimal management of POI.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Design, Size, Duration&lt;/h3&gt;&lt;div&gt;The guideline was developed according to the structured methodology for development of ESHRE guidelines. Key questions were determined by a group of experts and informed by a scoping survey of women and health care professionals. Literature searches and assessment were then performed. Papers published up to January 30&lt;sup&gt;th&lt;/sup&gt;, 2024, and written in English were included in the guideline. An integrity review was conducted for the randomised controlled trials (RCTs) on POI included in the guideline.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Participants/Materials, Setting, Methods&lt;/h3&gt;&lt;div&gt;Based on the collected evidence, recommendations were formulated and discussed within the guideline development group until consensus was reached. Women with lived experience of POI informed the recommendations in general, and particularly on those on provision of care. A stakeholder review was organised after finalisation of the draft. The final version was approved by the guideline development group and the ESHRE Executive Committee.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Main Results and The Role of Chance&lt;/h3&gt;&lt;div&gt;New data indicate a higher prevalence of POI, 3.5%, than was previously thought. This guideline aims to help health care professionals to apply best practice care for women with POI. The recent update of the POI guideline covers 40 clinical questions on diagnosis of the condition, the different sequelae, including bone, cardiovascular, neurological and sexual function, fertility and general well-being, and treatment options, including hormone therapy. The list of clinical questions was expanded from the previous iteration of the guideline (2015) based on the scoping survey and appreciation of emerging knowledge of POI.&lt;/div&gt;&lt;div&gt;Questions were added on the role of anti-Müllerian hormone (AMH) in the diagnosis of POI, fertility preservation, muscle health, and specific considerations for HT in iatrogenic POI. Additionally, the topic on complementary treatments was extended with specific focus on non-hormonal treatments and lifestyle management options.&lt;/div&gt;&lt;div&gt;Significant changes from the previous 2015 guideline include the recommen","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":"123 2","pages":"Pages 221-236"},"PeriodicalIF":6.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142799986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Predicting a successful match among applicants to reproductive endocrinology and infertility fellowship","authors":"Leigh A. Humphries M.D., M.S.C.E. ,&nbsp;Jeremy Applebaum M.D. ,&nbsp;Monica A. Mainigi M.D. ,&nbsp;Caitlin E. Martin M.D., M.S. ,&nbsp;Divya K. Shah M.D., M.M.E.","doi":"10.1016/j.fertnstert.2024.08.337","DOIUrl":"10.1016/j.fertnstert.2024.08.337","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;To identify independent predictors of a successful match to reproductive endocrinology and infertility (REI) fellowships, and to develop and internally validate a prediction model for REI match results.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Design&lt;/h3&gt;&lt;div&gt;Retrospective cohort study.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Subjects&lt;/h3&gt;&lt;div&gt;Reproductive endocrinology and infertility fellowship applications sent to the University of Pennsylvania from 2019 to 2023 (excluding 2020), which represented nearly all REI applicants nationally according to National Resident Matching Program data.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Exposure&lt;/h3&gt;&lt;div&gt;Demographics, education, training, and academic achievements.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Main Outcome Measure(s)&lt;/h3&gt;&lt;div&gt;Match result, confirmed through online search and communication with program administrators. Univariate analyses identified variables associated with match, which were then included in multivariable models to identify independent predictors. Bootstrapping was used to assess model discrimination and calibration. The final model was integrated into a web-based tool.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Result(s)&lt;/h3&gt;&lt;div&gt;Of 286 applications (99.0% of REI applications to the National Resident Matching Program), 199 (69.6%) resulted in a successful match. In univariate analyses, variables associated with match were younger age, attendance at an allopathic US medical school, United States Medical Licensing Examination (USMLE) and Council on Resident Education in Obstetrics and Gynecology scores, residency rank, residency affiliation with a fellowship, research experiences, first-author publications, abstracts/articles in progress, and poster presentations. In the adjusted model, independent predictors of match included residency affiliation with an REI fellowship (adjusted odds ratio [aOR], 5.43; 2.02–14.64), residency rank (aOR, 1.77; 1.25–2.50), USMLE score (aOR, 1.05; 1.02–1.08), at least one first-author publication (aOR, 2.32; 1.08–4.96), projects in progress (aOR, 1.26; 1.02–1.55), and poster presentations (aOR, 1.07; 1.00–1.15). Attendance at an international medical school was a negative predictor (aOR, 0.32; 0.11–0.88). The model achieved an area under the curve of 0.883, with 88.5% sensitivity and 65.8% specificity. A refined model without USMLE scores maintained strong performance (C-statistic, 0.85; 0.81–0.91; calibration slope, 0.91; 0.72–1.24).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion(s)&lt;/h3&gt;&lt;div&gt;Affiliation with an REI fellowship, residency reputation, and research output strongly predicted match success. Gender, race, and ethnicity were not major predictors, yet underrepresentation of certain racial and ethnic groups limited the power to detect potential differences. Our prediction model correctly classified &gt;75% of candidates’ match results. These findings may help candidates optimize applications and estimate chances of a successful match into REI fellowship, as well as assist programs in critically reviewing their selection criteria ","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":"123 2","pages":"Pages 333-341"},"PeriodicalIF":6.6,"publicationDate":"2025-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142072417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}