Gynecologic and Obstetric Investigation最新文献

{"title":"The impact endometrial compaction after progesterone administration on pregnancy outcomes in artificial frozen thawed embryo transfer cycles: A prospective cohort study.","authors":"Azadeh Akbari Sene, Tayebe Azadbakht, Mahnaz Ashrafi, Eva Esmael, Fatemehsadat Amjadi, Zahra Zandiyeh, Azar Mohammadzadeh, Arash Mohazzab","doi":"10.1159/000547321","DOIUrl":"https://doi.org/10.1159/000547321","url":null,"abstract":"<p><strong>Objectives: </strong>The primary aim of this study was to association between endometrial compaction and pregnancy outcomes in HRT-FET protocols. The secondary objective was to investigate the correlation between serum progesterone levels and pregnancy success in FET cycles.</p><p><strong>Design: </strong>Prospective cohort study was conducted January- April 2024 Setting: A university-affiliated hospital, Tehran, Iran Participants: Infertile women under 40 years undergoing Hormone Replacement Therapy-Frozen Embryo Transfer (HRT-FET). Patients with uterine and genetic factors were excluded.</p><p><strong>Materials and method: </strong>Data on endometrial thickness and serum progesterone levels were gathered, and patients were divided into groups based on the presence or absence of endometrial compaction using transvaginal sonography. Univariate and multivariate statistical analyses, including logistic regression models, were employed to assess factors associated with pregnancy outcomes.</p><p><strong>Results: </strong>Ninety participants with similar demographic profiles were enrolled in the study. The biochemical and clinical pregnancy rates were higher in the group with endometrial compaction, at 37.3% and 33.3%, respectively, compared to 15.4% in both categories for the group without compaction, with a statistically significant difference in biochemical pregnancy rates (p = 0.022). The live birth rate was also higher in the compaction group (21.6%) compared to the non-compaction group (7.7%), showing a borderline statistical difference in the Chi-square analysis (p = 0.072). No significant difference in serum progesterone levels was observed between patients with and without endometrial compaction.</p><p><strong>Limitations: </strong>While simultaneous evaluation of endometrial compaction and serum progesterone with adjustment for confounders enhanced internal validity, the study's single-center design and limited sample size restricted subgroup analyses and statistical power. Further research with larger cohorts and consideration of progesterone administration routes is needed to confirm and extend these findings.</p><p><strong>Conclusion: </strong>Endometrial compaction on the day of embryo transfer is linked to increased rates of biochemical and clinical pregnancies. This association remains consistent regardless of serum progesterone levels, highlighting the independent influence of endometrial compaction on pregnancy success.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1-14"},"PeriodicalIF":2.0,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144636885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Large Cervical Varices: A Key Risk Factor for Hemorrhage in Placenta Previa.","authors":"Akio Kamiya, Takahiro Yamada, Aya Yoshida, Shuhei Nishibata, Kaede Oku, Mamoru Morikawa, Hidetaka Okada","doi":"10.1159/000547269","DOIUrl":"https://doi.org/10.1159/000547269","url":null,"abstract":"<p><strong>Objectives: </strong>To determine whether the volume of cervical varices, quantified by magnetic resonance imaging (MRI), predicts massive intraoperative blood loss in placenta previa. The secondary objective was to examine the relationship between cervical varices volume and placental location, sponge-like findings on transvaginal ultrasound (TVUS), and active lower uterine segment bleeding.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Participants/materials, setting, methods: </strong>This study included 98 individuals with singleton pregnancies and placenta previa who underwent prenatal MRI and cesarean section (CS) at a tertiary care center in Japan between April 2012 and March 2021. MRI was performed around 34 weeks of gestation as part of routine PAS screening. Cervical varices were defined as high-signal vascular structures located within the cervix and lower uterine segment on sagittal T2-weighted MRI. Their volume was manually calculated as an approximate cervical varices volume (aVCV). Receiver operating characteristic (ROC) analysis was used to determine the optimal aVCV cutoff for predicting massive blood loss (defined as ≥1500 mL). Logistic regression was used to assess independent predictors of bleeding. A subgroup analysis was conducted among patients with posterior placenta previa without placenta accreta spectrum (PAS).</p><p><strong>Results: </strong>Cervical varices were detected by MRI in 94.9% of cases. ROC analysis identified 36.0 cm³ as the optimal aVCV cutoff (AUC: 0.63), with a specificity of 86.2% and positive predictive value of 75.9%. Large cervical varices (aVCV > 36.0 cm³) were significantly associated with massive bleeding (adjusted odds ratio: 9.44; 95% CI: 3.11-28.7). They also correlated with sponge-like findings on TVUS and posterior placental location, but were smaller in cases with anterior placenta or PAS despite high bleeding volumes. Active bleeding from the lower uterine segment was more common in the large aVCV group and was associated with massive hemorrhage in non-PAS cases. In a subgroup of patients with posterior placenta previa without PAS (n = 43), predictive performance improved (AUC: 0.72; specificity: 95.8%; odds ratio: 9.53; 95% CI: 2.19-41.4).</p><p><strong>Conclusions: </strong>Large cervical varices are an independent predictor of massive blood loss in placenta previa, particularly in posterior previa without PAS. Recognition of cervical venous enlargement as a core hemorrhagic risk factor may improve preoperative preparedness and promote broader efforts to refine diagnostic approaches.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1-19"},"PeriodicalIF":2.0,"publicationDate":"2025-07-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144591140","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic Accuracy of MRI Using the #Enzian Classification in Endometriosis: A Single-Center Retrospective Cohort Study.","authors":"Ala Aiob, Dina Gumin, Amirit Luder Stinski, Lior Lowenstein, Avishalom Sharon","doi":"10.1159/000547069","DOIUrl":"https://doi.org/10.1159/000547069","url":null,"abstract":"<p><strong>Objectives: </strong>To evaluate the diagnostic accuracy of pelvic magnetic resonance imaging (MRI) interpreted using the #Enzian classification system by comparing MRI findings with laparoscopic outcomes in women suspected of having endometriosis.</p><p><strong>Design: </strong>Retrospective observational study.</p><p><strong>Participants and setting: </strong>Twenty-four women aged 19 to 49 who underwent laparoscopic surgery for endometriosis at Galilee Medical Center from 2016 to 2023 had preoperative pelvic MRI available.</p><p><strong>Methods: </strong>MRI and laparoscopic findings were classified using the #Enzian classification across 64 anatomical compartments. Diagnostic accuracy was evaluated for lesion location and size. Associations between MRI accuracy and patient characteristics were analyzed using appropriate statistical tests.</p><p><strong>Results: </strong>MRI accurately identified the lesion location in 31.3% of compartments and lesion size in 20.3%. The highest accuracy was found in the tubo-ovarian region (60%), rectovaginal septum (42.9%), and ovaries (41.7%), while the lowest accuracy was observed in the parametrium (7.1%) and compartments C, F, FA, and FB (0%). Higher age, parity, and gastrointestinal symptoms were significantly associated with improved MRI accuracy (p < 0.05).</p><p><strong>Limitations: </strong>The small sample size, retrospective design, and MRI scans from various centers with differing imaging quality and radiologist expertise may restrict generalizability.</p><p><strong>Conclusions: </strong>MRI utilizing the #Enzian classification offers a structured method for evaluating deep infiltrating endometriosis, but it demonstrates limited accuracy for superficial or parametrial disease. While it is useful for surgical planning, MRI cannot substitute for laparoscopy, which remains crucial for a thorough evaluation and treatment of endometriosis.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1-12"},"PeriodicalIF":2.0,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144484088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of Gonadotropin Dose Reduction during Controlled Ovarian Hyperstimulation on Progesterone Levels and Embryo Outcomes in Women Undergoing IVF/ICSI-ET with GnRH-A Protocol.","authors":"Hongmei Xu, Jianwei Huo, Wujian Huang, Guoyong Chen, Lingyun He, Yun Liu","doi":"10.1159/000546691","DOIUrl":"10.1159/000546691","url":null,"abstract":"<p><strong>Objectives: </strong>This study investigates the impact of reduced gonadotropin doses during controlled ovarian hyperstimulation (COH) on progesterone levels in the late follicular phase of IVF/ICSI-ET.</p><p><strong>Design: </strong>This was a retrospective cohort study employing propensity score matching to balance groups. Participants/Materials: This study enrolled infertile patients undergoing IVF/ICSI-ET at the Reproductive Medicine Center of the 900th Hospital from January 2017 to July 2020.</p><p><strong>Setting: </strong>This study was carried out at the Reproductive Medicine Center, 900th Hospital of PLA Joint Logistic Support Force, formerly Fuzhou General Hospital.</p><p><strong>Methods: </strong>A total of 1,380 patients were enrolled; 670 received reduced gonadotropin doses (12.5-75 units/day from days 6 to 8), and 710 underwent routine treatment. The primary outcome measured was progesterone levels on trigger day.</p><p><strong>Results: </strong>Progesterone levels on trigger day were significantly lower in the gonadotropin dose reduction group (1.24 ± 0.51) compared to the control group (1.34 ± 0.53, p < 0.001). The proportion of patients with P ≥1.5 ng/mL was significantly lower in the gonadotropin dose reduction group compared to the control group (22.7% vs. 29.9%, p = 0.003). Multivariable logistic regression indicated that dose reduction decreased the risk of progesterone elevation (OR = 0.535, 95% CI: 0.404-0.709).</p><p><strong>Limitations: </strong>The study is limited by its retrospective design, which may introduce biases.</p><p><strong>Conclusions: </strong>Reducing gonadotropin doses during COH may lower elevated progesterone levels in the late follicular phase, potentially improving embryo outcomes in IVF/ICSI-ET.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1-6"},"PeriodicalIF":2.0,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144484089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Erratum.","authors":"","doi":"10.1159/000546453","DOIUrl":"10.1159/000546453","url":null,"abstract":"","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1"},"PeriodicalIF":2.0,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12178580/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144368814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Are the Morphokinetics of Embryos Obtained from HPV-Positive Sperm Altered? A Retrospective Cohort Study.","authors":"Giorgio Maria Baldini, Daniele Ferri, Dario Lot, Antonio Malvasi, Marco Cerbone, Antonio Simone Laganà, Miriam Dellino, Domenico Baldini, Giuseppe Trojano","doi":"10.1159/000546754","DOIUrl":"10.1159/000546754","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;The objective of the study was to evaluate the impact of male human papillomavirus (HPV) sexually transmitted infection on sperm parameters, embryo morphokinetics, and clinical pregnancy outcomes in assisted reproductive technology (ART) procedures.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;Between 2019 and 2023, 3,360 ART cycles were performed at the private IVF center MOMO' Fertilife (Bisceglie, Italy), including 1,035 first-time cycles. Of the 787 males tested for seminal HPV, 62 tested positive.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;A study group of 57 HPV-positive and a matched control group of 57 HPV-negative males were selected using our clinic management software. Exclusion criteria included female age ≥42, advanced endometriosis, and HPV positivity in both partners.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Participants: &lt;/strong&gt;Couples undergoing homologous ART with only the male partner testing HPV positive were included, while those with both partners positive were excluded. HPV-positive sperm was used without standard preparation, and all semen procedures followed WHO guidelines. All couples enrolled in the study provided written informed consent, which specified that spermatozoa from HPV-positive participants would be used without undergoing standard sperm preparation procedures.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;ICSI was the only ART procedure performed in all cycles included in this study. Semen samples were collected following 3-5 days of abstinence and analyzed within 60 min post-ejaculation. Sperm concentration, motility, and morphology were assessed using phase contrast microscopy. For ICSI procedures in both groups, a standardized \"horizontal swim-up\" technique developed in-house was employed, an alternative method of semen preparation for ICSI developed in our center. Following liquefaction, an aliquot of the semen sample was sent to the virology laboratory, while a duplicate was stored at -80°C. In cases of inconclusive results, reanalysis was conducted using the frozen sample. IVF laboratory personnel were blinded to HPV status. Sperm quality, the morphokinetics of 210 resulting embryos, and pregnancy outcomes were analyzed. Statistical tests included the Student's t test, Shapiro-Wilk test, Mann-Whitney U test, and Chi-square or Fisher's exact tests.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The study found no statistically significant differences in embryo morphokinetics or ART outcomes between HPV-positive and HPV-negative groups. Pregnancy rates (33.3% vs. 31.6%) and first-trimester miscarriage rates (1 case each) were comparable between the two treatment groups, which also presented similar blastocyst transfer timing and transfer of high-quality embryos. Sperm parameters showed no clinically relevant variation.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;The retrospective cohort design and limited sample size represent study limitations. Furthermore, the absence of data on potentially relevant confounders constrains the analysis. Specifically, abort","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1-11"},"PeriodicalIF":2.0,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144325481","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mechanisms of KLF10 in Regulating Proliferation of Endometriotic Stromal Cells in Endometriosis.","authors":"Boyao Xia, Yang Liu, Jing Li, Shan Jiang","doi":"10.1159/000546836","DOIUrl":"10.1159/000546836","url":null,"abstract":"<p><strong>Objectives: </strong>Endometriotic stromal cells (ESCs) are extensively found in endometriosis (EM). This study aims to investigate the effects and regulatory mechanisms of KLF10 on the proliferation of ESCs in EM.</p><p><strong>Methods: </strong>Human ESCs from eutopic and ectopic endometrium were isolated and identified. Levels of KLF10, miR-200c-3p, and lncRNA NEAT1 in cells were detected by reverse transcription-quantitative polymerase chain reaction and Western blot analysis. Expression of KLF10, miR-200c-3p, and NEAT1 were silenced in ectopic ESCs, followed by an assessment of cell proliferation. Chromatin immunoprecipitation and dual-luciferase reporter assays were conducted to analyze the binding of KLF10 to the miR-200c-3p promoter. RNA immunoprecipitation and dual-luciferase reporter assays were performed to analyze the interaction between miR-200c-3p and NEAT1. NEAT1 RNA stability was measured.</p><p><strong>Results: </strong>Compared to Eut-ESCs, Ect-ESCs exhibited decreased KLF10 and miR-200c-3p expression and increased NEAT1 expression. Overexpression of KLF10 inhibited the proliferation of Ect-ESCs. Mechanistically, KLF10 transcriptionally promoted miR-200c-3p expression, reducing the binding of miR-200c-3p to NEAT1 and downregulating NEAT1 expression. Combined experimental results showed that miR-200c-3p downregulation or NEAT1 overexpression could alleviate the inhibitory effect of KLF10 overexpression on the proliferation of Ect-ESCs.</p><p><strong>Limitations: </strong>We only investigated the function of KLF10 in Ect-ESC proliferation of EM on the cellular level, but the effect of KLF10 on abnormal Ect-ESC migration and invasion remains to be explored. Besides, there is no interference experiments performed on Eut-ESCs, and no animal experiment was included.</p><p><strong>Conclusions: </strong>KLF10 transcriptionally promoted miR-200c-3p expression reduced the binding of miR-200c-3p to NEAT1, thus downregulating NEAT1 expression and inhibiting the proliferation of Ect-ESCs.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1-10"},"PeriodicalIF":2.0,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144325484","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"S1PR4 Promotes Cell Viability, Invasion, and Glycolysis via the Mammalian Target of Rapamycin Signaling Pathway in Endometriosis.","authors":"Huizhi Yuan, Zhongju Xie, Minqing Feng, Jianying Zheng, Rong Geng, Cankun Zhou, Qunxiu Lao, Xiaobin Huang","doi":"10.1159/000546571","DOIUrl":"10.1159/000546571","url":null,"abstract":"<p><strong>Objective: </strong>Endometriosis is a chronic gynecological disorder that can cause infertility in women of reproductive age, and its clinical treatment still faces significant challenges. However, the pathogenesis of endometriosis remains unclear.</p><p><strong>Methods: </strong>S1PR4 knockdown and overexpression were constructed in primary ectopic endometrial stromal cells (EESCs) with or without the glycolysis inhibitor 2-deoxy-D-glucose and normal endometrial stromal cells (ESCs) with or without the mTOR signaling pathway inhibitor AZD8055, respectively. CCK-8 and Transwell assays were used to evaluate the viability and invasive capabilities. The cellular glycolytic capacity was assessed by measuring the extracellular acidification rate and lactate levels in the cell culture supernatant. An endometriosis mouse model was established in vivo, and histopathological changes in the endometrium were analyzed by hematoxylin-eosin staining. The expression of S1PR4, LDHA, and p-mTOR in endometrium and ESCs was assessed using qRT-PCR, Western blotting, or immunofluorescence.</p><p><strong>Results: </strong>Glycolytic levels were increased in EESCs, and inhibiting glycolysis in vitro reduced the viability and invasive capabilities of EESCs, as well as suppressed the growth of ectopic lesions in vivo. S1PR4 was abnormally overexpressed in endometriosis, and knocking down S1PR4 inhibited the viability, invasion, and glycolysis of EESCs, along with downregulation of p-mTOR expression. Conversely, overexpression of S1PR4 promoted the viability, invasion, and glycolysis of ESCs via the mTOR signaling pathway.</p><p><strong>Conclusions: </strong>In endometriosis, S1PR4 enhances cellular glycolysis by activating the mTOR signaling pathway, thereby promoting the viability and invasion of EESCs.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1-13"},"PeriodicalIF":2.0,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144325485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association of low dose oxytocin with pain intensity and delivery outcomes among primiparas who delivered vaginally with epidural block analgesia.","authors":"Fuxue Tang, Zhijie Zhang, Peikun Han","doi":"10.1159/000546524","DOIUrl":"https://doi.org/10.1159/000546524","url":null,"abstract":"<p><strong>Objective: </strong>This paper aimed to evaluate the influence of low-dose oxytocin (LDO) on pain intensity and delivery outcomes in primiparas who delivered vaginally with epidural block analgesia (EBA).</p><p><strong>Methods: </strong>A total of 150 primiparas were retrospectively collected, and finally, 120 cases were included. They were divided into a control group (n = 60, received EBA) and an oxytocin group (n = 60, received EBA combined with LDO). Analgesic onset time, analgesic duration, time to flatus, and time to first bowel movement were compared. Pain intensity was assessed using the Visual Analog Scale (VAS) at pre-analgesia, cervical dilation of 3 cm, and fetal delivery. Serum levels of cortisol (Cor), norepinephrine (NE), and C-reactive protein (CRP) before and 24 hours post-delivery, postpartum bleeding, Apgar scores, delivery outcomes, and adverse reactions were compared.</p><p><strong>Results: </strong>The oxytocin group had shorter times for gas passage and first bowel movement, as well as shorter durations of the first, second, and third stages of labor (p < 0.05). VAS scores at cervical dilation of 3 cm and fetal delivery were lower than pre-analgesia in both groups (p < 0.05), with no inter-group differences at each time point (p > 0.05). Serum Cor and NE decreased, while CRP increased at 24 hours postpartum (p < 0.05), with no inter-group differences (p > 0.05). The oxytocin group had less postpartum bleeding at 2 hours (p < 0.05), a higher natural delivery rate, and a lower incidence of uterine atony (p < 0.05), with no significant difference in Apgar scores (p > 0.05).</p><p><strong>Conclusion: </strong>EBA with LDO shortens labor duration, promotes gastrointestinal recovery, reduces uterine atony, postpartum hemorrhage, and vaginal assistive delivery rates, without affecting analgesia or stress response.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1-17"},"PeriodicalIF":2.0,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144325482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Does daily co administration of gonadotropins and letrozole during the ovarian stimulation improve IVF outcome for normal, poor and sub optimal responders?","authors":"Jigal Haas, Raoul Orvieto, Adva Aizer, Ettie Maman, Merav Noach-Hirsh, Lilach Marom Haham, Oshrit Lebovitz, Moran Shapira, Ravit Nahum","doi":"10.1159/000546147","DOIUrl":"https://doi.org/10.1159/000546147","url":null,"abstract":"<p><strong>Background: </strong>Previous studies have described similar or improved IVF outcomes following co-administration of letrozole during ovarian stimulation (OS) in different patients' sub-populations.</p><p><strong>Objectives: </strong>Address and identify the sub-group of patients that might benefit from letrozole co-treatment throughout the entire OS. Methods,Setting, Participants: We reviewed the medical files of patients attending our IVF unit over a three-year period, for different indications, who underwent two successive IVF cycle attempt, where the 2nd included the co-administration of 5 mg Letrozole from OS day 1 until trigger day.</p><p><strong>Results: </strong>Two hundred patients met the inclusion criteria and were included in the study. Of whom, 65 were poor responders (oocytes≤ 3) during the first IVF cycle attempt, 85 were sub-optimal responders (4-9 oocytes) and 50 were normal responders (≥ 10 oocytes). The total dose of gonadotropins (4525±1553 vs. 4293±2166, p = NS) and length of stimulation (11.3±2.2 vs. 11.1±2.3, p=NS) were comparable between the two cycle attempts. Numbers of follicles ≥ 13mm (7.2±4.7 vs 6.2±4.3, p < 0.001), retrieved oocytes (8.6±6.1 vs. 6.9±5.5, p<0.001), zygotes (5.7±4.5 vs. 4.5±3.7 p<0.001) and number of TQE (2.5±2.5 vs. 1.8±1.9, p<0.001) were significantly higher in letrozole cycles. Sub analysis according to patients' ovarian response during the first attempt revealed that the poor and sub-optimal responders significantly benefit from the letrozole co-administration, while the normal responders did not.</p><p><strong>Conclusions: </strong>Letrozole co-administration during OS for IVF increases the number of retrieved oocytes, zygotes and TQE in poor and suboptimal responders but not in normal responders.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1-12"},"PeriodicalIF":2.0,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144325483","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}