Gynecologic and Obstetric Investigation最新文献

{"title":"Retraction Statement.","authors":"","doi":"10.1159/000543019","DOIUrl":"https://doi.org/10.1159/000543019","url":null,"abstract":"","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1"},"PeriodicalIF":2.0,"publicationDate":"2024-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142846452","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":"The prevalence of occult malignancy in women undergoing hysterectomy or myomectomy for benign indications and the impact of morcellation on survival outcomes: a meta-analysis.","authors":"Dan Jiang, Hongxuan Liu, Kui Huang, Yan Chen, Qiao Liu, Chuqiang Shu, Qi Tian","doi":"10.1159/000542894","DOIUrl":"https://doi.org/10.1159/000542894","url":null,"abstract":"<p><p>Introduction Uterine fibroids (UFs), also known as leiomyomas, are the most common benign gynecological tumors. Currently, morcellation is discouraged owing to the risk of disseminating undetected malignancies. This study aims to update the prevalence data on occult malignancies in surgeries for suspected benign uterine lesions and analyze the impact of treatment strategies on survival outcomes in patients with occult malignancies. Methods Five English-language literature databases were systematically searched up to July 25, 2024, for studies reporting the incidence of occult malignancies in patients with suspected UFs and their survival outcomes. The study was preregistered on PROSPERO(CRD42024580233). Results A total of 34 studies were included in the analysis. The pooled incidence of occult malignancies, calculated via a random effects model, was 2.88 (2.10-3.94) per 1,000 individuals. Significant regional variations were observed in the subgroup comparisons (p<0.01). Moreover, morcellation did not significantly affect progression-free survival (PFS) (hazard ratio [HR]: 1.26, 95% CI: 0.86 - 1.84, p = 0.240) or overall survival (OS) (HR: 1.13, 95% CI: 0.70 - 1.82, p = 0.614). Pooled HR analysis revealed that chemotherapy significantly improved PFS (HR: 0.49; 95% CI: 0.32-0.77; p = 0.002) and OS (HR: 0.49; 95% CI: 0.28-0.87; p = 0.015). Conclusions The incidence of occult malignancies in women undergoing hysterectomy or myomectomy for benign conditions is approximately 2.88 per 1,000 individuals. Morcellation does not impact survival outcomes, whereas adjuvant chemotherapy provides a survival benefit. Further well-designed clinical trials are needed to validate these findings.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1-23"},"PeriodicalIF":2.0,"publicationDate":"2024-12-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142828215","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":"Clinical and Ultrasound Features of Normocyclic Non-Hyperandrogenic Adolescents in Early Gynecological Life.","authors":"Anna Maria Fulghesu, Stefano Di Michele, Ilaria Zangaris, Martina Cordella, Elena Pittui, Giulia Scalise, Salvatore Giovanni Vitale, Stefano Angioni","doi":"10.1159/000542393","DOIUrl":"https://doi.org/10.1159/000542393","url":null,"abstract":"<p><strong>Objective: </strong>This study aimed to determine the prevalence of Polycystic Ovarian Morphology (PCOM) in healthy postmenarchal girls and assess whether it represents a crucial physiological phase in gynecological development. Additionally, it evaluated if an elevated stromal-to-surface area (S/A) ratio could identify individuals at risk of developing Polycystic Ovary Syndrome (PCOS).</p><p><strong>Design: </strong>Observational cross-sectional study.</p><p><strong>Setting: </strong>The study was carried out at the Pediatric and Adolescent Gynecology Service of the Policlinico Universitario Duilio Casula, Monserrato, University of Cagliari, from 2020 to 2023.</p><p><strong>Participants: </strong>A total of 302 healthy postmenarchal girls aged 14-18 were included in the study.</p><p><strong>Methods: </strong>Participants were divided into three groups: Normal Ovarian Morphology (NOM), PCOM with normal S/A ratio (PCOM-NS), and PCOM with increased S/A ratio (PCOM-IS). Anthropometric, clinical, hormonal, and ultrasound (US) characteristics were analyzed.</p><p><strong>Results: </strong>The overall prevalence of PCOM was 43% (95% CI: 0.37-0.49). Among 302 subjects, 171 (57%) exhibited NOM, 90 (30%) showed PCOM-NS, and 41 (13%) had PCOM-IS. The age and years of postmenarchal life were significantly lower in the PCOM-NS group than in the NOM group. PCOM-NS exhibited a higher waist-to-hip ratio (WHR), hirsutism prevalence, and follicle count per ovarian section. PCOM-IS was associated with elevated androgen levels. A significant reduction in the PCOM pattern was observed after the third postmenarchal year, while the NOM pattern increased significantly beyond five years postmenarche.</p><p><strong>Limitations: </strong>The study is limited by its cross-sectional design, which precludes establishing causality. Additionally, the exclusion of certain participants due to technical limitations in ultrasound evaluation may introduce selection bias.</p><p><strong>Conclusions: </strong>PCOM may represent a normal physiological phase in ovarian development during early adolescence, predominantly observed in the first 1-3 years postmenarche. An increased S/A ratio could help identify adolescents who may benefit from monitoring for potential PCOS development.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1-13"},"PeriodicalIF":2.0,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142794163","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":"Validated questionnaires for the assessment of Italian patients with pelvic floor dysfunctions: a systematic review.","authors":"Andrea Braga, Annalisa Vigna, Marta Barba, Giorgio Caccia, Andrea Papadia, Maria Rosaria Campitiello, Maurizio Serati, Matteo Frigerio","doi":"10.1159/000542409","DOIUrl":"https://doi.org/10.1159/000542409","url":null,"abstract":"<p><strong>Background: </strong>Pelvic floor dysfunctions (PFDs) have a complex, multifactorial pathophysiology that impacts women's health and must be identified to provide the most appropriate care and treatment. Therefore, symptom and quality of life (QoL) questionnaires, briefly identified as patient-reported outcomes (PROs), have been developed. Despite the large number of questionnaires available for the assessment of PFDs and QoL-related issues in English, few of them have been validated for the Italian language.</p><p><strong>Objectives: </strong>The aim of this article is to systematically review the literature on Italian-language validated PROs for PFDs assessment, along with practical information on literature references and suggestions on how to obtain each individual questionnaire.</p><p><strong>Methods: </strong>A systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Statement was performed up to 1 March 2024. PubMed/MEDLINE databases and websites were used to identify validated questionnaires in Italian language for PFDs. Once identified, the possibility of obtaining a copy of the questionnaire was checked, and the steps to obtain one are given in the text.</p><p><strong>Outcome: </strong>Thirty-five Italian-validated questionnaires were included: 17 out of 35 (48.6%) questionnaires focused on Lower urinary tract symptoms, 1 (2.8%) on genital prolapse symptoms, 8 (22.8%) on sexuality, 3 (8.6%) on bowel symptoms and 6 (17.2%) on pelvic dysfunctions. The literature search turned up seven more Italian PRO validation papers than the previous review. Specifically, the newly validated PROs include: Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12), Sexual Desire and Erotic Fantasies (SDEF) Questionnaire, Sexual Inhibition/Sexual Excitation Scales (SIS/SES), 12-Item Sexual Distress Scale (SDS) and 5-Item Sexual Distress Scale-Short Form (SDS-SF), Vaizey and Wexner and fecal incontinence severity index (FISI) questionnaires, Pelvic Floor Distress Inventory (PFDI-20) questionnaire, Intermittent Catheterization Acceptance Test (I-CAT).</p><p><strong>Conclusions and outlook: </strong>This systematic review is intended to be a tool to promote the adoption of appropriate PROs when studying PFDs in Italian patients.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1-17"},"PeriodicalIF":2.0,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142768476","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":"Pain level and analgesic requirements in patients who underwent vaginal pelvic floor surgery following general or spinal anesthesia.","authors":"Zehava Yohay, Yair Binyamin, Alla Saban, Adi Y Weintraub, Nurit Cohen, Neriya Yohay, Michael Dubilet","doi":"10.1159/000541962","DOIUrl":"https://doi.org/10.1159/000541962","url":null,"abstract":"<p><strong>Objective: </strong>This retrospective cohort study aimed to investigate postoperative pain levels and analgesic drug requirements in women who underwent GA or SA during vaginal pelvic floor surgeries.</p><p><strong>Design: </strong>A retrospective cohort study.</p><p><strong>Participants/materials, setting, methods: </strong>Women aged 18 or above who underwent vaginal pelvic floor surgery between 2019 and 2021 were included in the study. Univariate and multivariate analyses were performed separately for vaginal wall repair and stress urinary incontinence surgery.</p><p><strong>Results: </strong>During the study period, 101 women underwent surgery under SA, and 99 women underwent surgery under GA. Intravenous analgesia administration rates were significantly lower under SA for both vaginal wall repair (20.2% vs. 38.9%, P=0.017) and mid-urethral sling placement (20.2% vs. 37.8%, p=0.007). Multivariate analysis revealed that intravenous analgesia requirement was significantly lower in the SA group than in the GA group after controlling for patient's age, concurrent hysterectomy, and mesh placement for vaginal wall repair (aOR= 0.33, p=0.008) and mid-urethral sling placement (aOR= 0.37, p=0.004). Limitaions: This is a rerospective study, thus the choice of anesthesia may be biased.</p><p><strong>Conclusion: </strong>SA is associated with less postoperative pain and intravenous analgesia requirement in women who undergo vaginal pelvic floor surgeries. However, further research is needed to determine the preferred anesthesia method for specific types of pelvic floor surgeries.</p><p><strong>Keywords: </strong>GENERAL ANESTHESIA; SPINAL ANESTHESIA, ANALGESIA, PELVIC FLOOR SURGERY, PELVIC ORGAN PROLAPSE, STRESS URINARY INCONTINENCE, ERAS.</p><p><strong>Synopsis: </strong>Vaginal pelvic floor surgeries under spinal anesthesia is associated with less postoperative pain and intravenous analgesia requirement.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1-11"},"PeriodicalIF":2.0,"publicationDate":"2024-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142768472","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":"A model for predicting severe intra-abdominal adhesions following prior cesarean sections.","authors":"Shai Ram, Hila Shalev-Ram, Shira Alon, Ziv Shapira, Roza Berkovitz-Shperling, Margaret Johansson-Lipinski, Yariv Yogev, Ariel Many","doi":"10.1159/000542825","DOIUrl":"https://doi.org/10.1159/000542825","url":null,"abstract":"<p><strong>Objective: </strong>The increasing rate of cesarean sections (CS) raises concerns over severe intra-abdominal adhesions, which are associated with numerous complications. We aimed to identify risk factors and predictive tools for severe adhesions.</p><p><strong>Methods: </strong>In a prospective study at a tertiary medical center from January-July 2021, women with at least one prior CS were evaluated. Surgeons assessed adhesions at four anatomical sites, scoring them from 0 (none) to 2 (dense), with a total possible score of 0-8. Severe adhesions were defined as a score of ≥5. Risk factors were analyzed using logistic regression to create a prediction model.</p><p><strong>Results: </strong>Overall, 341 women were included in the study. Significant predictors included the number of previous CS, maternal BMI, maternal morbidity at the time of the previous CS, and operation time. The model predicted severe adhesions with 79.1% accuracy, a positive predictive value of 68.4%, and a negative predictive value of 79.5%.</p><p><strong>Conclusion: </strong>The severity of most cases of post-CS adhesions can be predicted by a model which considers common risk factors.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1-15"},"PeriodicalIF":2.0,"publicationDate":"2024-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142750787","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":"Global, Regional, and National Prevalence and Disability-Adjusted Life-Years for Female Infertility: Results from a Global Burden of Disease Study, 1990-2019.","authors":"DongYi Shen, Sen Yang, Cong Qi, Hong Yang","doi":"10.1159/000542408","DOIUrl":"10.1159/000542408","url":null,"abstract":"<p><strong>Objectives: </strong>We aimed to determine the prevalence of female infertility in 204 countries and territories from 1990 to 2019.</p><p><strong>Design: </strong>We evaluated the female infertility global burden between 1990 and 2019 in this systematic study.</p><p><strong>Materials: </strong>The Global Health Data Exchange query tool (<ext-link ext-link-type=\"uri\" xlink:href=\"http://ghdx.healthdata.org/gbd-results-tool\" xmlns:xlink=\"http://www.w3.org/1999/xlink\">http://ghdx.healthdata.org/gbd-results-tool</ext-link>) and sociodemographic index (SDI) (<ext-link ext-link-type=\"uri\" xlink:href=\"http://ghdx.healthdata.org/data-type/estimate\" xmlns:xlink=\"http://www.w3.org/1999/xlink\">http://ghdx.healthdata.org/data-type/estimate</ext-link>) provided data on the annual prevalence numbers, age-standardized prevalence rates (ASR), and disability-adjusted life-years (DALYs) of female infertility in 204 countries and territories from 1990 to 2019 for various age groups.</p><p><strong>Setting: </strong>Female infertility has a devastating impact on the physical and mental health of individuals and national fertility. However, most of the previous studies on this subject were conducted on rather small sample sizes and have certain limitations.</p><p><strong>Methods: </strong>We examined female infertility in terms of prevalence, ASR, and DALYs across different age groups in 204 countries and territories from 1990 to 2019 using data from the Global Health Data Exchange query tool.</p><p><strong>Results: </strong>From 1990 to 2019, ASR and DALYs for female infertility increased globally. At the SDI quintile level, middle-SDI and high-middle-SDI countries exhibited a faster increase in the ASR of female infertility. In 2019, with the highest female infertility rate recorded among those between the ages of 30-34 years and the lowest among those between the ages of 45-49 years. In 2019, high-income North America recorded the highest proportion of primary infertility, while East Asia recorded the lowest proportion.</p><p><strong>Limitations: </strong>First, the global burden of disease (GBD) database lacks data for some countries and regions. Second, data access and quality differ across locations. Third, the causes of infertility are not comprehensive, and data on Klinefelter in GBD 2019 in relation to primary infertility were absent.</p><p><strong>Conclusion: </strong>Globally, the prevalence of DALYs and age-standardized female infertility rates increased from 1990 to 2019.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1-17"},"PeriodicalIF":2.0,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142686847","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":"Characterization of Coping with Primary Dysmenorrhea in Women according to Their Level of Physical Activity: A Cross-Sectional Observational Study.","authors":"Alfonso Javier Ibáñez-Vera, María Cobertera-Pintor, Lorena Del Carmen Tejero-Olalla, Esther Díaz-Mohedo","doi":"10.1159/000542096","DOIUrl":"10.1159/000542096","url":null,"abstract":"<p><strong>Introduction: </strong>Primary dysmenorrhea (PD) is one of the most common gynecological pathologies in women. The aim was to determine the differences in coping with PD in women who practice high-intensity sport, compared to women who are less physically active.</p><p><strong>Methods: </strong>This was a cross-sectional observational study. A total of 476 women were recruited and administered a Google Form multiple-choice questionnaire divided into six sections. The following scales were used: Numerical Pain Rating Scale (NPRS), Pain Catastrophizing Scale (PCS), Menstruation-related Quality of Life Questionnaire (MQOL-22), Tampa Scale for Kinesiophobia (TSK), and Borg scale.</p><p><strong>Results: </strong>The 389 participants meeting the inclusion criteria were divided into three groups according to their score in Borg test: high-intensity physical activity group (n = 178), moderate-intensity physical activity group (n = 101), and low-intensity physical activity group (n = 110) for those scoring under 4. ANOVA analysis showed statistical significance only for PCS (p = 0.024). Tukey group per group comparison determined differences between high-intensity physical activity group and low-intensity physical activity group regarding PCS (p = 0.018). Spearman correlation analysis showed a high relation between PCS and NPRS (r = 0.664) and between MQOL-22 and NPRS (r = -0.562).</p><p><strong>Conclusion: </strong>The intensity of the exercise training does not influence PD-related pain perception nor kinesiophobia. High-intensity exercise reduces catastrophizing when compared with sedentary or low-intensity exercise. Level of catastrophizing is highly related with perceived pain and quality of life in menstruation in these PD patients.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1-11"},"PeriodicalIF":2.0,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142675442","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":"Relation of Endocan Serum Levels with Patient Characteristics and Morphological Features of Uterine Fibroids: A Case-Control Study.","authors":"Inci Başkır, Şebnem Özyer","doi":"10.1159/000542405","DOIUrl":"10.1159/000542405","url":null,"abstract":"<p><strong>Objectives: </strong>This study aimed to compare the serum endocan levels of patients with uterine fibroids and the healthy control group.</p><p><strong>Design: </strong>A case-control study was designed. Participants/Materials: The study group includes women diagnosed with uterine fibroids, and the control group includes healthy women.</p><p><strong>Setting: </strong>The study was conducted at a tertiary education and research hospital with 130 women (uterine fibroid group, n = 65; control group, n = 65).</p><p><strong>Methods: </strong>Serum endocan levels were determined in the study and control groups using the ELISA method. The number of uterine fibroids was identified, and the volume of uterine fibroids was calculated with ellipsoid formula by ultrasonography. The primary outcome parameter was serum endocan levels in patients with uterine fibroids and healthy control groups. Second, it is aimed to determine the distribution of the serum endocan level of patients according to uterine fibroid number, volume, and clinical presentation.</p><p><strong>Results: </strong>The mean serum endocan level of patient with uterine fibroid was 145.18 ± 169.86 (median: 94.10; Q25-Q75%: 54.50-116.50) pg/mL; it was 88.94 ± 54.21 (median: 76.9; Q25-Q75%: 64.20-152.65) pg/mL in the control group (p = 0.016). According to ROC analysis, cutoff value of the endocan level for uterine fibroid was determined as ≥133.1 pg/mL. For the cutoff value of 133.1 pg/mL, sensitivity was 36.92%, specificity was 89.23%, positive predictive value was 77.40%, and negative predictive value was 58.60%. Above this cutoff value, a 4.8-fold increased significant risk (OR) for uterine fibroid was detected.</p><p><strong>Limitations: </strong>The major limitation of the study is the lack of histopathological examination.</p><p><strong>Conclusion: </strong>Serum endocan levels were found to be higher in women with uterine fibroids compared to the control group, so endocan may be considered as a significant serum marker.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1-9"},"PeriodicalIF":2.0,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142675647","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":"A Cost-Effectiveness Analysis of Gonadotropins Used for Ovarian Stimulation during Assisted Reproductive Technology Based on Data from the French Nationwide Claims Database (SNDS).","authors":"Isabelle Borget, Mehdi Benchaib, Philippine Poignant, Laetitia Rey, Gerard Harty, Vivek Chaudhari, Thomas D'hooghe, Juan-Enrique Schwarze, Isabelle Cedrin Durnerin, Claudia Roeder, Michael Grynberg","doi":"10.1159/000542074","DOIUrl":"10.1159/000542074","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Various gonadotropins are used for ovarian stimulation (OS). This study investigated the cost-effectiveness of different gonadotropins based on real-world data from the French National Health Database (SNDS) over a 7-year follow-up of assisted reproductive technology (ART) treatments.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;Cost-effectiveness analysis of different gonadotropins based on real-world data from the SNDS was conducted.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Participants: &lt;/strong&gt;Women from SNDS undergoing OS leading to oocyte pick-up registered between January 31, 2013, and December 31, 2018 (N = 245,534 stimulations), and receiving either recombinant human follicle stimulating hormone (r-hFSH alfa originator; 110,439), its biosimilars (12,287), or urinaries (mainly highly purified human menopausal gonadotropin [HP-hMG; 65,654] and marginally highly purified urinary-human follicle stimulating hormone [7,821]) were included (follow-up: December 31, 2019).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Settings and methods: &lt;/strong&gt;Clinical inputs for this model, including live birth (LB) and cumulative LB (CLB) were calculated from data as published in [Best Pract Res Clin Obstet Gynaecol. 2023;88:102308]. A decision-tree model was developed comprising pregnancy and live birth rate (LBR) states for a complete ART cycle, including one fresh and ≤4 frozen/thawed embryo transfers and related costs. Cost inputs included those of drugs, ART procedure, pregnancy and delivery, and adverse events. Cost per LB and CLB and incremental cost-effectiveness ratio (ICER) were assessed. Robustness of results was determined by comprehensive sensitivity analyses.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Overall, r-hFSH alfa originator was found to be associated with a lower cost per LB and per CLB (cost per LB: EUR 26,010; CLB: EUR 22,278) versus its biosimilars (cost per LB: EUR 28,037; CLB: EUR 23,807) and versus urinaries (cost per LB: EUR 26,636; CLB: EUR 23,335). Calculated ICERs with r-hFSH alfa for LB were EUR 5,538 and EUR 14,090, whereas for CLB were EUR 1,945 and EUR 13,742 versus biosimilars and urinaries, respectively. Cost-effectiveness acceptability curve showed that in a majority of iterations, r-hFSH alfa originator had a probability of being cost-effective at a hypothetical threshold of EUR 20,000/LB. Sensitivity analyses showed that the most important variable impacting the outcome in fresh transfers was the probability of birth for biosimilars and the probability of pregnancy for urinaries, while for cumulative transfers, it was the probability of pregnancy for biosimilars and the probability of birth for urinaries.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;As the clinical data were obtained from a non-interventional study and not a randomized controlled trial, the results may still be susceptible to residual confounding or other biases.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;r-hFSH alfa originator is cost-effective compared to its biosimilars and to urinaries (mainly HP-hMG) and is as","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"1-15"},"PeriodicalIF":2.0,"publicationDate":"2024-11-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142675395","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}