Gynecologic and Obstetric Investigation最新文献

{"title":"Impact of Sodium Butyrate Supplementation on Insulin Resistance and Adipose Tissue Modulation in Murine Models of Polycystic Ovary Syndrome.","authors":"Mariana Muros Ferreira, Yasmin Silva Frank, Giuliana Petri, Juliana Mora Veridiano, Nuha Ahmad Dsouki, Beatriz da Costa Aguiar Alves Reis, Carina Ulsen, Jhonatan Jair Arismendi Florez, Luciano Melo Pompei, Marcelo Luiz Steiner, Bianca Bianco","doi":"10.1159/000551076","DOIUrl":"10.1159/000551076","url":null,"abstract":"<p><strong>Objectives: </strong>Polycystic ovary syndrome (PCOS) is an endocrine-metabolic disorder affecting up to 10% of women of reproductive age, commonly associated with visceral obesity, insulin resistance, and chronic low-grade inflammation. Sodium butyrate, a microbial-derived short-chain fatty acid, has been proposed as a therapeutic agent due to its anti-inflammatory and metabolic regulatory properties. However, its efficacy under hyperandrogenic and pro-inflammatory conditions remains uncertain.</p><p><strong>Design: </strong>Experimental study using prepubertal female BALB/c mice (n = 40) allocated into five groups: control (CT), high-fat diet (HFD), DHEA (HFD + dehydroepiandrosterone), BUT (HFD + sodium butyrate), and DHEA+BUT (HFD + DHEA + sodium butyrate).</p><p><strong>Participants/materials, setting, methods: </strong>Hyperandrogenism was induced by subcutaneous DHEA implants, and obesity by a high-fat diet (60% kcal from fat). Sodium butyrate (100 mg/kg/day) was administered by oral gavage during the last 40 days of the 90-day protocol. This five-group design allowed the evaluation of butyrate effects in obesity alone (BUT) and in the combined obese-hyperandrogenic state (DHEA + BUT). Body weight, glucose tolerance, adipose depot weights, gene expression (IL-6, TNF-α, UCP1), serum adipokines.</p><p><strong>Results: </strong>Butyrate-treated groups, particularly DHEA + BUT, exhibited greater body weight gain and adipose tissue expansion than controls (p < 0.01). Glucose tolerance tests revealed impaired glycemic control in all HFD-fed groups, with the BUT group showing the highest peaks (p < 0.05). IL-6 and TNF-α expression were upregulated in visceral adipose tissue of butyrate-treated animals, while adiponectin levels were reduced in DHEA + BUT.</p><p><strong>Limitations: </strong>The modest number of animals per group reduced statistical power, reflecting constraints in breeding and availability of age-matched BALB/c mice. Their relatively small adipose depots limited tissue yield for molecular and histological assays. Daily oral gavage, required for precise dosing, was technically challenging and led to the loss of one DHEA+BUT animal.</p><p><strong>Conclusions: </strong>In this model of preestablished obesity and hyperandrogenism, sodium butyrate supplementation was not metabolically protective. Instead, it exacerbated adipose inflammation, altered adipokine profiles, and impaired glucose regulation. These findings underscore the context-dependent nature of butyrate's effects and suggest caution in extrapolating its benefits to hyperandrogenic or obesity-associated PCOS phenotypes.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"512-518"},"PeriodicalIF":2.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147316701","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":"From Transition to Reproduction: A Narrative Review of Evolving Evidence in Transgender Obstetrics and Gynecology.","authors":"Pietro Serra, Giuseppe Mascellino, Maria Teresa Bruno, Simone Garzon, Maria Francesca Guarneri, Giorgio Maria Baldini, Marco La Verde, Baydaa Alsannan, George Mpourazanis, Antonio Simone Laganà","doi":"10.1159/000551771","DOIUrl":"10.1159/000551771","url":null,"abstract":"<p><strong>Background: </strong>Transgender and gender-diverse (TGD) people assigned female at birth (AFAB) increasingly seek reproductive and gynecologic care, yet evidence and clinical pathways remain variable across health systems, including in Europe.</p><p><strong>Objectives: </strong>The objective of this study was to synthesize evidence on fertility, pregnancy, gynecologic care, and access to care in TGD populations and to highlight practical implications for gender-affirming clinical practice, with attention to European settings.</p><p><strong>Methods: </strong>A narrative review supported by a structured PubMed/MEDLINE search (January 1, 2014-May 31, 2025). Two reviewers screened 146 titles/abstracts; 58 full texts were assessed; and 31 publications were included. Nine primary studies reported quantitative pregnancy and/or assisted reproduction outcomes after prior testosterone exposure in AFAB TGD individuals.</p><p><strong>Outcome: </strong>Available data, largely small retrospective cohorts and case series, suggest that pregnancy and assisted reproduction are feasible after prior testosterone exposure, typically after temporary cessation. In studies with cisgender comparators, oocyte yield and embryology metrics appeared broadly comparable, but evidence remains heterogeneous and underpowered for robust safety conclusions. Survey-based studies indicate that more than half of pregnancies may be unintended. Barriers to fertility preservation (FP) and preventive gynecologic care include financial and structural constraints, limited provider training, and avoidance of pelvic examinations and cervical cancer screening.</p><p><strong>Conclusions and outlook: </strong>Reproductive counseling, FP, contraception, and organ-based screening should be integrated into gender-affirming pathways using trauma-informed, patient-centered communication. Prospective multicenter studies and standardized outcome reporting are needed to better define safety, effectiveness, and equity of care.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"485-494"},"PeriodicalIF":2.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147653934","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":"Late Cervical Shortening following Midtrimester Screening: Associations with Obstetric History and Risk of Preterm Birth.","authors":"Raneen Abu Shqara, Maisa Assy, Lior Lowenstein, Maya Frank Wolf","doi":"10.1159/000552724","DOIUrl":"10.1159/000552724","url":null,"abstract":"&lt;p&gt;&lt;p&gt;&lt;p&gt;Objectives: The objective of this study was to evaluate the clinical significance of late-onset cervical shortening diagnosed between 24.0 and 34.0 weeks of gestation following normal midtrimester screening and to assess its association with spontaneous preterm birth (sPTB) and adverse neonatal outcomes. We also examined whether obstetric history modifies this risk.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;This was a retrospective cohort study. Participants/Materials: A total of 500 singleton pregnancies with normal midtrimester cervical length (CL) who were subsequently diagnosed with cervical shortening (&lt;25 mm) between 24.0 and 34.0 weeks of gestation were included in the study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Setting: &lt;/strong&gt;This study was conducted at a tertiary, university-affiliated medical center (Galilee Medical Center, Israel) between March 2020 and May 2025.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Patients with asymptomatic late cervical shortening were categorized into three groups: &lt;10 mm, 11-15 mm, and 16-25 mm. CL measurements were further stratified by gestational age at diagnosis (24.0-27.6, 28.0-31.6, and 32.0-34.0 weeks). The primary outcome was sPTB &lt;37 weeks. Secondary outcomes included sPTB &lt;34 and &lt;32 weeks and neonatal morbidity. Multivariable logistic regression was used to estimate adjusted odds ratios. Receiver operating characteristic (ROC) curve analysis was performed to determine gestational age-specific CL thresholds for predicting sPTB.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;A total of 500 patients were included: 24/500 (4.8%) with CL &lt;10 mm, 80/500 (16.0%) with CL 11-15 mm, and 396/500 (79.2%) with CL 16-25 mm. Baseline characteristics were comparable across groups. Rates of sPTB &lt;37 weeks were 18/24 (75.0%) in patients with CL &lt;10 mm, 42/80 (52.5%) in those with CL 11-15 mm, and 99/396 (25.0%) in those with CL 16-25 mm (p &lt; 0.001). Similarly, sPTB &lt;34 weeks occurred in 14/24 (58.3%), 20/80 (25.0%), and 33/396 (8.3%), and sPTB &lt;32 weeks in 11/24 (45.8%), 12/80 (15.0%), and 20/396 (5.1%) (all p &lt; 0.001). When stratified by CL groups, sPTB rates did not differ according to obstetric history among patients with CL &lt;10 mm and 11-15 mm. In contrast, among patients with CL 21-25 mm, sPTB occurred in 7/26 (26.9%) of those with a prior sPTB, 17/78 (21.8%) of nulliparas, and 10/78 (12.8%) of those with a prior term birth (p = 0.041). ROC analysis identified gestational age-specific thresholds for predicting sPTB &lt;37 weeks: 22 mm at 24.0-27.6 weeks (area under the curve [AUC] 0.69, p &lt; 0.001), 20 mm at 28.0-31.6 weeks (AUC 0.62, p = 0.002), and 18 mm at 32.0-34.0 weeks (AUC 0.72, p &lt; 0.001). Correspondingly, sPTB rates were higher below these cutoffs: 49.1% vs. 18.2% (p &lt; 0.001), 49.1% vs. 23.2% (p &lt; 0.001), and 43.9% vs. 18.8% (p &lt; 0.001), respectively.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;The retrospective design may introduce selection and information bias. Measurements were performed by multiple clinicians, potentially leading to interobserver variabil","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"589-598"},"PeriodicalIF":2.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13363110/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148015186","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":"Development of a Predictive Model for the Latency Period in Preterm Premature Rupture of Membranes before 32 Weeks' Gestation.","authors":"Junnan Ji, Qin Fang, Ting Zou, Fengli Yin, Tianyi Ye, Bin He, Yuyan Zhou, Haojing Ma, Guirong Tan, Zhangye Xu","doi":"10.1159/000551927","DOIUrl":"10.1159/000551927","url":null,"abstract":"<p><strong>Background: </strong>Only 13.7% of corticosteroid treatments occurred within the most effective treatment time window for preterm premature rupture of membranes (PPROM), mainly due to the lack of relevant predictive models. This study aimed to analyze the risk factors associated with the duration of the latency period in PPROM to develop a predictive model for the latency period in cases of PPROM before 32 weeks' gestation, thereby increasing the effective use rate of prenatal corticosteroids.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on pregnant women with PPROM before 32 weeks' gestation between 2018 and 2022 at the Second Affiliated Hospital of Wenzhou Medical University. The group was divided based on the latency period: duration of <5 days group (n = 192) and duration of ≥5 days group (n = 162). Five machine learning algorithms were utilized to predict the probability of a latency duration of treatment of ≥5 days. Model performance was evaluated using the area under the curve (AUC), predictive accuracy, sensitivity, and specificity.</p><p><strong>Results: </strong>Significant differences (p < 0.05) were observed between the two groups in terms of white blood cell count, gestational age at rupture, cervical dilation, uterine contractions, and color of vaginal discharge. The AUC values for the five predictive models ranged from 0.66 to 0.90. The Logistic Regression model was identified as the best predictive model for latency duration in PPROM patients.</p><p><strong>Conclusion: </strong>Elevated body temperature, cervical dilation, increased white blood cell count, and the color of vaginal discharge are risk factors for a longer latency period in PPROM before 32 weeks' gestation. The gestational age at the time of spontaneous membrane rupture is a protective factor for the latency period in PPROM.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"573-581"},"PeriodicalIF":2.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147672500","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":"Maternal Use of Fertility Treatments and the Risk for Celiac Disease in the Offspring.","authors":"Noa Haramati, Gil Gutvirtz, Gali Pariente, Tamar Wainstock, Eyal Sheiner","doi":"10.1159/000551751","DOIUrl":"10.1159/000551751","url":null,"abstract":"<p><p><p>Background: Fertility treatments affect the maternal hormonal and immunological milieu, which also support the developing fetus. Given that celiac disease is an immune-mediated disorder, it has been hypothesized that fertility treatments may influence immune programming in utero and potentially increase the risk of immune-related conditions in the offspring, such as celiac disease.</p><p><strong>Objective: </strong>We sought to investigate whether offspring conceived following fertility treatments are at increased risk of developing celiac disease during childhood.</p><p><strong>Study design: </strong>A large population-based cohort study was conducted, including all singleton deliveries at a tertiary medical center between the years 1991 and 2021. The risk of developing celiac disease was compared between offspring (followed up to the age of 18) of women who conceived using fertility treatments - including ovulation induction and in vitro fertilization - and those born following natural conception. Data regarding celiac disease diagnoses were extracted from community-based clinics and hospitalization records of the offspring. Kaplan-Meier survival analysis was used to compare the cumulative incidence of celiac disease between the study groups. A Cox proportional hazards model was applied to control for potential confounders.</p><p><strong>Results: </strong>A total of 356,356 singleton deliveries were included in the study, of which 7,711 (2.2%) were conceived using fertility treatments. Offspring born following fertility treatments had a comparable rate of celiac disease to those born after natural conception (0.6% vs. 0.5%, p = 0.477). Kaplan-Meier survival analysis demonstrated similar cumulative incidence of celiac disease between the groups (log-rank test, p = 0.285). In a Cox proportional hazards model, adjusted for maternal age and gestational age, fertility treatments were not associated with an increased risk of celiac disease in the offspring (adjusted hazard ratio = 1.13, 95% confidence interval 0.84-1.52, p = 0.392).</p><p><strong>Limitations: </strong>Follow-up was limited to age 18, and cases diagnosed later in life could not be captured.</p><p><strong>Conclusion: </strong>In our large cohort with long-term follow up, fertility treatments were not associated with an increased risk of celiac disease in the offspring up to the age of 18. </p>.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"526-533"},"PeriodicalIF":2.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13262987/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147591806","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":"Cabergoline's Promise in Endometriosis: Restoring Molecular Balance to Improve Reproductive Potential.","authors":"Niloofar Shahgholi, Zahra Noormohammadi, Ashraf Moini, Morteza Karimipoor","doi":"10.1159/000546198","DOIUrl":"10.1159/000546198","url":null,"abstract":"<p><strong>Objectives: </strong>Endometriosis is a chronic gynecological condition characterized by abnormal angiogenesis and cell adhesion processes driven by VEGF-VEGFR-2 signaling. cabergoline, a dopamine agonist, has been shown to inhibit angiogenesis in endometriosis. This study investigates the therapeutic potential of cabergoline in modulating these pathways to mitigate endometriotic lesion progression and improve oocyte quality.</p><p><strong>Design: </strong>A randomized, placebo-controlled study was conducted, involving two groups of participants: one receiving cabergoline treatment and the other receiving a placebo.</p><p><strong>Methods: </strong>Eutopic endometrial tissue from women diagnosed with endometriosis was analyzed. VEGFR-2, FAK, PXN, ITGB3, and ITGAV expression levels were measured using qPCR. DNA methylation at the VEGFR-2 promoter was assessed using high-resolution melting analysis to examine epigenetic modifications. Western blot analysis was performed to evaluate the phosphorylation status of tyrosine residue 951 on the VEGFR-2 receptor, which is implicated in cell migration and survival. Oocyte quality was also assessed in both groups.</p><p><strong>Results: </strong>Cabergoline treatment reduced the expression levels of VEGFR-2, FAK, PXN, ITGB3, and ITGAV, with ITGAV showing a statistically significant decrease (p = 0.0174). Hypomethylation of the VEGFR-2 promoter was observed in the treatment group (p = 0.3566). However, phosphorylation of tyrosine residue 951 on VEGFR-2 significantly increased in the cabergoline-treated group (p = 0.004). Notably, oocyte quality significantly improved in the cabergoline group (p = 0.0318). A strong correlation was found between reduced VEGFR-2 expression (p = 0.0184), decreased promoter methylation (p = 0.0159), and downregulation of PTK2 expression (p = 0.0057), all of which are associated with improved oocyte quality.</p><p><strong>Limitations: </strong>The sample size was limited, and additional long-term studies are needed to confirm the therapeutic potential of cabergoline in endometriosis treatment.</p><p><strong>Conclusions: </strong>Cabergoline may enhance oocyte quality by modulating key regulators of the angiogenic pathway. These findings suggest its potential role in the management of endometriosis-related infertility, warranting further clinical investigation.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"10-25"},"PeriodicalIF":2.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143997490","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":"Analysis of Lymph Node Metastasis and Risk Factors in 424 Patients with Low-Grade Endometrioid Endometrial Carcinomas.","authors":"Lina Cao, Xiaoyuan Lu, Yijun Wang, Luyao Wang","doi":"10.1159/000546522","DOIUrl":"10.1159/000546522","url":null,"abstract":"<p><p><p>Objectives: The objective of this study was to explore the lymph node metastasis (LNM) and related risk factors of low-grade endometrioid endometrial carcinomas (EECs) and analyse the efficacy of related risk factors in predicting LNM.</p><p><strong>Design: </strong>Data from 424 patients with low-grade EEC treated between January 2019 and June 2024 were retrospectively analysed, according to the International Federation of Gynecology and Obstetrics (FIGO) 2009.</p><p><strong>Methods: </strong>Univariate and multivariate logistic regression analyses were used to examine the factors associated with LNM. Receiver operating characteristic (ROC) curves were plotted to assess the predictive efficacy of independent risk factors for LNM.</p><p><strong>Results: </strong>The rate of LNM was 7.8% (33/424). Histological grade, tumour size, depth of myometrial invasion, cervical stromal invasion, lymphovascular space invasion (LVSI), microcystic, elongated, fragmented (MELF) pattern, carbohydrate antigen 125 (CA125), carbohydrate antigen 199, and human epididymis protein 4 were associated with LNM. However, only LVSI, MELF pattern, depth of myometrial invasion, and CA125 were identified as independent risk factors. The area under the ROC curve for CA125 and depth of myometrial invasion was 0.796 and 0.734, respectively. The optimal cut-off value for CA125 was 31.36 U/mL, with a maximum Youden index of 53.9%. Combining CA125 with depth of myometrial invasion improved diagnostic accuracy compared to either parameter alone.</p><p><strong>Limitations: </strong>This is a single-center retrospective study.</p><p><strong>Conclusions: </strong>LNM is more likely with independent risk factors. Combining CA125 and depth of myometrial invasion enhances diagnostic accuracy for LNM. This study provides valuable insights for predicting LNM risk in low-grade EEC patients and guiding stratified management. </p>.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"56-64"},"PeriodicalIF":2.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12180777/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144173573","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":"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":"10.1159/000547069","url":null,"abstract":"<p><p><p>Objectives: The aim of this study was 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%), rectum, extragenital sites, bladder and ureter (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 provides a structured method for evaluating deep infiltrating endometriosis; however, 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>.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"226-232"},"PeriodicalIF":2.7,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12286583/pdf/","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":"OA","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":"10.1159/000546147","url":null,"abstract":"<p><strong>Objectives: </strong>Address and identify the sub-group of patients that might benefit from letrozole co-treatment throughout the entire ovarian stimulation (OS).</p><p><strong>Design: </strong>A retrospective cohort study.</p><p><strong>Patients: </strong>Patients who underwent two successive IVF cycle attempts, where the 2nd included the co-administration of 5 mg Letrozole from OS day 1 until trigger day.</p><p><strong>Setting: </strong>IVF institute of a tertiary medical center.</p><p><strong>Methods: </strong>First and second cycle attemtps were compared with regard to cycle characteristics and results. Different subroups according to ovarian response were considered.</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 (4,525 ± 1,553 vs. 4,293 ± 2,166, 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 ≥13 mm (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 top quality embryos (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 sub-optimal responders but not in normal responders.</p>","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"220-225"},"PeriodicalIF":2.3,"publicationDate":"2026-01-01","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}

{"title":"Impact of Localization of Diffuse Adenomyosis on Frozen Embryo Transfer Outcomes and Perinatal Outcomes: A Prospective Cohort Study of 585 Patients.","authors":"Sunita Sharma, Sourav RoyChoudhury, Meenakshi Karan, Kishan Shaw, Pranab Paladhi, Prithwis Palchaudhuri, Dibyendu Datta, Ratna Chattopadhyay, Arup Kumar Majhi","doi":"10.1159/000546437","DOIUrl":"10.1159/000546437","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;The objective of this study was to investigate the impact of localization of diffuse adenomyosis on reproductive outcomes after frozen embryo transfer (FET).&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Design: &lt;/strong&gt;This prospective cohort study was conducted between January 2019 and December 2022. A total of 585 infertile women undergoing the first FET cycle were recruited.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Participants/materials, setting, methods: &lt;/strong&gt;The study population included 368 women with diffuse adenomyosis where 167 women had diffuse adenomyosis of outer myometrium (OM) (group A) and 201 women had diffuse adenomyosis of the junctional zone (JZ) (group B). 217 women with male infertility were taken as controls. Adenomyosis was diagnosed on transvaginal ultrasound using MUSA criteria where diffuse adenomyosis patients with two or more features were included. These patients were further divided based on the localization of adenomyotic lesions in OM or JZ. All the patients underwent FET cycle. Pregnancy outcomes and complications were compared between different groups. Additionally, adenomyosis patients as a whole were compared with the control group.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;Women with diffuse adenomyosis have similar (p &gt; 0.05) pregnancy rates (36.14% vs. 35.94%), biochemical pregnancy rates (11.27% vs. 3.84%), and clinical pregnancy rates (32.06% vs. 35.02%) but higher miscarriage rates (22.03% vs. 9.21%; OR: 2.79, 95% CI: 1.14-6.79, p = 0.024) and a lower live birth rates (20.65% vs. 29.95%; OR: 0.61, 95% CI: 0.41-0.89, p = 0.011) than women without adenomyosis. However, women with diffuse adenomyotic lesions affecting the JZ (group B) exhibited significantly lower positive pregnancy (26.37% vs. 47.9%; OR: 0.39, 95% CI: 0.25-0.60, p &lt; 0.0001), clinical pregnancy (23.38% vs. 42.51%; OR: 0.41, 95% CI: 0.26-0.65, p = 0.0001), and live birth (16.42% vs. 25.75%; OR: 0.57, 95% CI: 0.34-0.94, p = 0.029) compared to those with adenomyosis of the OM (group A) but comparable (p &gt; 0.05) biochemical pregnancy (11.32% vs. 11.25%) and miscarriage (23.4% vs. 21.13%). Pregnancy complications were comparable between the adenomyosis groups; however, there was a significantly higher incidence of pregnancy complications, particularly gestational hypertension (OR: 6.41, 95% CI: 1.79-22.92, p = 0.0042), IUGR (OR: 9.08, 95% CI: 2.01-40.99, p = 0.0041), and preterm labor (OR: 9.41, 95% CI: 3.09-28.62, p = 0.0001) in adenomyosis patients compared to the controls.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Limitations: &lt;/strong&gt;It is an observational prospective study, and the study included patients with endometriosis as a comorbidity. The population size is limited to ascertain the effect of diffuse adenomyosis on pregnancy complications, particularly between subgroups.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;This study emphasizes the importance of evaluation and localization of adenomyotic lesions before initiating ART, which can aid in effective counseling and personalized treatment strategies ","PeriodicalId":12952,"journal":{"name":"Gynecologic and Obstetric Investigation","volume":" ","pages":"163-171"},"PeriodicalIF":2.3,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144173628","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}