Obstetrical & Gynecological Survey最新文献

{"title":"Sentinel Lymph Node Biopsy for Gynecologic Cancers.","authors":"Romelyn Imperio-Onglao, Joseph Ng","doi":"10.1097/OGX.0000000000001553","DOIUrl":"https://doi.org/10.1097/OGX.0000000000001553","url":null,"abstract":"<p><strong>Importance: </strong>Determination of lymph node metastasis is crucial for prognosis and treatment strategies for gynecologic cancers. Assessing metastases using a sentinel lymph node biopsy (SLNBx) approach decreases surgical morbidity and improves quality of life.</p><p><strong>Objective: </strong>This review evaluates the efficacy, safety, and clinical utility of SLNB in gynecologic cancers to inform clinical practice and highlight areas for future research.</p><p><strong>Evidence acquisition: </strong>Endometrial, vulvar, cervical, and ovarian cancer studies on SLNB were obtained from databases including PubMed, Scopus, and Web of Science. The search focused on peer-reviewed articles, systematic reviews, meta-analyses, clinical practice guidelines, and expert consensus statements published in English.</p><p><strong>Results: </strong>SLNBx is an effective alternative to systematic lymphadenectomy for staging gynecologic malignancies. It is established for vulvar and endometrial cancer staging. For cervical cancer, the SENTICOL and SENTIX studies demonstrate high detection rates and comparable survival outcomes to lymphadenectomy with fewer comorbidities. In ovarian cancer, SLNBx detection rates vary, and additional research is needed to determine the role of SLNBx.</p><p><strong>Conclusions: </strong>Clinical studies support the use of SLNBx for staging of endometrial, vulvar, and cervical cancers. Future research and standardized protocols are essential to establish SLNBx as a standard practice in ovarian cancer.</p>","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":"81 7","pages":"345-354"},"PeriodicalIF":4.7,"publicationDate":"2026-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148397233","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":"Amniotic Fluid Embolism: A Silent Threat to Maternal Life- An Up-to-Date Comprehensive Review of the Pathophysiology, Diagnosis, and Outcome.","authors":"Oluwateniayo O Okpaise, Jorge Lima, João Feldman de Pinho, Edna Kathleen Porter, Rodrigo Ruano","doi":"10.1097/OGX.0000000000001554","DOIUrl":"10.1097/OGX.0000000000001554","url":null,"abstract":"<p><strong>Importance: </strong>Amniotic fluid embolism is a serious complication of pregnancy where fetal cells, amniotic fluid, and debris enter the maternal circulation, leading to cardiovascular collapse, respiratory issues, and disseminated intravascular coagulation, which can cause acute hemorrhage. Although the exact cause of this embolization is unknown, it frequently occurs in healthy women during pregnancy, after obstetric procedures, or within 48 hours after delivery. Early symptoms of amniotic fluid embolism are often nonspecific, potentially leading to misdiagnosis and increased maternal mortality and morbidity.</p><p><strong>Objective: </strong>The goal of this review is to synthesize the current literature on early diagnosis methods, increase awareness and understanding of AFE, and ultimately improve outcomes for mothers and their babies. The importance of early recognition and intervention is also highlighted, as well as the potential for long-term complications such as cognitive disabilities in affected infants.</p><p><strong>Evidence acquisition: </strong>We conducted a literature review and highlighted articles that pertained to the historical perspectives of the disease, its pathophysiology, diagnosis, and management. Sources, including PubMed, were used as search engines, and applicable articles were cited as references.</p><p><strong>Results: </strong>AFE is one of the leading causes of maternal mortality and morbidity, as misdiagnosis is prevalent due to a lack of definitive diagnostic protocols for AFE. While new diagnostic methods are available, further study is needed to ensure that disease sensitivity is accurate.</p><p><strong>Conclusions and relevance: </strong>Further research is needed to understand the mechanism and presentation of AFE, as prompt intervention is associated with positive maternal and fetal outcomes.</p>","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":"81 6","pages":"304-314"},"PeriodicalIF":3.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148163989","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":"Atrial Fibrillation and Atrial Flutter in Pregnancy: Epidemiology, Pathophysiology, and Management.","authors":"Jessie Y Li-Barton, Virginia Y Watkins, Sarah C Snow, Jeffrey A Kuller, Jerome J Federspiel","doi":"10.1097/OGX.0000000000001538","DOIUrl":"10.1097/OGX.0000000000001538","url":null,"abstract":"<p><strong>Importance: </strong>The prevalence of atrial fibrillation (AF) and atrial flutter (AFL) among pregnant patients has increased over time, with AF now being the most common sustained cardiac arrhythmia in pregnancy. Management of AF/AFL in pregnancy presents unique clinical challenges, with careful consideration of both maternal and fetal well-being.</p><p><strong>Objectives: </strong>To review the current evidence and expert guidance regarding the evaluation and management of AF and AFL in pregnancy, with emphasis on epidemiology, risk factors, pregnancy-specific considerations, and treatment strategies.</p><p><strong>Evidence acquisition: </strong>Relevant literature on AF and AFL in pregnancy was reviewed, including epidemiologic data, pathophysiologic insights, pharmacologic and nonpharmacologic management approaches, and expert consensus guidelines. Key topics included maternal and fetal safety of commonly used medications, considerations for antepartum and intrapartum care, and strategies for addressing both stable and emergent arrhythmia presentations.</p><p><strong>Results: </strong>AF and AFL in pregnancy are associated with increased maternal and fetal risks. Pregnancy-specific physiological changes increase susceptibility to arrhythmia and thromboembolic complications, highlighting the importance of timely recognition and multidisciplinary management. Antepartum and intrapartum care planning is essential, including strategies for rhythm and rate control, anticoagulation, and emergency interventions.</p><p><strong>Conclusions and relevance: </strong>As AF and AFL become more prevalent in pregnancy, clinicians must be equipped with knowledge of pregnancy-specific considerations and evidence-based management strategies to optimize maternal and fetal outcomes. Early recognition, individualized therapy, and multidisciplinary coordination are key to improving prognosis for both mother and child.</p>","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":"81 6","pages":"281-292"},"PeriodicalIF":3.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148163981","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 System Review of Pathophysiology, Diagnosis, and Clinical Management of Intrauterine Adhesions.","authors":"Hongjiao Ma, Meixia Yang","doi":"10.1097/OGX.0000000000001555","DOIUrl":"10.1097/OGX.0000000000001555","url":null,"abstract":"<p><strong>Importance: </strong>Intrauterine adhesions are a major cause of menstrual abnormalities, infertility, and adverse obstetric outcomes, most commonly resulting from iatrogenic endometrial injury after uterine curettage. Despite advances in hysteroscopic treatment, prevention, recurrence, and endometrial regeneration remain unresolved clinical challenges.</p><p><strong>Objective: </strong>To elucidate the pathogenesis of intrauterine adhesions, particularly curettage-induced injury, and to summarize current diagnostic methods, classification systems, and evidence-based treatments, including emerging regenerative strategies to reduce adhesion formation and recurrence.</p><p><strong>Evidence acquisition: </strong>PubMed, Web of Science, and Embase were searched for studies on IUA pathogenesis, diagnosis, and management, with emphasis on curettage methods, hysteroscopic treatment, adjuvant therapies, and emerging biological interventions.</p><p><strong>Results: </strong>Evidence indicates that IUA develops through basal endometrial injury followed by dysregulated inflammation, impaired angiogenesis, and excessive fibrotic repair. Sharp curettage, particularly when repeated or unguided, confers a higher adhesion risk than vacuum aspiration. Hysteroscopy is the diagnostic gold standard and guides severity-based classification. Hysteroscopic adhesiolysis remains the primary treatment, with technique selection based on adhesion extent. Adjunctive therapies, including estrogen, antifibrotic agents, physical barriers, and emerging biologics, may enhance endometrial regeneration and reduce recurrence, though efficacy varies across disease severity.</p><p><strong>Conclusions and relevance: </strong>Clinicians should prioritize strategies that minimize endometrial trauma during uterine evacuation, including the preferential use of vacuum aspiration and image-guided techniques. Optimized hysteroscopic management combined with appropriate adjuvant therapies is essential to reduce recurrence and improve reproductive outcomes in women with IUAs.</p>","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":"81 6","pages":"293-303"},"PeriodicalIF":3.6,"publicationDate":"2026-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148163949","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":"Uterine Sarcomas: Clinical Management and a Review of Systemic Therapy.","authors":"Ana Kouri, Olivia Lara, Jacob Stein","doi":"10.1097/OGX.0000000000001513","DOIUrl":"10.1097/OGX.0000000000001513","url":null,"abstract":"<p><strong>Importance: </strong>Uterine sarcomas are rare but aggressive tumors with high rates of recurrence and limited effective treatment options; a deeper understanding of their molecular and histologic diversity is critical to improving outcomes.</p><p><strong>Objective: </strong>To provide a comprehensive overview of clinical management and current systemic treatment strategies for uterine sarcomas. Specific histologic subtypes and molecular features are also reviewed.</p><p><strong>Evidence acquisition: </strong>A thorough review of the literature was conducted using PubMed and clinical trial databases, with a focus on recent studies evaluating histology-specific management, molecular diagnostics, and novel systemic therapies across uterine sarcoma subtypes.</p><p><strong>Results: </strong>Uterine sarcomas comprise 3% to 5% of uterine malignancies and include multiple distinct subtypes such as leiomyosarcoma, low and high-grade endometrial stromal sarcoma, undifferentiated uterine sarcoma, and adenosarcoma. Each displays unique clinical behavior and molecular alterations that guide treatment. While surgery remains the foundation of management for early-stage disease, the role of adjuvant therapy is unclear and best guided by individual risk. In advanced disease, combination regimens such as doxorubicin and trabectedin have shown improved outcomes in the treatment of leiomyosarcomas. Targeted therapies, hormonal agents, and immunotherapy have variable activity across subtypes. Molecular diagnostics, including next-generation sequencing, are increasingly essential in diagnosis, prognostication, and treatment planning.</p><p><strong>Conclusions and relevance: </strong>The landscape of uterine sarcoma treatment is rapidly evolving due to advances in molecular biology and emerging systemic therapies. Personalized management based on histology and molecular profiling, along with the development of subtype-specific clinical trials, will be essential in improving survival. Centralized, multidisciplinary care remains a cornerstone for patients with these rare tumors.</p>","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":"81 5","pages":"231-240"},"PeriodicalIF":4.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147840662","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":"Female Sexual Dysfunction: Current Models and Treatment Options.","authors":"Emma E H Peek, Meagan Kelly, Jeffrey A Kuller, Sarah Dotters-Katz, Jennifer O Howell","doi":"10.1097/OGX.0000000000001512","DOIUrl":"10.1097/OGX.0000000000001512","url":null,"abstract":"<p><strong>Importance: </strong>Male sexual dysfunction has been well described in scientific literature; however, female sexual dysfunction is an area of research that remains vastly overlooked.</p><p><strong>Objective: </strong>Female sexual dysfunction represents 4 separate diagnoses according to the DSM-5-sexual pain disorder, sexual interest/arousal disorder, orgasmic disorder, and medication/substance-induced sexual dysfunction. In this review, we will briefly discuss early studies of female sexual function. We will also describe each subtype of female sexual dysfunction, its etiology, vulnerable populations, and current treatment options. Treatment options discussed will include pharmacological options, as well as therapeutic techniques, including behavioral and physical therapy.</p><p><strong>Evidence acquisition: </strong>Information for this review was obtained by means of PubMed search with relevant keywords, in addition to the use of pertinent citations from original research.</p><p><strong>Results: </strong>We find evidence for multiple treatment options for patients with female sexual dysfunction specific to the subtype of disorder defined by the DSM-5.</p><p><strong>Conclusions: </strong>Treatment of female sexual dysfunction should include a team-based approach that involves the partner, a therapist, psychiatrist, physical therapist, and pharmacological intervention if appropriate.</p><p><strong>Relevance: </strong>Tremendous progress has been made in the last several decades in dedicating more research attention to the topic of female sexual dysfunction-there are a multitude of randomized clinical trials on both pharmacological and therapeutic options for each of the sexual dysfunction disorders. However, improved standardization of tools to measure sexual desire, satisfaction, and orgasm attainment remains a weakness in current studies, as does lack of data on sexual function in transgender women and lesbian women.</p>","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":"81 5","pages":"219-230"},"PeriodicalIF":4.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147840414","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":"Heavy Menstrual Bleeding in the Gynecology Clinic: A Call for Awareness and Standardized Screening for Underlying Bleeding Disorders.","authors":"Silvia Luijten, Laurens Nieuwenhuizen, Karin P M van Galen, Marlies Y Bongers, Peggy M A J Geomini, Jaklien C Leemans","doi":"10.1097/OGX.0000000000001514","DOIUrl":"10.1097/OGX.0000000000001514","url":null,"abstract":"<p><strong>Importance: </strong>Heavy menstrual bleeding (HMB) is a common problem existing in nearly 30% of women worldwide. An underlying bleeding disorder has been identified as a cause of HMB in a significant proportion of women seeking gynecological care for HMB. In practice, however, there is a significant underdiagnosis of bleeding disorders in these patients, highlighting a need for improvement in awareness and detection.</p><p><strong>Objective: </strong>To present a comprehensive review of the literature on HMB and bleeding disorders and to increase awareness of their interrelation. In addition, to propose a standardized diagnostic approach to help identify which women with HMB may have an underlying bleeding disorder and require further hemostatic evaluation.</p><p><strong>Evidence acquisition: </strong>A literature review was performed using PubMed to identify relevant primary research and review articles on the topic of HMB and bleeding disorders in English. This was supplemented by manual reference searches and review of relevant guidelines in English and Dutch.</p><p><strong>Results: </strong>A significant proportion (10% to as much as 62%) of women with HMB have an underlying bleeding disorder, yet many such disorders go unrecognized. Various screening instruments, particularly the validated PBAC, Philipp tool or self-BAT, can help distinguish between HMB with or without a suspected bleeding disorder, and indicate who needs additional hemostatic evaluation.</p><p><strong>Conclusions and relevance: </strong>An underlying bleeding disorder is far more frequent in HMB than currently appreciated. Gynecologists should be aware of this and be familiar with screening instruments and a diagnostic workflow for bleeding disorders. Multidisciplinary collaboration between gynecology and hematology is crucial for accurately diagnosing and managing potential bleeding disorders in women with HMB.</p>","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":"81 5","pages":"241-250"},"PeriodicalIF":4.7,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13148511/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147840438","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":"Birth Trauma and Postpartum Childbirth-related Posttraumatic Stress Disorder: A Narrative Review of Pathology, Risk Factors, and Practice Recommendations.","authors":"Carmen Rauh Garrido, Jennifer Okunbor, Lillian B Boettcher, Jeffrey A Kuller, Sarah Dotters-Katz, Marie Claire Kimmel","doi":"10.1097/OGX.0000000000001493","DOIUrl":"10.1097/OGX.0000000000001493","url":null,"abstract":"<p><strong>Importance: </strong>Trauma and childbirth-related posttraumatic stress disorder (c-PTSD) are underrecognized possible consequences of birth and obstetric care that may affect maternal well-being, parent-infant bonding, and future reproductive decisions. Despite a growing body of research, gaps remain in the implementation of robust screening, timely diagnosis, and trauma-informed practices to prevent and address c-PTSD.</p><p><strong>Objective: </strong>Review our current understanding of psychological birth trauma and c-PTSD, emphasizing provider roles in prevention, identification, and management.</p><p><strong>Evidence acquisition: </strong>PubMed and Google Scholar literature search from 2000 to 2024.</p><p><strong>Results: </strong>Birth trauma is a subjective experience, often driven by factors such as poor communication, lack of informed consent, and perceived loss of control. Only a subset of individuals with traumatic births develops c-PTSD. Prior trauma, mental health conditions, obstetric complications, and inadequate support exacerbate risk. c-PTSD affects approximately 3% to 6% of low-risk, postpartum individuals and up to 18% of postpartum individuals in high-risk populations. Diagnosis requires assessment of associated symptoms with validated tools. Interventions range from psychosocial support, medications, and trauma-focused therapies. Preventive strategies include maternal mental health collaborative models and trauma-informed care that emphasizes respectful communication, autonomy, and continuity of care.</p><p><strong>Conclusions and relevance: </strong>Obstetric providers are key actors in shaping a positive childbirth experience through respectful communication and shared decision-making. Early follow-up, mental health screening, and collaborative, trauma-informed care may help mitigate long-term psychological sequelae of birth trauma and c-PTSD to improve outcomes for birthing individuals and families.</p>","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":"81 4","pages":"177-185"},"PeriodicalIF":4.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147639422","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":"Letrozole for Ovulation Induction in Women With Polycystic Ovary Syndrome.","authors":"Xue-Lian Li","doi":"10.1097/OGX.0000000000001494","DOIUrl":"10.1097/OGX.0000000000001494","url":null,"abstract":"<p><strong>Importance: </strong>Polycystic ovary syndrome (PCOS) affects about 5% to 20% of women worldwide in their fertile years and often combines with infertility. Ovulation induction is often needed for those who want to get pregnant.</p><p><strong>Objective: </strong>To review the research advances of letrozole for ovulation induction in women with PCOS.</p><p><strong>Evidence acquisition: </strong>The papers are searched in Cochrane libraries, SinoMed, PUBMED, and EMBASE till June 2024 and reviewed.</p><p><strong>Results: </strong>Letrozole, one of the third-generation of aromatase inhibitors, is increasingly recommended as a first-line agent for ovulation induction in anovulatory PCOS women due to better pregnancy and live birth rates, especially in those with clomiphene citrate (CC) resistance (CC is an earlier contacted and frequently used ovulation inducer). In this review, we focus on the usages, advantages, and disadvantages of letrozole for ovulation induction in PCOS, and show that different timing of initiation, extending treatment duration, stair-step protocol, and letrozole combined with other drugs such as FSH, ethinylestradiol and cyproterone acetate, metformin, aspirin, dexamethasone, and N-acetylcysteine.</p><p><strong>Conclusions: </strong>Letrozole is effective for inducing ovulation and achieving pregnancy in patients with PCOS, and report variations in letrozole treatment protocols.</p><p><strong>Relevance: </strong>Better understanding of letrozole for ovulation induction is important for gynecologists and women with PCOS to achieve better pregnancy and live birth rates.</p>","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":"81 4","pages":"186-191"},"PeriodicalIF":4.7,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147639436","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":"Comment on “Ribosome Dysregulation and Intervention in Age-related Infertility”","authors":"David L. Keefe","doi":"10.1097/01.ogx.0001191248.97955.fb","DOIUrl":"https://doi.org/10.1097/01.ogx.0001191248.97955.fb","url":null,"abstract":"It is well established that female fertility decreases with age, and that this is largely due to diminishing oocyte quality that can impair embryo development and cause failure of assisted reproductive technology such as in vitro fertilization (IVF). Aneuploidy is one of the leading causes of reproductive aging, and factors contributing to it include precocious separation of sister chromatids, chromosome misalignment, spindle disruption, and deficient spindle checkpoints. Other contributors to ovarian aging include DNA damage responses, oxidative stress, mitochondrial dysfunction, telomere attrition, autophagy, inflammation, and fibrosis. Previous studies focusing on single-cell sequencing methods have typically grouped individuals as “young” or “old.” This study, however, used transcriptome analysis through correlation analysis with age and other factors to characterize molecular changes in aging oocytes and the cumulus cells (CCs) surrounding them. This study was conducted using a mouse model and subsequent human models, with the human models including 100 patients undergoing IVF after previous failure of more than one IVF cycle as a clinical trial of rapamycin. Exclusion criteria for these patients were a history of endometriosis, cancer, chronic infections, and autoimmune or genetic disease, or a diagnosis of male factor infertility. Standard long GnRH agonist protocols, oocyte retrieval, fertilization, and planned embryo transfer were used. Patients were randomized to either the control or rapamycin group. The primary outcomes were oocyte number and embryo number, and the secondary outcome was the rate of clinical pregnancy. A total of 71 oocytes and 114 CC samples were obtained from human donors, and showed that the antral follicle count, number of follicles greater than 12 mm, number of oocytes retrieved during IVF, and estrogen levels all decreased with age, and the levels of follicle-stimulating and luteinizing hormones increased, consistent with expectations based on previous evidence. Sequencing of RNA showed cutoffs of correlation coefficients at 0.4 for oocytes and 0.5 for CCs, which produced significant differences between age and gene expression. A significant shift was identified around age 34, showing 517 downregulated and 253 upregulated genes in older oocytes. Age-related changes were more prominent in CCs than in oocytes, with 2181 downregulated and 396 upregulated genes. Aging showed significant differences in several mechanisms, including ribosome dysregulation and DNA methylation in both oocytes and CCs. In light of these observed mechanisms, a clinical trial was performed to test whether rapamycin could improve oocyte quality, embryo development, and clinical pregnancy rates in IVF for patients with more than one previous IVF cycle failure. A significantly increased number of zygotes, embryos, and embryos of good quality were identified in the rapamycin group ( P = 0.012 for zygotes, P = 0.001 for embryos, and P &lt; 0.001","PeriodicalId":19409,"journal":{"name":"Obstetrical & Gynecological Survey","volume":"81 3","pages":"123-125"},"PeriodicalIF":0.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147903325","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}