Current Opinion in Obstetrics & Gynecology最新文献

Interface between reproductive and metabolic dysfunction in polycystic ovary syndrome. 多囊卵巢综合征中生殖和代谢功能障碍的界面。

IF 2.2 4区医学

Current Opinion in Obstetrics & Gynecology Pub Date : 2025-08-01 Epub Date: 2025-04-29 DOI: 10.1097/GCO.0000000000001037

Melody A Rasouli, Jessica Katz, Daniel A Dumesic

{"title":"Interface between reproductive and metabolic dysfunction in polycystic ovary syndrome.","authors":"Melody A Rasouli, Jessica Katz, Daniel A Dumesic","doi":"10.1097/GCO.0000000000001037","DOIUrl":"10.1097/GCO.0000000000001037","url":null,"abstract":"Purpose of review: New concepts have emerged regarding how interrelationships of hyperandrogenism and hyperinsulinemia from systemic insulin resistance contribute to the origins of polycystic ovary syndrome (PCOS). Although these androgen-insulin interrelationships are associated with several reproductive and metabolic variables, their specific cause and effect relationships remain unclear. This review examines specific causal relationships between hyperandrogenism and hyperinsulinemia from systemic insulin resistance to understand how these complex interactions contribute to the phenotypic expression of PCOS.Recent findings: Clinical interventions for the treatments of hyperandrogenism and hyperinsulinemia from systemic insulin resistance as well as in-vitro studies of androgen and insulin actions on critical target tissues are examined to understand why androgen-insulin interrelationships are central to the origins of PCOS.Summary: Bidirectional interrelationships between hyperandrogenism and hyperinsulinemia from systemic insulin resistance in normal-weight PCOS women may have originally evolved as an ancient metabolic adaptation to simultaneously favor fat storage and energy utilization for survival and reproduction during famine. These androgen-insulin interactions in PCOS now predispose to metabolic diseases and pregnancy complications in today's obesogenic environment and, therefore, require improved preventive healthcare to optimize the long-term health of PCOS women and their children.","PeriodicalId":55194,"journal":{"name":"Current Opinion in Obstetrics & Gynecology","volume":" ","pages":"167-174"},"PeriodicalIF":2.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144010132","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}

引用次数: 0

Update on the management of subclinical hypothyroidism in patients with infertility. 不孕症患者亚临床甲状腺功能减退的治疗进展。

IF 2.2 4区医学

Current Opinion in Obstetrics & Gynecology Pub Date : 2025-08-01 Epub Date: 2025-04-30 DOI: 10.1097/GCO.0000000000001040

Arielle S Yeshua, Benjamin S Harris, Alexander M Quaas

{"title":"Update on the management of subclinical hypothyroidism in patients with infertility.","authors":"Arielle S Yeshua, Benjamin S Harris, Alexander M Quaas","doi":"10.1097/GCO.0000000000001040","DOIUrl":"10.1097/GCO.0000000000001040","url":null,"abstract":"Purpose of review: This review is timely and relevant as it addresses recent guideline updates regarding subclinical hypothyroidism (SCH) in infertility. The manuscript examines updates in SCH management, focusing on a significant shift in guidelines following the exclusion of a key randomized-controlled trial. This trial, central to previous guidelines and included in multiple meta-analyses, was excluded because of concerns about its validity, prompting a re-evaluation of management approaches.Recent findings: There is insufficient data to definitively link SCH to infertility. Current evidence does not support universal screening or treatment of SCH in infertile women. Specifically, levothyroxine treatment for SCH has not been shown to reduce pregnancy loss or improve pregnancy outcomes, including live birth rates. SCH is not associated with a significantly increased risk of miscarriage. Routine screening for thyroid antibodies in the infertile population is not recommended. Following a re-evaluation of the literature, the latest guidelines emphasize selective screening for SCH rather than universal screening or treatment in the general infertile population.Summary: These findings challenge previous guidelines advocating routine screening and treatment of SCH in infertile women. The updated guidelines now recommend more personalized approaches, with selective screening for women with specific risk factors.","PeriodicalId":55194,"journal":{"name":"Current Opinion in Obstetrics & Gynecology","volume":" ","pages":"182-187"},"PeriodicalIF":2.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144027766","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}

引用次数: 0

Trends in gynecologic surgery reimbursement and physician pay. 妇科手术报销和医生薪酬的趋势。

IF 2.2 4区医学

Current Opinion in Obstetrics & Gynecology Pub Date : 2025-08-01 Epub Date: 2025-05-01 DOI: 10.1097/GCO.0000000000001042

Michelle DenAdel, Parisa Rose Khalighi, Caitlin Hamilton, Marisa Dahlman

{"title":"Trends in gynecologic surgery reimbursement and physician pay.","authors":"Michelle DenAdel, Parisa Rose Khalighi, Caitlin Hamilton, Marisa Dahlman","doi":"10.1097/GCO.0000000000001042","DOIUrl":"10.1097/GCO.0000000000001042","url":null,"abstract":"Purpose of review: Relative value units (RVUs) are a primary metric composed of several components including physician work, practice expenses, and insurance costs, that drive physician reimbursement. There is known RVU variation across medical specialties, with gynecology generating relatively lower RVUs and consequently, lower overall reimbursement compared to other surgical specialties. The objective of this review is to describe historical and current trends in gynecologic surgery and physician reimbursements, including pertinent sex-related biases.Recent findings: Disparities persist in reimbursement for female-specific compared to male-specific procedures. RVUs do not reflect changes in patient complexity.Summary: Shifts toward minimally invasive (MIS) and outpatient procedures, inaccuracies in RVU assignments, and Medicare budget constraints have led to decreasing reimbursement for gynecologic surgery. Gynecologic procedures are frequently undervalued, and there is a persistent disparity in reimbursement for paired sex-specific procedures. Addressing reimbursement challenges is critical to preserving access to high-quality gynecologic surgical care. Proposed solutions include using objective work measures to determine RVU assignments, shifting toward an outcomes-based payment model, and eliminating sex-specific codes.","PeriodicalId":55194,"journal":{"name":"Current Opinion in Obstetrics & Gynecology","volume":" ","pages":"255-260"},"PeriodicalIF":2.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144000237","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}

引用次数: 0

Gut feeling: understanding the endometriosis-digestive link to enhance patient care and symptom control. 直觉：了解子宫内膜异位症与消化的联系，以加强病人护理和症状控制。

IF 2.2 4区医学

Current Opinion in Obstetrics & Gynecology Pub Date : 2025-08-01 Epub Date: 2025-05-08 DOI: 10.1097/GCO.0000000000001041

Liron Bar-El, Ido Veisman, Madison Simons, Courtney Delpra, Cara R King, Ashley Gubbels

{"title":"Gut feeling: understanding the endometriosis-digestive link to enhance patient care and symptom control.","authors":"Liron Bar-El, Ido Veisman, Madison Simons, Courtney Delpra, Cara R King, Ashley Gubbels","doi":"10.1097/GCO.0000000000001041","DOIUrl":"10.1097/GCO.0000000000001041","url":null,"abstract":"Purpose of review: Endometriosis is a chronic inflammatory condition that frequently presents with gastrointestinal (GI) symptoms that overlap with disorders such as irritable bowel syndrome, inflammatory bowel disease, and gastroparesis, leading to diagnostic delays. Recent research highlights the intricate relationship between endometriosis and gut health, including the role of microbiota, hormonal influences, and immune dysregulation. This review explored these mechanisms and their clinical implications for enhancing diagnosis and management strategies.Recent findings: Recent studies have suggested that hormonal fluctuations, prostaglandin dysregulation, and gut microbiota alterations contribute to GI symptoms in endometriosis. The microbiota-gut-brain axis has been implicated in disease progression, with dysbiosis influencing systemic inflammation and estrogen metabolism. Additionally, endometriotic lesions directly infiltrating the bowel can mimic GI disorders. Multidisciplinary care models, including gastroenterologists and gynecologists, are increasingly being recognized as essential for accurate diagnosis and care. Emerging therapies such as microbiome-targeted interventions, dietary modifications, and novel biomarkers offer promising avenues for improving patient outcomes.Summary: Recognizing the gut-endometriosis connection is crucial for reducing diagnostic delays and optimizing treatment strategies. Future research should focus on refining noninvasive diagnostic tools, exploring microbiome-based therapies, and enhancing interdisciplinary collaboration to improve patient care.","PeriodicalId":55194,"journal":{"name":"Current Opinion in Obstetrics & Gynecology","volume":" ","pages":"285-293"},"PeriodicalIF":2.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144210313","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}

引用次数: 0

Novel biomarkers for preeclampsia: Promises and pitfalls. 先兆子痫的新生物标志物：希望和陷阱。

IF 2.2 4区医学

Current Opinion in Obstetrics & Gynecology Pub Date : 2025-08-01 Epub Date: 2025-06-03 DOI: 10.1097/GCO.0000000000001047

Rachel L Wiley, Minhazur R Sarker, Douglas A Woelkers

{"title":"Novel biomarkers for preeclampsia: Promises and pitfalls.","authors":"Rachel L Wiley, Minhazur R Sarker, Douglas A Woelkers","doi":"10.1097/GCO.0000000000001047","DOIUrl":"10.1097/GCO.0000000000001047","url":null,"abstract":"Purpose of review: Advances in the understanding of preeclampsia are reshaping recognition of the disease and forcing reappraisal of traditional clinical definitions. Historically, the diagnosis of preeclampsia relied on nonspecific criteria not rooted in the biology of the disease. Efforts to refine these criteria led to diagnostic expansion and clinical uncertainty, creating challenges for prediction, treatment, and management. Recently available preeclampsia biomarkers offer the promise of more accurate diagnosis and risk stratification. The purpose of this review is to provide physiologic context for preeclampsia biomarkers, to summarize clinical performance, and to highlight gaps in knowledge that may hinder adoption.Recent findings: Over the past decade, several preeclampsia biomarkers have been proposed, primarily angiogenic and anti-angiogenic factors that modulate placental and maternal vascular growth and adaptation. The recent availability of rapid and precise laboratory assays has allowed researchers to demonstrate high diagnostic concordance with the syndrome of preeclampsia, and superior prediction of adverse outcomes as compared with traditional clinical criteria. Nonetheless, widespread implementation remains in its early stages because of the absence of validated intervention pathways.Summary: This review provides an update of the most promising diagnostic advances in preeclampsia, highlighting both their potential benefits and the challenges of redefining the disease with biomarkers.","PeriodicalId":55194,"journal":{"name":"Current Opinion in Obstetrics & Gynecology","volume":" ","pages":"294-301"},"PeriodicalIF":2.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144210315","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}

引用次数: 0

Updates on adenomyosis and fertility. bb0和生育率的最新消息。

IF 2.2 4区医学

Current Opinion in Obstetrics & Gynecology Pub Date : 2025-08-01 Epub Date: 2025-04-30 DOI: 10.1097/GCO.0000000000001039

Maya Shats, Michal Zajicek, Matthew T Siedhoff, Raanan Meyer

{"title":"Updates on adenomyosis and fertility.","authors":"Maya Shats, Michal Zajicek, Matthew T Siedhoff, Raanan Meyer","doi":"10.1097/GCO.0000000000001039","DOIUrl":"10.1097/GCO.0000000000001039","url":null,"abstract":"Purpose of review: Adenomyosis, characterized by ectopic endometrial tissue within the myometrium, causes chronic pelvic pain, heavy bleeding, and reduced fertility. Nowadays, diagnosis relies heavily on imaging, primarily transvaginal ultrasound, supplemented by MRI. While hysterectomy remains a definitive treatment, the rise in younger patients desiring fertility necessitates uterine-sparing approaches. This review aimed to evaluate these approaches in relation to their impact on fertility and obstetrical outcomes.Recent findings: Research highlights the association between adenomyosis and increased risk for pregnancy loss, preterm birth, and pre-eclampsia. Minimally invasive thermal ablation therapies and hysteroscopic techniques, including adenomyomectomy, offer promising fertility-sparing options, although long-term data on fertility outcomes and potential complications like uterine rupture remain limited. Advances in laparoscopic and laparotomy-based cytoreductive surgeries are also explored, but large-scale studies comparing efficacy and safety are lacking.Summary: This review examines recent advancements in understanding and managing adenomyosis, focusing on fertility-sparing interventions. Studies show varying success rates for these interventions, highlighting the need for larger, well-designed trials with standardized diagnostic criteria, to assess long-term fertility outcomes, and refine patient selection for optimal results. A consistent challenge across all approaches is the potential for uterine rupture and placenta accreta spectrum, demanding careful patient selection and close monitoring.","PeriodicalId":55194,"journal":{"name":"Current Opinion in Obstetrics & Gynecology","volume":" ","pages":"198-206"},"PeriodicalIF":2.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144010286","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}

引用次数: 0

Beyond uterine artery embolization for fibroids: what can interventional radiology do for you? 子宫动脉栓塞治疗肌瘤：介入放射学能为你做些什么？

IF 2.2 4区医学

Current Opinion in Obstetrics & Gynecology Pub Date : 2025-08-01 Epub Date: 2025-04-29 DOI: 10.1097/GCO.0000000000001034

Teale Muir, Nicholas Jesse, Hannah French, Nicholas Voutsinas, Lara Harvey

引用次数: 0

Deep endometriosis demystified: Natural progression, hormonal treatment, and malignant transformation. 深层子宫内膜异位症揭秘：自然进展，激素治疗，恶性转化。

IF 2.2 4区医学

Current Opinion in Obstetrics & Gynecology Pub Date : 2025-08-01 Epub Date: 2025-06-24 DOI: 10.1097/GCO.0000000000001036

Kelsey A Stewart, Adela G Cope, Tatnai L Burnett, Isabel C Green

{"title":"Deep endometriosis demystified: Natural progression, hormonal treatment, and malignant transformation.","authors":"Kelsey A Stewart, Adela G Cope, Tatnai L Burnett, Isabel C Green","doi":"10.1097/GCO.0000000000001036","DOIUrl":"10.1097/GCO.0000000000001036","url":null,"abstract":"Purpose of review: We present a review of the natural progression, response to hormonal therapy, and risk of malignancy associated with deep endometriosis (DE) to guide evidence-based discussion of conservative treatment.Recent findings: Advanced imaging protocols have enhanced nonsurgical detection of DE, allowing noninvasive diagnosis, treatment, and surveillance. While some DE is progressive, 50% of disease appears stable over time, and progression is reduced by half with hormonal treatments (21 versus 12%). Hormonal treatment can reduce the size of DE lesions by 1 cm³, with reductions occurring after 6 months and remaining stable up to 3 years. Most hormonal therapies improve symptoms and quality of life, regardless of changes in DE size, with combined contraceptives and progestins being the most studied. DE may present a higher risk of ovarian and extraovarian cancer than previously hypothesized, though further research is needed to confirm findings. Limitations of DE research include differing imaging strategies, definitions of disease and progression, short follow-up, focus on rectosigmoid DE only, and lack of randomized trials.Summary: DE is a subtype of endometriosis that is increasingly diagnosed and treated with noninvasive strategies. Hormonal treatments improve symptoms and reduce progression of DE. Further research on optimal conservative management and risk of malignancy is warranted.","PeriodicalId":55194,"journal":{"name":"Current Opinion in Obstetrics & Gynecology","volume":" ","pages":"221-232"},"PeriodicalIF":2.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143995964","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}

引用次数: 0

Impact of fibroids on fertility, pregnancy loss, and preconception management. 子宫肌瘤对生育、妊娠丢失和孕前处理的影响。

IF 2.2 4区医学

Current Opinion in Obstetrics & Gynecology Pub Date : 2025-08-01 Epub Date: 2025-04-29 DOI: 10.1097/GCO.0000000000001033

Ogechukwu Ezike, Rebecca Schneyer, Kelly Wright, Kacey Hamilton

{"title":"Impact of fibroids on fertility, pregnancy loss, and preconception management.","authors":"Ogechukwu Ezike, Rebecca Schneyer, Kelly Wright, Kacey Hamilton","doi":"10.1097/GCO.0000000000001033","DOIUrl":"10.1097/GCO.0000000000001033","url":null,"abstract":"Purpose of review: Although fibroids are understood to be a predominantly benign and common pathology, they can have significant impacts on patients' quality of life and reproductive health. This review summarizes the impact of uterine fibroids on fertility and spontaneous abortion, while also addressing how the treatment for fibroids can affect fertility. Lastly, the review will address strategies for preconception management of fibroids to optimize patients' reproductive health.Recent findings: The data regarding the impact of fibroids on fertility and pregnancy loss is evolving. However, it is agreed that the impact of fibroids is predominantly determined by their location in the uterus. Fibroids located in the submucosal layer or otherwise disrupting the endometrial cavity can impede the implantation of an embryo or potentially increase the risk of spontaneous abortion. When treating fibroids for the purpose of fertility, surgical management is preferred over medication management. There is limited data supporting procedures such as uterine artery embolization or radiofrequency ablation for the management of fibroids to improve fertility. Surgical management of fibroids not impacting the uterine cavity remains controversial.Summary: Uterine fibroids can have a detrimental impact on fertility and therefore require purposeful attention to both the diagnosis and management of the condition in reproductive-aged women. The treatment of fibroids for the purpose of fertility alone remains controversial. Regardless, fibroid size and location should be cataloged, and surgical management should be offered to patients experiencing difficulties with conception.","PeriodicalId":55194,"journal":{"name":"Current Opinion in Obstetrics & Gynecology","volume":" ","pages":"207-214"},"PeriodicalIF":2.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143995974","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}

引用次数: 0

The use of GLP-1: receptor agonist medications for benign gynecology. GLP-1受体激动剂在良性妇科的应用。

IF 2.2 4区医学

Current Opinion in Obstetrics & Gynecology Pub Date : 2025-08-01 Epub Date: 2025-04-04 DOI: 10.1097/GCO.0000000000001028

Megan D Howard, Sarah E Allen

{"title":"The use of GLP-1: receptor agonist medications for benign gynecology.","authors":"Megan D Howard, Sarah E Allen","doi":"10.1097/GCO.0000000000001028","DOIUrl":"10.1097/GCO.0000000000001028","url":null,"abstract":"Purpose of review: This review summarizes research on glucagon-like peptide-1 receptor agonist (GLP-1 RA) medications and their relevance in the treatment of benign gynecologic conditions.Recent findings: GLP-1 RA use is increasing in popularity in the USA, with expanding applications for gynecology. GLP-1 RA may improve weight loss, metabolic dysfunction, and menstrual regularity in patients with polycystic ovarian syndrome (PCOS). Side effects of these medications, including delayed gastric emptying, impact perioperative management, and the efficacy of oral contraception for patients on tirzepatide. Research is ongoing for their use in infertility and endometrial hyperplasia treatment. Recent studies showed a higher spontaneous conception rate and pregnancy rate with combined GLP-1 RA and metformin therapy when taken before IVF. Further studies are needed to establish recommendations for GLP-1 RA medication use in treating gynecologic conditions.Summary: With obesity, diabetes, and cardiovascular disease on the rise in the USA, the use of GLP-1 RA medication is also increasing. GLP-1 RAs are currently indicated for the treatment of diabetes with cardiovascular disease to improve glycemic control, in addition to weight loss management. Gynecologists must consider the implications of GLP-1 RA medication in treating metabolic disorders, such as PCOS, contraceptive management, perioperative care, and potential impacts on infertility and endometrial hyperplasia.","PeriodicalId":55194,"journal":{"name":"Current Opinion in Obstetrics & Gynecology","volume":" ","pages":"279-284"},"PeriodicalIF":2.2,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143782002","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}

引用次数: 0