Current Opinion in Obstetrics & Gynecology最新文献

{"title":"Editorial introductions.","authors":"","doi":"10.1097/GCO.0000000000001026","DOIUrl":"https://doi.org/10.1097/GCO.0000000000001026","url":null,"abstract":"","PeriodicalId":55194,"journal":{"name":"Current Opinion in Obstetrics & Gynecology","volume":"37 3","pages":"I-II"},"PeriodicalIF":2.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144043298","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":"Management of women with endometriosis in the 21st century.","authors":"Attilio Di Spiezio Sardo, Christian M Becker, Stefan P Renner, Pia A Suvitie, Josep Estadella Tarriel, Silvia Vannuccini, Juan A Garcia Velasco, Jasper Verguts, Antonio Mercorio","doi":"10.1097/GCO.0000000000001027","DOIUrl":"https://doi.org/10.1097/GCO.0000000000001027","url":null,"abstract":"<p><strong>Purpose of review: </strong>Endometriosis is a chronic inflammatory condition that significantly affects women's quality of life and fertility. Despite advancements in treatment, many areas of uncertainty persist in clinical management. This review provides a symptom-focused, patient-centered update, addressing cases from asymptomatic to those complicated by pain and infertility.</p><p><strong>Recent findings: </strong>Advancement in imaging technology has increased incidental diagnoses of asymptomatic endometriosis, raising the debate between immediate treatment and watchful waiting. Medical therapy primarily aims to suppress symptoms, with oral gonadotropin-releasing hormone antagonists and add-back therapy offering promising long-term pain control. Research into local neurogenesis and central sensitization supports complementary approaches, though high-quality evidence is still limited. For pain refractory to medical therapy, conservative surgical strategies can minimize postoperative complications without significantly increasing recurrence rates. In infertility, assisted reproductive technology (ART) provides effective options, although the optimal endometrial preparation and the necessity of pre-ART surgery remain to be fully elucidated.</p><p><strong>Summary: </strong>The optimal management of endometriosis requires a personalized, multidisciplinary approach within specialized centers. Long-term suppressive medical therapy remains the cornerstone of pain management while emerging targeted agents hold promise for better symptom control with fewer side effects. Surgical intervention should be performed by experienced surgeons as a single definitive procedure when possible. Tailored ART protocols can address infertility challenges. Standardized classification systems and robust randomized trials are crucial to refining treatment pathways, optimizing fertility outcomes, and enhancing quality of life.</p>","PeriodicalId":55194,"journal":{"name":"Current Opinion in Obstetrics & Gynecology","volume":"37 3","pages":"149-157"},"PeriodicalIF":2.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12039902/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144059216","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":"Late bloomers: exploring the reproductive potential of day 7 embryos.","authors":"Blake Vessa, Jason Franasiak","doi":"10.1097/GCO.0000000000001021","DOIUrl":"10.1097/GCO.0000000000001021","url":null,"abstract":"<p><strong>Purpose of review: </strong>The purpose of this review is to evaluate the reproductive potential of day 7 embryos. With effective cryopreservation and subsequent frozen embryo transfers, extended blastocyst culture to day 7 is now possible. However, assessing the true reproductive potential of day 7 embryos is essential to adequately counsel patients on the expected pregnancy and live birth rates in comparison to embryos that reach the blastocyst stage on day 5 or day 6.</p><p><strong>Recent findings: </strong>Day 7 embryos have a lower blastulation rate and higher aneuploidy rate compared with day 5 and day 6 embryos. Although day 7 blastocysts comprise less than 10% of usable embryos for transfer, recent studies have repeatedly demonstrated lower, but not negligible, pregnancy and live birth rates with day 7 embryo transfers. Based on the current literature reviewed in this paper, the clinical pregnancy rates for euploid day 7 embryos appear to be between 16.7 and 52.6%, whereas the live birth rates are between 21.5 and 46%. Therefore, while the blastulation and pregnancy rates are lower and the aneuploidy rates are higher, euploid day 7 embryos have reproductive potential.</p><p><strong>Summary: </strong>While recent data supports reduced reproductive potential of euploid day 7 embryos when compared with the success rates of day 5 and 6 embryos, their associated pregnancy and live birth rates are nonzero and still represent a viable option for certain patients.</p>","PeriodicalId":55194,"journal":{"name":"Current Opinion in Obstetrics & Gynecology","volume":" ","pages":"158-163"},"PeriodicalIF":2.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765646","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":"Advancing human reproduction: challenges and innovations.","authors":"Juan A Garcia-Velasco, Emre Seli","doi":"10.1097/GCO.0000000000001024","DOIUrl":"https://doi.org/10.1097/GCO.0000000000001024","url":null,"abstract":"","PeriodicalId":55194,"journal":{"name":"Current Opinion in Obstetrics & Gynecology","volume":"37 3","pages":"121-122"},"PeriodicalIF":2.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144000241","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":"Gene editing using CRISPR-Cas9 technology: potential implications in assisted reproduction.","authors":"Gizem Nur Sahin, Emre Seli","doi":"10.1097/GCO.0000000000001022","DOIUrl":"https://doi.org/10.1097/GCO.0000000000001022","url":null,"abstract":"<p><strong>Purpose of review: </strong>This article reviews the mechanisms, advancements, and potential implications of clustered regularly interspaced short palindromic repeats-associated (CRISPR-Cas) gene editing technology, with a specific focus on its applications in reproductive biology and assisted reproduction. It aims to explore the benefits and challenges of integrating this revolutionary technology into clinical and research settings.</p><p><strong>Recent findings: </strong>CRISPR-Cas9 is a transformative tool for precise genome editing, enabling targeted modifications through mechanisms like nonhomologous end joining (NHEJ) and homology-directed repair (HDR). Innovations such as Cas9 nickase and dCas9 systems have improved specificity and expanded applications, including gene activation, repression, and epigenetic modifications. In reproductive research, CRISPR has facilitated gene function studies, corrected genetic mutations in animal models, and demonstrated potential in addressing human infertility and hereditary disorders. Emerging applications include mitochondrial genome editing, population control of disease vectors via gene drives, and detailed analyses of epigenetic mechanisms.</p><p><strong>Summary: </strong>CRISPR-Cas9 technology has revolutionized genetic engineering by enabling precise genome modifications. This article discusses its mechanisms, focusing on the repair pathways (NHEJ and HDR) and methods to mitigate off-target effects. In reproductive biology, CRISPR has advanced our understanding of fertility genes, allowed corrections of hereditary mutations, and opened avenues for novel therapeutic strategies. While its clinical application in human-assisted reproduction faces ethical and safety challenges, ongoing innovations hold promise for broader biomedical applications.</p>","PeriodicalId":55194,"journal":{"name":"Current Opinion in Obstetrics & Gynecology","volume":"37 3","pages":"141-148"},"PeriodicalIF":2.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144040848","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 genetics of preimplantation embryonic arrest: the role of aneuploidies.","authors":"Ludovica Picchetta, Katharina Spath, Antonio Capalbo, Christian Simon Ottolini","doi":"10.1097/GCO.0000000000001020","DOIUrl":"10.1097/GCO.0000000000001020","url":null,"abstract":"<p><strong>Purpose of the review: </strong>Aneuploidy is a major cause of embryonic arrest. While meiotic aneuploidies, especially maternal, are a well-documented cause of embryo and fetal arrest, increasing evidence highlights the crucial role played by mitotic aneuploidies. This review explores the molecular and cellular pathways underlying these abnormalities, focusing on abnormal cleavage, chromatin cohesion, spindle stability, maternal effect genes, and mitochondria.</p><p><strong>Recent findings: </strong>Approximately half of human embryos cease development in vitro or shortly after transfer to the uterus. Genetic investigation of these embryos has highlighted that 90% of these exhibit aneuploidies. Surprisingly, most of these arise from errors during the early mitotic divisions of preimplantation embryos. These findings strongly correlate with disruptions of early cleavage possibly due to faulty spindle assembly or mitochondrial dysfunction during the in-vitro development. Moreover, maternal effects, such as faulty meiotic recombination and variants in maternal effect genes involved in the subcortical maternal complex, may further predispose the embryo to high rates of chromosomal imbalance.</p><p><strong>Summary: </strong>Meiotic and mitotic aneuploidies play a significant role in embryo arrest, yet their molecular and cellular origin are not well understood. Investigating these pathways may lead to interventions that could be developed to improve success rates with IVF or even fertility rates in general.</p>","PeriodicalId":55194,"journal":{"name":"Current Opinion in Obstetrics & Gynecology","volume":" ","pages":"123-129"},"PeriodicalIF":2.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143756070","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 body weight on IVF: pathophysiology, outcomes, and clinical considerations.","authors":"Nicole M Sekula, Murat Basar, Lubna Pal","doi":"10.1097/GCO.0000000000001023","DOIUrl":"10.1097/GCO.0000000000001023","url":null,"abstract":"<p><strong>Purpose of review: </strong>This study aimed to examine if excess body weight impacts the outcomes of IVF treatment cycles.</p><p><strong>Recent findings: </strong>While data on the effect and/or association of excess weight on IVF outcomes continue to produce mixed results, recent studies stratifying analyses by age are yielding clarity on a detrimental potential of obesity on IVF outcomes. Specifically, IVF outcomes in the third decade of life are susceptible to adverse implications of excess weight, as reflected in lower clinical pregnancy and live birth rates. Plausible pathogenic mechanisms underlying the detrimental impact of excess weight on IVF outcomes include inflammation, DNA repair, insulin resistance, and the targets of such mechanisms that include the spectrum of players critical to reproductive success, including the oocyte, sperm, embryo, and uterine receptivity.</p><p><strong>Summary: </strong>The detrimental implications of excess weight on IVF outcomes are more pronounced by age, and inflammatory processes seem to be particularly relevant to the interplay of weight excess, adiposity, and IVF cycle outcomes.</p>","PeriodicalId":55194,"journal":{"name":"Current Opinion in Obstetrics & Gynecology","volume":" ","pages":"130-140"},"PeriodicalIF":2.2,"publicationDate":"2025-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143765632","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":"Trends in gynecologic surgery reimbursement and physician pay.","authors":"Michelle DenAdel, Parisa Rose Khalighi, Caitlin Hamilton, Marisa Dahlman","doi":"10.1097/GCO.0000000000001042","DOIUrl":"https://doi.org/10.1097/GCO.0000000000001042","url":null,"abstract":"<p><strong>Purpose of review: </strong>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.</p><p><strong>Recent findings: </strong>Disparities persist in reimbursement for female-specific compared to male-specific procedures. RVUs do not reflect changes in patient complexity.</p><p><strong>Summary: </strong>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.</p>","PeriodicalId":55194,"journal":{"name":"Current Opinion in Obstetrics & Gynecology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-05-01","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}

{"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":"https://doi.org/10.1097/GCO.0000000000001040","url":null,"abstract":"<p><strong>Purpose of review: </strong>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.</p><p><strong>Recent findings: </strong>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.</p><p><strong>Summary: </strong>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.</p>","PeriodicalId":55194,"journal":{"name":"Current Opinion in Obstetrics & Gynecology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-04-30","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}

{"title":"Updates on adenomyosis and fertility.","authors":"Maya Shats, Michal Zajicek, Matthew T Siedhoff, Raanan Meyer","doi":"10.1097/GCO.0000000000001039","DOIUrl":"https://doi.org/10.1097/GCO.0000000000001039","url":null,"abstract":"<p><strong>Purpose of review: </strong>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.</p><p><strong>Recent findings: </strong>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.</p><p><strong>Summary: </strong>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.</p>","PeriodicalId":55194,"journal":{"name":"Current Opinion in Obstetrics & Gynecology","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-04-30","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}