Obstetric and gynecological violence (OGV) is a long-standing issue that affects the experiences of both patients and caregivers. This study explores the awareness, experiences, and practices of obstetrics and gynecology residents in France, within a context of ongoing controversy. A nationwide survey was carried out between September and December 2023, via a questionnaire distributed to French obstetrics-gynecology and medical gynecology residents. It consists of 37 questions, most of which are closed-ended (answers based on Likert scales, ranging from 1 to 10), but some of which could be completed with free text. The primary objective of this study was to assess gynecology residents' awareness of OGV (defined according to the French Haut Conseil à l'Égalité criteria). The secondary objectives were to evaluate their knowledge and personal experiences and to identify areas for improvement in training. Of the 1459 eligible French gynecology residents, 455 (31.2%) participated. Nearly all respondents (98.9%) were familiar with the concept of OGV, and 98.7% acknowledged its existence. Awareness was primarily acquired through social networks (74.5%) and clinical internships (73.4%), while university teaching played only a minor role (16%). A total of 398 residents (87.5%) reported witnessing OGV during their training, with 42.9% encountering it frequently. The most commonly reported forms were procedures performed without explicit consent (31.2%) and insufficient communication (14.1%). Residents also identified major contributors to OGV, including emergencies (93.2%), lack of time (92.7%), fatigue (85.5%), and stress (81.8%). In their clinical practice, residents reported more systematic consent seeking, clearer information provided to women, and greater consideration of patient modesty and pain management. This nationwide survey shows that nearly all French gynecology residents are aware of OGV and acknowledge its existence. However, awareness is mainly acquired during residency, largely through informal sources such as social networks and clinical internships, rather than through university teaching. The high frequency of reported exposure to OGV and the identification of modifiable contributing factors highlight the need to strengthen structured education, communication training, and formal teaching on respectful care during medical training.
Endometriosis is a chronic disorder that affects approximately 10% of reproductive aged women and can have wide-ranging detrimental effects. While endometriosis is known to be associated with early menopause, the rates of primary ovarian insufficiency and surgical menopause in these patients compared to the general population are not well defined. The objective of this study is to evaluate the rates of primary ovarian insufficiency and surgical menopause in patients with a diagnosis of endometriosis. The TriNetX database was used to identify women 18 and older with surgically diagnosed endometriosis. Diagnostic codes were used to estimate the rates of primary ovarian insufficiency and surgical menopause, which were then tested against a matched comparison group, using propensity score matching to include patients presenting for a routine gynecologic encounter without a diagnosis of endometriosis. Rates were then assessed by age groups: 18-39, 40-44, 45-49. Prevalence of primary ovarian insufficiency and surgical menopause as well as prevalence of oophorectomy and hysterectomy were assessed in patients with a diagnosis of endometriosis from 2013-2023 and stratified by age. Patients with endometriosis had a 3.7x the risk of primary ovarian insufficiency and 12.4x the risk of surgical menopause (p < 0.0001), with an overall risk of 1.4% and 0.7%, respectively. Rates of menopause in patients with endometriosis aged 18-39 were 4.7x that of the general population. Reported prevalence proportions of primary ovarian insufficiency and surgical menopause among patients with a diagnosis of endometriosis increased over the past decade, alongside rates of oophorectomy and hysterectomy. The mean annual change in period prevalence were 0.10% (95% CI: 0.09%-0.11%), 1.40% (95% CI: 1.19% ∼ 1.61%), 0.05% (95% CI: 0.04% ∼ 0.06%), 1.97% (95% CI: 1.73% ∼ 2.21%), 0.83% (95% CI: 0.73% ∼ 0.92%) for Premature Ovarian Insufficiency, Menopausal State, Surgical Menopause, Hysterectomy, and Oophorectomy, respectively, during the study period from 2013 to 2023. Rates of primary ovarian insufficiency and surgical menopause are higher among patients with endometriosis. With higher rates of oophorectomy and hysterectomy at younger ages, adequate counseling on the risks of premature menopause are essential. Further studies are required to guide management of hormone replacement therapy for patients with premature menopause while minimizing endometriosis recurrence. A focus on early diagnosis and preventative strategies is essential to improve the long-term health outcomes for these patients.
Practices in induction of labor for medical termination of pregnancy or intra uterine fetal death are controverted. DILAPAN-S dilators are often used as an adjunction of oral prostaglandins to reduce the time of delivery, but protocols may differ between practicians. At the University Hospital of Saint-Etienne, the DILAPAN-S were applied the evening before induction until 2020, and the same day as misoprostol intake since 2022. To evaluate these two protocols of induction of labor with DILAPAN-S, on the day before and on the same day as prostaglandins, on the reduction of time of labor. Retrospective, single-center, before-and-after observational study carried out in the Department of Obstetrics and Gynecology at the University Hospital of Saint-Etienne between 2018-2020 and 2022-2024. Patients were respectively included in the ″Day-1″ or in the ″Day 0″ group. The primary endpoint was the time of labor in each group, measured in hours. 205 patients were included, 97 in the ″Day-1″ and 108 in the ″Day 0" group. The analysis of the primary outcome was per-protocol. The time interval between the first dose of misoprostol and delivery was on average 7h25 ± 7h41 in the ″Day -1″ group and 10h35 ± 7h18 in the ″Day 0″ group, which means a difference of 3h10 (p < 0,0001). Duration in delivery room as well as duration of epidural analgesia were shorter in the ″Day -1″ group, but duration of hospitalization and obstetrical complication were lower in the ″Day 0″ group. The proportion of patients experiencing a labor duration longer than 12 hours was significantly higher in the ″Day 0" group. The use of DILAPAN-S dilators the day before a misoprostol induction reduces the time of labor in comparison as DILAPAN-S used concomitate with prostaglandins in a situation of TOP or IUFD, but it increases the duration of hospitalization. The reduction of 3 hours is not clinically significant. Other studies are needed to explore the possibility of outpatient used and the women's experiences.
Obstetric anal sphincter injury (OASI) is one of the major complications of vaginal delivery. Several lesions remain clinically undiagnosed at delivery. The objective of this study was to evaluate the feasibility and impact of performing a transperineal ultrasound (TPUS) in the immediate postpartum period by a non-expert obstetrician. We conducted a prospective bicentric randomized controlled trial comparing clinical examination alone (CE group) versus clinical examination associated with transperineal ultrasound (TPUS group), in primiparous women following a vaginal birth with ≥ second degree perineal tear or episiotomy. If a 3rd or 4th degree perineal tear was diagnosed clinically and/or by TPUS, an OASI repair was performed. Patient tolerance was assessed using a visual analogue scale (VAS), and associated complications were recorded. The primary outcome was anal incontinence at 5 months postpartum, evaluated using the Wexner scale. All TPUS images were independently reviewed by an expert gastroenterologist (expert) to assess the inter-observer agreement. A total of 110 nulliparous women were enrolled, 54 in the CE group and 56 in the TPUS group. Of these, 51 and 47, respectively, completed the 5-month follow-up. The rate of operative vaginal delivery was 44% (49/110), mainly using spatulas (42/49), and 57% (63/110) of women had a mediolateral episiotomy. The rate of severe perineal tears diagnosed by clinical examination alone was 12.7% (14/110) (9, 3, 0, and 2 patients had 3a, 3b, 3c, and fourth-degree tears, respectively). Transperineal ultrasound was performed in all patients randomized to the TPUS group. Among 51 patients diagnosed with a second-degree tear on clinical examination, TPUS revealed four (7.8%) occult OASIs (three 3a and one 3c tears). Tolerance to TPUS was good, with a mean VAS score of 0.43 (±1.33), which was lower than that for clinical examination. The rate of anal incontinence at 5 months postpartum (Wexner score >4) was lower in the TPUS group (1/47, 2.1%) than in the CE group (4/51, 7.8%), but this difference was not statistically significant (p=0.19). Inter-observer agreement between the obstetrician and the expert was poor for identifying both external (κ=0.259) and internal (κ=0.367) anal sphincter lesions on TPUS. Improving the diagnosis and prognosis of OASI at the time of delivery using transperineal ultrasound combined with clinical rectal examination is feasible when performed by a non-expert obstetrician and is well tolerated by women. However, it requires specific ultrasound equipment, which is not always available, and inter-observer agreement with expert assessment remains poor for both external and internal anal sphincter lesions.
While previous studies have correlated blastocyst expansion with pregnancy, there is limited evidence regarding post-warming characteristics and specifically the capability of the vitrified and warmed blastocyst to re-expand fully to the pre-vitrification state. This study aimed to examine the effect of blastocyst re-expansion on clinical pregnancy rates (CPRs) in frozen embryo transfer (FET) cycles. In this retrospective cohort, FET patients were stratified into "collapsed" and "re-expanded" groups and further categorized into good (≥ 3BB) or low (<3BB) embryo quality at time of vitrification. Patients were age-matched on a 1:2 ratio for comparison between the collapsed (n=165) and re-expanded (n=330) groups. The primary outcome of clinical pregnancy rate (CPR), in addition to secondary pregnancy outcomes, was reported. Chi-square tests of independence and Cramer's V test were performed to examine the association between CPR of collapsed versus re-expanded blastocysts; embryo quality; and age (< 38 years vs ≥ 38 years). Odds ratios with 95% confidence intervals were reported. A total of 5,996 patients underwent frozen embryo transfer (FET) between 2005 and 2012, of whom 165 (2.8%) received a collapsed blastocyst. Patients were age-matched in a 1:2 ratio in comparison to patients who implanted a re-expanded blastocyst (n = 330). Clinical pregnancy rate (CPR) was 28.5% in the re-expanded group compared with 15.8% in the collapsed group (OR = 2.145, 95% CI [1.324, 3.473]). There was a significant association between CPR and blastocyst expansion, χ²(1, N = 496) = 9.901, p = .002, with a small effect size (V = 0.14). CPR was also significantly associated with embryo quality (p = .017) and age (p < .001), regardless of embryo expansion. Our findings suggest that the transfer of a collapsed blastocyst during FET is associated with a lower CPR than a re-expanded blastocyst. Despite these differences, a viable pregnancy can be achieved after the transfer of a collapsed blastocyst, especially in younger patients with good quality embryos at the time of vitrification.
Infertility impacts 17.5% of couples worldwide, and many of those struggling rely on assisted reproductive technology (ART) to aid in conception. Although ART techniques are invasive and known to increase risk of pregnancy complications, no studies have considered the relationship between ART, sex, and hypertension developed during pregnancy. In this retrospective cohort study, we analyzed 19,727,414 live births between 2016-2021 in the US, stratified by presence of chronic hypertension (yes or no) and further by conception type (spontaneous, non-IVF assisted conception, ART). Modified Poisson regression models were fit to estimate risk ratios (RRs) and 95% confidence intervals (CIs) for hypertensive disorders of pregnancy among fetal male vs fetal female pregnancies across each conception strata, and further by gestational age stratified groups. Among individuals without chronic hypertension, we identified a greater rate of hypertensive disorders of pregnancy in the non-IVF-assisted and ART strata compared with spontaneous conception, with slightly higher crude rates of hypertensive disorders of pregnancy in fetal male pregnancies across all conception strata. Fetal males in the spontaneous conception group displayed a slightly greater risk ratio of hypertensive disorders of pregnancy overall (aRR 1.010, 95% CI 1.007, 1.013). Among gestational age stratified analyses in the spontaneous conception population, fetal females were more strongly associated with hypertensive disorders of pregnancy among early preterm (22-26 weeks; aRR 0.823, 95% CI 0.797, 0.850) and late preterm (27-36 weeks; aRR 0.938, 95% CI 0.932, 0.944) births, whereas fetal males demonstrated a modest excess risk at term (≥37 weeks; aRR 1.016, 95% CI 1.012, 1.019). Similar trends were observed across conception strata. Results were consistent in a sensitivity analysis of only nulliparous patients. No difference by fetal sex was observed among individuals with chronic hypertension overall. Stratification by gestational age in the chronic hypertension population revealed an increased fetal female risk for hypertensive disorders of pregnancy among preterm pregnancies in the spontaneous conception strata only (aRR 0.884, 95% CI 0.796, 0980). These results further inform the importance of considering fetal sex in obstetric outcomes, as assessing mixed-sex populations across all gestational ages at delivery may mask heterogeneity driven by sexual dimorphism. Irrespective of sex, these findings also provide insight on the risks of assisted reproductive technology in the context of maternal health outcomes.
TikTok pregnancy-related information content has not yet been investigated. To assess the quality, reliability, and misinformation on TikTok videos regarding induction of labor (IOL). A cross-sectional analysis of TikTok videos, employing the "Induction of Labor" keyword, was conducted on the 13th of January 2025. All videos retrieved under this search term were evaluated. The TikTok materials were compared between patients and healthcare with the following tools: Patient Education Materials Assessment Tool (PEMAT A/V), the modified Development of a Quality Index for Health Information (mDISCERN), global quality scale (GQS), and video information and quality index (VIQI). One hundred fifty TikTok videos were examined. The contents were created mainly from patients 52 % (78/150), 39 % from healthcare (59/150), and 9 % (13/150) from other sources. Healthcare content showed a higher PEMAT A/V for actionability and understandability median score, 81.8 % and 66.7 %, respectively, compared to the patient-generated content median score of 75.0 %, and 33.3 % (P = 0.01 and P < 0.001). On VIQI, healthcare videos outperformed patients' content, in information accuracy (4.0 vs 2.5), precision (4.0 vs 2.5), and total VIQI score (14.0 vs. 10.0; all P < 0.001). Healthcare and other sources had a median of 2.0 for mDISCERN reliability (P < 0.001). GQS showed a median of 4.0 for healthcare content versus 2.5 median for patients' content (P < 0.001). Patients' TikTok content reporting low scores on all validated assessment tools. Healthcare videos reported a higher score of understandability, actionability, and accuracy. These findings suggest that obstetric healthcare content on social media are probably necessary to offer IOL evidence-based information.
Digital twin technology, originating from aerospace and manufacturing industries, has emerged as a transformative tool in healthcare. In vitro fertilisation (IVF) faces persistent challenges including suboptimal embryo selection, unpredictable treatment outcomes, and limited personalisation of protocols. Despite advances in assisted reproductive technology, existing literature exhibits fragmentation: artificial intelligence applications in embryo selection, ovarian stimulation, and endometrial assessment have been developed independently without systematic integration into comprehensive treatment frameworks. Digital twin technology offers unprecedented opportunities to create virtual replicas of biological systems, enabling real-time monitoring, predictive modelling, and personalised treatment strategies. This narrative review aims to critically examine the current applications of digital twin technology in IVF, evaluate its potential benefits and limitations, synthesize existing evidence into an integrative conceptual model, and identify future directions for implementation in reproductive medicine. A comprehensive narrative review was conducted using PubMed, Scopus, Web of Science, and IEEE Xplore databases. A narrative review approach was selected over systematic review to accommodate the heterogeneity of evidence types in this emerging field, including theoretical frameworks, simulation studies, and proof-of-concept implementations that would be excluded from systematic reviews. Search terms included "digital twin," "IVF," "in vitro fertilisation," "assisted reproductive technology," "embryo selection," and "predictive modelling." Studies published between 2015 and 2025 were included, focusing on original research articles, systematic reviews, and proof-of-concept studies describing digital twin applications in reproductive medicine. Digital twin technology in IVF demonstrates significant potential across multiple domains including embryo development simulation, ovarian response prediction, endometrial receptivity modelling, and personalised stimulation protocols. Current applications integrate artificial intelligence, machine learning algorithms, time-lapse imaging, and omics data to create comprehensive virtual models. Early evidence suggests improvements in embryo selection accuracy, ovarian response prediction, and treatment protocol optimization, though large-scale randomized controlled trials remain limited. Implementation challenges include data integration complexity, computational requirements, regulatory considerations, and validation requirements. Digital twin technology represents a paradigm shift in IVF practice, offering personalised, predictive, and precision medicine approaches. This review synthesizes existing evidence to propose an integrative conceptual model for digital twin implementation across the IVF treatment spectrum, identifies critical knowledge gaps, and establishes research priorities to advance clinical translation. Despite current limitations, continued advancement promises improved success rates and patient outcomes.
To evaluate whether the combination of misoprostol and an intracervical Foley catheter shortens the induction-to-abortion interval compared to misoprostol alone in second-trimester pregnancy terminations. We conducted a comprehensive search through a search strategy across PubMed, Embase, and Cochrane from the establishment of the database to November 2024. The references from included studies, previous systematic reviews and meta-analyses were searched manually for any additional studies. We performed a systematic review and meta-analysis of RCTs and retrospective cohorts comparing the induction-to-abortion interval in patients with second-trimester terminations of pregnancy. A random effects model was used to calculate the risk ratios (RRs) and mean differences (MDs), with 95% confidence intervals (CIs). Statistical analyses were performed using R, version 4.4.3. Five studies comprising 657 patients were included, of whom 273 (41.6%) received misoprostol and Foley catheter and 384 (58.4%) received misoprostol alone. Compared with misoprostol alone, misoprostol and Foley catheter combination did not reduce the induction-to-abortion interval (MD -1.29 h; 95% CI -5.92, 3.33; p = 0.58; I²=85%). Furthermore, there were no significant differences in complications such as incomplete abortion (need for surgery) (RR 1.72; 95% CI 0.77-3.85; p = 0.18; I²=0%), uterine rupture (RR 0.93; 95% CI 0.10-8.20; p = 0.94; I²=0%), hemorrhage (RR 1.07; 95% CI 0.52-2.19; p = 0.85; I²=0%), and fever (RR 0.64; 95% CI 0.13-3.29; p = 0.59; I²=37%). However, the number of doses of misoprostol in the misoprostol and Foley catheter group was reduced (MD -1.95 doses; 95% CI -3.18, -0.72; p = 0.0019, I²=98%). No reduction in the induction-to-abortion interval was observed in favor of the misoprostol and Foley catheter group. In addition, no differences were observed in need for surgery, uterine rupture, hemorrhage, and fever. However, the misoprostol plus Foley catheter group required a lower total dose of misoprostol required to abortion.
Current literature comparing laparoscopic (LSC) and robot-assisted sacrocolpopexy (RASC) for pelvic organ prolapse (POP) management is often limited by small cohort sizes. This study aimed to compare the efficacy and morbidity of LSC and RASC in a large cohort treated across three distinct medical specialties (Gynecology, Urology, and Digestive Surgery), and to evaluate practice variations among these departments. We conducted a retrospective, single-center, multi-departmental study. The primary outcome was the overall reoperation rate for recurrence or complications. Secondary outcomes included intraoperative and postoperative complication rates, length of hospital stay, and 5-year recurrence-free survival. The study included 266 patients (RASC, n = 201; LSC, n = 65) with a mean follow-up of 42.2 months. The overall reoperation rate did not differ significantly between the RASC (13.93%) and LSC (18.46%) groups (p = 0.490). However, the LSC group experienced significantly higher rates of late minor postoperative complications (61.54%vs. 45.27%, p = 0.032) and constipation (43.08%vs. 25.87%, p = 0.013), as well as a longer median hospital stay (4 days vs. 3 days, p = 0.007). Inter-departmental analysis highlighted significant differences in concomitant surgical procedures, with the Gynecology department treating a significantly younger patient population. RASC is a safe and reliable alternative to the conventional LSC approach for POP management. The choice of surgical approach should be guided by the surgeon's preference and expertise. Further prospective randomized trials are required to comprehensively evaluate all aspects of POP management.
To assess adherence to the International Ovarian Tumor Analysis (IOTA) terminology in Danish routine clinical practice and to evaluate how non-adherence affects the diagnostic performance and calibration of the Assessment of Different NEoplasias in the adneXa (ADNEX) model and the Two-Step Strategy with modified benign descriptors (BD) with Cancer Antigen 125 (CA125). This prospective, multicenter cohort study included patients ≥18 years with adnexal masses across 14 gynecology departments and general gynecology practices. Reference standard was histopathology for surgically managed patients and clinical follow-up for conservatively managed patients. Ultrasound descriptions recorded at recruitment using IOTA terminology by examining clinicians with varying experience and IOTA certification were reviewed by three blinded IOTA-certified experts to identify deviations from IOTA definitions. Based on expert reassessment of stored representative images, obvious non-adherent terminology was corrected. Agreement in modified BD applicability was assessed using Cohen's kappa (κ). Performance and calibration were compared using predictive values (10% threshold), area under the curve (AUC), prediction error, and calibration plots. Of 1065 enrolled patients, 948 constituted the complete-case cohort. Non-adherence to the IOTA terminology was identified in 198 (20.9%) clinician-recorded ultrasound descriptions. Agreement on the modified BD category was 90.0%, κ = 0.79. NPVs increased for both models (ADNEX: 95.7% to 96.8%; Two-Step: 95.4% to 96.9%), as did PPVs (ADNEX: 48.6% to 52.0%; Two-Step: 50.4% to 52.8%) and AUCs (ADNEX: 90.8% to 93.4%; Two-Step: 90.3% to 93.6%). Prediction error decreased, while overall calibration remained unchanged. Non-adherence to IOTA terminology is a potential barrier to successful implementation and highlights the need for strategies that promote consistent use of standardized IOTA terminology. Expert reassessment was based on stored still ultrasound images and may not fully capture dynamic features of real-time examination.
To compare the complication rates of surgical versus medical abortion between 14 and 16 weeks of gestation (primary objective), and to assess patient experience (secondary objective). This prospective bicentric cohort study was conducted in Marseille, France, and included adult patients undergoing abortion between 14 and 16 weeks of gestation. Medical abortion was performed at Hôpital Nord (from May 2023), and surgical abortion at Hôpital de la Conception (from January 2025). The primary outcome was the occurrence of early complications (hemorrhage >500 mL, blood transfusion, scheduled or emergency surgical intervention, cervical laceration, or uterine perforation) or late complications (pelvic inflammatory disease (PID), unplanned consultation, or hospitalisation). Secondary outcomes included patient-reported experience (pain, anxiety, and satisfaction). Follow-up continued to six weeks after the procedure. Seventy-four patients were included (41 surgical abortions and 33 medical abortions). Baseline characteristics were comparable between groups. Effectiveness defined as abortion of the fetus was 100% for surgical abortion versus 91% for medical abortion (p = 0.084). Overall, complications occurred in 26% of patients, with a trend toward a higher rate in the medical group (36%vs 17%, p = 0.059). Surgical reinterventions for retained products occurred exclusively after medical abortion (24%vs 0%; p < 0.001). Four cervical lacerations were reported in the surgical group. Prolonged hospitalization occurred in 48% of patients in the medical group, never exceeding one night, compared with none in the surgical group (p < 0.001). Gestational age and parity were not significantly associated with complications (all p > 0.05). Maximum pain scores were higher in the medical group (VAS 7.1 ± 2.7 vs 1.5 ± 2.5; p < 0.001). Pre-procedure anxiety was higher in the surgical group (severe anxiety in 63% vs 14%, p = 0.003), but decreased after abortion in both groups with no intergroup difference. Patient satisfaction was higher after surgical abortion (82% positive experience vs 42%, p = 0.004). Both medical and surgical methods are effective for abortions between 14 and 16 weeks of gestation. Overall complication rates were not significantly different between methods, except for the higher rate of surgical reintervention after medical abortion. Patient experience appeared less favorable after medical abortion, highlighting the need to optimize pain management and the management of retained products in order to support informed patient choice.
Chronic Pelvic Pain (CPP) is challenging to treat, with many patients living in pain for up to 15 years before finding suitable treatment. Patients frequently report sexual dysfunction, emergency room visits, opioid use, and impaired ability to work and perform everyday functions. Altogether, CPP is associated with reduced quality of life, presenting a need for additional treatment options. We performed a retrospective cohort study in 1517 CPP patients who displayed trigger points, pelvic floor hypertonia, and tenderness of the levator ani sling. Patients also demonstrated tenderness along the pudendal nerve and posterior femoral cutaneous nerve at Alcock's canal and obturator canal bilaterally. These patients underwent a minimally invasive, office-based protocol involving six ultrasound-guided percutaneous pelvic peripheral nerve blocks and trigger point injections. Patients with data from an initial consult and a visit approximately three months following initiation of treatment were included. Patients with missing data were excluded. Patients demonstrated a 48.8% reduction in pain and significant improvement across all functional domains (P < 0.001). The proportion of patients reporting emergency room visits and opioid use decreased by 88.5% and 44.8%, respectively (P < 0.001). Sexual function improved by 16.7% (P < 0.001). Patients reported a 45.4% increase in 0 workdays missed from pain and a 93.2% increase in 0 hours of impaired productivity (P < 0.001). This procedure is associated with significant improvements in pain and quality of life metrics. Further analysis of its long-term efficacy, especially compared to a control group, is suggested.
IVM rescue is based on the in vitro maturation of mainly Germinal Vesicle (GV) oocytes collected from stimulated cycles. The objective was to investigate the effects of growth hormone (GH) and autologous cumulus cells co culture (CC) on oocyte meiosis resumption and maturation after 32 h post cumulus denudation, in order to obtain additional embryos for the couple as a rescue system to increase the changes of cumulative pregnancy. Our study concerned 300 patients who underwent ICSI cycles, during which a total of 1940 cumulus-complex-oocytes were retrieved, giving 1260 metaphase II stage (MII), 200 at the metaphase I stage, and 480 at the Germinal Vesicle (GV) stage. Mature oocytes were microinjected on the same day of retrieval. Immature GV oocytes were divided into four groups, with the first undergoing in vitro maturation (IVM) without cumulus cells (group 1) and the second undergoing IVM with CC (group 2), the third undergoing IVM without CC and with GH (group 3), the fourth undergoing IVM with CC and with GH (group 4). After 32 h of IVM, the matured oocytes, underwent microinjection, followed by embryonic development monitoring. When comparing the IVM outcomes, we observed a significant increase in oocyte maturation, fertilization rates and the percentage of 8-cell embryos on day 3 across the different study groups (p < 0.001) (Figs. 2-5). Furthermore, all study groups (1-4) exhibited notably blastulation rates, with group 3 demonstrating the most promising clinical outcomes. A preliminary pregnancy rate of approximately 20% was recorded in group 3, suggesting a potential improvement in the developmental competence of oocytes matured under specific conditions. The IVM rescue of germinal vesicle oocyte could serve as an additional strategy to increase the chance getting extra embryos to patients. Autologous cumulus cells co-culture combined to GH supplementation to IVM media, appear to play a crucial role to enhance successful meiosis resumption, oocyte maturation and competency to support embryos development when the injected spermatozoa is not carrier of severe genome and epigenomic decays.
To compare the surgical and postoperative outcomes of vaginal natural orifice transluminal endoscopic surgery (vNOTES) with conventional or single-site laparoscopy in the management of tubal ectopic pregnancy. Studies were eligible if they directly compared vNOTES with conventional or single-site laparoscopy for the surgical treatment of tubal ectopic pregnancy. Two reviewers independently screened titles and abstracts, assessed full texts, and evaluated risk of bias using the Cochrane Risk-of-Bias tool for randomized trials or the ROBINS-I tool for nonrandomized studies. Discrepancies were resolved through discussion or third-party adjudication. After removing duplicates, 2661 records were screened, 14 underwent full-text review, and 5 studies met the inclusion criteria. Five studies comprising 550 women (224 vNOTES; 326 laparoscopy) were included. Meta-analysis revealed a nonsignificant trend toward shorter operative time with vNOTES (MD, -10.08 min; 95 % CI, -22.03 to 1.86; p = .10) and no significant differences in estimated blood loss (MD, -2.79 mL; p = .51) or postoperative VAS pain scores (MD, -1.69; p = .23). vNOTES was associated with significantly reduced postoperative analgesic requirements (OR 0.27; 95 % CI 0.13-0.58; p < .001) and shorter hospital stay (MD, -0.32 days; 95 % CI, -0.59 to -0.05; p = .08). The conversion rate was higher with vNOTES (OR 6.72; 95 % CI 1.11-40.78; p = .04), occurring in 2.9 % of vNOTES cases, all converted to laparoscopy. Overall complication rates were comparable, with only Clavien-Dindo I-II events reported. This systematic review with meta-analysis provides preliminary evidence that vNOTES is a feasible minimally invasive alternative to laparoscopy for tubal ectopic pregnancy when performed by experienced surgeons. The higher conversion rate reflects both patient-specific factors and the technical demands of the transvaginal approach, emphasizing that vNOTES requires appropriate surgical training and expertise. High-quality prospective studies are required to clarify patient selection, long-term reproductive outcomes, and training requirements before widespread clinical adoption.
Active cigarette smoking is a prevalent, modifiable risk factor hypothesised to impair success in assisted reproductive technology (ART). Prior meta‑analyses have combined never‑smokers and former smokers in control groups, potentially diluting effect estimates. To determine the effect of active cigarette smoking on live birth and other ART outcomes using a strict comparison between active smokers and never‑smokers. We conducted a systematic review and meta‑analysis (PROSPERO: CRD420251128852) per PRISMA 2020. Databases were searched for observational studies comparing ART outcomes (using autologous oocytes) in active smokers versus never‑smokers. Two reviewers independently screened records, extracted data, and assessed risk of bias (Newcastle‑Ottawa Scale). Random‑effects models (REML‑HKSJ) pooled risk ratios (RRs) for dichotomous outcomes and mean differences (MD) for oocytes retrieved. Sensitivity analyses included restriction to strict never‑smoker controls. Certainty of evidence was assessed using GRADE. From 2,585 records, 26 studies (16,359 participants) were included. Active smoking was associated with a significant 15% reduction in live birth (13 studies; RR 0.85, 95% CI: 0.79-0.92, I² = 72.4%) and 18% reduction in clinical pregnancy (21 studies; RR 0.82, 95% CI: 0.77-0.88, I² = 66.7%), but both were attenuated to non‑significance when restricted to strict never‑smoker controls (RR 0.88 for both). Miscarriage was not significantly associated with smoking (7 studies; RR 1.15, 95% CI: 0.89-1.48, I² = 78.1%). A small reduction in oocytes retrieved was observed (18 studies; MD -1.06, 95% CI: -2.01 to -0.12, I² = 98.9%). Certainty of evidence was moderate for live birth and clinical pregnancy, and low for miscarriage and oocytes retrieved. While pooled estimates suggest active smoking is associated with reduced live birth and clinical pregnancy rates in ART, these associations are not robust when a methodologically pure never‑smoker comparator is applied, and miscarriage was non‑significant. The moderate certainty for live birth and clinical pregnancy indicates a more robust evidence base than previously appreciated, though the precise risk remains uncertain. High‑quality prospective studies with biochemical verification and dose‑response data are urgently needed.
Accurate quantification of circulating androgens, particularly the biologically active free fraction, is analytically challenging due to ultra-low concentrations and extensive protein binding in human serum. Here, we developed and validated an integrated ultrafiltration-LC-MS/MS workflow for simultaneous quantification of nine endogenous serum free androgens. Free fractions were isolated by phosphate-buffered saline dilution followed by temperature-controlled centrifugal ultrafiltration (37 °C) using pretreated regenerated-cellulose membranes to minimize non-specific adsorption. Ultrafiltrates were purified and enriched by magnetic solid-phase extraction (MSPE), and in-situ oximation derivatization with a quaternary aminooxy reagent was applied to enhance electrospray response. The validation data demonstrated pg/mL-level sensitivity with LLOQ of 0.5-10 pg/mL, good linearity (r > 0.99), acceptable matrix effects, and high recovery. The method was applied to serum samples from 86 female patients (21-50 years) undergoing infertility evaluation, showing higher free testosterone, 11β-hydroxyandrostenedione, and androstenedione in an AMH-enriched PCOS-suspicion subgroup versus a control group. Overall, this ultrafiltration-MSPE-in-situ derivatization LC-MS/MS method provides a practical and robust platform for multiplexed measurement of serum free androgens at pg/mL levels for clinical research applications.
To evaluate the association between uterine healing and uterine artery blood flow changes after vaginal repair of cesarean section scar defects (CSDs) with two-dimensional power Doppler ultrasound and Doppler velocimetry. A cohort prospective study (level of evidence II-2), run in University-affiliated hospitals: 98 women with CSDs underwent vaginal repair (VR), between June 2021 and March 2022. During follow up 9 patients withdrew from the study. After VR, all patients were followed by Doppler ultrasound scanning at 2 days, 1 month and 3 months postoperatively. The size and location of the CSDs, The thickness of the residual myometrium (TRM) and Doppler velocimetry of the uterine arteries were evaluated. TRM was significantly improved after vaginal repair (P < 0.05). There was a significant (P < 0.05) progressive reduction in the uterine scar area from 82% on the second day in the first month to 67% in the third month. The pulsation index (PI), resistance index (RI), and systolic peak flow rate/diastolic flow rate (S/D) of the uterine artery showed little change after vaginal repair. The peak systolic velocity (PSV) value of the uterine artery significantly increased from 50.35 preoperatively to 53.92 on the second day after repair (p = 0.006). According to the preoperative duration of menstruation, the patients were divided into two groups (menstruation duration ≤ 7 days group and menstruation duration >7 days group). The PSV values of the uterine artery in the first postoperative month were 53.32 ± 8.49 and 48.24 ± 7.35, respectively, and there was a significant difference between the two groups (p = 0.028). The TRMs of CSD patients can be improved by vaginal repair. Traditional two-dimensional ultrasound and Doppler velocimetry can dynamically assess the healing process of the uterus after vaginal repair. Moreover, the PSV value in the first month after surgery may be a marker for predicting wound healing.
To compare the effectiveness and safety of carbetocin versus oxytocin for the prevention of postpartum hemorrhage in women with obesity undergoing cesarean delivery. PubMed, CENTRAL, and Embase databases were searched from inception through July 2025, with no language restrictions. Randomized controlled trials were included. Outcomes assessed were mean blood loss, need for blood transfusion, use of additional uterotonics, hemodynamic parameters, and adverse events. Random-effects meta-analyses were performed in R software. Continuous outcomes were pooled as mean differences (MD), and binary outcomes as risk ratios (RR). Statistical heterogeneity was assessed using the I² statistic. Three RCTs (n = 269 participants) were included. Carbetocin was associated with a greater reduction in blood loss than oxytocin (MD -230.11 ml; 95% CI -370.90 to -89.33; p = 0.0014), and significantly fewer blood transfusions when compared to oxytocin (RR 0.14; 95% CI 0.03 to 0.63; p = 0.011); although these results lacked robustness in sensitivity analysis. However, in the pooled and sensitivity analyses, carbetocin demonstrated a significant and consistent reduction in the incidence of postpartum hemorrhage (RR 0.19; 95% CI 0.06 to 0.63; p = 0.006). Carbetocin was associated with significantly reduced incidence of postpartum hemorrhage compared with oxytocin in obese women undergoing cesarean delivery. These findings suggest potential benefit of carbetocin in this high-risk population; however, larger, high-quality trials are required to confirm these results.
The persistent underrepresentation of women in academic forums is concerning. Their equitable representation in gynecology conferences is not only emblematic of progress but pivotal for advancement of the field. We studied the prevalence of "manels" (all-male panels) within gynecologic surgery congresses spanning France and Europe. We examined the scientific programs from five leading gynecologic surgery conferences held in France and Europe during 2020-2021. Comprehensive data, including faculty details, was collected. Primary outcomes were: (1) mean male faculty percentage across all sessions, and (2) overarching manel presence. Results were stratified by specific congresses and subspecialties, with further comparative analyses between manels vs. multigender sessions and male vs. female faculty attributes. Of 144 sessions, 45 (31.3%) were identified as manels. Male faculty averaged 78.7% across all sessions. Consistent male predominance was observed across all congresses and subspecialties. Interestingly, sessions with a gender mix were not only lengthier but also featured a greater number of chairs/moderators and speakers compared to manels (p < 0.001). Among the 882 faculty members, male faculty exhibited more practice years, a higher publication count, superior H-index (p < 0.001), and predominant professor presence compared to their female counterparts. Conversely, female faculty demonstrated a propensity towards non-gynecology specializations (p < 0.001). After adjusting for years of experience, female faculty remained less likely to hold university positions and had lower publication counts and H-index than male faculty (all p < 0.001). Our investigation highlights manel presence in gynecologic surgery congresses across France and Europe. Women underrepresentation in academic congregations underscores the need for gynecological societies to promote gender equality. As the medical domain becomes more gender-diverse, it is paramount for professional platforms to promote this shift towards inclusivity.