Obstetrics and gynecology:

BACKGROUND: This network meta-analysis aimed to assess the efficacy of different acupuncture-related therapies in improving pregnancy outcomes among women undergoing in vitro fertilization and embryo transfer (IVF-ET).

The use of hormonal treatments for endometriosis has increased in recent years. Their effectiveness lies in creating a stable hormonal environment, reducing peripheral estrogen levels, and suppressing ovulation and menstruation. Although these agents do not cure endometriosis and symptoms often return after discontinuation, they effectively relieve pain in most cases and help prevent disease progression or recurrence. Women are therefore typically managed with long-term hormonal treatments, with or without surgery. However, this approach is unsuitable for those seeking natural pregnancy or undergoing IVF, as all hormonal treatments hinder conception. For women pursuing natural pregnancy, these treatments should be discontinued for about 1 year, the time needed to diagnose infertility. However, this suspension exposes women to the risk of recurrence or progression and is therefore clinically acceptable only if the woman has a reasonable likelihood of achieving pregnancy naturally. In women with endometriosis who are infertile and therefore require IVF, ovarian stimulation significantly raises estrogen levels-up to 10 times those of a natural cycle-potentially boosting the risk of endometriosis relapse. Evidence is reassuring on this issue even if some limited data suggest that ovarian stimulation may promote deep invasive endometriosis progression. Overall, physicians and patients must balance the chances of natural or ART-assisted pregnancy against the risk of disease recurrence or progression during treatment discontinuation or IVF. This choice is also complicated by the increased risk of severe pregnancy complications in women with endometriosis, possibly depending on the conception method. This review discusses the available evidence that can be helpful in guiding the decision-making process.

PURPOSE: To compare the effects of the gonadotrophin-releasing hormone (GnRH) agonist protocol, GnRH antagonist protocol, progestin-primed ovarian stimulation (PPOS) protocol, and mild stimulation/natural cycle protocol on the cumulative live birth rate (CLBR) in patients with adenomyosis and Poseidon group 3/4.

BACKGROUND: Pre-eclampsia is a leading cause of maternal and perinatal morbidity and mortality. There are several determinants of individual pregnant women's risk of developing pre-eclampsia, including biomarkers and ultrasound markers.

Hormone receptor-positive, HER2-negative metastatic breast cancer (HR+/HER2-mBC) is incurable, but recent progress has been made in developing new treatment options and the treatment landscape is rapidly shifting. There are published recommendations for treatment choices and sequencing to help guide oncologists in treating HR+/HER2-mBC, but little evidence has been published regarding real-world practice patterns. The REal-world TReatment patterns And Considerations of Toxicity in HR+/HER2-mBC (RETRACT) survey was designed to evaluate real-world practice patterns in the testing and management of this disease by US oncologists. The survey questions were answered via an online platform and the data were anonymized before analysis. A total of 150 oncologists practicing at academic and community centers completed the survey. The results showed this sample of oncologists largely followed recommended best practices for testing biomarkers, selecting treatments, and managing adverse events. However, several items did show substantial minorities of oncologists not in alignment with recommendations in areas including the definition and treatment of visceral crisis, ideal treatment for patients with endocrine resistance, the routine use of next-generation sequencing for biomarker testing, and the use of prophylactic measures for treatment-related adverse events in patients receiving alpelisib.

In vitro gametogenesis offers a powerful platform to explore the complexities of female germline development while bypassing ethical and technical barriers in human and non-human primate research. This systematic review examined 23 articles that reported meiotic entry from differentiated pluripotent stem cells or ex vivo-cultured fetal germ cells from humans, cynomolgus monkeys or marmosets and were published between 2009 and 2025. By comparing methodologies and outcomes, the review highlighted current progress and ongoing challenges in inducing meiotic progression in primates. Although complete oogenesis using in vitro gametogenesis has been successfully achieved in mice, extending this success to primates remains a major hurdle, with meiotic entry representing a key milestone toward realizing in vitro gametogenesis in humans.

Ethical considerations for developing policies regarding providing assisted reproductive care to individuals of advanced reproductive age are complex; considerations include both reproductive autonomy and the well-being of the potential offspring. This document replaces the previously published document titled "Oocyte or embryo donation to women of advanced reproductive age: an Ethics Committee opinion" (Fertil Steril 2016;106:e3-7).

CONCLUSIONS: We report frequencies and timings for 41 complications and mortality from delivery to one year postpartum. Of the nine complications that underwent meta-analysis, anxiety, depression, hypertension and hemorrhage were reported most frequently. These results can inform evidence-based resource allocation and guide optimal postpartum monitoring and care pathway development.

Triple-negative breast cancer (TNBC) is an aggressive subtype characterized by limited targeted therapies and high recurrence rates. While immune checkpoint inhibitors (ICIs) have shown promise, their efficacy as monotherapy is limited. Clinically, ICIs demonstrate significant benefit primarily when combined with chemotherapy, particularly in the neoadjuvant setting for early-stage TNBC, which yields superior outcomes compared to adjuvant therapy. This review elucidates the tumor immunological principles underlying these observations. We discussed how the suppressive tumor microenvironment (TME), progressive T cell exhaustion, and associated epigenetic scarring constrain ICI monotherapy effectiveness. Crucially, we highlight the immunological advantages of the neoadjuvant approach: the presence of the primary tumor provides abundant antigens, and intact tumor-draining lymph nodes (TDLNs) act as critical sites for ICI-mediated priming and expansion of naïve and precursor exhausted T cells. This robust activation within TDLNs enhances systemic anti-tumor immunity and expands the T cell repertoire, a process less effectively achieved in the adjuvant setting after tumor resection. These mechanisms provide a strong rationale for the improved pathological complete response (pCR) rates and event-free survival observed with neoadjuvant chemoimmunotherapy, as demonstrated in trials like KEYNOTE-522. We further explore the implications for adjuvant therapy decisions based on treatment response, the challenges of ICI resistance, the need for predictive biomarkers, management of immune-related adverse events (irAEs), and future therapeutic directions. Understanding the dynamic interplay between chemotherapy, ICIs, T cells, and the TME, particularly the role of TDLNs in the neoadjuvant context, is essential for optimizing immunotherapy strategies and improving outcomes for patients with TNBC.

CONCLUSIONS: Splenic metastatic involvement is common in OC and splenectomy is predicted by high PCI. Survival prognosis is equally impaired by all types of spleen metastasis. Splenectomy is an indicator of high tumour burden, high surgical complexity and high-grade postoperative complications, impaired survival and, indirectly, of cytoreduction success.

OBJECTIVE: To provide an overview of cesarean scar pregnancy (CSP) including its risk factors and diagnosis; describe a case of CSP managed via robotic-assisted laparoscopic resection; and provide eight tips for minimally invasive surgical management of such cases. Currently, there is no gold standard treatment for CSP. Therefore, treatment options include a wide array of surgical and nonsurgical therapies. The technique described here may be useful to increase the success of minimally invasive surgical management of such cases where future pregnancy is desired, and to avoid complications associated with more invasive surgical management.

BACKGROUND: Randomised Clinical Trials (RCTs) show conflicting results on the effectiveness of a cervical pessary after an arrested episode of preterm labor(PTL) aiming to prolong pregnancy.

BACKGROUND: Advanced endometrial carcinoma (EC) is a therapeutic challenge with limited treatment options. Folate receptor alpha (FRα)-targeted antibody-drug conjugates (ADCs) are being explored for EC treatment. However, the molecular profiles of FRα-expressing ECs remain understudied. This study aims to evaluate FRα expression in advanced EC and its associations with clinicopathological features, molecular alterations, and prognosis value.

CONCLUSIONS: Anti-inflammatory MPS may assist women with BC or healthy perimenopausal women experience less MLS.

CONCLUSIONS: Follicle size could predict oocyte developmental competence with corresponding optimal thresholds identified. However, the benefits for embryological fate may plateau at follicle sizes ≥ 15-16 mm once the oocytes achieve maturation or fertilisation.

CONCLUSIONS: Patient demographics and fertility treatment utilization changed after the adoption of fertility benefits at a single institution, highlighting that implementation of fertility benefits have potential to improve healthcare access and empower reproductively aged women in family planning. No changes were observed in the self-reported racial diversity of patients. However, the marked increase in oocyte cryopreservation utilization and the engagement of women without fertility issues in family planning options underscores the importance of fertility benefits in fostering proactive reproductive health management.

CONCLUSIONS: A quarter of women delivering in France felt they had experienced disrespectful care during childbirth and/or postpartum stay. Support for psychological vulnerabilities and awareness campaigns for all maternity care professionals could improve women's experiences. Professionals should address women's expectations respectfully, especially in complex childbirth situations. The healthcare system may play a role in this phenomenon, although its impact is more challenging to quantify. Interventions are necessary to promote and ensure respectful maternity care.

OBJECTIVE: To evaluate the variability in magnetic resonance imaging (MRI)-based parameters used for fetal lung volume estimation in the prediction of pulmonary hypoplasia and the degree of liver herniation in cases of antenatally diagnosed left congenital diaphragmatic hernia (CDH) across North American Fetal Therapy Network (NAFTNet) centers.

CONCLUSIONS: While our findings suggest that PMRT does not enhance survival outcomes in T1-T2N1mic BC patients, it may offer a survival advantage in high-risk subgroups.

No abstract available