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Current Opinion in Obstetrics & Gynecology

Michael P Dougherty, Shelley Dolitsky, Rhea Chattopadhyay, Mark V Sauer
PURPOSE OF REVIEW: The present study briefly reviews the history of mitochondrial replacement therapy (MRT); however, the focus is on recent advancements and future directions of the field. Specifically addressing societal and legal concerns and advances in MRT. RECENT FINDINGS: There continue to be new ethical debates surrounding MRT. In addition, there have been advancements in MRT techniques which could improve potential outcomes. Furthermore, advances in genetics continue to provide alternative approaches to treatment of many diseases, including alternatives to MRT...
June 12, 2018: Current Opinion in Obstetrics & Gynecology
José Bellver, Carlos Simón
PURPOSE OF REVIEW: To review recent findings related to possible causes of recurrent implantation failure of endometrial origin in normal uterus. RECENT FINDINGS: Recent evidences suggest that in apparently normal endometria, RIF may associate with molecular and functional changes in the uterus such as abnormal endometrial microbiota, including the presence of chronic endometritis, poor synchronization between the blastocyst and endometrium, and/or excessive uterine peristalsis...
June 9, 2018: Current Opinion in Obstetrics & Gynecology
Jessica Shields, Andrew Lupo, Teresa Walsh, Kimberly Kho
PURPOSE OF REVIEW: Preoperative testing is a routine component of surgical planning, however, the majority of literature agree that laboratory and diagnostic studies are over utilized. We aim to summarize the available literature and provide gynecologists performing elective surgery for benign indications guidance to determine when, in whom, and in what time frame preoperative studies should be collected. RECENT FINDINGS: Current literature supports previous publications indicating routine laboratory and diagnostic testing for elective surgery is unnecessary and continues to be excessive...
June 9, 2018: Current Opinion in Obstetrics & Gynecology
Arthur M Dizon, Erin T Carey
PURPOSE OF REVIEW: Nonobstetric surgery is performed in 1 : 200 to 1 : 500 of pregnant women in the United States annually. Previously, many argued that laparoscopy was contraindicated during pregnancy because of concerns for uterine injury and fetal malperfusion. Because surgeons have gained more experience with laparoscopy, it has become the preferred treatment modality for many surgical diseases in the gravid patient. RECENT FINDINGS: Specific preoperative considerations, intraoperative techniques, and postoperative management per trimester will be reviewed to optimize patient and surgical outcomes...
June 9, 2018: Current Opinion in Obstetrics & Gynecology
Marron C Wong, Keith Isaacson, Stephanie Morris
PURPOSE OF REVIEW: Postoperative urinary retention (POUR) is a common occurrence after minimally invasive gynecologic surgery (MIGS). This review discusses the definition, incidence, evaluation, diagnosis, and treatment of POUR after MIGS. RECENT FINDINGS: Reported incidence of POUR after MIGS ranges from 0.5 to 21%. Active void trials or awaiting spontaneous void after surgery are both viable options for diagnosing POUR, but active void trials appear to be more accurate, quicker, and preferred by patients...
June 7, 2018: Current Opinion in Obstetrics & Gynecology
Michelle Louie, Kelly Wright, Matthew Siedhoff
PURPOSE OF REVIEW: Endometrial ablation is a common treatment for heavy menstrual bleeding, but serious limitations and long-term complications exist. Our purpose is to summarize the use of endometrial ablation devices, potential short-term and long-term complications, cost effectiveness, and quality of life in relation to alternative treatments. RECENT FINDINGS: There is insufficient evidence to strongly recommend one endometrial ablation device over another. Providers should consider and discuss with their patients, complications including risk of future pregnancy, endometrial cancer, and hysterectomy for continued bleeding or pain...
April 27, 2018: Current Opinion in Obstetrics & Gynecology
Traci Ito, Patricia J Mattingly, Ambareen G Jan, Shan M Biscette, Jin Hee J Kim
PURPOSE OF REVIEW: This article provides a clinical review of the alternatives to traditional excisional surgical therapies for uterine leiomyomas, such as myomectomy or hysterectomy. RECENT FINDINGS: In this review, currently available hormonal medications will be briefly discussed. Then, nonhormonal medical therapy will be addressed with respect to mechanism of action, safety, and efficacy. Finally, the risk-benefit profile of nonexcisional procedures for management of leiomyomas will be addressed...
August 2018: Current Opinion in Obstetrics & Gynecology
Jaclyn A Friedman, Jacqueline M K Wong, Angela Chaudhari, Susan Tsai, Magdy P Milad
PURPOSE OF REVIEW: Submucosal uterine leiomyomas are a common benign pelvic tumor that can cause abnormal uterine bleeding and may contribute to infertility and miscarriage. Hysteroscopic myomectomy is the treatment of choice to alleviate bleeding from these myomas and to normalize the uterine cavity. This review discusses the techniques and recent evidence for hysteroscopic myomectomy and examines the two primary surgical tools employed today: the bipolar resectoscope and hysteroscopic mechanical morcellator...
August 2018: Current Opinion in Obstetrics & Gynecology
Cynthia Arvizo, Sumit T Mehta, Amanda Yunker
PURPOSE OF REVIEW: Laparoscopy is routinely performed for the treatment and management of gynaecologic disorders. During gynaecologic laparoscopy, the patient is placed in the Trendelenburg position to optimize visualization and access to the pelvis. The Trendelenburg position may result in complications in many organ systems. RECENT FINDINGS: Trendelenburg positioning may cause rare, potentially life-threatening complications of the respiratory and cardiovascular systems...
August 2018: Current Opinion in Obstetrics & Gynecology
Ann Peters, Suketu M Mansuria
PURPOSE OF REVIEW: The risk-benefit ratio of concurrent appendectomy at the time of gynecologic surgery has long been debated and remains controversial. However, emerging data on the appendix's role in chronic pain syndromes point to a previously unrecognized link between gynecologic disorders and appendicular pathology. In this article, we review the indications for appendectomy at the time of laparoscopic gynecologic surgery for the treatment of endometriosis and chronic pelvic pain...
August 2018: Current Opinion in Obstetrics & Gynecology
Gustavo N Cecchino, Juan A García-Velasco
PURPOSE OF REVIEW: Surgery has traditionally been the primary treatment option for endometriosis-related infertility of any phenotype. However, advances and refinements of assisted reproductive technologies (ART) permit a more conservative approach in many scenarios. This review summarizes the latest findings in the field of reproductive medicine, which have supported a paradigm shift towards more conservative management of ovarian endometrioma. RECENT FINDINGS: The presence of ovarian endometrioma per se is likely to impair ovarian reserve and alter ovarian functional anatomy...
August 2018: Current Opinion in Obstetrics & Gynecology
Svend Lindenberg, Gitte J Almind, Frederikke B Lindenberg
PURPOSE OF REVIEW: Gonadotrophin in IVF increases the number of oocytes retrieved, and many doctors regard a high number of oocytes as a measurement of success in IVF. Thus, the dogma of more oocytes provides better IVF success has been broadly accepted. However, some European fertility specialists have argued against this concept, saying fewer eggs might, in some instances, be a better option for the patient. RECENT FINDINGS: The concept of 'one size fits all' stimulation in artificial reproductive technologies is not broadly supported by the current literature...
June 2018: Current Opinion in Obstetrics & Gynecology
Richard Scott, Man Zhang, Emre Seli
PURPOSE OF REVIEW: To discuss the common aspects of energy generation in the cell, substrate utilization by the oocyte and the preimplantation embryos, metabolic characteristics of the reproductive tract, and how metabolic characteristics of an embryo can be exploited to assess viability. RECENT FINDINGS: Utilization of pyruvate, lactate and glucose by the oocyte and the preimplantation embryo seems to be tightly controlled by the most essential molecular regulatory pathways...
June 2018: Current Opinion in Obstetrics & Gynecology
Elisa Varela, Irene Sánchez-de-Puerta, Juan A García-Velasco
PURPOSE OF REVIEW: Telomere attrition and dysfunction has become a well established pathway involved in organismal aging, not only because it imposes a limitation to cell division and therefore, tissue regeneration but also because telomere homeostasis influences other pathways involved in aging. However, the implication of telomere biology in ovarian aging and fertility is barely starting to be unveiled. RECENT FINDINGS: During the last years, mounting evidence in favor of the relationship between the accumulation of short telomeres and ovarian senescence has emerged...
June 2018: Current Opinion in Obstetrics & Gynecology
Scott J Morin, Daniel J Kaser, Jason M Franasiak
PURPOSE OF REVIEW: Preimplantation genetic testing for aneuploidy (PGT-A) has been demonstrated to improve implantation and pregnancy rates and decrease miscarriage rates over standard morphology-based embryo selection. However, there are limited data on its efficacy in patients with diminished ovarian reserve or a poor response to stimulation who may have fewer embryos to select amongst. RECENT FINDINGS: Early findings demonstrate that PGT-A reduces the miscarriage rate and decreases the time to delivery in poor responders...
June 2018: Current Opinion in Obstetrics & Gynecology
Diego Marin, Richard T Scott
PURPOSE OF REVIEW: Extracellular vesicles have recently emerged as a promising field of research due to their pivotal roles in intercellular communication and potential to serve as biomarkers. This review focuses on extracellular vesicles secreted by the human preimplantation embryo. The most recent findings on embryo-derived extracellular vesicles are described and discussed, as well as current technical challenges to study them. RECENT FINDINGS: So far, only a few studies have addressed extracellular vesicles of embryonic origin and explored their potential as biomarkers for embryo selection...
June 2018: Current Opinion in Obstetrics & Gynecology
Biljana Popovic-Todorovic, Annalisa Racca, Christophe Blockeel
PURPOSE OF REVIEW: Traditional approach of ovarian stimulation monitoring for in-vitro fertilization involves transvaginal sonography and serum estradiol measurements. Accumulating evidence has shown that hormonal evaluations during ovarian stimulation allow individual cycle optimization, moving away from only predicting the risk of ovarian hyperstimulation syndrome, but in addition assessing the impact of ovarian stimulation on endometrial receptivity, quality of oocytes, and subsequently embryos...
June 2018: Current Opinion in Obstetrics & Gynecology
Francesca Pennetta, Cristina Lagalla, Andrea Borini
PURPOSE OF REVIEW: The purpose of the current review is to provide an update on time-lapse morphokinetic assessment related to embryo ploidy status. RECENT FINDINGS: The main limitation of the available studies regarding correlation between morphokinetic variables and ploidy is that each embryo is considered as an independent unit whereas recent findings show that embryo kinetics may be affected by patient and ovarian stimulation-related factors, so that clustered data analysis is more appropriate...
June 2018: Current Opinion in Obstetrics & Gynecology
Carlos Balmori, Elisa Varela
PURPOSE OF REVIEW: The purpose of this review is to analyze what is known to date about the relation between telomeres and male fertility, and if it is possible for telomeres, or elements related to them, to be used as new prognostic biomarkers in fertility treatment. RECENT FINDINGS: Cells in germ series, including spermatozoids, have longer telomeres (10-20 kb), and do not seem to undergo the shortening that takes place in somatic cells with age as they present telomerase activity...
June 2018: Current Opinion in Obstetrics & Gynecology
Alberto Vaiarelli, Danilo Cimadomo, Nicolò Ubaldi, Laura Rienzi, Filippo Maria Ubaldi
PURPOSE OF REVIEW: The management and treatment of patients with poor ovarian response is still a controversial issue in IVF. Increasing evidences demonstrate that the number of oocytes retrieved after a controlled ovarian stimulation (COS) greatly influences the clinical outcome in terms of cumulative live birth per started cycle. For this reason, any COS should aim to optimize the number of oocytes according to the ovarian reserve of the patient. The aim of this review is to provide an overview of new strategies proposed to manage poor responders according to the novel POSEIDON classification...
June 2018: Current Opinion in Obstetrics & Gynecology
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