Abstract Study question Are there a morphological features measured in coronal plane obtained by tridimensional transvaginal sonography (3D-TVS), associated with euploid blastocyst implantation? Summary answer Mean laeral angle (mLA) below 143 degrees was associated with lower clinical pregnancy rate among 47 euploid blastocyst transfers. What is known already The ESHRE/ESGE 2013 consensus on uterine malformation clustered in Class U1 (namely Dysmorphic uterus): T-shaped uterus (class U1a), uterus infantilis (Class U1b) and Class U1c including other minor abnormalities. Diagnostic criteria are still under major debate, however a few studies report an association between dysmorphic uterus and impaired fertility outcomes. In the literature, no evidence has been published on a selected population of euploid blastocyst transfers. Moreover, sonographic predictors of successful transfer in patients with dysmorphic uterus undergoing ART are not available. Study design, size, duration Cohort study involving 122 infertile couples undergoing ICSI with NGS-based PGT-A on trophectoderm biopsies between July-2022 and December-2023. A 3D-TVS was acquired in the luteal phase before starting ovarian stimulation. The primary outcome was to assess whether uterine morphological features associate with clinical pregnancy rate, defined as an ultrasonographic evidence of a gestational sac with fetal heartbeat per transfer. To date, 47 patients underwent vitrified-warmed single euploid blastocyst transfer. Participants/materials, setting, methods Uterine morphology was assessed in a coronal plane. Following measurements, we registered: (1) the distance between the two internal tubal ostia, (2) the width of the uterine cavity at corpus-isthmic level, (3) the lateral angle between the corpus-isthmic cavity, (4) the lateral indentation. The optimal cut-off values of mLA was evaluated with ROC curve; p < 0.05 was considered statistically significant. SPSS version 25.0 was used for statistics. Main results and the role of chance Median age was 38 (IR:26-43). The main cause of infertility was tubal/ovulatory in 22 cases (46%), severe male factor in 18 (39%) and idiopathic in 18 (39%). Thirteen women (28%) experienced a previous miscarriage, and half of them were submitted to a uterine cavity revision. The mLA ranged from 126 to 180 degrees (median:156 degrees), whereas mean indentation ranged from 0 to 7.2 mm (median: 3.0 mm). The patients were categorized in 2 groups by the optimal cutoff value of mLA calculated based on ROC curve analysis. Dysmorphic uterus was defined in case of mLA (mean between right and left lateral angle) below 143 degrees (sensitivity 90%, specificity 54%; AUC=0.67). mLA levels were higher than this threshold in 37 women (80%). Relative risk to have a clinical pregnancy was 0.35 (95%CI 0.15-0.83) in dysmorphic uterus. Two women (25%) got pregnant in dysmorphic uterus group compared to 18 (72%) in normal uterus (p:0.026). After adjusting blastocyst quality and day of transfer, mLA association with a clinical pregnancy remained significant (RR 7.38, 95%CI 1.09-50.18 p = 0.04, Post hoc power: 65.3%). Limitations, reasons for caution Preliminary results. A larger sample is required to confirm these data. Wider implications of the findings The strength of the study is the definition of the impact of a dysmorphic uterus in IVF cycles with PGT-A. If confirmed in larger multicenter datasets, these data may select patients who could benefit from hysteroscopic metroplasty. Trial registration number not applicable
Several infertile patients, who may even represent around 40% of the infertile cohort, may respond "suboptimally" (4-9 oocytes retrieved) following IVF, despite being predicted as normal responders. The aim of our longitudinal study was to evaluate the ovarian response of suboptimal responders in terms of the number of oocytes retrieved, following their second IVF cycle, evaluating exclusively patients who had the same stimulation protocol and used the same or higher initial dose of the same type of gonadotropin compared to their previous failed IVF attempt. Overall, our analysis included 160 patients treated with a fixed antagonist protocol in their second cycle with the same [53 (33.1%)] or higher [107 (66.9%)] starting dose of rFSH. The number of oocytes retrieved was significantly higher in the second IVF cycle [6 (5-8) vs. 9 (6-12), p < 0.001]. According to our results, a dose increment of rFSH remained the only significant predictor of the number of oocytes retrieved in the subsequent IVF cycle (coefficient 0.02, p-value = 0.007) after conducting GEE multivariate regression, while adjusting for relevant confounders. A regression coefficient of 0.02 for the starting dose implies that an increase of 50 IU of the initial rFSH dose would lead to 1 more oocyte.
Up until the last Ovarian Cancer Consensus Conference in 2015,[1][1] standard treatment for advanced-stage ovarian cancer was established to be intravenous 3-weekly carboplatin and paclitaxel, with the addition of maintenance bevacizumab considered as an acceptable alternative. No data about
Purpose of review To provide the latest insight on the rare vulvar and vaginal malignancies, able to impact on clinical practice, and to outline new potential research developments. Recent findings Many efforts are being made to produce technical and scientific advances in the fields of vulvar and vaginal carcinoma, including imaging work-up, interventional procedures and minimally invasive surgical approach, as well as molecular profiling and identification of new target treatments. Summary In the evaluation of lymph node status, ultrasound has demonstrated promising results because of high predictive value, low risk and low cost. Positron Emission Tomography-Computed Tomography is confirmed to be reliable and should be prospectively investigated for its potential applications in radiomics, whilst Fusion-US could allow a precision guidance in diagnostics and interventional procedures. Regarding interventional procedure, surgery is becoming less invasive with the aim to increase quality of life; in carefully selected patients it would be possible to overcome the current strict criteria in the use of sentinel node biopsy. Future research should focus on potential target therapy, on the basis of tumor-specific biological features. Rare cancers should be referred to experienced centers with a high case flow, able to offer a full range of diagnostic and therapeutical options and a multidisciplinary approach. Networking should be encouraged to promote research opportunities and enable data sharing and multicenter trials.
In un contesto di rapido invecchiamento della popolazione e della forza lavoro, in Italia il settore sociosanitario rappresenta un comparto particolarmente critico. L'aumento dell'età media degli operatori, le previsioni di pensionamento della numerosa generazione del baby boom e le difficoltà di ricambio generazionale determinano un serio rischio di labour and skill shortage, mentre aumenta la domanda di servizi di cura e assistenza da parte di una collettività che invecchia. La digitalizzazione dei servizi, nonostante l'accelerazione ricevuta dalla pandemia, è rallentata da molteplici criticità legate anche all'età degli operatori, allo sviluppo delle loro competenze digitali e alla relativa offerta formativa. Le opportunità di rinnovamento dei servizi offerte dalle risorse del Pnrr esigono misure di sostegno e potenziamento, quantitativo e qualitativo, del personale. Su tali temi hanno indagato le due ricerche presentate in questo articolo.
Introduction: The objective of this review is to summarize results from clinical trials that tested cytotoxic drugs and target strategies for the treatment of platinum resistant (PR) recurrent ovarian cancer (ROC) with particular attention to Phase III and ongoing trials.Areas covered: Since platinum free interval (PFI) represents the most important predictive factor for response to platinum re-treatment in ROC, non-platinum regimens are conventionally considered the most appropriate approaches.Impressive progress has been made in recent decades, resulting in the identification of most effective cytotoxic agents and in the development of new target strategies.However, the efficacy of most of these drugs for the treatment of PR disease is still limited.Expert opinion: The most favorable benefit for the treatment of PR disease, has been described by the AURELIA trial that showed a 3.3 months increase in progression free survival (PFS) when bevacizumab was combined with non-platinum single agent chemotherapy in bevacizumab-naïve patients.Nevertheless, the use of novel agents is associated to important costs for just little gains in survival.Thus, in our opinion the economic evaluation, such as the incorporation of quality of life into the clinical studies is crucial for the development of future trials for PR-ROC.
