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
This retrospective surgical clinical study compares clinical and functional effects of laparoscopic sacrocolpopexy (LSC) and laparoscopic pelvic organ prolapse suspension (L-POPS) for anterior and central prolapse correction. Thirty patients enrolled were affected by a symptomatic vaginal central compartment stage 2-3 prolapse and vaginal anterior compartment stage 1-3 prolapse without vaginal posterior compartment prolapse. A successful correction of anterior and central compartments prolapse without relapses were observed in both groups (LSC group versus L-POPS group). In patients who underwent L-POPS, a de novo posterior compartment prolapse was recorded. In this group, 7/15 patients complained more bowel symptoms and underwent vaginal colpoperineoplasty. In 20% (group LSC) and in 13.3% (group L-POPS) of cases, a condition of de novo urinary stress incontinence was described. LSC seems to remain the gold standard for pelvic organ prolapse correction, while further preventive strategies should be carried out in L-POPS to avoid a de novo posterior compartment prolapse.Impact StatementWhat is already known on this subject? Laparoscopic sacrocolpopexy is the gold standard technique for the correction of pelvic organ prolapse; however, laparoscopic pelvic organ prolapse suspension, based on the surgical technique of lateral suspension, is an innovative surgical method for the treatment of POP.What do the results of this study add? L-POPS could be considered a valid alternative to LSC for women with multiple comorbidities because of less operative time and reduced surgical risks. However, in the long follow-up period, some patients underwent L-POPS complained rectal discomfort and dysfunction on quality of life questionnaire and on clinical evaluation from six to twelve months after surgery probably due to the post-operative appearance of posterior compartment prolapse.What are the implications of these findings for clinical practice and/or further research? Considering the retrospective design and the small sample size the major limits of this study, larger, prospective, randomized studies could be encouraged to better compare a modified technique of L-POPS with posterior mesh apposition (preventing the post-operative appearance of posterior compartment prolapse) with the gold standard LSC for the correction of multi-compartment POP.
Thanks to the recent advances in reproductive medicine, more and more young women with breast cancer may be offered the possibility of preserving their fertility. Fertility can be endangered by chemotherapy, by treatment duration and by patient's age at diagnosis. The currently available means to preserve a young woman's fertility are pharmacological protection with gonadotrophin-releasing hormone analogues during chemotherapy, and ovarian tissue or oocyte/embryo freezing before treatment. New future venues, including in vitro maturation, will improve the feasibility and efficacy of the fertility preservation methods in breast cancer patients.
