Assisted oocyte activation significantly improves zygote formation, cleavage, and implantation rates in patients with a history of fertilization failures.

Background: Fertilization check performed at the 18th hour following classic in vitro fertilization procedure (IVF) or intracytoplasmic sperm injection (ICSI) is a critical stage in assisted reproduction. The success of the treatment is significantly reliant on the quantity of zygotes exhibiting two pronuclei. Consequently, low fertilization rates or complete fertilization failure are highly undesirable outcomes for both patients and reproductive specialists. Applying additional calcium ionophore for oocyte activation subsequent to ICSI may offer benefits and potentially enhance treatment outcomes, particularly for patients who have experienced low or absent fertilization rates (FR) in previous treatment cycles. The aim of the study is to evaluate the efficacy of Ca2+ ionophore application for oocyte activation. Methods: A retrospective analysis of 924 oocytes obtained from 120 patients who underwent ICSI cycles with a history of low or no fertilization as a result of previous unsuccessful treatment rounds. The next ART cycle followed with additional oocyte Ca2+ ionophore activation applied in 57 of the cases in order to optimize the treatment process (Group 1), and 63 patients were included and their outcomes followed as a control group (Group 2).We conducted a comparative analysis of results in both groups. The study's primary outcomes encompassed fertilization, cleavage embryo quality, blastocyst rate, and established clinical pregnancies. Results: At day 1 fertilization check we had 274/386 zygotes (71%FR) in group 1 and 132/410 in group 2 (32.2%FR), (P < 0.0001). Twenty-two (34.9%) cycles in group 2 resulted in total fertilization failure (TFF). At the cleavage stage top-quality embryos from group 1 were significantly higher (P = 0.0021) in comparison to group 2. Forty-eight embryo transfers (ET) were performed in group 1 resulting in 41.67% clinical pregnancies versus 33 ET and only 4 pregnancies (12.12%) for group 2 (P = 0.0044). Conclusions: The results confirm the appropriateness of assisted oocyte activation as an additional method in cases of previous fertilization failure cycles.

Evaluation of Soluble CD90: Potential for Diagnostic Significance in Endometriosis Patients.

Background: Endometriosis is a chronic and debilitating gynecologic disorder, driven by endocrine and immune dysfunctions, which lead to poor endometrial differentiation and attenuated fertility. Escape from immune surveillance and involvement of inflammatory mechanisms appear to be factors in disease progression. Current diagnostic guidelines for endometriosis still lack an efficient biomarker. Here, we report a study on two previously unexplored factors as potential biomarkers for endometriosis. Methods: A case-control study was performed to evaluate the diagnostic potential of serum CD90 and CD83 levels in endometriosis patients (cases validated by surgical and histological examination) compared to healthy controls. Serum was collected from age-matched females and analyzed by ELISA. Results: Comparison of endometriosis patients to the control group showed significantly elevated levels of serum CD90 (1160 ± 856 pg/mL vs. 334 ± 228 pg/mL; ∗∗∗∗ p < 0.0001). A threshold value of 479.4 pg/mL was defined based on the control results, and the diagnostic efficiency of the test was estimated. The obtained sensitivity (70.4%), specificity (92.9%), positive predictive value (90.5%), and negative predictive value (76.5%) rated the test as one with promising diagnostic potential. In contrast, the analysis of serum CD83 levels showed comparable values in both groups, suggesting no association with patient status. Conclusion: Elevated soluble CD90 in human serum is associated with endometriosis, which suggests its putative clinical significance as a biomarker in screening and/or diagnosis of the disease.

The incidence of small for gestational age neonates in singleton IVF pregnancies.

INTRODUCTION: Various factors related to an "in vitro" fertilization (IVF) procedure may influence the rate of small for gestational age (SGA) newborns in such pregnancies. AIM: The aim of the study was to determine neonatal SGA incidence in singleton IVF pregnancies compared to spontaneous ones. MATERIALS AND METHODS: We conducted both a prospective and a retrospective study within the period of January 2013-December 2017, which included 336 patients with a singleton IVF pregnancy at the time of delivery - the study group (SG), and 493 women with a spontaneous conception - the control group (CG). RESULTS: Neonatal SGA rate was significantly higher in the SG as compared to the CG, p < .05, as well as in case of multiple embryotransfer (ET), vanishing twin syndrome (VTS), fresh ET against frozen embryotransfer (FET), female infertility factor. CONCLUSION: Singleton pregnancies after an IVF technique show a higher neonatal SGA rate compared to spontaneous ones.

[TORSION OF FALLOPIAN TUBE LEIOMYOMA TREATED BY LAPAROSCOPY].

Leiomyomas of the Fallopian tubes are rare and their correct diagnosis is extremely difficult. Usually they are incidental findings seen at autopsy or unrelated surgical procedures: A 34-year-old woman presented with lower abdominal pain. Transvaginal ultrasound revealed a solid 7 cm extrauterine mass. Both ovaries are normal. Our preoperative diagnosis was torsion of the fallopian tube due intratubal leiomyoma. Laparoscopic surgery was performed and the leiomyoma was found to have originated from the isthmus of the right Fallopian tube. Laparoscopic myomectomy was performed with preservation of the ramus tubarius dextra. The histological examination concluded to a leiomyoma with ischemic changes. We report a case of torsion of a tubal leiomyoma, which was successfully managed laparoscopically.

[LAPAROSCOPIC BURCH COLPOSUSPENSION WITH PARAVAGINAL REPAIR].

Genuine urinary stress incontinence (GUSI) is defined by the International Continence Society (ICS) as involuntary loss of urine coincident with increased intra-abdominal pressure in the absence of a detrusor contraction or an over-distended bladder. If the patient demonstrates a cystocele secondary to a paravaginal defect, a paravaginal defect repair should be performed before the colposuspension. The laparoscopic retropubic colposuspension gained popularity because of its reported advantages of improved visualization, shorter hospital stay, faster recovery and decreased blood loss. A review of our experience revealed 11 of 24 patients had a Burch urethropexy and paravaginal repair and 13 of 24 a Burch urethropexy alone. Average operative time was 80 min, estimated blood loss of less than 50 ml and hospital stays less than 48 h.

[LAPAROSCOPIC PELVIC LYMPNADENECTOMY OF EARLY ENDOMETRIAL CANCER].

Lymphadenectomy has traditionally been performed using large incisions during laparotomy. Since the initial report by Dargent and colleagues in the late 1980s, laparoscopic lymphadenectomy has been utilized in the management of gynecologic malignancies. After Dargent's description of the first pelvic lymphadenectomy performed laparoscopically, Nezhat et al. described the first para-aortic lymphadenectomy performed laparoscopically forcancer of the uterine cervix. Many raports since have described the safety and effectiveness of laparoscopic lymphadenectomy for gynecologic malignancies.

[LAPAROSCOPIC MYOMECTOMY AFTER ULIPRISTAL ACFTATF TRFATMFMT.]

Uterine myoma is the most common benign uterine tumor in women of reproductive age and occurs in 20-25 % of the worldwide population. Heavy menstrual bleeding, pelvic pressure and pain and reproductive disfunction are common symptoms that impair women's health and quality of live. No currently approved medical treatment is able to completely eliminate fibroids. Until recently, gonadotropin-releasing hormone agonist were the only available drugs for preoperative treatment of fibroids. Since February 2012, ulipristal acetate (UPA) is also approved in Europe for preoperative fibroid treatment. One-third from them need adjuvant surgical treatment.

[NEW TECHNIQUE FOR UTERINE ARTERY IDENTIFICATION.]

Laparoscopic myomectomy and total laparoscopic hysterectomy are challenging surgical procedures for gynecologists, which can result in great blood loss. Most of the conversions to laparotomy happened because of intraoperative bleeding. Blocking uterine perfusion during,, Class II" laparoscopic procedures is valuable and feasible for the management of our patients. We present our modification of uterine artery identification and clipping.

[LAPAROSCOPIC ANTERIOR UTERINE LIGAMENTOPEXY--OUR EXPERIENCE].

A great number operative techniques for correction of retroverted uterus are reported in the last years. The aim of these different methods is correction of the retroversion of the uterus, which is connected with pelvic congestion and symptomatic relief. We present a clinical case of 26 years old patient with one Caesarean section. The lady complains of chronic pelvic pain, dispareunia and dismenorrhea. The US exam shows an uterus in strong retroversion position. We restored the anatomic position of the uterus using laparoscopic anterior ligementopexy.

[LAPAROSCOPIC MYOMECTOMY WITH UTERINE ARTERY CLIPPING VERSUS CONVENTIONAL LAPAROSCOPIC MYOMECTOMY].

OBJECTIVE: To evaluate the differences in the intraoperative blood loss during laparoscopic myomectomy with or without uterine artery clipping (UAC). METHODS: From January 2013 to April 2015, we enrolled prospectively 119 women with symptomatic intramural myomas who were scheduled to undergo laparoscopic myomectomy (37 with UAC (study group) and 82 without (control group)). RESULTS: Characteristics of the myomas, operating time, duration of hospital stay and blood loss were comparable between the two groups. The average operating time and blood loss were 75 +/- 11 minutes and 100 +/- 20 ml for the experimental group and 60 +/- 9 minutes and 178 +/- 56 ml for the control group respectively statistically significant. CONCLUSION: Concurrent UAC during laparoscopic myomectomy reduces the intraoperative blood loss and the frequency of excessive bleeding. This study demonstrated the superiority of laparoscopic uterine artery ligation combined with myomectomy in treatment of symptomatic myomas.

[LAPAROSCOPIC SACROCOLPOPEXY].

Numerous surgical procedures have been described for the management of pelvic organ prolapse. Laparoscopic sacrocolpopexy has evolved from classical abdominal sacrocolpopexy and provides the potential to combine the success rate of an abdominal approach with faster recovery time associated with a minimally invasive technique. Pelvic organ support was assessed objectively using the pelvic organ prolapse quantification scale (POP-Q). Tissue dissection and mesh placement are facilitated by magnification of the operating field using laparoscopic approach. Our results confirm previous findings that laparoscopic sacrocolpopexy is a safe and efficacious surgical treatment for pelvic organ prolapse. It provides excellent support and good functional outcome with overall improvement in sexual function.

[LAPAROSCOPIC MYOMECTOMY WITH UTERINE ARTERY CLIPPING VERSUS CONVENTIONAL LAPAROSCOPIC MYOMECTOMY].

Uterine leiomyomas are one of the most common benign smooth muscle tumors in women, with a prevalence of 20 to 40% in women over the age of 35 years. Fifty percent of them may necessitate treatment, because of bleeding, pelvic pain and infertility. Laparoscopic myomectomy is one of the treatment options. The major concern of myomectomy either by open procedure or by laparoscopy is the bleeding encountered during the operation. One of the methods to reduce the intraoperative blood loss and to prevent excessive bleeding is the clipping of both uterine arteries and aa. ovaricae.

[Factors affecting duration of the laparoscopic myomectomy].

Laparoscopic myomectomy (LM) has been an alternative to abdominal myomectomy in cases of subserosal and intramural myomas since 1990. In the literature less attention is paid to the factors responsible for the length of the surgical time of the LM. Our study comprehends 66 patients underwent laparoscopic myomectomy for one or more intramural myomas with size > 5 sm. In order to evaluate the factors that are responsible for the duration of the procedure we survey the following indicators: age, BMI, year of the operation, previous abdominal operations, way of delivery, size, number and localization of the myomas. Our results show that statistically significant effect for the duration of LM have the yearof the operation, numberof the myomas and their localization in the uterine wall. Significantly longer operative time is detected in 2012 (133.57 +/- 17,805 min.) and the shorter time was in 2014 (66.67 +/- 20, 237 min.) (P < 0.05). We established statistically significant relation between the number of the myomas and duration of the operation (P=0.023). The analysis of the indicator localization of the myomas shows that myomas in the anterior uterine wall are with shortest average surgical time--90.5 +/- 33, 321 min., next are these in the posterior uterine wall--93.81+/- 39, 176 min. Myomas in the fundus of the uterus have longest average surgical time--115.83 +/- 35, 253 min.