Fertility specialists' views, behavior, and attitudes towards the use of endometrial scratching in Italy.

BACKGROUND: Endometrial scratching (ES) or injury is intentional damage to the endometrium performed to improve reproductive outcomes for infertile women desiring pregnancy. Moreover, recent systematic reviews with meta-analyses and randomized controlled trials demonstrated that ES is not effective, data on the safety are limited, and it should not be recommended in clinical practice. The aim of the current study was to assess the view and behavior towards ES among fertility specialists throughout infertility centers in Italy, and the relationship between these views and the attitudes towards the use of ES as an add-on in their commercial setting. METHODS: Online survey among infertility centers, affiliated to Italian Society of Human Reproduction (SIRU), was performed using a detailed questionnaire including 45 questions with the possibility to give "closed" multi-choice answers for 41 items and "open" answers for 4 items. Online data from the websites of the infertility centers resulting in affiliation with the specialists were also recorded and analyzed. The quality of information about ES given on infertility centers websites was assessed using a scoring matrix including 10 specific questions (scored from 0 to 2 points), and the possible scores ranged from 0 to 13 points ('excellent' if the score was 9 points or more, 'moderate' if the score was between 5 and 8, and 'poor' if it was 4 points or less). RESULTS: The response rate was of 60.6% (43 questionnaires / 71 infertility SIRU-affiliated centers). All included questionnaires were completed in their entirety. Most physicians (~ 70%) reported to offer ES to less than 10% of their patients. The procedure is mainly performed in the secretory phase (69.2%) using pipelle (61.5%), and usually in medical ambulatory (56.4%) before IVF cycles to improve implantation (71.8%) without drugs administration (e.g., pain drugs, antibiotics, anti-hemorrhagics, or others) before (76.8%) or after (64.1%) the procedure. Only a little proportion of infertility centers included in the analysis proposes formally the ES as an add-on procedure (9.3%), even if, when proposed, the full description of the indications, efficacy, safety, and costs is never addressed. However, the overall information quality of the websites was generally "poor" ranging from 3 to 8 and having a low total score (4.7 ± 1.6; mean ± standard deviation). CONCLUSIONS: In Italy, ES is a procedure still performed among fertility specialists for improving the implantation rate in IVF patients. Moreover, they have a poor attitude in proposing ES as an add-on in the commercial setting.

Histopathological Examination and Endoscopic Sinusectomy: Is It Possible?

Introduction: Although carcinomatous degeneration is a rare occurrence, some authors support the need for a histopathological examination after pilonidal cyst excision. Today, minimally invasive techniques are widely spread for the treatment of pilonidal sinus disease but opposed to standard procedures, these techniques could not allow to perform a histopathological examination because of the absence of a specimen. The aim of this two-institutions study is to evaluate whether histopathological examination of the pilonidal sinus excision material can be successfully performed after an endoscopic ablation of the cyst. Materials and Methods: We identified all consecutive patients from January 2021 to September 2021 with diagnosis of pilonidal sinus disease who underwent Video Assisted Ablation of Pilonidal Sinus (VAAPS) followed by histopathological examination. Results: A total of 45 patients were included in the study. All patients were Caucasians and aged below 50 years. Nine of them underwent surgery due to recurrence of PSD. No evidence of malignancy was detected in the histopathological examination of the pilonidal sinus sampling material. Discussion: We were able to send pilonidal sinus sampling material for a histopathological examination in all patients who underwent minimally invasive technique for the treatment of pilonidal sinus disease. No evidence of malignancy was found in any of the 45 samples. Our findings prove that minimally invasive ablation of pilonidal sinus does not preclude histopathological examination of the cysts.

Early versus delayed endoscopic treatment of acute pilonidal abscess: a propensity score-matched analysis.

BACKGROUND: According to the Italian Society of Colorectal Surgery guidelines, the most effective approach to the pilonidal abscess is adequate surgical drainage, concerning incision and drainage of the pilonidal cavity. Few recent studies have demonstrated that endoscopic approach could be a valid treatment option even in the case of acute pilonidal abscess. The aim of our study is to assess if video-assisted ablation of pilonidal sinus (VAAPS) could be an alternative to treat an acute pilonidal abscess and to evaluate if an immediate endoscopic approach to the pilonidal abscess is preferable to a delayed procedure after incision and drainage. METHODS: All consecutive patients with an acute pilonidal abscess since 1 January 2014 to 31 December 2018 were enrolled in our propensity score-matched analysis and divided into two groups: the early VAAPS group and the delayed VAAPS group. Primary outcomes were recurrence rate at 1-year, 3-year, and 5-year follow-up. Secondary outcomes were time off, time to wound healing, incomplete wound healing, perioperative infection, patients' satisfaction 1 month after the complete wound healing, and their health status before surgery and 6 months after complete wound healing. RESULTS: After the propensity score matching, 82 patients were included in the final analysis (41 in each group). No differences were found in terms of recurrence in the two groups. Early endoscopic approach was associated with a better patients' satisfaction (8.17 ± 1.2 vs 6.06 ± 1.48, p = 0.001) and a better postoperative health status (86.27 ± 6.54 vs 77.32 ± 5.85, p = 0.001). CONCLUSIONS: Our results encouraged to perform an immediate endoscopic approach to an acute pilonidal abscess.

Does Bariatric Surgery Improve Assisted Reproductive Technology Outcomes in Obese Infertile Women?

BACKGROUND: Little is known about the impact of bariatric surgery on obese infertile women seeking an assisted reproductive technology. METHODS: All obese women with a history of assisted reproductive technology (ART) failure that underwent ART treatment cycles both prior to and following bariatric surgery were included. ART outcomes were compared evaluating the duration and dose of gonadotrophins used; the measurement of day 3 FSH; the anti-mullerian hormone dosage; the number of follicles >15 mm; the number of retrieved and fertilized oocytes; the number of metaphase II, metaphase I and germinal vesicle oocytes; the number of embryos obtained; the number of top-quality oocytes and embryos; the number of transferred embryo; the pregnancy rate and the live birth rate. RESULTS: Forty women were included. The total number of gonadotropin units required and in the length of stimulation following bariatric surgery decreased (p = .001), with an increase of the number of follicles ≥15 mm (p = .005), of retrieved oocytes (p = .004), of top-quality oocytes (p = .001) and metaphase II oocytes (p = .008). More oocytes were fertilized (4.2 ± 1.7 vs 5.3 ± 2.4; p = .02). After surgery, we have registered also a better number of top-quality embryos (0.5 ± 0.6 vs 1.1 ± 0.9; p = .003). Pregnancy rate following the bariatric surgery increased to 15/40 (37.5%) (p < .001), and live birth rate (LBR) increased to 14/40 (35%) in the post-surgery group (p<. 001). CONCLUSIONS: Although additional research would be useful to draw definitive conclusion, our results appear to be encouraging enough to suggest the use of bariatric surgery in obese infertile women seeking an ART treatment.