The Effect of Baseline Ovarian Cyst on Pregnancy Outcomes in Ovulation Induction/Intrauterine Insemination Cycles.

Objective: To determine the effects of a baseline ovarian cyst on ovulation induction/intrauterine insemination (OI/IUI) cycle outcomes. Methods: A retrospective cohort analysis of 270 patients and 461 OI/IUI cycles performed between 2011 and 2021 was performed. The exposure variable was a simple appearing ovarian cyst diagnosed at baseline ultrasound measuring ≥10 mm with an estradiol level <75 ng/mL. The primary outcome analyzed was an ultrasound-confirmed intrauterine pregnancy. Secondary outcomes included positive pregnancy test and live birth. Summary data were presented with percentages, mean (standard deviation), or median (interquartile range). Comparisons of dichotomous variables were performed with the chi-square test, and continuous variables were compared using t-test. Regression analysis was performed using a general linear model. p-Values <0.05 were considered statistically significant. Results: The clinical pregnancy rate was nominally higher in the group without a cyst present at baseline ultrasound compared with those cycles with a simple cyst present, but the difference was not statistically significant (45/300 [15%] vs. 15/161 [9.3%], risk ratio [RR] 0.63 [0.36, 1.1]). After adjusting for BMI ≥30 and age ≥35, there remained no significant difference in clinical pregnancy rate (adjusted RR 0.65 [0.37, 1.1]). Conclusion: Given the present data, it is reasonable to proceed with IUI in the case of a baseline simple ovarian cyst. However, this finding may have an impact on clinical pregnancy outcomes in OI/IUI, and further research on the topic is warranted. Although this study was underpowered with fewer cycles than needed to demonstrate a significant difference, the point estimate suggests that the difference in clinical pregnancy rate could be ∼35%.

Uterine fibroid cell cytoskeletal organization is affected by altered G protein-coupled estrogen receptor-1 and phosphatidylinositol 3-kinase signaling.

OBJECTIVE: To determine whether cyclic strain affects fibroid cell cytoskeletal organization, proliferation, and collagen synthesis differently than myometrial cells. DESIGN: A basic science study using primary cultures of patient-matched myometrial and fibroid cells. SETTING: Academic laboratory. PATIENT(S): Premenopausal women undergoing myomectomy or hysterectomy for the treatment of symptomatic uterine fibroids. INTERVENTION(S): Application of uniaxial strain patterns mimicking periovulation, menses, or dysmenorrhea using the Flexcell tension system or static control. Secondarily, inhibition of G protein-coupled estrogen receptor-1 and phosphatidylinositol 3-kinase. MAIN OUTCOME MEASURE(S): Cell alignment, cell number, and collagen content. RESULT(S): Menses-strained cells demonstrated the most variation in cell alignment, cell proliferation, and procollagen content between myometrial and fibroid cells. Procollagen content decreased in myometrial cells with increasing strain amplitude and decreasing frequency. G protein-coupled estrogen receptor-1 inhibition decreases cellular alignment in the presence of strain. CONCLUSION(S): Mechanotransduction affecting cytoskeletal arrangement through the G protein-coupled estrogen receptor-1-phosphatidylinositol 3-kinase pathway is altered in fibroid cells. These results highlight the importance of incorporating mechanical stimulation into the in vitro study of fibroid pathology.

Analysis of the Literature and Patient Counseling Considerations for Planned Oocyte Cryopreservation.

As oocyte cryopreservation use increases among reproductive-aged women, health care professionals are challenged with counseling patients on fertility-sparing technology based on limited high-quality research. Since the first successful slow freezing of mouse embryos in England in 1972, reproductive scientists have employed various protocols for successful cryopreservation and warming of gametes. From outdated slow-freeze technologies to improved vitrification methods, science has successfully shifted the pendulum from cryoinjury-related cell death to the preservation of cellular immortality. The clinical applications of oocyte cryopreservation first increased among oncofertility patients faced with limited fertility-sparing options. Breakthroughs in oncofertility opened a window of opportunity for the transgender community, which also led to an entirely new frontier-planned oocyte cryopreservation for potential future use. Reasons for cryopreservation are complex and often overlap. Socially, these can include not having a support person to share childcare responsibilities, prioritizing career goals and aspirations, and the financial constraints of the ever-rising cost of childrearing. Medically, reasons can include diseases, primary ovarian insufficiency, traumatic injury, planned female to male gender transition, and fertility loss that occurs with aging. Women are faced with many, if not all, of the above scenarios during their "ideal" reproductive window. These women are presenting to fertility centers in hopes of allowing for future reproductive freedom. Owing to media influence, women may be misled of the success potential of cryopreserved oocytes as a guarantee of future biological children. Here, we review current literature and propose guidelines for counseling patients on planned oocyte cryopreservation.

Interstitial Ectopic Pregnancy in a 34-Year-Old Woman After Removal of Essure Microinserts and Reversal of Hysteroscopic Sterilization.

BACKGROUND Interstitial ectopic pregnancy, a pregnancy occurring in the part of the fallopian tube that is within the body of the uterus, poses a significant risk to patients, with a mortality rate of up to 2.5%, which is 7 times higher than for tubal ectopic pregnancies. Hysteroscopic sterilization reversal carries a potential risk of interstitial ectopic pregnancy; therefore, it is important to counsel patients appropriate and review the alternative option for in vitro fertilization. In vitro fertilization has been shown to have a superior pregnancy and live birth rate in comparison to sterilization reversal. Women who have undergone sterilization via hysteroscopic placement of the Essure device may complete in vitro fertilization with sterilization devices left in situ without significantly reducing the pregnancy rate. CASE REPORT A 34-year-old woman, G6P3023, presented to the Emergency Department after incidental detection of left interstitial ectopic pregnancy measuring 9 weeks of gestation. She had previously undergone a right salpingectomy for ectopic pregnancy soon after reversal of Essure sterilization via bilateral tubouterine reimplantation; this is a procedure that is infrequently performed due to limited evidence to suggest that this is a safe and efficacious method to achieve future pregnancies. This patient underwent an uncomplicated left cornuostomy and salpingectomy, rendering the need for in vitro fertilization to conceive in the future. CONCLUSIONS Patients seeking fertility treatment after hysteroscopic sterilization should be counseled that tubouterine reimplantation poses significant morbidity risk based on the nature of the surgery. Instead, patients who have undergone hysteroscopic sterilization who desire future pregnancy should be advised that in vitro fertilization, with or without salpingectomy, may be a safer and more efficacious option to achieve live birth.

Bilateral ovarian torsion with ovarian fusion in the setting of polycystic ovarian syndrome: A case report.

BACKGROUND: Adnexal torsion requires a high degree of suspicion in women presenting with pelvic pain. Polycystic ovaries are an infrequent cause of ovarian torsion but should be considered in cases without adnexal masses. CASE: A 25-year-old woman had a delayed diagnosis of adnexal torsion due to polycystic ovaries despite typical presentation and imaging. A unique finding was ovarian fusion; separation was required in order to resolve the torsion. Oophoropexy was performed to prevent the recurrence of torsion. CONCLUSION: Ovarian torsion should be suspected in the setting of abdominal pain, enlarged polycystic ovaries, and absent adnexal blood flow on ultrasound. This case demonstrates the resilience of the adnexa and the highly variable time to necrosis in the setting of torsion.