The latest advances in the pharmacological management of endometriosis.

INTRODUCTION: Endometriosis is a benign disease, characterized by a wide range of symptoms and different degrees of severity, which is why therapy should be individually adapted to the patient's needs. Over the years, a lot of research has gone into finding new therapeutic approaches for this enigmatic disease. AREAS COVERED: This review presents the latest advances in pharmacological management of endometriosis and is solely focused on studies published from 2010 to 2021. EXPERT OPINION: Clinicians and researchers are constantly searching for new therapeutic strategies for endometriosis patients. As there are well-established treatments, however, any new medication should fulfill at least one of the three criteria: increased efficacy, comparable efficacy but a better safety profile, or treatments that have a lack of accompanying contraceptive effects that are seen in most endometriosis treatments. While some new substances show promising results, further studies are needed to demonstrate the fulfillment of one of the above-mentioned criteria.

Development of a tool for prediction of ovarian cancer in patients with adnexal masses: Value of plasma fibrinogen.

OBJECTIVE: To develop a tool for individualized risk estimation of presence of cancer in women with adnexal masses, and to assess the added value of plasma fibrinogen. STUDY DESIGN: We performed a retrospective analysis of a prospectively maintained database of 906 patients with adnexal masses who underwent cystectomy or oophorectomy. Uni- and multivariate logistic regression analyses including pre-operative plasma fibrinogen levels and established predictors were performed. A nomogram was generated to predict the probability of ovarian cancer. Internal validation with split-sample analysis was performed. Decision curve analysis (DCA) was then used to evaluate the clinical net benefit of the prediction model. RESULTS: Ovarian cancer including borderline tumours was found in 241 (26.6%) patients. In multivariate analysis, elevated plasma fibrinogen, elevated CA-125, suspicion for malignancy on ultrasound, and postmenopausal status were associated with ovarian cancer and formed the basis for the nomogram. The overall predictive accuracy of the model, as measured by AUC, was 0.91 (95% CI 0.87-0.94). DCA revealed a net benefit for using this model for predicting ovarian cancer presence compared to a strategy of treat all or treat none. CONCLUSION: We confirmed the value of plasma fibrinogen as a strong predictor for ovarian cancer in a large cohort of patients with adnexal masses. We developed a highly accurate multivariable model to help in the clinical decision-making regarding the presence of ovarian cancer. This model provided net benefit for a wide range of threshold probabilities. External validation is needed before a recommendation for its use in routine practice can be given.

Measurement of Thermal Effects of Doppler Ultrasound: An In Vitro Study.

OBJECTIVE: Ultrasound is considered a safe imaging modality and is routinely applied during early pregnancy. However, reservations are expressed concerning the application of Doppler ultrasound in early pregnancy due to energy emission of the ultrasound probe and its conversion to heat. The objective of this study was to evaluate the thermal effects of emitted Doppler ultrasound of different ultrasound machines and probes by means of temperature increase of in-vitro test-media. METHODS: We investigated the energy-output of 5 vaginal and abdominal probes of 3 ultrasound machines (GE Healthcare, Siemens, Aloka). Two in-vitro test objects were developed at the Center for Medical Physics and Biomedical Engineering, Medical University Vienna (water bath and hydrogel bath). Temperature increase during Doppler ultrasound emission was measured via thermal sensors, which were placed inside the test objects or on the probes' surface. Each probe was emitting for 5 minutes into the absorbing test object with 3 different TI/MI settings in Spectral Doppler mode. RESULTS: During water bath test, temperature increase varied between 0.1 and 1.0°C, depending on probe, setting and focus, and was found highest for spectral Doppler mode alone. Maximum temperature increase was found during the surface heating test, where values up to 2.4°C could be measured within 5 minutes of emission. CONCLUSIONS: Activation of Doppler ultrasound in the waterbath model causes a significant increase of temperature within one minute. Thermally induced effects on the embryo cannot be excluded when using Doppler ultrasound in early pregnancy.

Therapy of a clear cell adenocarcinoma of unknown primary arising in the abdominal wall after cesarean section and after hysterectomy.

Clear cell carcinoma arising in a cesarean section scar is extremely rare. Due to the rarity of the tumor, treatment strategies still need to be further elucidated. We report a case of a woman with a clear cell carcinoma of 10 cm outside the abdominal cavity in her cesarean section scar. Staging surgery revealed two lymph nodes with metastatic dissemination of a clear cell adenocarcinoma. After staging surgery, six cycles of adjuvant chemotherapy with carboplatin/paclitaxel were performed. The patient was disease-free 10 months after completion of chemotherapy. Comprehensive treatment consisting of radical surgery combined with adjuvant chemotherapy can be considered for this uncommon tumor entity.

Decline of semen quality during IVF is not associated with subjective male stress.

The aim of the present study was to assess if semen quality declines during in vitro fertilization (IVF) and whether or not this phenomenon is triggered by chronic male stress. In order to test this hypothesis, we first investigated a retrospective cohort of 155 male IVF patients (testing cohort). Subsequently, we started a prospective cohort study in men undergoing their first IVF and assessed semen quality and subjective male chronic stress using a validated tool, i.e. the Fertility Problem Inventory (FPI) questionnaire. The association between stress and sperm quality decline measured 4-6 weeks before the start of IVF (T1) and at the day of oocyte retrieval (T2) was the primary outcome. Live birth rate, first trimester abortion and rate of poor responders were secondary outcomes. In the testing cohort, mean progressive motility, but not mean sperm density significantly declined. There were 78/154 (51%) men who showed a decline in semen density and 50/154 (32%) men who showed a decline in progressive motility. In the validation cohort, progressive motility declined, whereas, sperm density increased from T1 to T2. Of 78 men, 27 men had increased stress (FPI-score > 146). Sperm density and progressive motility were not significantly different in men with and without stress. However, in the presence of male stress, couples had a higher rate of poor responders, miscarriages and a lower rate of live births. Subjective stress is not associated with a decline in semen quality observed during IVF but may be associated with adverse pregnancy outcome.

Saliva cortisol levels and subjective stress are not associated with number of oocytes after controlled ovarian hyperstimulation in patients undergoing in vitro fertilization.

OBJECTIVE: To establish an association between the number of oocytes retrieved after controlled ovarian hyperstimulation (COH) and saliva cortisol (F) levels, as well as subjective stress, in women undergoing their first IVF cycle. DESIGN: Prospective clinical study. SETTING: Academic research institution. PATIENT(S): Women with primary or secondary infertility undergoing IVF. INTERVENTION(S): Fertility problem inventory (FPI) questionnaire and measurement of morning and evening saliva F by RIA. MAIN OUTCOME MEASURE(S): Number of oocytes and stress, defined as low morning F and/or a positive FPI result. RESULT(S): Eighty-three women provided saliva specimens, 66 of whom also filled in the FPI. The median number of oocytes was 8.4 (range 0-26). A state of stress was observed in 38/83 (46%) women. The mean number of oocytes was not significantly different between women with and without stress (7.3 ± 4.3 vs. 8.9 ± 6.9, respectively). In a multivariate analysis, stress (odds ratio 2.6; 95% confidence interval 0.03-225.7) and morning F (odds ratio 0.9; 95% confidence interval 0.6-1.3) were not significantly associated with the number of oocytes. There were no statistically significant correlations between F concentrations, FPI results, and age, number of poor responders, live birth rate, and clinical pregnancy rate (PR). CONCLUSION(S): Stress, as measured by saliva F and the FPI questionnaire, does not negatively impact the effectiveness of COH and is not associated with a reduced number of oocytes.