Impact of Endometrial Receptivity Analysis on Pregnancy Outcomes In Patients Undergoing Embryo Transfer: A Systematic Review and Meta-Analysis.

To analyze the influence of endometrial receptivity analysis (ERA) on embryo transfer (ET) results in patients undergoing in vitro fertilization (IVF) treatment. PubMed, Embase, Cochrane Central Register of Controlled Trials, and BioMed Central databases were searched from inception up to December 2022 for studies comparing pregnancy outcomes in patients undergoing personalized embryo transfer (pET) by ERA versus standard ET. Data were pooled by meta-analysis using a random effects model. We identified twelve studies, including 14,224 patients. No differences were observed between patients undergoing ERA test and those not undergoing ERA test prior to ET in terms of live birth (OR 1.00, 95% CI 0.63-1.58, I2 = 92.7%), clinical pregnancy (OR 1.20, 95% CI 0.90-1.61, I2 = 86.5%), biochemical pregnancy (OR 0.83, 95% CI 0.46-1.49, I2 = 87%), positive pregnancy test (OR 0.99, 95% CI 0.80-1.22, I2 = 0%), miscarriage (OR 0.91, 95% CI 0.62-1.34, I2 = 67.1%), and implantation rate (OR 1.18, 95% CI 0.44-3.14, I2 = 93.2%). pET with ERA is not associated with any significant differences in pregnancy outcomes as compared to standard ET protocols. Therefore, the utility of ERA in patients undergoing IVF should be revisited.

Positive association of high-density lipoprotein cholesterol with lumbar and femoral neck bone mineral density in postmenopausal women.

OBJECTIVE: Experimental studies suggest that lipids affect bone metabolism. We aimed to elucidate whether lipid levels are associated with bone mineral density (BMD) in a cohort of postmenopausal women. DESIGN: A cross-sectional study of participants in the Chronic Ailment Reduction after MENopause (CARMEN) cohort. Women underwent assessment of clinical and analytical parameters, including fasting lipid levels. BMD was assessed at both lumbar spine and hip. Homogeneity in the cohort was optimized by filtering out a series of confounding variables with a known impact on bone. MAIN OUTCOME MEASURES: Association of BMD at lumbar spine and femoral neck with lipid levels. RESULTS: A total of 667 of the 1304 screened women were analyzed. A strong correlation was revealed between total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) in univariate analysis. Multivariate analysis detected a significant positive association of HDL-C with BMD at both spine (p = 0.007) and femoral neck (p = 0.013). Other independent predictors of spine BMD were years since menopause (ysm, negatively associated), and body mass index (BMI) and estradiol, both positively associated with BMD. The other independent variables in the femoral neck were ysm and glucose (negatively associated) and BMI, estradiol, and phosphate, all positively associated with BMD. CONCLUSION: Levels of HDL-C, but not TC, LDL-C or triglycerides, were positively associated with BMD at both the lumbar spine and femoral neck in a homogeneous cohort of postmenopausal women.

Diet to Reduce the Metabolic Syndrome Associated with Menopause. The Logic for Olive Oil.

The rates of metabolic syndrome are increasing in parallel with the increasing prevalence of obesity, primarily due to its concomitant insulin resistance. This is particularly concerning for women, as the years around menopause are accompanied by an increase in visceral obesity, a strong determinant of insulin resistance. A fall in estrogens and increase in the androgen/estrogen ratio is attributed a determining role in this process, which has been confirmed in other physiological models, such as polycystic ovary syndrome. A healthy lifestyle, with special emphasis on nutrition, has been recommended as a first-line strategy in consensuses and guidelines. A consistent body of evidence has accumulated suggesting that the Mediterranean diet, with olive oil as a vital component, has both health benefits and acceptable adherence. Herein, we provide an updated overview of current knowledge on the benefits of olive oil most relevant to menopause-associated metabolic syndrome, including an analysis of the components with the greatest health impact, their effect on basic mechanisms of disease, and the state of the art regarding their action on the main features of metabolic syndrome.

Mediterranean diet and health: A systematic review of epidemiological studies and intervention trials.

Diet is a crucial variable for a healthy life. A rapidly growing number of studies in recent years support the hypothesis that the Mediterranean diet (MedDiet) has a beneficial effect on certain body systems, but the highly varied objectives and quality of these publications warrants an updated assessment. In the present review we performed a comprehensive evaluation of current evidence on the impact of the MedDiet on human health, assessing its effect on the incidence or progression of the main non-communicable diseases and their intermediate outcomes and risk factors. We scrutinised the clinical evidence from observational studies and randomised controlled trials. Cardiovascular disease was the condition with most information. The MedDiet showed a general preventive effect, which was reproduced to varying degrees for certain intermediate cardiovascular outcomes such as blood pressure, lipids, obesity, metabolic syndrome and diabetes. Benefits were also found for several types of cancer, brain function (including cognition, mood and to a lesser extent Parkinson's disease) and mortality. The quality of the published evidence was, however, generally moderate or low. In conclusion, the MedDiet shows a favourable impact on health. General adoption of a MedDiet is concordant with current policies promoting healthy and sustainable nutrition worldwide. Nonetheless, more high-quality research is needed to improve the consistency of the findings.

The Mediterranean diet: A historical perspective on food for health.

The Mediterranean diet (MedDiet) represents the crystallisation of the centuries-old cooking legacies of different civilisations. The association of the MedDiet with longevity and low cardiovascular risk prompted the Seven Countries Study, which provided epidemiological evidence on the health effects of diet. This led to further studies, both epidemiological and interventional. Scales to measure adherence as well as studies of food components have consolidated a body of knowledge that is of great interest to institutions and governmental agencies. The recognition of its benefits for health has made the widespread introduction of the MedDiet an urgent challenge. Parallel efforts are being made to extend research through experimental and clinical studies. The purpose of this review is to present the historical background of the MedDiet, the main steps leading to the recognition of its health benefits, and the current strategy to facilitate its global implementation.

Riesgos y complicaciones de la punción ovárica / Risks and complication of oocyte retrieval

La aspiración folicular transvaginal ecoguiada representa actualmente el método de lección para la recuperación ovocitaria, tanto por su simplicidad, seguridad como eficacia. Es una técnica que se utiliza desde el 1983 y que precisa de una curva de aprendizaje relativamente corta (1). Aunque las complicaciones asociadas a la técnica son poco frecuentes estimándose entre 0,1 -0,5 % (2) en algunos casos pueden ser graves, incluso letales (3), destacando entre ellas la hemorragia y la lesión e infección de estructuras pélvicas

Ecoguided transvaginal follicular aspiration currently represents the method of choice for ovocyte recovery, both for its simplicity, safety and efficacy. It is a technique that has been used since 1983 and requires a relatively short learning curve (1). Although complications associated with the technique are rare, estimated between 0.1 -0.5% (2)in some cases can be serious, even lethal (3), including bleeding and injury and infection of pelvic structures

Hemangiopericitoma presacro diagnosticado como lesión anexial maligna / Presacral hemangiopericytoma diagnosed as malignant adnexal lesion

No disponible

Acrania en feto con síndrome de Turner / Acrania in fetus with Turner syndrome

El síndrome de Turner es la alteración cromosómica más frecuente de los caracteres sexuales. Puede ser sospechado intraútero mediante ecografía por la frecuente presencia de malformaciones fetales asociadas, siendo las más habituales las cardiacas, renales y esqueléticas. Excepcionalmente se han descrito malformaciones del sistema nervioso central en fetos con síndrome de Turner. Presentamos el primer caso publicado hasta el momento de un feto acráneo afectado por síndrome de Turner. Como han señalado diversos estudios, la presencia de malformaciones fetales del sistema nervioso central debe hacer sospechar la presencia de aneuplodías (AU)

Turner’s síndrome is the most common sex chromosome abnormality. It may be suspected in utero by ultrasound by the frequent presence of associated fetal malformations, the most common being congenital heart defects, renal abnormalities and skeletal anomalies. Rarely central nervous system malformations have been described in fetuses with Turner’s syndrome. We present the first reported case of anacranial fetus affected by Turner’s syndrome. As noted by different studies, the presence of fetal malformations of the central nervous system should alert the presence of aneuploidies (AU)

Solitary fibrous tumor of the greater omentum mimicking an ovarian tumor in a young woman.

We report a case of solitary fibrous tumor (SFT) of greater omentum in a young woman. SFT arising from the greater omentum can mimic a gynecologic neoplasm. SFTs are generally benign but some of them are malignant and have uncertain prognosis. An adequate follow-up is essential in these patients.

Embarazo ectópico sobre cicatriz de cesárea / Ectopic caesarean scar pregnancy

El embarazo ectópico sobre cicatriz de cesárea previa ha aumentado su incidencia en los últimos años, debido probablemente al aumento en el número de cesáreas realizadas. Su importancia se debe a las potenciales graves consecuencias que pueden surgir en caso de progreso del embarazo. El anidamiento embrionario en esta zona se ha explicado aludiendo a que la liberación de diferentes factores, como citocinas, y la expresión de distintos receptores de superficie facilitarían la adhesión embrionaria, favorecida en las cicatrices de cirugías endometriales por su gran atracción quimiotáctica secundaria al proceso inflamatorio y de reparación tisular que allí se produce. Su manejo resulta controvertido por el escaso número de casos publicados, lo que hace difícil establecer un protocolo de actuación. Se han descrito varios tipos de tratamiento, tanto quirúrgicos como farmacológicos, con buenos resultados. Presentamos un caso en el que fue diagnosticada ecográficamente una gestación ectópica sobre cicatriz de cesárea, resuelta con tratamiento farmacológico con metotrexate. En este caso, se evidencia la importancia del seguimiento, tanto clínico como ecográfico y del nivel de beta-HCG, hasta su resolución completa (AU)

Ectopic caesarean scar pregnancy has increased in incidence in recent years, probably as a result of the rise in the number of caesarean sections performed. Its importance is due to the potentially serious consequences that can arise if the pregnancy progresses. It has been suggested that the embryonic nesting in this area may be due to the release of factors such as cytokines, and the expression of different surface receptors. These factors would facilitate the embryonic adherence, favoured in endometrial surgery scars for their great chemotactic attraction, which is secondary to the inflammatory process and tissue repair that occurs there. Its management remains controversial as the low number of reported cases makes it difficult to establish a protocol. Several types of treatment, surgical as well as pharmacological, have been described with good results. We report a case of caesarean scar pregnancy diagnosed on ultrasound, and resolved with conservative treatment with methotrexate. In this case, it demonstrates the importance of monitoring the clinical condition, as well as using ultrasound and beta-HCG levels until its full resolution (AU)

Evolución obstétrica de paciente afectada de síndrome de Ehlers-Danlos / Pregnancy outcome in Ehlers-Danlos Syndrome

El síndrome de Ehlers-Danlos (SED) es un grupo de enfermedades del tejido conectivo caracterizado principalmente por fragilidad tisular e hiperlaxitud articular. Es poco frecuente su asociación con el embarazo y algunos tipos cursan con complicaciones severas maternas. Presentamos nuestra experiencia con una paciente de 35 años afectada de SED tipo clásico, que presentó un embarazo sin complicaciones, que alcanzó las 38 semanas y, un aborto espontáneo en el primer trimestre de una gestación gemelar(AU)

Ehlers-Danlos syndrome (EDS) is a group of connective tissue disorders characterised by tissue fragility and joint hypermobility. Although it is rarely associated with pregnancy, some types may have severe maternal complications. We report our experience of a 35-year-old patient suffering from a classic EDS, who had a successful pregnancy at 38 weeks, and first trimester spontaneous miscarriage of a twin pregnancy(AU)

Mesenchymal hamartoma: prenatal and postnatal diagnosis by imaging.

We present a case of a twin pregnancy in which one fetus developed a rapidly growing unilateral intrathoracic tumor. While a cystic adenomatoid malformation was suspected in the ultrasound scan, the magnetic resonance scan suggested a pulmonary blastoma or a bronchioalveolar carcinoma. Postnatal chest radiography and contrast-enhanced computed tomography of the affected newborn were performed, and it was ruled out the possibility of malignant origin. Finally, the anatomopathologic exam revealed the presence of a mesenchymal hamartoma in the chest wall. Nevertheless, parents refused any treatment for the newborn.

Fetal arthrogryposis secondary to a giant maternal uterine leiomyoma.

Arthrogryposis multiplex congenital is a rare condition defined as contractures in multiple joints at birth due to disorders starting in fetal life. Its etiology is associated with many different conditions and in many instances remains unknown. The final common pathway to all of them is decreased fetal movement (fetal akinesia) due to an abnormal intrauterine environment. Causes of decreased fetal movements may be neuropathic abnormalities, abnormalities of connective tissue or muscle, intrauterine vascular compromise, maternal diseases, and space limitations within the uterus. When the cause of arthrogryposis is space limitations in uterus, the most common etiology is oligohydramnios. The same can result from intrauterine tumours as fibroids, although to our knowledge there are only two papers reporting cases of fetal deformities related to uterine leiomyomas. We describe a well-documented exceptional case of arthrogryposis associated with the presence of a large uterine fibroid. It could illustrate the importance of a careful and appropriate assessment of uterine fibroids before and in the course of a pregnancy considering that they can cause both serious maternal and fetal complications.

Evolución y manejo intrauterino de las taquicardias fetales / Outcome and intrauterine management of fetal tachycardia

Objetivo. Revisar la evolución y las opciones terapéuticas en las gestaciones con diagnóstico intrauterino de taquicardia fetal. Materiales y métodos. Estudio observacional retrospectivo en 23 pacientes con diagnóstico de taquicardia fetal y seguimiento gestacional en el Servicio de Obstetricia del Hospital Universitario La Fe de Valencia entre los años 2002 y 2010. Los datos de las gestaciones incluidas en el estudio fueron recogidos mediante revisión de las historias clínicas de las pacientes. Resultados. La edad gestacional media de detección de la taquicardia fetal fue 30,2 semanas. De los 23 fetos, 18 (78,26%) presentaron taquicardia supraventricular, 2 (8,69%) flutter auricular y 3 (13,04%) taquicardia no filiada. Seis fetos desarrollaron hidrops (26,08%). En 13 casos (56,52%) se prescribió inicialmente tratamiento con digoxina en monoterapia, en uno (4,34%) con digoxina y amiodarona, en 2 (8,69%) con digoxina y flecainida y en otro (4,34%) únicamente con flecainida, debiendo modificarse el tratamiento inicial en 15 casos (65,21%). La taquicardia fue revertida en 9 fetos. Finalizaron mediante parto vaginal 11 gestaciones (47,82%), mientras que en las 12 restantes se realizó cesárea (52,17%). Conclusión. Nuestros resultados apoyan la evidencia actual, considerando que una proporción significativa de taquicardias fetales pueden ser tratadas exitosamente mediante administración transplacentaria de antiarrítmicos, siendo la digoxina el fármaco de primera elección. Con el tratamiento y el seguimiento adecuados el pronóstico fetal de esta afección es favorable, resolviéndose el ritmo cardiaco anormal en un alto porcentaje de casos durante la gestación (AU)

Objective. To review the intrauterine management and outcome of fetal tachycardia. Methods. A total of 23 fetuses with distinct types of tachycardia, diagnosed at a median gestational age of 30.2 weeks, were included. The inclusion criteria were fetal tachycardia diagnosed prenatally, and complete, long-term follow-up in utero and after birth in the Obstetrics Department, La Fe University Hospital, Valencia, Spain from 2002 to 2010. Data from included pregnancies were collected from a review of the patients’ medical records. Results. Of 23 fetuses with fetal tachycardia diagnosed in utero, 18 (78.26%) had supraventricular tachycardia, two (8.69%) had atrial flutter and three (13.04%) had tachycardia of unknown origin. Six fetuses (26.08%) developed hydrops. Of the 23 fetuses, 13 (56.52%) received digoxin, one (4.34%) digoxin with amiodarone, two (8.69%) digoxin with flecainide and one (4.34%) received flecainide alone. The initial treatment was adjusted in 15 fetuses (65.21%). The tachycardia was reverted in nine fetuses. Eleven pregnancies (47.82%) ended at full term by vaginal delivery. A cesarean section was performed in 12 women (52.17%). Conclusion. Our data are consistent with current evidence that a significant proportion of fetal tachycardias can be treated successfully by transplacental administration of antiarrhythmic drugs. The first-line treatment is digoxin, which can be associated with flecainide. The long-term prognosis for fetuses diagnosed with tachycardia is excellent, with the abnormal rhythm resolving spontaneously during pregnancy in a high percentage of cases (AU)

Pharmacologic therapies in endometriosis: a systematic review.

To assess the literature on preclinical and clinical efficacy and safety data of pharmacologic groups proposed in the treatment of endometriosis, we performed a systematic review of publications from March 2002 to January 2012 via PubMed search. Additional relevant articles were identified from citations within these publications. A high number of medications were tested in preclinical models of endometriosis due to their theoretic capacity of disrupting important pathophysiologic pathways of the disease, such as inflammatory response, angiogenesis and cell survival, proliferation, migration, adhesion, and invasion. Tumor necrosis factor α-blockers, nuclear factor κB inhibitors, antiangiogenic agents, statins, antioxidants, immunomodulators, flavonoids, histone deacetylase inhibitors, matrix metalloproteinase inhibitors, metformin, novel modulators of sex steroids expression, and apoptotic agents were all effective in in vitro/animal models. Most of these agents have not been tried in the clinical setting, mainly because of the high risk of adverse effects. However, some of them can be used in humans. Dopamine agonists and valproic acid have already been tested in pilot studies with good results. Etanercept, metformin, and statins are used in humans for other indications, and endostatin is now being tested in phase 2 oncologic trials. These drugs may constitute alternatives to conventional therapy with estrogen inhibitors and anti-inflammatory agents.

Mastectomía por fibroadenoma gigante juvenil recidivante / Mastectomy due to recurrent juvenile giant fibroadenoma

Los fibroadenomas son las lesiones mamarias más frecuentes durante la adolescencia. Se habla de «fibroadenoma gigante» cuando alcanza un tamaño mayor de 5cm o un peso superior a 500g. Su tratamiento consiste en la tumorectomía, siendo necesaria excepcionalmente la mastectomía. En ocasiones resulta complicada su diferenciación histológica con el tumor filodes, lesión mamaria benigna muy recidivante que raramente evoluciona como maligna. Presentamos el caso de una paciente diagnosticada de fibroadenoma gigante a los 17 años y sometida a cinco intervenciones por sucesivas recidivas tumorales, con resultado final de la realización de una mastectomía. En dos ocasiones la lesión fue catalogada como tumor filodes borderline. Consideramos de interés su presentación por su excepcional evolución y como ejemplo de la dificultad de las indicaciones quirúrgicas en determinadas lesiones mamarias benignas de difícil diagnóstico anatomopatológico (AU)

Fibroadenomas are the most common breast lesions in adolescents. The term “giant fibroadenoma” is used when the tumor reaches a size of more than 5cm or weighs more than 500g. Treatment consists of tumorectomy or, in a very few cases, mastectomy. The histological differential diagnosis between fibroadenoma and phyllodes tumor, a highly recurrent and usually benign lesion, is sometimes difficult. We present the case of a 17-year-old patient diagnosed with a giant fibroadenoma, who underwent five interventions due to multiple tumoral recurrences, with the final result of a mastectomy. The lesion was twice diagnosed as a borderline phyllodes tumor. The interest of this case lies in its exceptional clinical course. This case also illustrates the difficulty of surgical indication in some benign breast lesions with difficult histological diagnosis (AU)

Retroperitoneal ectopic pregnancy after intrauterine insemination.

OBJECTIVE: To report the exceptional condition of retroperitoneal ectopic pregnancy after intrauterine insemination. DESIGN: Case report. SETTING: University hospital. PATIENT(S): A 37-year-old woman, gravida 2, para 1, presented to the emergency department 1 month after intrauterine insemination complaining of lower abdominal pain. INTERVENTION(S): A transvaginal ultrasound assessment revealed a complex mass containing a gestational sac with vitelline vesicle behind the left ovary. At laparoscopy, a nodular lesion was seen next to the left uterosacral ligament, suggesting the presence of an ectopic pregnancy in the retroperitoneal space. MAIN OUTCOME MEASURE(S): The unusual location of an ectopic pregnancy such as in the retroperitoneum should be examined in patients with clinical findings that suggest ectopic pregnancy if both the uterus and adnexa are normal during laparoscopic exploration. RESULT(S): The patient's retroperitoneal pregnancy was treated with a wide laparoscopic excision. To allow the removal of all trophoblastic tissue, a 3×2×2 cm hemorrhagic mass containing the ectopic pregnancy was removed from the retroperitoneal space. Retroperitoneal ectopic pregnancy was confirmed by the pathology diagnosis. CONCLUSION(S): Retroperitoneal pregnancy after assisted reproductive techniques is an exceptional condition that must be considered in patients with clinical findings that suggest ectopic pregnancy if both the uterus and adnexa are normal during laparoscopic exploration.