GnRH antagonist does not prevent premature luteinization and ovulation in stimulated cycles with gonadotropins for IVF: two case reports.

The use of GnRH antagonists (GnRHant) is increasing in the ovarian stimulation protocol. Among several other benefits, GnRHant should prevent a premature luteinization and premature ovulation, the first described either as a 'reassuringly rare event' or 'frequent event', while the second as occurring more frequently in women with decreased ovarian reserve, advanced age and poor ovarian response. Two cases of associated premature luteinization and premature ovulation, during treatment with gonadotropins and GnRHant in IVF cycles, are here reported. In both cases, premature luteinization occurred and ovulation took place during ovarian stimulation protocols with exogenous gonadotropins and GnRHant, before reaching the criteria of hCG administration, regardless of the age of the patients and their ovarian reserve. Ovulation was documented by the disappearance of most of the developing follicles, by the transformation of endometrium from a triple line picture into a uniform hyper-echogenic image, by the presence of fluid in the pouch of Douglas, by the increase of progesterone plasma levels and the simultaneous reduction of estradiol plasma levels. This evidence can be important for a correct counseling with infertile patients in preparation for an IVF cycle.

Pelvic floor evaluation with transperineal ultrasound: a new approach.

The increased life expectancy, the importance of the prevention in younger age and the role of the pelvic floor dysfunction not only in the disease of the third age, but also in the childbearing age, as the influence on the type of delivery, underline the importance of the evaluation of the pelvic floor. The evaluation of pelvic floor is generally clinical, but in the last 2 decades, the use of ultrasound has become a mainstream diagnostic tool in the investigation of female pelvic organ prolapse, urinary and fecal incontinence and defecation disorders, providing an immediate objective confirmation of findings obtained on clinical examination and filling some of the gaps of the urogynecological exam. The use of transabdominal ultrasound was the first developed, while the use of translabial, transrectal and transvaginal techniques started later. This review will focus on the use of transperineal ultrasound, including two-dimensional (2D), three-dimensional (3D) and 4D imaging, as a valuable and objective method in the urogynecological evaluation, allowing the assessment of the pelvic floor anatomy and its functions and dysfunctions, the choice of the right type of treatment and the analysis of the changes after surgical treatment and its complications. The ultrasound approach has become an important instrument for the prevention, but also for the analysis of the disease, and to understand the importance of the pelvic floor function in different period of life of a woman.

Learning curve for the single-incision suburethral sling procedure for female stress urinary incontinence.

OBJECTIVE: To evaluate the learning curve for the single-incision sling (SIS) procedure in a single-surgeon case series. METHODS: Data were retrospectively analyzed from women with non-recurrent symptomatic stress urinary incontinence confirmed by urodynamics and treated at San Gerardo Hospital, Monza, Italy, between October 2008 and November 2015. All women underwent the SIS procedure using a MiniArc sling fitted by the same urogynecologic surgeon. Blood loss, operative time, and complications were recorded. At follow-up visits, objective cure was assessed with a stress test and subjective outcome was determined by International Consultation on Incontinence Questionnaire-Short Form and Patient Global Impression of Improvement scores. Postoperative overactive bladder syndrome and voiding symptoms were recorded. RESULTS: In total, 192 patients underwent the SIS procedure. Estimated blood loss, operative time, and complication rate were not influenced by the number of procedures performed. Among 191 patients who completed 12 months of follow-up, neither objective nor subjective outcomes at longest follow-up available were influenced by surgeon's experience. Conversely, de novo overactive bladder syndrome (P<0.001) and voiding symptoms (P=0.029) decreased with increasing experience. CONCLUSION: SIS showed encouraging objective and subjective outcomes with a minimal complication rate even at the beginning of the learning curve. However, increasing experience reduced postoperative voiding symptoms and overactive bladder syndrome.

Mini-sling efficacy in obese versus non-obese patients for treatment of stress urinary incontinence.

BACKGROUND: The impact of obesity on single-incision has been object of concerns. The aim of the study was to compare the outcomes of MiniArc single-incision sling in normal weight, overweight and obese patients. METHODS: This retrospective study analyzed women with proven stress urinary incontinence (SUI). Patients were divided into three groups according to BMI: normal weight (group A), overweight (group B) and obese (group C). Objective cure rate was assessed with stress test and subjective cure rate was determined by ICIQ-SF and PGI-I scores. Postoperative overactive bladder syndrome and voiding symptoms were recorded. RESULTS: One hundred ninety-two patients were analyzed (A=97; B=68; C=27). Mean follow-up was 23.2 months without differences among groups. Estimated blood loss and operative time were not influenced by BMI. No bladder perforation were observed. Objective cure rate (A=87.6%; B=86.8%; C=81.5%) and subjective outcomes resulted similar irrespective of BMI class. De novo onset of overactive bladder syndrome and voiding symptoms were reported without significant differences among groups. CONCLUSIONS: The current study showed that single-incision sling Miniarc seems to be an effective treatment irrespective of BMI. Operative data, complications, objective and subjective outcomes were similar for normal weight, overweight and obese women.

Serum markers for the noninvasive diagnosis of endometriosis.

Endometriosis is a disease that affects millions of women worldwide and its diagnosis is still challenging. Medical history, symptoms together with imaging data may address the correct diagnosis, but the gold standard remains laparoscopic assessment with histological confirmation. The development of serum markers as diagnostic tools for endometriosis may allow a prompt and noninvasive diagnosis. Several serum biomarkers have been investigated over the years, but none of these have shown a clinical utility and nowadays the more realistic diagnostic biomarker consists in a panel of biomarkers. The recent introduction of new technologies such as genomics and proteomics may represent the future perspective of endometriosis diagnosis.

Mood disorders and quality of life in polycystic ovary syndrome.

Polycystic ovary syndrome (PCOS) affects 5-10% of the population of women. The exact etiology of PCOS remains unclear, but it is believed to result from complex interactions between genetic, behavioral and environmental factors. The spectrum of its symptoms such as hirsutism, skin problems, obesity and finally infertility has a huge negative impact on the individuals' psychological and interpersonal functioning. PCOS symptoms can lead to significant deterioration in quality of life and be highly stressful negatively affecting psychological well-being and sexuality. Fear symptoms like palpitation, being out of breath and tension might be caused by many somatic diseases. Moreover, detection and continuous thinking about illness can lead to significant negative impact on individual functioning in society. PCOS may be a factor potentially favoring the occurrence of mood disorders and depression. Biological, social and psychological consequences of PCOS among women of reproductive age are opening a new perspective on management of women's health in these patients.