Impact of underlying stress in infertility
Purpose of review To review the latest findings about the impact of women's physiological stress on fertility treatment outcomes and the main biomarkers used. Recent findings Women with infertility report high levels of distress that can impact their treatment outcome. The combination of multiple methodologies in psychological stress evaluation result in higher validity, precision and richness in the data. Hair cortisol levels seem to be a promising biomarker to be associated to treatment outcomes. Summary The impact of distress on treatment outcome can be assessed with the help of biomarkers. Decreasing burden of ...
Source: Current Opinion in Obstetrics and Gynecology - May 7, 2020 Category: OBGYN Tags: FERTILITY, IVF AND REPRODUCTIVE GENETICS: Edited by Emre Seli and Juan A. García Velasco Source Type: research

Preconception diet, fertility, and later health in pregnancy
This article summarizes recent literature assessing preconception dietary intake and the association with fertility, time to pregnancy, and also the relationship with polycystic ovary syndrome and gestational diabetes; these conditions associate with each other, and also with infertility. The impact of paternal diet is also reported. Summary There is recent interest investigating diet and time to pregnancy, suggesting higher intakes of fruit, minimal intake of fast food and sugar sweetened beverages, and a diet lower in glycemic load, may improve time to pregnancy. There is minimal recent literature on paternal diet and...
Source: Current Opinion in Obstetrics and Gynecology - May 7, 2020 Category: OBGYN Tags: FERTILITY, IVF AND REPRODUCTIVE GENETICS: Edited by Emre Seli and Juan A. García Velasco Source Type: research

Anti-Müllerian hormone as a qualitative marker – or just quantity?
Purpose of review In this review, we will summarize research looking into anti-Müllerian hormone (AMH) as a measure of oocyte quality. Recent findings AMH is a key factor involved in embryogenesis but also in the development of early follicles. Owing to its relatively small inter and intracycle variability, it has become a widely used method of ovarian reserve testing. In the realm of assisted reproductive technology, it has demonstrated a reliable ability to gauge the number of oocytes obtained during an in-vitro fertilization cycle. For these purposes, AMH is a readily measured quantitative tool. However, its q...
Source: Current Opinion in Obstetrics and Gynecology - May 7, 2020 Category: OBGYN Tags: FERTILITY, IVF AND REPRODUCTIVE GENETICS: Edited by Emre Seli and Juan A. García Velasco Source Type: research

Frozen embryo transfer and preeclampsia: where is the link?
This article provides a review of frozen embryo transfer and available protocols, the highest incidence of gestational hypertensive disorders presented by the infertile population and an overview of the possible impact of the absence of corpus luteum on the genesis of this disease. (Source: Current Opinion in Obstetrics and Gynecology)
Source: Current Opinion in Obstetrics and Gynecology - May 7, 2020 Category: OBGYN Tags: FERTILITY, IVF AND REPRODUCTIVE GENETICS: Edited by Emre Seli and Juan A. García Velasco Source Type: research

Mitochondrial function in women with polycystic ovary syndrome
Purpose of review To provide an overview of mitochondrial functional alterations in women with polycystic ovary syndrome (PCOS). Recent findings Although numerous studies have focused on PCOS, the pathophysiological mechanisms that cause this common disease remain unclear. Mitochondria play a central role in energy production, and mitochondrial dysfunction may underlie several abnormalities observed in women with PCOS. Recent studies associated mtDNA mutations and low mtDNA copy number with PCOS, and set out to characterize the potential protective role of mitochondrial and endoplasmic reticulum unfolded protein respo...
Source: Current Opinion in Obstetrics and Gynecology - May 7, 2020 Category: OBGYN Tags: FERTILITY, IVF AND REPRODUCTIVE GENETICS: Edited by Emre Seli and Juan A. García Velasco Source Type: research

Determining diagnostic criteria and cause of recurrent implantation failure
Purpose of review Recurrent implantation failure (RIF) refers to the absence of implantation after repeated transfer of good embryos into a normal uterus. This review discusses the diagnostic criteria and cause of RIF. Recent findings Regardless of the advancements in IVF practice, RIF is still a challenge that has to be solved. Exact definition of RIF is lacking today. For the initial evaluation, a rigorous algorithmic evaluation should be compromised with an individualized principle. Factors that might affect the number and quality of the oocyte and sperm cells should be investigated in order to obtain a good-qualit...
Source: Current Opinion in Obstetrics and Gynecology - May 7, 2020 Category: OBGYN Tags: FERTILITY, IVF AND REPRODUCTIVE GENETICS: Edited by Emre Seli and Juan A. García Velasco Source Type: research

Oocyte activation, oolemma piercing, and real-time viability confirmation in human oocytes using electrophysiological techniques
We describe the potential clinical applications and their advantages such as creation of reliable automated cell injection systems and novel manual intracytoplasmic sperm injection (ICSI) training platforms. We also discuss theoretical adverse effects and ways to mitigate them. (Source: Current Opinion in Obstetrics and Gynecology)
Source: Current Opinion in Obstetrics and Gynecology - May 7, 2020 Category: OBGYN Tags: FERTILITY, IVF AND REPRODUCTIVE GENETICS: Edited by Emre Seli and Juan A. García Velasco Source Type: research

Testing the endometrium: is there enough evidence to justify clinical use?
Purpose of review Embryo implantation remains the limiting factor in assisted reproduction outcomes. To date research has mainly focused on improving embryo quality, numbers and selection as the route to improve treatment results. However, with success rates plateauing, interest in the possibility of modulating the endometrial factor is increasing, and a number of biomarkers are now available that offer the possibility of assessing endometrial function. Recent findings In this review, we review recent evidence for the efficacy of a number of these biomarkers, with emphasis on those that aim to enable improvement in em...
Source: Current Opinion in Obstetrics and Gynecology - May 7, 2020 Category: OBGYN Tags: FERTILITY, IVF AND REPRODUCTIVE GENETICS: Edited by Emre Seli and Juan A. García Velasco Source Type: research

Extracellular vesicles as a potential diagnostic tool in assisted reproduction
Purpose of review Extracellular vesicles have emerged as a promising field of research for their potential to serve as biomarkers. In the pathophysiology of reproduction, they have attracted significant attention because of their diverse roles in gametogenesis and embryo-endometrial cross-talk. Advances in extracellular vesicle translational potential are herein reviewed with a particular focus in oocyte competence, semen quality diagnostics, embryo selection and detection of endometrial receptivity. Recent findings Specific miRNAs present in follicular fluid-derived extracellular vesicles have been associated with fo...
Source: Current Opinion in Obstetrics and Gynecology - May 7, 2020 Category: OBGYN Tags: FERTILITY, IVF AND REPRODUCTIVE GENETICS: Edited by Emre Seli and Juan A. García Velasco Source Type: research

The vaginal microbiome as a tool to predict IVF success
Purpose of review Herein, we present an overview of the recent microbiome research and findings within the field of reproductive medicine and its relation with the outcome of Assisted reproductive technology (ART). Analyses of the microbiome composition all throughout the female reproductive trace during the process of assisted reproductive techniques are discussed. Recent findings Only the vaginal microbiome can be sampled without possible risks of contamination. Although this also seems to apply to the cervical microbiome, collection has to be performed with extreme caution. Because of the high risk of cross contami...
Source: Current Opinion in Obstetrics and Gynecology - May 7, 2020 Category: OBGYN Tags: FERTILITY, IVF AND REPRODUCTIVE GENETICS: Edited by Emre Seli and Juan A. García Velasco Source Type: research

Editorial: Challenges in ART diagnostics
No abstract available (Source: Current Opinion in Obstetrics and Gynecology)
Source: Current Opinion in Obstetrics and Gynecology - May 7, 2020 Category: OBGYN Tags: FERTILITY, IVF AND REPRODUCTIVE GENETICS: Edited by Emre Seli and Juan A. García Velasco Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Obstetrics and Gynecology)
Source: Current Opinion in Obstetrics and Gynecology - May 7, 2020 Category: OBGYN Tags: EDITORIAL INTRODUCTIONS Source Type: research

Hysteroscopic endometrial resection vs. hysterectomy for abnormal uterine bleeding: impact on quality of life and sexuality. Evidence from a systematic review of randomized controlled trials
Purpose of review The aim of this systematic review is to summarize the current evidence regarding the effectiveness of hysterectomy and hysteroscopic endometrial resection in improving quality of life (QoL), sexual function and psychological wellbeing of women abnormal uterine bleeding. Recent findings We performed a systematic literature search in PubMed/MEDLINE and Embase for original studies written in English (registered in PROSPERO 2019 CRD42019133632), using the terms ‘endometrial ablation’, ‘endometrial destruction’, ‘endometrial resection’, ‘hysterectomy’, &lsqu...
Source: Current Opinion in Obstetrics and Gynecology - March 3, 2020 Category: OBGYN Tags: SPECIAL COMMENTARY Source Type: research

Predicting fetoplacental mosaicism during cfDNA-based NIPT
Purpose of review Cell-free DNA-based noninvasive prenatal testing (cfDNA-based NIPT) using maternal blood is highly sensitive for detecting fetal trisomies. However, false-positive and false-negative results can occur, which prevents NIPT from being a diagnostic test. Fetoplacental mosaicism is one of the main reasons for discordant test results. It is therefore important to understand this phenomenon to enable more comprehensive and appropriate genetic counselling. The present review aims to summarize the current knowledge of fetoplacental mosaicism ascertained during cfDNA-based NIPT and refers to the development of r...
Source: Current Opinion in Obstetrics and Gynecology - March 3, 2020 Category: OBGYN Tags: PRENATAL DIAGNOSIS: Edited by Jane Chueh Source Type: research

Fetal surgery and stem cell therapy for meningomyelocele
Purpose of review To review the advance of maternal--fetal surgery, the research of stem cell transplantation and tissue engineering in prenatal management of fetal meningomyelocele (fMMC). Recent findings Advance in the imaging study provides more accurate assessment of fMMC in utero. Prenatal maternal--fetal surgery in fMMC demonstrates favourable postnatal outcome. Minimally invasive fetal surgery minimizes uterine wall disruption. Endoscopic fetal surgery is performed via laparotomy-assisted or entirely percutaneous approach. The postnatal outcome for open and endoscopic fetal surgery shares no difference. Single ...
Source: Current Opinion in Obstetrics and Gynecology - March 3, 2020 Category: OBGYN Tags: PRENATAL DIAGNOSIS: Edited by Jane Chueh Source Type: research

A review of the intriguing interaction between testosterone and neurocognitive development in males with 47,XXY
Purpose of review Although 47,XXY (Klinefelter syndrome) was first discovered more than 50 years ago, there have been limited comprehensive studies on this disorder. The present review explains the study of neurodevelopmental dysfunction and the impact of testosterone replacement at specific junctions in the life of males with 47,XXY. The intricate relationship between testosterone, neurodevelopment, health, and well being warrants an in-depth investigation in order to achieve optimal outcomes. Recent findings Current literature suggests that the implementation of biological treatment has a positive impact on numerous...
Source: Current Opinion in Obstetrics and Gynecology - March 3, 2020 Category: OBGYN Tags: PRENATAL DIAGNOSIS: Edited by Jane Chueh Source Type: research

Genetic counseling for fetal gastrointestinal anomalies
Purpose of review Congenital gastrointestinal anomalies are common findings with relatively established methods of treatment. However, the genetic cause of how these defects occur and how that may impact a child's lifelong care is less established. Genetic testing has improved significantly in recent years, yet reviews documenting prenatal genetic counseling and testing guidelines have not been comprehensively updated. Recent findings Congenital anomalies of the foregut, such as tracheoesophageal fistula carry a high association with genetic disorders, both in isolation and syndromic forms. Duodenal atresia remains hi...
Source: Current Opinion in Obstetrics and Gynecology - March 3, 2020 Category: OBGYN Tags: PRENATAL DIAGNOSIS: Edited by Jane Chueh Source Type: research

From screening chromosomal anomalies to early diagnosis of fetal malformations
Purpose of review The aim of this review is to understand why and how to improve the detection rate of the fetal anomalies in the first trimester. Recent findings The role of the first trimester is evolving from aneuploid and basic anatomical screening to a necessary tool to identifying early fetal malformations. In the past 20 years, several studies were conducted to assess the detection rate of anomalies in the first trimester, and despite the improvement in the diagnoses of spina bifida and cleft lip, many anomalies detectable in the first trimester are still being diagnosed in the second trimester scan. Analyzing ...
Source: Current Opinion in Obstetrics and Gynecology - March 3, 2020 Category: OBGYN Tags: PRENATAL DIAGNOSIS: Edited by Jane Chueh Source Type: research

New approaches to congenital diaphragmatic hernia
Purpose of review Congenital diaphragmatic hernia (CDH) is a structural birth defect that results in significant neonatal morbidity and mortality. CDH occurs in 2–4 per 10 000 pregnancies, and despite meaningful advances in neonatal intensive care, the mortality rate in infants with isolated CDH is still 25–30%. In this review, we will present data on the molecular underpinnings of pathological lung development in CDH, prenatal diagnosis, and prognostication in CDH cases, existing fetal therapy modalities, and future directions. Recent findings Developments in the prenatal assessment and in-utero therapy o...
Source: Current Opinion in Obstetrics and Gynecology - March 3, 2020 Category: OBGYN Tags: PRENATAL DIAGNOSIS: Edited by Jane Chueh Source Type: research

Enhanced recovery after surgery for cesarean delivery
Purpose of review The aim of this article is to describe enhanced recovery after surgery (ERAS) and its application to cesarean delivery. Recent findings ERAS is a standardized, multidisciplinary approach to improving the care of surgical patients, from the preoperative planning through the surgery and postoperative period. ERAS is associated with many benefits, including improved patient outcomes and satisfaction as well as reduced length-of-stay and cost. Obstetric implementation of ERAS protocols has lagged compared to other surgical subspecialties. Given the volume of cesarean deliveries worldwide, improving the q...
Source: Current Opinion in Obstetrics and Gynecology - March 3, 2020 Category: OBGYN Tags: MATERNAL FETAL MEDICINE: Edited by Deirdre Lyell, Mark Boddy, and Martha Rode Source Type: research

Induction of labor with an unfavorable cervix
Purpose of review Recent evidence supports elective induction of labor after 39 weeks; however, labor induction in patients with an unfavorable cervix, a Bishop score less than 6, may take several days. In this review, we focus on the efficacy and safety of methods of labor induction for the unfavorable cervix. Recent findings Recent evidence on the use of mechanical cervical preparation with transcervical balloons suggests balloons are the most effective option for decreasing time to delivery in the nulliparous patient. Single and double balloons are equally effective, with a volume of more 30 ml being more effecti...
Source: Current Opinion in Obstetrics and Gynecology - March 3, 2020 Category: OBGYN Tags: MATERNAL FETAL MEDICINE: Edited by Deirdre Lyell, Mark Boddy, and Martha Rode Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Obstetrics and Gynecology)
Source: Current Opinion in Obstetrics and Gynecology - March 3, 2020 Category: OBGYN Tags: EDITORIAL INTRODUCTIONS Source Type: research

Prognostic and predictive markers for adjuvant therapy
Purpose of review To avoid both overtreatment and undertreatment accurate risk assessment is mandatory. The present review gives an overview of recently published articles covering prognostic and predictive factors for adjuvant therapy in early breast cancer. Recent findings Gene expression signatures enhance prognostic accuracy with a high level of evidence. These signatures can be further improved by incorporating traditional pathological factors like tumor size. Newer genomic techniques like next-generation sequencing lead to a deeper understanding of the relationship between somatic mutations and prognosis or pred...
Source: Current Opinion in Obstetrics and Gynecology - January 3, 2020 Category: OBGYN Tags: BREAST CANCER: Edited by Michael Untch Source Type: research

Breast and axillary surgery in malignant breast disease: a review focused on literature of 2018 and 2019
Purpose of review There have been fundamental changes in the surgical approach to breast cancer management over the last decades. The primary objective of achieving locoregional control, however, remains unchanged. Recent findings In addition to strategies optimizing systemic treatment and radiotherapy, current discussions focus on improving the surgical approach to breast cancer. Especially in view of the increasingly pivotal role of neoadjuvant chemotherapy NAT/NAC (NACT), gauging the extent of tissue removal in the breast and the width of resection margins in breast-conserving surgery is highly important, as is the...
Source: Current Opinion in Obstetrics and Gynecology - January 3, 2020 Category: OBGYN Tags: BREAST CANCER: Edited by Michael Untch Source Type: research

Biomarkers that may predict response to immunotherapy in ovarian malignancies
Purpose of review Immune checkpoint blockade (ICB) is a promising area of cancer therapeutic research. Therapies targeting the programmed cell death protein 1 (PD-1)/programmed death-ligand 1 (PD-L1) mechanism of tumor immune evasion have resulted in durable responses in many difficult-to-treat tumor types. While these inhibitors are being actively investigated in clinical trials for ovarian cancer, most patients fail to respond to initial treatment with immune therapy. This review focuses on biomarkers for predicting response to treatment, and discusses clinical trials using ICB for recurrent ovarian cancer. Recent fin...
Source: Current Opinion in Obstetrics and Gynecology - January 3, 2020 Category: OBGYN Tags: GYNECOLOGIC CANCER: Edited by Gottfried E. Konecny Source Type: research

Molecular characterization of endometrial cancer and therapeutic implications
Purpose of review The present article reviews molecular subtyping and genomic characterization of endometrial carcinoma, and the associated therapeutic and prognostic implications. Recent findings Endometrial cancer has historically been classified through histology into endometrioid and nonendometrioid subtypes with poor prognostic predictability. Molecular classification through genomic analysis now allows for a major advance in characterization. Four distinct subgroups have been identified: polymerase (POLE) ultramutated, microsatellite unstable, copy number-low--microsatellite stable, and copy number-high—&l...
Source: Current Opinion in Obstetrics and Gynecology - January 3, 2020 Category: OBGYN Tags: GYNECOLOGIC CANCER: Edited by Gottfried E. Konecny Source Type: research

Symptom relief and palliative care in gynecologic oncology
Purpose of review Patients with gynecologic malignancies experience varied and often difficult-to-manage symptoms through their disease course, along with decisions surrounding preferences for advance care planning. This review focuses on evidence-based symptom management for these patients and offers a framework for conversations regarding goals of therapy. Recent findings There is increasing literature on palliative care specifically in gynecologic oncology, including barriers and possible solutions for early palliative care use, along with updated guidelines on postoperative pain management and tools for communicat...
Source: Current Opinion in Obstetrics and Gynecology - January 3, 2020 Category: OBGYN Tags: GYNECOLOGIC CANCER: Edited by Gottfried E. Konecny Source Type: research

Targeting human epidermal growth factor receptor 2 (HER2) in gynecologic malignancies
Purpose of review The purpose of this review is to describe the role of the human epidermal growth factor receptor 2 (HER2) as a biomarker and potential target in gynecologic malignancies and to describe contemporary updates in the use of anti-HER2 treatments for these cancers. Recent findings Approximately 25–30% of all patients with uterine serous carcinoma overexpress tumoral HER2. The anti-HER2 antibody trastuzumab represents an effective, targeted therapy with significant efficacy in the treatment of HER2-positive breast and gastric cancer. Recently, trastuzumab efficacy has also been demonstrated in a rand...
Source: Current Opinion in Obstetrics and Gynecology - January 3, 2020 Category: OBGYN Tags: GYNECOLOGIC CANCER: Edited by Gottfried E. Konecny Source Type: research

Fertility preserving treatment for gynecologic malignancies: a review of recent literature
Purpose of review A significant number of women diagnosed with a gynecologic malignancy meet criteria for fertility-sparing treatment. Women are continuing to delay childbearing; the importance of fertility-sparing therapy is, therefore, increasing. It is imperative that physicians understand the options for, and limitations of, these treatments. Recent findings Recent research has demonstrated improved outcomes for endometrial cancer by adding targeted hysteroscopic resection to progestin therapy. Cervical cancer research has focused on oncologic and pregnancy outcomes following management with radical trachelectomy,...
Source: Current Opinion in Obstetrics and Gynecology - January 3, 2020 Category: OBGYN Tags: GYNECOLOGIC CANCER: Edited by Gottfried E. Konecny Source Type: research

Endometrial cancer in the morbidly obese: a review
This article also reviews bariatric surgery and endometrial cancer as well as new updates in radiation, chemotherapy and hormonal therapy research in the obese population. Summary The current article reviews therapeutics and surgery in the morbidly obese for the treatment of endometrial cancer. (Source: Current Opinion in Obstetrics and Gynecology)
Source: Current Opinion in Obstetrics and Gynecology - January 3, 2020 Category: OBGYN Tags: GYNECOLOGIC CANCER: Edited by Gottfried E. Konecny Source Type: research

Mechanisms of PARP inhibitor resistance in ovarian cancer
Purpose of review To summarize recently discovered PARP inhibitor resistance mechanisms and highlight the clinical relevance of these findings to date. Recent findings A predominant mechanism of acquired PARP inhibitor resistance in homologous recombination-deficient cancers is the acquisition of homologous recombination proficiency as a consequence of secondary genetic or epigenetic events, such as secondary mutations in BRCA1 or BRCA2, or reversal of BRCA1 promoter methylation that restores homologous recombination and leads to PARP inhibitor resistance. Multiple other potential mechanisms of acquired resistance to ...
Source: Current Opinion in Obstetrics and Gynecology - January 3, 2020 Category: OBGYN Tags: GYNECOLOGIC CANCER: Edited by Gottfried E. Konecny Source Type: research

Multimodality screening and prevention of cervical cancer in sub-Saharan Africa: a collaborative model
Purpose of review Although cervical cancer continues to decrease in incidence throughout the developed world because of rigorous screening and vaccination campaigns, the disease remains a major cause of cancer-related morbidity and mortality in resource-limited regions including sub-Saharan Africa. This review summarizes current efforts to implement cost-effective and widespread cervical cancer education, screening, and community-based interventions in Africa and the challenges faced by local healthcare workers. Recent findings Effective screening with cytology (with or without high-risk human papillomavirus [HPV] DNA...
Source: Current Opinion in Obstetrics and Gynecology - January 3, 2020 Category: OBGYN Tags: GYNECOLOGIC CANCER: Edited by Gottfried E. Konecny Source Type: research

Changing treatment landscape for early cervical cancer: outcomes reported with minimally invasive surgery compared with an open approach
Purpose of review The aim of the article is to review recent studies that compare the oncologic efficacy of minimally invasive radical hysterectomy with that of open radical hysterectomy. Recent findings The Laparoscopic Approach to Cervical Cancer (LACC) trial, a randomized study design to test the hypothesis that minimally invasive radical hysterectomy is not inferior to open radical hysterectomy, was stopped early by the data and safety monitoring committee after enrolling 631 of a planned 740 patients. The disease-free survival rate at 4.5 years was 86% among women assigned to minimally invasive surgery and 96.5% ...
Source: Current Opinion in Obstetrics and Gynecology - January 3, 2020 Category: OBGYN Tags: GYNECOLOGIC CANCER: Edited by Gottfried E. Konecny Source Type: research

Latest clinical evidence of maintenance therapy in ovarian cancer
Purpose of review To summarize the data supporting the use of maintenance therapy in ovarian cancer treatment. Recent findings Since December 2016, the United States Food and Drug Administration has approved four drugs for six different ovarian cancer maintenance indications based on the results of clinical trials demonstrating efficacy and tolerability. These include antiangiogenesis and poly (adenosine diphosphate-ribose) inhibitors (PARP inhibitors). Four drugs are approved for use in maintenance therapy for recurrent ovarian cancer, including bevacizumab (GOG-0213 and OCEANS), niraparib (NOVA), olaparib (Study 19 ...
Source: Current Opinion in Obstetrics and Gynecology - January 3, 2020 Category: OBGYN Tags: GYNECOLOGIC CANCER: Edited by Gottfried E. Konecny Source Type: research

New treatment standards for vulvar cancer 2020
Purpose of review To highlight the recent advances regarding molecular mechanisms and therapeutic strategies in vulvar squamous cell carcinoma (VSCC), a rare but continuously rising disease. Recent findings Clinical research focuses on deescalation especially with regard to surgery. Recurrence patterns have been analyzed to further understand the course of disease showing a persistent risk for local recurrence even several years after the initial diagnosis. The main focuses of recent translational research are the distinct molecular mechanisms behind human papillomavirus (HPV)-positive and -negative VSCC. Next-generat...
Source: Current Opinion in Obstetrics and Gynecology - January 3, 2020 Category: OBGYN Tags: GYNECOLOGIC CANCER: Edited by Gottfried E. Konecny Source Type: research

Optimizing immunotherapy for gynecologic cancers
Purpose of review This review will provide an update on the most recent clinical developments in immuno-oncology in advanced gynecologic cancers and will also highlight ongoing studies in this field. Recent findings Although immune checkpoint blockade (ICB) therapy is rapidly altering the treatment landscape in a myriad of solid tumors, the efficacy of ICB therapy with antibodies directed against CTLA-4, PD-1, and PD-L1 in advanced gynecologic cancers has been limited. The exception has been the PD-1 inhibitor pembrolizumab in microsatellite instability high (MSI-H) or mismatch repair-deficient (dMMR) advanced endomet...
Source: Current Opinion in Obstetrics and Gynecology - January 3, 2020 Category: OBGYN Tags: GYNECOLOGIC CANCER: Edited by Gottfried E. Konecny Source Type: research

Editorial introductions
No abstract available (Source: Current Opinion in Obstetrics and Gynecology)
Source: Current Opinion in Obstetrics and Gynecology - January 3, 2020 Category: OBGYN Tags: EDITORIAL INTRODUCTIONS Source Type: research

Old wine into new wineskins: an update for female stress urinary incontinence
Purpose of review To review minimally invasive modifications of traditional surgeries for female stress urinary incontinence (SUI) in light of increased demand. Recent findings Prior to the synthetic mid-urethral sling (MUS), traditional procedures were used to correct SUI. Often these were retropubic colposuspension procedures for a hypermobile urethra and fascial slings for sphincter deficiency but fell out of favor because of increased morbidity compared with synthetic MUS. As controversy rages over use of mesh in female pelvic reconstructive surgery, more women desire nonmesh alternatives. Traditional approaches h...
Source: Current Opinion in Obstetrics and Gynecology - November 8, 2019 Category: OBGYN Tags: UROGYNECOLOGY: Edited by Kavita Mishra Source Type: research

Pelvic floor physical therapy in the treatment of pelvic floor dysfunction in women
Purpose of review To describe the principles of pelvic floor physical therapy (PFPT), review the evidence for PFPT as a treatment for pelvic floor dysfunction, and summarize the current recommendations for PFPT as a first-line conservative treatment option for pelvic floor disorders. Recent findings Pelvic floor dysfunction can cause voiding and defecation problems, pelvic organ prolapse (POP), sexual dysfunction, and pelvic pain. PFPT is a program of functional retraining to improve pelvic floor muscle strength, endurance, power, and relaxation in patients with pelvic floor dysfunction. Based on the available evidenc...
Source: Current Opinion in Obstetrics and Gynecology - November 8, 2019 Category: OBGYN Tags: UROGYNECOLOGY: Edited by Kavita Mishra Source Type: research

Historic transvaginal meshes and procedures: what did my patient have done?
Purpose of review Transvaginal mesh kits were widely used to treat pelvic organ prolapse for over a 10-year period in the early 2000s. Due to safety concerns and FDA regulations, these mesh kits are no longer available for use. Thus, current Obstetricians and Gynecologists are likely to encounter these meshes, but may have no previous experience or exposure to the devices making it difficult to adequately monitor, counsel, and care for patients that underwent these types of procedures. This review highlights the most commonly used transvaginal mesh kit types, provides insight into signs and symptoms related to transvagin...
Source: Current Opinion in Obstetrics and Gynecology - November 8, 2019 Category: OBGYN Tags: UROGYNECOLOGY: Edited by Kavita Mishra Source Type: research

Asymptomatic microscopic hematuria in women
Purpose of review The purpose of this review is to summarize the problem of asymptomatic microscopic hematuria (AMH) in women and the most recent publications on the topic. Recent findings Urologic malignancy is rarely associated with AMH in low-risk women. Screening for urologic malignancy includes upper urinary tract imaging and cystoscopy. Renal ultrasound is a cost-effective first-line imaging modality in patients with AMH. Multiphasic computed tomography (CT) urography increases healthcare costs, the risk of secondary malignancy due to cumulative radiation exposure, and the discovery of incidental benign findings...
Source: Current Opinion in Obstetrics and Gynecology - November 8, 2019 Category: OBGYN Tags: UROGYNECOLOGY: Edited by Kavita Mishra Source Type: research

Injectable contraception: emerging evidence on subcutaneous self-administration
Purpose of review Injectable contraception is a widely available and popular family planning method globally. It has evolved to allow for subcutaneous self-injection (DMPA-SC, Depo medroxyprogesterone acetate-subcutaneous). In this review, we will focus on research evaluating DMPA-SC, with specific regard to continuation rates, safety, and satisfaction among users. Recent findings Emerging evidence from the United States, Malawi, Uganda, and Senegal has established safety and higher continuation rates among self-inject users, compared with provider-inject users. Continuation is 10–28% higher among DMPA-SC self-i...
Source: Current Opinion in Obstetrics and Gynecology - November 8, 2019 Category: OBGYN Tags: FAMILY PLANNING: Edited by Paul D. Blumenthal Source Type: research

Mobile technology for family planning
Purpose of review To evaluate the recent literature on mobile health applications available to patients for contraception and abortion care. Recent findings Women are increasingly interested in contraceptive tools utilizing mobile technology, and a majority of women expect them to be science-based. The largest number of available mobile apps supports natural family planning methods, which is recognized as the least effective contraceptive method. Many available apps cannot be relied on for accurate, science-based pregnancy prevention methods. Further, there is a paucity of data regarding use of mobile technology for w...
Source: Current Opinion in Obstetrics and Gynecology - November 8, 2019 Category: OBGYN Tags: FAMILY PLANNING: Edited by Paul D. Blumenthal Source Type: research

Combined hormonal contraception and migraine: are we being too strict?
Purpose of review Combined hormonal contraception has been contraindicated in migraines, especially in migraines with aura, because of ischemic stroke risk. Newer formulations are now available and physicians may unnecessarily be limiting access to contraceptive and medical therapeutic options for patients with migraines. This review summarizes the available data regarding ischemic stroke risk of modern combined hormonal contraception in the setting of migraines. Recent findings Limited data exists on current formulations of combined hormonal contraception and outcomes in migraine patients. Studies indicate ischemic s...
Source: Current Opinion in Obstetrics and Gynecology - November 8, 2019 Category: OBGYN Tags: FAMILY PLANNING: Edited by Paul D. Blumenthal Source Type: research

Family planning in adolescents
Purpose of review As politics continue to shape contraception and abortion care, providers have a responsibility to address the specific needs of the adolescent patient. Here we review the current literature on contraception and abortion in adolescents. Recent findings Shared decision-making among patients, parents, and providers is the cornerstone of successful adolescent family planning. Providers should be aware of local state regulations related to consent in minors. When provided directive and noncoercive contraception counseling at no cost, adolescents are motivated and effective decision-makers in their care. L...
Source: Current Opinion in Obstetrics and Gynecology - November 8, 2019 Category: OBGYN Tags: FAMILY PLANNING: Edited by Paul D. Blumenthal Source Type: research

Postpartum hormonal contraception in breastfeeding women
Purpose of review To provide an overview of recent research and guidelines regarding contraception and breastfeeding. Recent findings Recent studies assessed lactogenesis, breastfeeding rates, and milk supply concerns in patients starting postpartum hormonal contraception. One study showed a small but statistically significant increase in milk supply concerns between users and nonusers of postpartum hormonal contraception. Mean time to lactogenesis and breastfeeding rates were similar between patients with immediate and delayed insertion of the levonorgestrel (LNG) implant in one study and the LNG intrauterine device ...
Source: Current Opinion in Obstetrics and Gynecology - November 8, 2019 Category: OBGYN Tags: FAMILY PLANNING: Edited by Paul D. Blumenthal Source Type: research

Self-managed abortion
Purpose of review To review the current state of self-managed or self-induced abortion in the United States and the emerging legal, political, and research questions surrounding this issue. Recent findings With the exponential rise of restrictive antiabortion laws in the United States, it has become increasingly difficult to access safe and legal abortion services. One response to this hostile environment for reproductive care access is an increased interest in methods of self-induced or self-managed abortions, primarily by medications sourced outside the medical setting. Medication abortion is established as a safe a...
Source: Current Opinion in Obstetrics and Gynecology - November 8, 2019 Category: OBGYN Tags: FAMILY PLANNING: Edited by Paul D. Blumenthal Source Type: research

Editorial: Developments in family planning and abortion care: dangerous liaisons? Not
No abstract available (Source: Current Opinion in Obstetrics and Gynecology)
Source: Current Opinion in Obstetrics and Gynecology - November 8, 2019 Category: OBGYN Tags: FAMILY PLANNING: Edited by Paul D. Blumenthal Source Type: research

The efficacy of using acupuncture in managing polycystic ovarian syndrome
Purpose of review Polycystic ovarian syndrome (PCOS) is a common reproductive disorder, which significantly impairs the fertility of 3–10% of women at reproductive age. It is getting very popular for women with PCOS to seek alternative therapies to treat PCOS, for example, acupuncture. This review examines the currently available evidence from the randomized controlled trial to guide future recommendation on using acupuncture to assist the treatment of PCOS. Recent findings PCOS is manifested by oligo-amenorrhoea, infertility, and hirsutism. The standard treatment of PCOS includes oral pharmacological agents, li...
Source: Current Opinion in Obstetrics and Gynecology - November 8, 2019 Category: OBGYN Tags: WOMEN'S HEALTH: Edited by Joseph Aquilina Source Type: research

Junctional zone endometrium alterations in gynecological and obstetrical disorders and impact on diagnosis, prognosis and treatment
Purpose of review To investigate the JZE alterations in gynecological and obstetrical disorders and impact on diagnosis, prognosis and treatment. Recent findings JZE was found to be significantly extended in patients with endometriosis, leading to the conclusion that endometriosis is a primary disease of the uterus, much like adenomyosis. Statistical correlation was then demonstrated between the severity of endometriosis and the depth of the adenomyosis infiltrates, hence the thickening of the JZE. Stem cells, predominantly found in the JZE were also found in histological sections of leiomyoma, suggested to be the ori...
Source: Current Opinion in Obstetrics and Gynecology - November 8, 2019 Category: OBGYN Tags: WOMEN'S HEALTH: Edited by Joseph Aquilina Source Type: research