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Genital Reconstructive Surgery for the Transmasculine Patient: An Overview for the OBGYN Practitioner
AbstractPurpose of ReviewTransmasculine patients will often seek care with obstetrician-gynecologists before, during, or after genital gender-affirmation surgery. This review provides an overview of gynecologic and reconstructive surgical procedures related to masculinizing genital surgery and highlights essential considerations for the OBGYN provider.Recent FindingsThe field of gender-affirming surgery continues to evolve, with a return of care to academic medical centers and a refocus on pooling data and evidence-based care. Nevertheless, the establishment of standardized surgical outcome measures and patient-centered me...
Source: Current Obstetrics and Gynecology Reports - April 13, 2024 Category: OBGYN Source Type: research

Laparoscopic Radiofrequency Fibroid Ablation: A Review of Current Use and Future Applications
We present the current literature that evaluates Lap-RFA in its current use, as well as present the future of the technology.Recent FindingsThe current literature demonstrates that Lap-RFA succeeds in treating a large amount of FIGO 2 –6 fibroids with clinical improvements in fibroid volume, menstrual blood loss, dysmenorrhea, fibroid-related symptom scores, and overall quality of life. Some data indicates that the technology may be safe for patients who desire future fertility or have adenomyosis, though large trials have yet to be performed.SummaryLap-RFA offers promising long-term data that demonstrate treatment effec...
Source: Current Obstetrics and Gynecology Reports - April 10, 2024 Category: OBGYN Source Type: research

Role of Immunological Testing in Infertility
AbstractPurpose of ReviewUnexplained infertility, recurrent pregnancy loss, and recurrent implantation failure are challenging clinical scenarios, both for patients and providers. The role of immunologic testing for these conditions is an area of new and expanding research. This review presents the current, existing evidence on the role of immunological testing in infertility.Recent FindingsA number of different immunological tests for infertility are available, including antiphospholipid antibodies, antithyroid antibodies, antinuclear antibodies, endometrial studies, uterine natural killer cells, systemic natural killer c...
Source: Current Obstetrics and Gynecology Reports - April 5, 2024 Category: OBGYN Source Type: research

The Role of Cytokines in Early Pregnancy: Fertilization, Implantation, and Maintenance
This article examines the responsible cytokines and their roles, and how their interplay predicts continued pregnancy or spontaneous miscarriage. It also explores the conflicting theories on their contribution to pregnancy outcomes.Recent FindingsRecent studies have furthered the hypothesis that the maternal immune response is responsible for outcomes across the pregnancy spectrum, from early pregnancy loss to preeclampsia. They dispute, however, previous notions that successful pregnancy is exclusively a phenomenon of immune suppression. Reproductive failure cannot easily be explained by simple imbalances of the Th1- and ...
Source: Current Obstetrics and Gynecology Reports - March 23, 2024 Category: OBGYN Source Type: research

Surgical Treatment of Adenomyosis
In conclusion, hysterectomy has traditionally been the primary treatment for adenomyosis in women. However, contemporary medicine offers several excisional and non-excisional techniques for patients who wish to preserve their fertility. (Source: Current Obstetrics and Gynecology Reports)
Source: Current Obstetrics and Gynecology Reports - March 22, 2024 Category: OBGYN Source Type: research

Non-surgical Treatment of Adenomyosis
AbstractPurpose of ReviewUterine-sparing excisional surgical techniques for adenomyosis are complex, carry significant risks, and after all have substantial recurrence rates. Consequently, there has been a trend towards adopting non-surgical treatments. This narrative review outlines the latest in non-surgical treatments for adenomyosis, highlighting their significance in managing this condition and stresses the importance of further research, especially concerning long-term outcomes and fertility implications.Recent FindingsEmerging evidence suggests that non-surgical techniques for the treatment of adenomyosis offer prom...
Source: Current Obstetrics and Gynecology Reports - February 22, 2024 Category: OBGYN Source Type: research

Endometrial Determinism of Endometriosis: An Unnecessary Adjunct to Retrograde Menstruation
AbstractPurpose of ReviewThe observation that retrograde menstruation is almost universal while only a small proportion of women suffer with endometriosis is among the most quoted challenges to Sampson ’s hypothesis. Addressing this challenge has focused on identifying unique features in the endometrium of affected women. The assumption that endometriosis develops from an aberrant endometrium forms the cornerstone of “endometrial determinism.” This review appraises the evidence for endometri al aberrations starting with an appraisal of retrograde menstruation.Recent FindingsThe quantity of endometrial tissue in retro...
Source: Current Obstetrics and Gynecology Reports - February 21, 2024 Category: OBGYN Source Type: research

An Overview of Office Hysteroscopy
AbstractPurpose of ReviewOffice hysteroscopy (OH) is safe and effective for diagnosing and managing intrauterine pathology. Newer technology like smaller cameras, improved tissue removal devices, and recommendations for pain control now make OH comfortable for both the physician and patient, with OH having a very high level of patient satisfaction. Despite these benefits, OH remains significantly underutilized in the United States. This review aims to outline the current capabilities, technology, and patient and physician factors associated with successful OH.Recent FindingsOH aids in the diagnosis of abnormal uterine blee...
Source: Current Obstetrics and Gynecology Reports - February 21, 2024 Category: OBGYN Source Type: research

Immunologic Aspects of Endometriosis
AbstractPurpose of ReviewEndometriosis is now widely considered to be a disease characterized by chronic inflammation. The purpose of this review is to summarize the literature regarding the immunologic aspects of endometriosis and highlight recent advances in the field.SummaryThe microenvironment of the endometrium and peritoneal cavity form the foundation for development of endometriosis. Each is structurally comprised of an assortment of immunologic components, including immune cells, signaling factors, and the microbiome, in an estrogen-dependent, pro-inflammatory setting, fueling endometriotic disease. This leads to t...
Source: Current Obstetrics and Gynecology Reports - February 14, 2024 Category: OBGYN Source Type: research

Immune Checkpoint Molecules and Maternal –Fetal Immunity
AbstractPurpose of ReviewBecause the fetus expresses paternally-derived foreign antigens, pregnancy poses unique immune challenges. The maternal immune system must balance protecting the semi-allogeneic fetus from immune rejection with defending the mother and fetus from pathogens. Fetally-derived trophoblast cells of the placenta serve as the immunologic interface with soluble and cellular maternal immune effectors and are thereby essential partners in supporting these tightly regulated interactions. While there are multiple ways that the maternal –fetal immune interface is controlled in a healthy pregnancy, this review...
Source: Current Obstetrics and Gynecology Reports - February 11, 2024 Category: OBGYN Source Type: research

Immunological Underpinnings of Autoimmune Primary Ovarian Insufficiency
AbstractPurpose of ReviewPrimary ovarian insufficiency (POI) is a heterogenous disease with numerous causes, affecting  ~ 1% of women in the USA. The autoimmune-driven subset is even less common and afflicts approximately 4% of POI patients. Although primary ovarian insufficiency is rare, the consequences of early menopause are significant and can lead to osteopenia, infertility, mental health problems, and sexu al dysfunction.Recent FindingsIn vitro maturation of oocytes and IVF may be a promising fertility treatment option for POI patients. Experimental treatments, such as stem cell therapy and intraovarian platelet-...
Source: Current Obstetrics and Gynecology Reports - February 3, 2024 Category: OBGYN Source Type: research

Immunology Updates in Recurrent Implantation Failure in In Vitro Fertilization
AbstractPurpose of ReviewTo summarize standards and recent advances in the understanding of immunology in recurrent implantation failure in IVF.Recent FindingsRecent consensus groups have put forth recommendations regarding the criteria for RIF. The focus of recent studies in RIF has shifted to more nuanced relationships of immunologic dysfunction at the maternal/fetal interface rather than systemic peripheral sources. Recent areas of novel therapy investigation include intrauterine PMBCs, PRP, and GCSF. Accumulating data on chronic endometritis suggests it may be associated with recurrent implantation failure and treatmen...
Source: Current Obstetrics and Gynecology Reports - February 3, 2024 Category: OBGYN Source Type: research

The Endometrial Microbiota ’s Role in Fertility: Updates and Future Directions
AbstractPurpose  of ReviewAdvances in RNA sequencing have revealed diverse endometrial microbiota. As the field of reproductive endocrinology and infertility continues to optimize in vitro fertilization success, the role of endometrial microbiota in endometrial receptivity has gained attention. This review aims to provide a comprehensive summary of our current understanding of the endometrial microbiota and its relationship with fertility while also highlighting future directions.Recent FindingsResearchers have been able to build profiles of endometrial microbiomes that are associated with both fertility and infertility. ...
Source: Current Obstetrics and Gynecology Reports - January 31, 2024 Category: OBGYN Source Type: research

Opioid Use Disorder: Approach to Intrapartum and Postpartum Management
AbstractPurpose of ReviewThe care of pregnant people with opioid use disorder (OUD) presents unique challenges that have escalated with the opioid epidemic in the USA. The pregnancy-related mortality attributable to OUD, as well as the increased contact with the healthcare system during pregnancy, make the opportunities for intervention and engagement in care in the intra- and postpartum period critical, particularly given that the birth hospitalization is an almost universal experience. We aim to summarize an evidence-based approach for intra- and postpartum care and to review the important controversies that remain.Recen...
Source: Current Obstetrics and Gynecology Reports - November 25, 2023 Category: OBGYN Source Type: research

Peripartum Sepsis
AbstractPurpose of ReviewMaternal sepsis is a leading cause of maternal mortality. The purpose of this review is to go in standard and nuanced care in its treatment and diagnosis.Recent FindingsRecent findings in the diagnosis of sepsis have found that criteria like quick Sequential Organ Failure Assessment  (qSOFA) may not be as effective as originally thought in its diagnosis. The treatment of maternal sepsis is still centered in early broad-spectrum antibiotics, fluid resuscitation, and source control.SummaryWe recommend that clinicians refrain from using modalities like qSOFA alone in the diagnosis of maternal sepsis....
Source: Current Obstetrics and Gynecology Reports - November 11, 2023 Category: OBGYN Source Type: research