Subscribe: Current Opinion in Obstetrics and Gynecology - Featured Articles
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Current Opinion in Obstetrics and Gynecology - Featured Articles

Last Build Date: Mon, 19 Mar 2018 22:16:27 -0500


Random-start ovarian stimulation in patients with cancer

Fri, 02 Oct 2015 09:52:49 GMT-05:00

(image) Purpose of review Awaiting menses to start ovarian stimulation for oocyte/embryo cryopreservation in patients with cancer may result in a significant delay of cancer treatment that may lead to patients forgoing fertility preservation. The purpose of this review is to describe the new protocols to facilitate the start of ovarian stimulation, including random-start ovarian stimulation. Recent findings In random-start protocols, the number of total and mature oocytes retrieved, oocyte maturity rate, mature oocyte yield and fertilization rates are similar to those in conventional (early follicular phase start) protocols. Starting ovarian stimulation in the late follicular or luteal phase did not show any superiority against the other. The presence of corpus luteum or luteal phase progesterone levels did not adversely affect synchronized follicular development, number of mature oocytes retrieved, and/or fertilization rates. Summary Random-start ovarian stimulation provides a significant advantage by decreasing total time for the IVF cycle, and in emergent settings, ovarian stimulation can be started at a random cycle date for the purpose of fertility preservation without compromising oocyte yield and maturity.

Next-generation sequencing for hereditary breast and gynecologic cancer risk assessment

Fri, 02 Oct 2015 09:54:40 GMT-05:00

(image) Purpose of review To summarize advances in next-generation sequencing and their application to breast and gynecologic cancer risk assessment. Recent findings Next-generation sequencing panels of 6–112 cancer-associated genes are increasingly used in patient care. Studies report a 4–16% prevalence of mutations other than BRCA1/2 among patients who meet evidence-based practice guidelines for BRCA1/2 testing, with a high rate (15–88%) of uninterpretable variants of uncertain significance. Despite uncertainty about results interpretation and communication, there is early evidence of a benefit from multiple-gene sequencing panels for appropriately selected patients. Summary Multiple-gene sequencing panels appear highly promising for the assessment of breast and gynecologic cancer risk, and they may usefully be administered in the context of cancer genetics expertise and/or clinical research protocols.

Oocyte mitochondrial function and reproduction

Fri, 02 Oct 2015 09:57:19 GMT-05:00

(image) Purpose of review Mitochondria are cellular organelles that are required for energy production. Emerging evidence demonstrates their role in oocyte development and reproduction. In this review, we examine recent animal and clinical studies on the role of mitochondria in fertility. We also analyse the impact of assisted reproductive techniques (ARTs) on mitochondrial function and discuss the future clinical implications of mitochondrial nutrients and mitochondrial replacement. Recent findings Mitochondria affect all aspects of mammalian reproduction. They are essential for optimal oocyte maturation, fertilization and embryonic development. Mitochondrial dysfunction causes a decrease in oocyte quality and interferes with embryonic development. ART procedures affect mitochondrial function, while mitochondrial nutrients may increase mitochondrial performance in oocytes. New mitochondrial replacement procedures using mitochondria obtained from polar bodies or from the patient's own oogonial stem cells are promising and may address concerns related to the induction of high-levels of heteroplasmy, which could potentially result in negative long-term health effects. Summary Optimal energy production is required for oocyte and embryo development, and mitochondrial abnormalities have devastating reproductive consequences. Improvement of oocyte mitochondrial function via intake of compounds that boost mitochondrial activity may have clinical benefits, and mitochondrial replacement could potentially be used for the prevention of mitochondrial diseases.

Apical prolapse repair: weighing the risks and benefits

Fri, 02 Oct 2015 10:01:58 GMT-05:00

(image) Purpose of review This article reviews the current literature regarding surgical repair of vaginal apical prolapse and discusses the risks and benefits of various surgical approaches. Recent findings Vaginal uterosacral ligament suspension has similar anatomic and subjective outcomes to sacrospinous ligament fixation at 1 year. Native tissue vaginal repairs offer decreased morbidity compared with mesh-augmented sacrocolpopexy; however, sacrocolpopexy has greater anatomic success. Minimally invasive sacrocolpopexy appears to be equivalent to open abdominal sacrocolpopexy. Native tissue repairs and transvaginal mesh kits support the vaginal apex with similar results; however, long-term follow-up is needed. Robotic and laparoscopic sacrocolpopexy are equally effective in restoring the vaginal apex. Summary Surgical restoration of the vaginal apex can be accomplished via a variety of approaches and techniques. When deciding on the proper surgical intervention, the surgeon must carefully calculate the risks and benefits of each procedure while incorporating the patient's individual medical and surgical risk factors. Lastly, a discussion regarding the patient's overall goals of care is paramount to the decision-making process.