Ovarian endometriosis is a gynecological condition that is closely associated with infertility—from its pathogenesis to treatment modalities, this condition presents a challenge both for patients and clinicians alike when seeking conception, due to low AMH levels, peritoneal inflammation, and the inadvertent removal of healthy ovarian parenchyma at surgery. In fact, around half of endometriosis patients seeking fertility require tertiary-level assisted reproduction techniques to achieve a live birth. Oocyte cryopreservation, a procedure initially designed for oncology patients, has emerged over recent years as a very promising treatment strategy for patients who have been diagnosed with ovarian endometriosis in order to preserve their fertility and obtain a live birth at a later stage in their lives. Counseling patients about oocyte preservation techniques at an early stage in the diagnosis, ideally before the age of 35 and especially prior to any surgical treatment, provides an excellent opportunity to discuss future fertility and the benefits associated with oocyte cryopreservation.

A T-shaped uterus is a rare uterine malformation that is classically associated with diethylstilbesterol (DES) exposure. Surprisingly, the prevalence of T- and Y-shaped uterus has increased in recent years despite the absence of a diagnostic consensus and a correlation with the reproductive outcomes has been observed. A systematic electronic database search for all English-language studies published on reproductive outcomes associated with dysmorphic uteri over the past 10 years using PubMed, Google Scholar, and Scopus was performed. This uterine malformation is associated with impaired reproductive outcomes, including primary infertility, miscarriage, ectopic pregnancy, and preterm birth. Hysteroscopic metroplasty is a simple surgical procedure that could potentially improve outcomes in subfertile women, but the data are not robust. Studies reported significant improvements in implantation and pregnancy rates after corrective metroplasty in women undergoing in vitro fertilization. However, multicenter, prospective, randomized, and controlled trials are needed to validate these findings and to help define clear diagnostic criteria, surgical indications, and appropriate follow-up of reproductive outcomes after the procedure.

Intraovarian platelet-rich plasma (PRP) has been proposed as an experimental treatment for women with diminished ovarian reserve and poor ovarian response, but the optimal route of administration remains unclear. This study compared laparoscopic and transvaginal ultrasound-guided PRP administration and investigated whether the route of injection was independently associated with ovarian response and reproductive outcomes. This retrospective multicenter study included 119 women undergoing intraovarian PRP at two Italian fertility centers: 50 received laparoscopic PRP and 69 underwent transvaginal ultrasound-guided administration. In both groups, 3 mL of PRP was injected into each ovary. Post-treatment ovarian response was available for 79 women. Primary outcomes were the numbers of retrieved and mature (MII) oocytes. Secondary outcomes included embryo yield, pregnancy outcomes, and longitudinal changes in ovarian reserve markers. Multivariable linear regression was used to adjust for baseline anti-Müllerian hormone (AMH), antral follicle count (AFC), and double ovarian stimulation (DUO-STIM). Retrieved oocytes were 4.64 ± 3.61 after laparoscopic versus 3.45 ± 3.86 after transvaginal administration (p = 0.06), while MII oocytes were 3.38 ± 2.84 versus 2.83 ± 3.04 (p = 0.25). After adjustment for AMH, AFC, and DUO-STIM, the route of administration was not independently associated with retrieved (β −0.78; 95% CI −2.49 to 0.92; p = 0.37) or mature oocytes (β −0.23; 95% CI −1.56 to 1.11; p = 0.74). DUO-STIM was positively associated with both outcomes. In the transvaginal cohort, a modest early increase in AMH was not sustained over subsequent follow-up. Pregnancy analyses were exploratory because of the limited number of embryo transfers. The route of intraovarian PRP administration was not independently associated with ovarian response after accounting for baseline ovarian reserve and stimulation strategy. These findings do not demonstrate an advantage of laparoscopic administration and support further prospective evaluation of the less invasive transvaginal approach using standardized PRP and stimulation protocols.