Background/Objectives: Endometrial B-cell lymphoma 6 (BCL6) overexpression has been proposed as a marker of progesterone resistance, occult endometriosis, and endometrial dysfunction in infertile women. Its possible association with reproductive outcomes and its potential role in guiding management before embryo transfer have attracted increasing interest. However, the prognostic and clinical significance of BCL6 across infertility settings remains incompletely defined. We systematically reviewed the literature on endometrial BCL6 expression and reproductive outcomes in infertile women. Methods: This systematic review was conducted according to a prospectively registered PROSPERO protocol. Studies evaluating endometrial BCL6 expression on biopsy in infertile women were eligible if they reported reproductive outcomes or clinically relevant comparative data. Two prespecified questions were addressed: whether high or abnormal BCL6 expression is associated with poorer reproductive outcomes than low or normal expression, and whether treatment before embryo transfer improves outcomes in BCL6-positive women. Thirteen studies were included in the review. Because the included studies differed substantially in infertility phenotype, embryo context, hormonal preparation, biopsy timing, and outcome reporting, findings were synthesized narratively. Results: The available evidence suggests that abnormal or elevated endometrial BCL6 expression may be associated with poorer reproductive outcomes in some infertility populations, particularly in women with unexplained infertility undergoing IVF, although this pattern was less evident in selected euploid embryo transfer cohorts. Treatment-oriented studies suggested a possible benefit of pre-transfer medical suppression or surgical management in some BCL6-positive women, but findings were variable across studies. Supportive non-comparative and mechanistic studies further indicated that interpretation of BCL6 is influenced by hormonal preparation, endometrial context, and whether BCL6 is considered in isolation or within a broader biological or multimarker framework. Interpretation of the available evidence was constrained by the limited number of comparative studies, observational study designs, variability in clinical populations, and incomplete standardization of reproductive outcome reporting. Conclusions: Endometrial BCL6 appears biologically and clinically relevant as a marker of endometrial dysfunction in selected infertility settings, but current evidence is insufficient to support routine stand-alone clinical use or strong treatment recommendations. Its apparent prognostic and clinical utility varies across patient populations and reproductive settings. Larger prospective comparative studies with harmonized biopsy protocols, standardized outcome reporting, and independent external validation are needed to clarify the role of BCL6 in reproductive medicine.

Background/Objectives: Chronic endometritis (CE) is an underrecognized inflammatory disorder associated with infertility, recurrent pregnancy loss, and implantation failure. CD138 immunohistochemistry is widely used to detect endometrial plasma cells; however, background epithelial staining and interobserver variability may limit diagnostic precision. MUM1 (IRF4), a nuclear transcription factor expressed in plasma cells, has emerged as a potential complementary marker. We aimed to systematically evaluate the diagnostic performance of MUM1 immunohistochemistry relative to CD138-based histopathologic reference frameworks for chronic endometritis using a Bayesian meta-analytic framework. Methods: We conducted a systematic review and diagnostic test accuracy meta-analysis in accordance with PRISMA 2020 and PRISMA-DTA guidelines. MEDLINE, Embase, Scopus, and CENTRAL were searched from inception to 28 February 2026. Studies assessing MUM1 immunohistochemistry against predefined histopathologic reference frameworks for CE were eligible. Risk of bias was evaluated using QUADAS-2. A bivariate Bayesian random-effects model was applied to jointly estimate pooled sensitivity, specificity, likelihood ratios, and diagnostic odds ratio (DOR). Results: Six studies (n = 1574 women) were included in the qualitative synthesis, and four provided sufficient 2 × 2 data for quantitative pooling. The pooled sensitivity of MUM1 was 0.876 (95% credible interval (CrI): 0.536–0.976), and the pooled specificity was 0.853 (95% CrI: 0.653–0.930). The pooled positive likelihood ratio was 5.83 (95% CrI: 2.18–12.04), and the negative likelihood ratio was 0.15 (95% CrI: 0.03–0.56), corresponding to a DOR of 40.27 (95% CrI: 5.04–254.59). Credible intervals were wide, reflecting statistical uncertainty related to the limited number of studies and heterogeneity in diagnostic thresholds. Conclusions: MUM1 (IRF4) immunohistochemistry demonstrates potentially favorable comparative diagnostic performance relative to CD138-based reference frameworks, although substantial uncertainty remains due to limited and heterogeneous evidence. As an adjunctive nuclear marker, MUM1 may support histopathologic assessment of chronic endometritis; however, prospective head-to-head studies using harmonized diagnostic criteria and predefined plasma cell thresholds are required before routine implementation can be firmly recommended.

Background/Objectives: Adenomyosis is a common yet frequently underdiagnosed cause of gynecological morbidity, and its definitive diagnosis still relies on histopathological examination of hysterectomy specimens. We aimed to determine the histopathological prevalence of adenomyosis in hysterectomy specimens removed for benign indications, characterize preoperative referral diagnoses and concurrent histopathological findings, and compare our results with the contemporary literature. Methods: We retrospectively analyzed 430 consecutive abdominal hysterectomies performed for benign gynecological indications at a tertiary referral center in Iasi, Romania, between January 2019 and October 2024. Adenomyosis was defined histopathologically. An “incidental” finding was defined as the absence of adenomyosis in the preoperative referral diagnosis, without re-review of the original ultrasound reports. We report prevalence and the incidental rate with Wilson-score 95% confidence intervals (CIs); we used the chi-square test with Yates continuity correction for categorical comparisons and calculated odds ratios (ORs), with correction for multiple comparisons. Results: Adenomyosis was identified in 188 of 430 specimens (43.7%; 95% CI 39.1–48.4%), of which 186 (98.9%; 95% CI 96.2–99.7%) were incidental; adenomyosis was recorded in the referral diagnosis in only 2 cases (1.1%). Endometrial hyperplasia was the only co-finding significantly associated with adenomyosis (OR 2.30; 95% CI 1.48–3.55; p = 0.0002), an unadjusted univariate association that remained significant after multiple-comparison adjustment (adjusted p = 0.0014). No referral diagnosis discriminated adenomyosis status; leiomyoma was frequent in both groups (75.5% vs. 69.0%; not significant). Mean age was 50.0 ± 7.6 years, with no between-group difference (p = 0.112). Conclusions: Approximately two in five women undergoing hysterectomy for benign disease have adenomyosis, and it is rarely suspected preoperatively. Because this study did not test whether structured sonographic assessment improves detection, prospective evaluation of the revised 2022 Morphological Uterus Sonographic Assessment (MUSA) criteria with imaging–histopathology correlation is warranted.

Background and Objectives: Hydrosalpinx is an important and treatable cause of impaired in vitro fertilization (IVF) outcomes, but the optimal intervention and its timing remain uncertain. This narrative review evaluates contemporary evidence to support individualized management before IVF. Materials and Methods: Targeted searches of PubMed/MEDLINE records and publisher websites prioritized systematic reviews, meta-analyses, randomized trials, cohort studies, and international guidelines published from January 2015 to September 2026, while retaining earlier landmark studies. Evidence concerning salpingectomy, laparoscopic proximal tubal occlusion (PTO), aspiration, sclerotherapy, ovarian reserve, and treatment timing was synthesized narratively. Results: Clinically significant communicating hydrosalpinx should generally be treated before embryo transfer. Salpingectomy remains the most established definitive intervention, whereas laparoscopic PTO appears to provide comparable clinical pregnancy outcomes and may reduce tubo-ovarian vascular disruption in selected patients. Evidence regarding ovarian reserve after salpingectomy is conflicting: total oocyte yield is often preserved, although some studies report lower anti-Müllerian hormone, antral follicle count, or ipsilateral follicular recruitment. Aspiration and sclerotherapy may be considered when standard surgery is not feasible, but recurrence and limited randomized evidence restrict routine use. Observational studies do not establish a universally superior sequence of surgery and oocyte retrieval. Conclusions: Management should move from a uniform procedure-centered approach toward patient-centered selection. Reproductive age, ovarian reserve, laterality, pelvic adhesions, surgical complexity, and treatment urgency should guide both the intervention and its timing, while effective hydrosalpinx treatment should precede embryo transfer.