Objective: This study aims to to evaluate the frequency of ovarian involvement in endometrial cancer patients aged 50 years and younger, identify associated clinicopathological factors, and uniquely assess the role of the Systemic Immune-Inflammatory Index (SII) in predicting ovarian involvement. Methods: Patients aged 50 years and younger diagnosed with endometrial cancer between 1992 and […] Abstract Objective: This study aims to to evaluate the frequency of ovarian involvement in endometrial cancer patients aged 50 years and younger, identify associated clinicopathological factors, and uniquely assess the role of the Systemic Immune-Inflammatory Index (SII) in predicting ovarian involvement. Methods: Patients aged 50 years and younger diagnosed with endometrial cancer between 1992 and […]

Background: The clinical relevance of a mildly elevated first-trimester thyroid-stimulating hormone (TSH) concentration is uncertain, recent meta-analyses disagree, and few studies have directly contrasted a TSH of 2.5–4.0 mIU/L with a TSH above 4.0 mIU/L. Methods: In this single-centre retrospective cohort study, 218 singleton pregnancies with a first-trimester TSH ≥ 2.5 and ≤10.0 mIU/L and a concurrent free thyroxine (fT4) measurement were classified as high-normal TSH (2.5–4.0 mIU/L; n = 168) or elevated TSH (>4.0–10.0 mIU/L; n = 50; subclinical hypothyroidism in 47 and biochemically overt hypothyroidism in 3). The primary outcome was gestational diabetes mellitus (GDM); secondary outcomes were a composite obstetric complication, individual obstetric and neonatal outcomes, and first- and second-trimester screening markers. Two logistic regression models adjusted for maternal age were fitted; because levothyroxine was started after the index TSH measurement, it was treated as a potential intermediate and examined only in post hoc sensitivity analyses. Results: GDM occurred in 7/50 (14.0%) women with TSH > 4.0 mIU/L versus 6/168 (3.6%) with TSH 2.5–4.0 mIU/L (Fisher’s exact test, p = 0.013; unadjusted odds ratio (OR) 4.40, 95% confidence interval (CI) 1.40–13.76; risk difference 10.4 percentage points, 95% CI 0.4–20.4). After adjustment for maternal age, TSH > 4.0 mIU/L remained associated with GDM (adjusted OR 5.24, 95% CI 1.60–17.16; p = 0.006), an estimate based on only 13 events; additional adjustment for levothyroxine use gave a similar estimate (adjusted OR 4.51, 95% CI 1.33–15.22). The composite obstetric complication did not differ (32.0% vs. 20.2%; χ²(1) = 3.02, p = 0.082; adjusted OR 1.95, 95% CI 0.96–3.98), nor did individual obstetric outcomes, neonatal outcomes or screening markers. Conclusions: First-trimester TSH > 4.0 mIU/L was associated with a higher frequency of GDM. Given the few events, the wide confidence interval, unmeasured body-mass index and thyroid-peroxidase-antibody status and the absence of a TSH < 2.5 mIU/L comparison group, the finding is hypothesis-generating and does not establish 4.0 mIU/L as a clinically discriminatory threshold.

Study question: How do the two-progestin type NETA and dienogest affect on pain and recurrence in patients with endometriosis? Summary answer: NETA and dienogest are progestin derivatives that have similar effects on pain and recurrence in treating endometriosis and canbe safely preferred for treatment. What is known already: Although surgical treatment significantly improves pain symptoms in endometriosis, it may be associated with significant urinary, intestinal and vascular complications; In addition, postoperative pain and recurrence rates of endometriotic lesions are high. Medical treatment gains importance, and progestins are mainly used in treatment. NETA is one of the most researched progestins for the treatment. It has a good safety profile and efficacy in curing endometriosis-related pain, making NETA a viable medical option among first-line treatments. Study design, size, duration: The study was designed as a single-center, prospective, randomized study. Patients were randomly assigned to one of the two treatment protocols, with the single digit 'NETA' and double 'dienogest' according to the last digit of their protocol number. Patient recruitment started in February 2022. The patients were evaluated at 6-month visits for one year. Participants/materials, setting, methods: Seventy patients aged 18-40 years were included. Patients with contraindicated progestins and pelvic inflammatory disease were excluded from the study. Demographic data, medical and surgical treatment histories were recorded. Patients were evaluated with detailed physical examination, ultrasound, and laboratory tests. They were questioned because of their chronic pain symptoms, they were asked to give a score between 1 and 10 with the numerical scoring system and recorded. They were re-evaluated at 6 and 12 months. Main results and the role of chance: 40 dienogest and 30 NETA patients were included in the study. There were eight patients (one headache, one orthostatic hypotension, five metrorrhagia, one pregnancy request) in the NETA group and 11 patients (1 headache, one decreased sexual desire, one surgery, eight metrorrhagia) in the dienogest group. In the final analysis, 48 patients were included in the study. There was no significant difference between the two groups regarding initial laboratory, ultrasonographic and demographic parameters. (p > 0.5) There was no significant difference between the two groups in dropout rates at six months. (p = 0.65) Dysmenorrhea, dyspareunia, dyschezia, and chronic pelvic pain scores were similar both at the beginning of treatment and at the 6th-month follow-up, and no significant difference was observed in both group. (p > 0.5) Significant improvement was observed in all scores in both groups.(p < 0.001) In the 6th month, the most common side effects in the dienogest group were emotional lability (26%), and metrorrhagia (15%), while the NETA group were metrorrhagia (40%) and weight gain (20%). No significant effect was observed on the lipid profile and bone mineral density at the 6th-month control. Limitations, reasons for caution: Our study is the first study in the literature to compare NETA and dienogest in the medical treatment of endometriosis. The strongest aspect is that it is a randomized control study. The small number of study population and the high dropout rates are the limitations. Wider implications of the findings: NETA and dienogest are two progestin derivatives that are effective on pain and recurrence in the medical treatment of endometriosis and can be safely preferred for treatment. An analysis of our long-term data and further studies are needed to evaluate which progestin preparation is more effective and safe in treatment. Trial registration number: NCT05476172

This retrospective study seeks to explore whether modifying the gonadotropin dose in cases of poor ovarian response during controlled ovarian hyperstimulation contributes to improved live birth rates in Poseidon Group 3-4 patients. The study took place at a tertiary level university. The electronic database spanning 2012-2021 was scrutinized to identify patients with diminished ovarian reserve (DOR) who underwent intra-cytoplasmic sperm injection – embryo transfer (ICSI-ET). Diminished ovarian reserve was determined using the POSEIDON criteria. Patients were categorized into two groups based on whether dose adjustment was implemented during the initial ultrasound assessment in controlled ovarian hyperstimulation (COH). There were 188 patients in the dose adjustment (DA) group and 310 patients in the fixed-dose (FD) group. The demographic parameters were similar between the groups. The started gonadotropin dose was similar in both groups (300 IU). The median dose adjustment on the first control was +75 IU in the DA group. The follicle output rates, follicle to oocyte indexes, and the embryology parameters were comparable between the groups. The positive pregnancy rate was 19.7% (36/188) in the DA group vs. 19.1% (61/310) in the FD Group (p=0.4). The primary outcome of the study; live birth rates were 12% in the DA group vs. 9% in the FD group, and the results were statistically similar (p=0.3). Our research revealed that adjusting the gonadotropin dose in cases of inadequate ovarian response during COH results in comparable live birth rates to those observed in the fixed-dose group. For patients exhibiting an inadequate response, dose adjustment may be deemed necessary.