The comparison of outcomes between the “skeleton uterus technique” and conventional techniques in laparoscopic hysterectomies

Aim: The aim of this study is to compare demographic characteristics, operative data, and complication rates of women who underwent total laparoscopic hysterectomy by the skeleton uterus technique (Skeleton-TLH) with those of women who underwent TLH by the standard technique (Standard-TLH) in a university teaching and research hospital. Materials and Methods: This retrospective study included 932 laparoscopic hysterectomies in a university teaching and research hospital between January 1, 2013 and December 31, 2017. Clinical characteristics, operative outcomes, and complications were recorded and compared for the two techniques. Results: In total, 932 laparoscopic hysterectomies were performed, 454 by Skeleton-TLH and 478 by Standard-TLH. The general demographic characteristics of the patients were similar; only gravida and parity were statistically significantly different between the groups (P < 0.001). Based on the primary outcomes (the operative data), total anesthesia time and main operation time were similar in the two groups. Estimated blood loss was statistically significantly lower in the Skeleton-TLH group than in the Standard-TLH group. Hospital stay was longer for the Skeleton-TLH group, and specimen weight was heavier. The secondary outcome was the complication rate. There were no differences between the Skeleton-TLH and Standard-TLH groups in the rates of all minor and major complications. Conclusion: TLH with the skeleton uterus technique is feasible and safe, especially for advanced pelvic surgeons. This technique not only provides retroperitoneal access to the pelvic spaces and good anatomical visibility; but it also delivers a safer laparoscopic hysterectomy by clamping the uterine arteries and monitoring the ureter throughout the operation

Are all antral follicles the same? Size of antral follicles as a key predictor for response to controlled ovarian stimulation

The aim of this study was to evaluate whether antral follicle size has any value with respect to antral follicle count (AFC) in predicting ovarian response to controlled ovarian stimulation. Patients who were considered to be normal responders based on their ovarian reserve markers were consecutively recruited. Total AFC was the number of 2–10 mm follicles in both ovaries. Antral follicles were separated into two subgroups according to the size: 2–5 mm and 6–10 mm follicles. Patients were divided into two main groups according to ovarian response to COS. Group 1 (suboptimal response, 4–9 oocytes retrieved, n = 61) and Group 2 (normal responders, ≥10 oocytes retrieved, n = 65). Demographic parameters were comparable between the groups. The number of 2–5 mm follicles was significantly lower in the suboptimal response group (5 [4:7] and 8 [6:10], respectively, p < .001). The ratio of 2–5 mm follicles to total antral follicles was also significantly lower in Group 1 (44.4% and 75%, respectively, p < .001). The ratio of small antral follicles was positively correlated with ovarian response (r = 0.587, p < .001). In conclusion, the ratio of small (2–5 mm) antral follicles could be a more specific predictive marker than AFC for ovarian response.IMPACT STATEMENT What is already known on this subject? Prediction of the ovarian response during ovarian stimulation is commonly based on antral follicle count and anti-mullerian hormone. The ovarian response may be inadequate even in patients with normal antral follicle count and anti-mullerian hormone. What do the results of this study add? A high ratio of small-size (2–5 mm) basal antral follicles is a predictive factor for higher ovarian response to ovarian hyperstimulation. What are the implications of these findings for clinical practice and/or further research? To obtain optimal ovarian response, the antral follicles should be evaluated initially in a more detailed and systematic way by taking their sizes into consideration in addition to their counts. Small antral follicle count rather than whole antral follicle count may be beneficial for optimising the ovarian response. Future studies may determine the cut off values of small antral follicle count for high/poor ovarian response

The Kisspeptin and Kisspeptin receptor in follicular microenvironment: is that really necessary for oocyte maturation and fertilisation?

The aim of this study was to determine whether Kisspeptin and Kisspeptin receptor in the follicular microenvironment is necessary for human oocyte maturation and fertilisation. The cumulus cell (CC) and follicle fluids (FF) obtained from the first aspirated follicles (n = 52) from 32 patients were divided into three groups considering nuclear maturation and fertilisation results of oocytes: (1) Metaphase I or germinal vesicle stage oocytes (incomplete nuclear maturation, n = 10), (2) unfertilised metaphase II oocytes (incomplete cytoplasmic maturation, n = 16), and (3) fertilised metaphase II oocytes (completed nuclear-cytoplasmic maturation, n = 26). The gene expression levels were assessed by RT-PCR. The levels of Kisspeptin (KISS1) and Kisspeptin receptor (KISS1R) were measured by ELISA. There were no significant efficacy KISS1 and KISS1R gene expressions in cumulus cells in terms of oocyte nuclear maturation stage (Group 1, vs Group 2 + Group 3) (respectively p = .49; p = .45). In terms of the cytoplasmic maturation stage (Group 2, vs Group 3); KISS1 and KISS1R expressions in CCs were comparable (respectively p = .07; p = .08). In FFs, KISS1 and KISS1R concentrations were similar between all groups (respectively p = .86; p = .26). In conclusion, the relative KISS1 and KISS1R expressions in CC and also KISS1 and KISS1R level of FF were independent of oocytes nuclear and/or cytoplasmic maturation. Impact statement What is already known on this subject? It has been demonstrated that Kisspeptin is an essential regulator of reproductive function and plays a key role in the modulation of GnRH secretion and gonadotropin release. Still, no information is available about the link between gene expression or concentration in the follicular microenvironment and oocyte development. What do the results of this study add? The study has shown that the relative Kisspeptin (KISS1) and Kisspeptin receptor (KISS1R) and expressions in cumulus cell (CC) and also KISS1 and KISS1R levels of follicle fluids (FF) were independent of oocytes nuclear and/or cytoplasmic maturation. What are the implications of these findings for clinical practice and/or further research? Based on the findings, it is difficult to establish a concept that kisspeptin can directly induce oocyte maturation. Nevertheless, to confirm these findings, further studies with a larger sample size are needed

Which is more predictive ovarian sensitivity marker if there is discordance between serum anti-Müllerian hormone levels and antral follicle count? A retrospective analysis

This retrospective study aims to determine the more predictive ovarian reserve marker when there is discordance between anti-Müllerian hormone (AMH) and antral follicle count (AFC) in patients with diminished ovarian reserve (DOR). Patients who underwent ICSI because of DOR were divided into three groups. Group 1: patients with low AMH (<1.1 ng/ml) and AFC (n < 7), group 2: patients with low AMH (<1.1 ng/ml) and normal AFC (n ≥ 7) and group 3: patients with normal AMH (≥1.1 ng/dl) and low AFC (n < 7). Demographic values, follicle output rate (FORT) score and follicle to oocyte index (FOI) score of the groups were compared. Totally, 662 cycles were enrolled in the study. There were 418 cycles in group 1, 167 cycles in group 2 and 77 cycles in group 3. As the primary result, FORT and FOI scores were higher in group 3 than the other two groups. Median FORT Score with quartiles: group 1: 100 (66–150), group 2: 71 (57–100), group 3: 136 (96–200), p<.01 – median FOI score with quartiles: group 1: 83 (50–140), group 2: 71 (40–100), group 3: 116 (66–216), p<.01. In conclusion, serum AMH level has more predictive value for stimulation success if there is discordance with AFC.Impact Statement What is already known on this subject? Female age, serum Anti-Müllerian Hormone (AMH) levels, and antral follicle count (AFC) are commonly used to assess ovarian reserve and predict response to ovarian stimulation. AMH and AFC are both positively correlated with ovarian reserve. What do the results of this study add? If there is discordance between AFC and AMH in patients with diminished ovarian reserve (DOR), the ovarian response is better in patients with high AMH and low AFC than the patients with low AMH and high AFC. What are the implications of these findings for clinical practice and/or further research? It is important to assess both AFC and AMH before controlled ovarian hyperstimulation, to predict ovarian response in DOR patients, rather than assessing AFC or AMH alone

EROSS study: effect of ovarian reserve on sexual satisfaction

The population of this multicenter prospective cohort study comprised 180 women. Women who were admitted to the gynaecology department with any symptoms aged 18–40 years, whose ovarian reserve was tested, were prospectively enrolled in the study. The Female Sexual Function Index (FSFI) survey was administered to all patients. Demographic parameters (age, body mass index), ovarian reserve tests and FSFI scores were analysed. FSFI scores were compared between the patients with diminished ovarian reserve (DOR) and normal ovarian reserve (NOR). Mean women age was 30.8 ± 5.1 years. Median (with quartiles) AFC was 15 (10–20) and anti-mullerian hormone (AMH) was 2.6 (1.3–4.3) ng/mL. Mean FSFI score was 27 ± 4.7. The FSFI score was positively correlated with AMH and AFC and negatively correlated with women age. FSFI score depending on ovarian reserve were; 24.7 ± 5.2 vs. 27.4 ± 4.3, p < .01 (Respectively; DOR group (n = 43) vs. NOR group (n = 132)). Threshold value for AMH to predict sexual hypofunction was 2.32 with 67% sensitivity – 62% specificity (AUC: 0.68 p < .01) and for AFC to predict sexual hypofunction was 15 with 65% sensitivity – 60% specificity (AUC: 0.67 p < .01). In conclusion, the ovarian reserve should be considered in reproductive aged women while assessing the exact aetiology of female sexual dysfunction. IMPACT STATEMENT What is already known on this subject? Sexual dysfunction is a common disorder and negatively affects the life quality of women. Its estimated prevalence is 40% in women worldwide. There are still unknown aetiologies for sexual dysfunction. What do the results of this study add? The female sexual function index is positively correlated with ovarian reserve. Decreasing sexual functions is related to decreased ovarian reserve. Lower AMH than 2.32 ng/dl and lower antral follicle count than 15 are associated with sexual hypofunction. What are the implications of these findings for clinical practice and/or further research? This pilot study showed the relationship between sexual functions and ovarian reserve. In daily practice, the ovarian reserve should be considered in reproductive-aged women while assessing the exact aetiology of the sexual dysfunction. TRIAL REGISTRATION NUMBER NCT04776902 Clinical Trial