Mayer–Rokitansky–Kuster–Hauser syndrome (MRKHs), or Mullerian agenesis, is a congenital disorder characterized by the absence or underdevelopment of the uterus and upper vagina. It remains a leading cause of primary amenorrhea, presenting significant reproductive challenges. Although normal ovarian function is typical, optimal ovarian stimulation protocols and ovarian reserve in MRKHs patients are not well defined. This study aimed to assess ovarian reserve and response to ovarian stimulation in MRKHs patients, comparing their outcomes to women with male-factor infertility. In this retrospective study, we reviewed ovarian stimulation cycles from 52 MRKHs patients treated at Royan Institute, Tehran, Iran. A control group of 208 women with male-factor infertility was included. Demographic data, hormonal levels [anti-Mullerian hormone (AMH), follicle-stimulating hormone (FSH), and luteinizing hormone (LH)], ovarian stimulation parameters, and embryo transfer outcome were analyzed using SPSS version 22, with paired t-tests and Chi-square tests to evaluate group differences. MRKHs patients required higher gonadotropin doses (P=0.001) and exhibited elevated mean LH levels (8.3 IU/L) compared to controls (4.4 IU/L, P=0.001). However, no significant differences were observed in FSH and AMH levels. The total number of retrieved oocytes was significantly lower in the MRKHs group (P=0.005); however, the oocyte maturation rate was comparable between the two groups. The total number of embryos obtained and the high-quality embryo rate did not differ significantly between the groups. Pregnancy outcomes, including implantation rate, clinical pregnancy, miscarriage, live birth, and preterm labor rates, did not differ significantly between the groups. Pregnancy complications, including gestational diabetes mellitus and gestational hypertension, were observed only in the control group. No fetal or neonatal anomalies were reported in either group. Elevated LH levels in MRKHs suggest possible hyperandrogenemia unrelated to polycystic ovary syndrome. The altered ovarian response underscores the need for individualized ovarian stimulation protocols, potentially involving androgen-lowering treatments. Early oocyte or embryo cryopreservation is recommended to mitigate age-related decline in ovarian reserve, especially when gestational surrogacy is not immediately available.
The etiology of preterm birth is complex and multifaceted, involving factors such as preterm cervical softening and remodeling, which poses challenges for prediction. Ultrasound, as a convenient and non-invasive tool, is commonly used to assess the cervix during pregnancy. However, cervical length measurement has limited accuracy in predicting preterm birth, highlighting the urgent need for more specific indicators to evaluate the cervix during gestation. This study aimed to investigate regional differences in cervical viscoelastic parameters, evaluate their changes between the first and second trimesters using paired statistical tests, and explore their association with cervical length via ultrasound viscoelastic imaging, thereby providing a foundation for future research on preterm birth prediction. A prospective cohort trial enrolled pregnant women undergoing prenatal examinations at Nanjing Drum Tower Hospital from May 2024 to October 2025. Viscoelastic parameters (shear elastic modulus, viscosity coefficient, and dispersion coefficient) were measured at the internal, middle, and external segments of both the anterior and posterior cervical lips by a Mindray Resona R9 ultrasound system equipped with a 7–9 MHz transvaginal probe at 11–13⁺⁶ weeks and 22–24⁺⁶ weeks of gestation. Viscoelasticity is an indicator for evaluating the intrinsic properties of tissue; higher values indicate stiffer and more viscous tissue. From the first to the second trimester, the mean of all viscoelastic measurements of the anterior and posterior cervical lips decreased significantly (P < 0.0001). Within each trimester, values were highest in the internal, intermediate in the middle, and lowest in the external segment (P < 0.01). Corresponding regions of the posterior lip consistently exhibited higher values than those of the anterior counterparts (P < 0.01). Cervical length showed a very weak positive correlation with some viscoelastic parameters in the first trimester, whereas a negative correlation emerged in the second trimester. All measurements demonstrated good intra- and inter-observer reproducibility (intraclass correlation coefficient, ICC > 0.75). Our study establishes reference ranges for cervical viscoelastic parameters in the first and second trimesters thereby providing new quantitative tools and reference data for assessing the cervix during pregnancy. Their clinical value is yet to be determined.
To assess IVF/ICSI outcomes and their determinants in young patients with low basal AMH stratified by basal FSH levels. This retrospective cohort study included 70,644 IVF/ICSI cycles conducted at a tertiary reproductive center between 2017 and 2022. After 1:2 propensity score matching for age and AMH, women aged 20–39 years with low AMH (< 1.1 ng/mL) were categorized into two extreme basal FSH phenotypes: low FSH (< 5 mIU/mL, n=298) an high FSH (> 25 mIU/mL, n=149). Among young women with low AMH, those with low basal FSH exhibited higher BMI and AFC, as well as longer stimulation duration and higher total Gn doses (all P < 0.01). They yielded more retrieved oocytes, fertilized embryos, and good-quality embryos than those in the high-FSH group (all P < 0.01). The cumulative clinical pregnancy and live birth rates were significantly higher in the low-FSH group (19.80
Develop a preliminary theoretical model of placental growth factor (PlGF), cell-free DNA fetal fraction (FF) and prior risks in pre-term preeclampsia (PE) and unaffected pregnancies. Fitting a bivariate Gaussian marker distribution and maternal prior risk factors to a preliminary series. Marker levels were expressed in multiples of the median (MoMs) using fitted regression equations. Unaffected parameters were obtained from the preliminary series; PE parameters from the literature or making reasonable assumptions. 2149 women were tested at 9–14 weeks; pregnancy outcome was not available. Log-linear MoMing equations, after log (PlGF) or square-root (FF) transformation, fitted the data well. Medians in 42 twins were higher than in singletons: PlGF 1.15 and 1.00 MoM, respectively (P < 0.01); FF 1.35 and 1.01 MoM (P < 0.0001). There was strong correlation between log PlGF and √FF: in singletons (R = 0.257, P < 0.0001) and twins (R = 0.221, although not significant P = 0.16). Applying the model retrospectively, 1 in 60 pre-term PE risk cut-off for singletons and 1 in 12 for twins classified 10.0
Most medical graduates and specialists of obstetrics and gynecology (OB/GYN) in Germany are female, and numbers of female urology specialists are rising. However, the number of women in higher academic positions does not correlate with this increase. This study analyzes female academic career advancement on a spatial and temporal scale in Germany using the Brüggmann–Groneberg (BG) Index. The academic BG Index relates female-to-male (f:m) ratios in chair positions of state universities while representing lower career levels. It is updated in this study from 2013 (OB/GYN) and 2015 (urology) onwards, while a modified clinical BG (BGclin) Index, introduced here for the first time, assesses career progression ratios in leadership positions in clinical medicine. The gender distribution among medical students, OB/GYN and urology specialists, clinical leaders, and academic chair holders was obtained from governmental and non-governmental sources. The f:m ratios of the populations were assessed and used in the BG indices which were calculated for five time points (2004, 2009, 2014, 2019 and 2024) and across Germany to identify spatial–temporal trends. F:m ratios among hospital specialists increased in OB/GYN (0.847 to 2.388) and urology (0.13 to 0.361) from 2004 to 2024. In contrast to urology, significant changes in the distribution of male and female chair holders toward gender equality could be observed in OB/GYN. Simultaneously, the academic BG Index rose from 0.045 to 0.099 in OB/GYN and from 0 to 0.084 in urology. The BGclin Index slightly decreased in OB/GYN (0.108 to 0.102) and increased in urology (0.086 to 0.114). No spatial trend could be observed. This study demonstrates persistent gender imbalance in German academic and clinical leadership positions in OB/GYN and urology. The academic and BGclin Indices indicate stagnation and/or decline in gender parity, emphasizing the need for targeted career development programs. Furthermore, a spatial analysis revealed an absence of spatial patterns in German chair holder positions. The continued use of these indices will prove a helpful tool to assess and document changes in the upcoming years.
Adenomyosis is associated with reduced IVF success, yet the optimal ovarian stimulation strategy remains unclear. Although prolonged GnRH agonist suppression has been widely used, its benefit in fresh embryo transfer cycles is inconsistent, and potential differences between focal and diffuse adenomyosis are poorly defined. This network meta-analysis compared reproductive outcomes across commonly used stimulation protocols in women with adenomyosis undergoing fresh embryo transfer, with additional analysis according to disease subtype. This network meta-analysis evaluates the effectiveness of commonly used stimulation protocols in women with adenomyosis undergoing fresh embryo transfer and examines whether outcomes differ between focal and diffuse disease. We systematically searched PubMed, Scopus, and Google Scholar from inception to November 2025 for randomized trials and cohort studies comparing ovarian stimulation protocols (ultra-long GnRH agonist, long GnRH agonist, GnRH antagonist, and short GnRH agonist) in women with adenomyosis undergoing fresh embryo transfer. Only studies with ultrasound- or MRI-confirmed adenomyosis and extractable fresh-cycle outcomes were included. Implantation, clinical pregnancy, miscarriage, and live birth were analyzed. A frequentist random-effects network meta-analysis was performed using risk ratios and 95
To evaluate a composite ultrasound cervical score integrating multiple sonographic markers of cervical disease severity and assess its association with severe prematurity and neonatal outcomes. As a secondary exploratory objective, we investigated whether triple antibiotic therapy influenced outcomes according to risk stratification. This retrospective cohort study included women with cervical insufficiency managed at a tertiary referral center between January 2019 and December 2023. All patients underwent transvaginal ultrasound assessment at admission. A composite cervical score (range 0–4) was developed by assigning one point for each abnormal parameter: cervical shortening, cervical funneling, intra-amniotic sludge, and fetal membrane prolapse. Patients were stratified into low-risk (score < 2) and high-risk (score ≥ 2) groups. The primary outcome was delivery at or beyond 32 weeks of gestation. Secondary outcomes included gestational age at delivery, neonatal birthweight, NICU admission, and neonatal morbidity. Multivariable logistic regression was performed adjusting for maternal age, gestational age at admission and previous preterm birth. Fifty-seven women were included. Median gestational age at admission was 22 weeks (IQR 20–23), and 61
We examined the prevalence of magnesium supplementation among pregnant women in Germany and assessed whether risk factors for preterm birth might be associated with magnesium use. We explored the association between magnesium supplementation and pregnancy duration . The LIFE Child Study (Leipzig, Germany) recruited pregnant women and collected data in the 24th and 36th week of pregnancy from 2011 to 2019. In this prospective observational cohort study (n = 1078 participants), we analysed potential associations for magnesium supplementation with health-related factors using logistic regression models adjusted for age and socioeconomic status (SES). Using a generalised linear model, we explored whether magnesium supplementation potentially affects pregnancy duration. During their current pregnancy, 60.0
The aim of this network meta-analysis (NMA) is to comprehensively analyze the effectiveness of different postoperative interventions for Intrauterine adhesion (IUA) recurrence prevention. Literature searching was performed to select eligible studies published prior to March 11, 2026 in PubMed, Cochrane and Embase. Randomized controlled trials (RCTs) involving interventions for IUA prevention after transcervical resection of adhesions (TCRA) were included. Outcomes included IUA recurrence rate, AFS score reduction, AFS score and clinical pregnancy rate. Twenty‑six studies (3040 patients) were included. Intrauterine estrogen releasing system showed the highest probability of being the best intervention for IUA recurrence rate (SUCRA: 95.40
Parity is associated with differences in birthweight, but the magnitude and consistency of this association when expressed as birthweight percentiles remain incompletely characterized. To evaluate the association between birth order and birthweight percentile at both the population-level and within mothers across successive pregnancies. This retrospective cohort study included 130,718 singleton live births from 55,057 women delivering at a single tertiary medical center between 2012 and 2024. Birthweight percentiles were calculated using a national sex-specific reference. Linear mixed-effects models with a random intercept for mother were used to evaluate the association between birth order and birthweight percentile, adjusting for maternal age, infant sex, and maternal diabetes. Complementary longitudinal within-mother analyses evaluated changes in birthweight percentile across successive pregnancies. Higher birth order was associated with higher birthweight percentile (β ≈ 0.074 SD per birth order increment, p < 0.001), corresponding to an average increase of approximately 3 percentile points per birth. The largest increase occurred between the first and second births, followed by progressively smaller but persistent increases with advancing birth order. This pattern was consistent across subgroup analyses and complementary within-mother analyses. Higher birth order was consistently associated with higher birthweight percentile both across the population and within mothers. The association followed a distinct nonlinear pattern, with the largest increase occurring between the first and second pregnancies and progressively smaller but persistent increases thereafter. These findings provide a more nuanced understanding of parity-associated variation in fetal growth across successive pregnancies.
To compare cesarean delivery rates and induction outcomes among women undergoing labor induction with a cervical ripening double balloon (DB), oral misoprostol (OM), or a combination of both (DOM). This single-center randomized controlled trial included women with singleton term pregnancies, cephalic presentation, Bishop score ≤ 4, and intact membranes. Participants were randomized to DB for 6 h, oral misoprostol, or combined treatment. The primary outcome was cesarean delivery rate. Secondary outcomes included Bishop score after 6 h, time from induction to delivery, failed induction, and maternal and neonatal outcomes. Due to slow recruitment, the study was stopped early, and complete-case analysis was performed. A total of 216 participants were included in the analysis (DB n = 65, OM n = 75, DOM n = 76). Cesarean delivery rates were 20
Abstract Background The diagnosis of a fetal goiter constitutes a potentially life-threatening in utero condition for the fetus. Even with early diagnosis and close therapy with highly specialized interdisciplinary management, the prognosis remains poor. We discuss diagnostic and therapeutic challenges regarding the pre- and postnatal outcome based on four consecutive cases with a critical appraisal of latest heterogeneous recommendations in literature. Methods A retrospective review of four cases of fetal goiter is presented that were diagnosed at a tertiary university centre during targeted ultrasound (US) examination in second and third trimester. All cases underwent close and intensive pre- and postnatal diagnostics and treatment. A detailed workup of current diagnostic and therapeutic recommendations with identifying potential pitfalls was carried out. Case series In one case, the mother suffered from Graves’ disease with euthyroid blood parameters under medication. The other three gravidae largely had an uneventful medical history including euthyroid metabolism. In all cases, fetal hypothyroidism was suspected and in three of them, cordocentesis was performed and intraamniotic levothyroxine (LT4) was given. In none of the cases, sonographic signs of tracheoesophageal compression had been noticed. In all four cases, a planned cesarean section was performed between 32 and 39 weeks of gestation (weeks). Out of all four cases, only one fetus managed to survive: one fetus died antenatally at 35 weeks, one newborn died due to insufficient ventilation, and one due to fetal cardiac decompensation with bilateral hydrothorax with suspected ductal obstruction. The fetus who survived showed primary hypothyroidism. Two of the deceased fetuses underwent autopsy, one showed ectopic thyroid tissue in the trachea. Conclusion Prenatal diagnosis of congenital fetal goiter remains a serious condition in specialized centers. In practice, the following crucial considerations might impede proper application of the non-standardized recommendations suggested in available literature. In addition to the assessment of the underlying etiology, the evaluation of fetal cervical structures with determination of fetal tracheoesophageal patency and cardiac functional diagnostics requires adequate practical expertise. Interdisciplinary cooperation is mandatory when determining the time and mode of delivery and planning an ex utero intrapartum treatment (EXIT) strategy.
To compare the diagnostic accuracy of transvaginal ultrasound (TVUS) and magnetic resonance imaging (MRI) for detecting urinary tract endometriosis (UTE), including ureteral and bladder involvement. A systematic review and meta-analysis were conducted according to PRISMA 2020 guidelines. PubMed, Embase, and Scopus were searched from inception to December 2025 for diagnostic accuracy studies evaluating TVUS and/or MRI for UTE. Surgical findings, with or without histopathological confirmation, were used as the reference standard. Studies reporting sufficient data to construct 2 × 2 contingency tables were included. Pooled sensitivity and specificity with 95
To evaluate whether preoperative clinical Enzian scoring and digital rectal examination improve accuracy of operative time prediction and surgical outcomes in women undergoing surgery for endometriosis. Prospective, randomized, multicenter pilot trial. Three urban teaching hospitals certified as endometriosis centers. A total of 107 women undergoing surgery for endometriosis. The participants were randomly assigned to three groups: Group 1 underwent clinical Enzian scoring combined with digital rectal examination (DRE); Group 2 underwent clinical Enzian scoring only; and Group 3 underwent digital rectal examination only. All patients received standard transvaginal ultrasound examinations. The primary endpoint was defined as an absolute difference of ≤ 10 min between the estimated and the actual operative time. Secondary end points included conversion to laparotomy, abandonment of the operation, complete resection rate, need for secondary surgery, correspondence between the preoperative Enzian assessment and intraoperative findings, and postoperative pain (visual analog scale) and patient satisfaction. The primary endpoint was achieved in 9 patients (23.7
To develop a stillbirth risk index based on cumulative burden of pre-pregnancy and early-pregnancy risk factors, to assist clinicians in planning antenatal care. This population-based cohort study used data from the Medical Birth Registry of Norway and Statistics Norway from 1999 to 2022. All individuals with singleton pregnancies in Norway who gave birth from gestational age ≥ 22 weeks were included, resulting in a study population of 1 350 936 births. Fifteen pre-pregnancy and early-pregnancy characteristics associated with ≥ 25
Despite forty years of intense research and multitudinous clinical innovations, live birth rates (LBR) among women diagnosed with decreased ovarian reserve (DOR) remain disappointingly poor. Is this because a solution has not yet been discovered, or are we searching in the wrong way? This persistent failure is probably the product of both undisputable biological realities, the exponential decline in oocyte euploidy with advanced maternal age, and persistent methodological flaws, most notably the inclusion of highly heterogeneous cohorts in clinical trials and inadequate stratification by critical variables, such as age. No ovarian stimulation protocol, adjuvant therapy, or laboratory add-on has consistently improved outcomes. The grouping of young and older DOR women in clinical studies, the focus on surrogate endpoints over live birth, and failure to account for cycle-to-cycle and operator variability further obscure valid conclusions and mislead both clinicians and patients. In this review, we delineate the evolution of DOR research, drilling down to the biological, technical, and methodological roots of failed progress. We argue that only by rigorously stratifying study populations by narrow age bands, repeated response criteria and prioritizing true endpoints, can future research genuinely advance the field and provide realistic, evidence based counseling. Clinical humility and research rigor are prerequisites for sparing patients needless interventions and false hope.
