Objective The aim of this study is to conduct a cross-cultural validation and adaptation of the Vulvodynia Experience Questionnaire (VEQ) within the Italian context. Design This study used a cross-sectional design to culturally adapt and validate the VEQ instrument. The study is reported following the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for cross-sectional studies. Methods The questionnaire was translated using the forward–backward translation method. Face and content validity were assessed through the calculation of the impact score and the Item-level Content Validity Index (I-CVI) and Scale-level Content Validity Index, Average (S-CVI/Ave). The comprehensibility of the items in Italian was evaluated. The final questionnaire was administered to women with vulvodynia through snowball sampling, and descriptive statistics and Cronbach’s alpha coefficient were calculated to assess its reliability and internal consistency. Results The content and face validity demonstrate good relevance, appropriateness, and comprehensibility. The internal consistency was measured using Cronbach’s alpha, which yielded a value of 0.875, indicating good reliability of the instrument. Conclusions The VEQ-IT demonstrated good reliability and validity in assessing the quality of life of Italian women affected by vulvodynia. Its clinical use could improve patient management and support the personalization of care pathway by systematically capturing the broader impact of symptoms on daily life, sexuality, and psychological well-being.
OBJECTIVE:To identify factors associated with intrapartum cesarean delivery (CD) among underweight women undergoing a trial of labor, and to evaluate whether underweight BMI independently influences intrapartum cesarean risk. METHODS:A retrospective cohort study conducted at a single university-affiliated tertiary medical center, including women with a pre-pregnancy BMI < 18.5 kg/m2 who planned a trial of labor between 2012 and 2024. Women undergoing elective CD or with nonviable fetuses were excluded. Associations were assessed using multivariable logistic regression. To evaluate the independent effect of BMI, an adjusted analysis was performed on the combined underweight and normal-BMI cohort (n = 77,662). Predictive performance was evaluated using receiver operating characteristic analysis, calibration testing, and decision-curve analysis. RESULTS:Among 147,045 deliveries, 8,967 women (6.1%) had a BMI < 18.5 kg/m2 and attempted a trial of labor; 287 (3.2%) underwent intrapartum CD, significantly lower than in a concurrent normal-BMI cohort (4.3%, p < 0.001). In the combined cohort analysis, underweight BMI was independently associated with a lower risk of intrapartum CD (aOR 0.71, 95% CI 0.63-0.81, p < 0.001), with no significant interaction between BMI category and any identified risk factor. Seven factors were independently associated with intrapartum CD: previous CD (aOR 14.57, 95% CI 8.60-24.69), multiple gestation (aOR 8.69, 95% CI 5.16-14.64), nulliparity (aOR 7.39, 95% CI 5.05-10.81), preeclampsia (aOR 3.76, 95% CI 1.96-7.21), maternal age ≥ 40 years (aOR 2.98, 95% CI 1.90-4.68), maternal height < 160 cm (aOR 2.19, 95% CI 1.68-2.84), and induction of labor (aOR 1.66, 95% CI 1.20-2.29). The model demonstrated good discrimination (AUC 0.746, 95% bootstrap CI 0.722-0.768), with sensitivity 92.7%, PPV 6.2%, and NPV 99.1%. CONCLUSION:Underweight women have a high likelihood of successful vaginal birth. Underweight BMI was independently associated with a lower risk of intrapartum CD, with no effect modification by any established risk factor. Intrapartum cesarean risk in this population is driven by established obstetric factors rather than low BMI itself, supporting individualized, risk-based counseling and management.
OBJECTIVE:To assess short-term hematologic response to a single 1000 mg dose of intravenous ferric carboxymaltose in pregnancy and determine whether subsequent oral iron use was associated with additional hematologic benefit. STUDY DESIGN:This retrospective cohort included 955 singleton pregnancies treated at Kayseri City Hospital between January 2021 and May 2025. Women receiving intravenous ferric carboxymaltose alone were compared with those with documented oral iron use after infusion and before the first antepartum follow-up complete blood count. Primary outcomes were hemoglobin and hematocrit changes. Multivariable linear regression adjusted for maternal age, parity, gestational age at treatment, baseline hematologic value, and follow-up interval. RESULTS:The intravenous-only and intravenous-plus-oral iron groups included 867 and 88 pregnancies, respectively. Overall, hemoglobin increased from 9.45 ± 1.27 to 11.48 ± 1.44 g/dL and hematocrit from 29.45 ± 3.27 % to 34.71 ± 3.75 %. Changes in hemoglobin (2.02 ± 1.39 vs 2.16 ± 1.21 g/dL; p = 0.318) and hematocrit (5.23 ± 3.89 vs 5.59 ± 3.05 percentage points; p = 0.308) did not differ between groups. Oral iron use was not independently associated with a greater change in hemoglobin (B = 0.188, 95 % CI - 0.049 to 0.426; p = 0.121) or hematocrit (B = 0.529, 95 % CI - 0.165 to 1.223; p = 0.135). CONCLUSION:Intravenous ferric carboxymaltose was associated with substantial short-term hematologic improvement. Subsequent oral iron use was not associated with a measurable additional response.
OBJECTIVES:To describe trends in and levels of short-term mortality risk of early-stage epithelial ovarian cancer (EOC) in Denmark and Sweden, overall and by age at diagnosis, stage, histology, and socioeconomic status (SES). METHODS:From the Danish (2004-2019) and Swedish (2004-2022) Cancer Registry, we included all patients registered with early-stage EOC, defined by the International Federation of Gynecology and Obstetrics (FIGO) as stages I + II. Information about SES, measured by educational level, income, and marital status, was retrieved from nationwide registries. We calculated short-term (3-month, 6-month, and 1-year) absolute all-cause mortality risks by calendar period using the Kaplan Meier method. The 1-year mortality risks were additionally stratified by age at diagnosis, stage, histology, and SES. RESULTS:The 1-year absolute mortality risk among Danish patients decreased by 6% per year (95% CI: -12 to 0%) in the study period, whereas it was stable in Sweden. The decreasing mortality risk in Denmark was seen for all levels of SES but tended to be more pronounced in patients with low SES and older patients. Time trends in mortality risk in Sweden did not seem to vary substantially across patient groups except for a decline in patients with mucinous tumors and an increase among those with other epithelial tumors. CONCLUSIONS:Since 2004, 1-year absolute mortality risk of early-stage EOC decreased in Denmark (low SES and older patients) and remained stable in Sweden, resulting in comparable levels in recent years, probably explained by improved diagnostics, surgery centralization, and implementation of standardized cancer patient pathways.
OBJECTIVE:To compare cervical cytological profiles between two distinct real-world screening pathways represented by public tertiary and private outpatient services in Romania and to examine age-adjusted associations between screening pathway and prespecified cytological outcomes. STUDY DESIGN:This retrospective comparative cohort study included 1,441 consecutive women undergoing routine cervical cancer screening in two Romanian healthcare settings. The public cohort comprised 726 conventional Papanicolaou smears obtained at a tertiary referral hospital, whereas the private cohort included 715 ThinPrep® liquid-based cytology examinations performed within a private outpatient network. Additionally, hrHPV testing was available for a clinically selected subgroup of 68 women from the private outpatient pathway and was performed according to routine clinical indications. Cytological findings were classified according to the 2014 Bethesda System. Between-group differences were evaluated using Pearson's chi-square test with post-hoc analysis of adjusted standardized residuals. Age-adjusted logistic regression was used to examine associations between screening pathway and prespecified cytological outcomes. RESULTS:A total of 1,441 women were included (public, n = 726; private, n = 715). Age distributions were comparable between healthcare settings (39.4 ± 13.4 vs. 38.3 ± 12.9 years; p = 0.120). The overall prevalence of abnormal cytology was comparable between the public and private pathways (7.4 % vs. 9.5 %; age-adjusted OR [aOR] for public vs. private, 0.77; 95 % CI 0.53-1.12; p = 0.168), whereas the distribution of Bethesda diagnostic categories differed significantly (χ2 = 21.70; p < 0.001). LSIL was more frequent in the private outpatient pathway, while ASC-H and the prespecified ASC-H/HSIL/AGC cytological composite were more frequent in the public tertiary pathway in age-adjusted analyses. Estimates for outcomes with small event counts, particularly ASC-H, were imprecise and should be interpreted cautiously. In the clinically selected private subgroup undergoing hrHPV testing, hrHPV positivity was associated with abnormal cytology (OR 6.91, 95 % CI 2.16-22.10; p = 0.001). CONCLUSIONS:Two distinct real-world cervical screening pathways showed comparable overall rates of abnormal cytology but different distributions of selected Bethesda categories. These differences remained apparent in age-adjusted analyses; however, healthcare setting was structurally aligned with cytological preparation method, and several potentially relevant patient-level determinants were unavailable. The findings should therefore be interpreted as associations between distinct screening pathways rather than as independent or causal effects of public versus private healthcare. The higher frequency of ASC-H in the public tertiary pathway, without a corresponding statistically significant difference in HSIL, should not be interpreted as evidence of a greater burden of confirmed high-grade disease.
BACKGROUND:The COVID-19 pandemic caused widespread disruptions to reproductive healthcare services and raised concerns regarding potential adverse effects on fertility. However, no study has quantified whether these disruptions translated into measurable changes in the global burden of infertility. We evaluated the impact of the pandemic on population-level infertility burden worldwide. METHODS:We conducted a population-based interrupted time-series analysis using data from the Global Burden of Disease Study 2023 for 204 countries and territories from 1990 to 2023. Age-standardized prevalence rates (ASPR) and age-standardized years lived with disability rates (ASYR) for male and female infertility were analyzed. Autoregressive integrated moving average models were fitted to pre-pandemic data (1990-2019) to generate counterfactual projections for 2020-2023 assuming no pandemic. Observed and expected estimates were compared globally and across sex, age, socio-demographic index (SDI), and selected countries. Sensitivity analyses evaluated alternative pandemic onset assumptions. RESULTS:The global infertility burden increased steadily between 1990 and 2019. During 2020-2023, observed ASPR and ASYR remained closely aligned with counterfactual projections. Relative deviations between observed and expected estimates ranged from 1.34 % to 2.80 % for ASPR and from 1.45 % to 3.38 % for ASYR. Across sex-, age-, SDI-, and country-specific analyses, most observed estimates remained within model-derived prediction intervals. Sensitivity analyses produced consistent findings and identified no statistically significant pandemic-associated increase in infertility burden. CONCLUSIONS:The COVID-19 pandemic was not associated with a measurable change in global infertility burden beyond expected long-term trends. Despite substantial disruptions to reproductive healthcare services, no measurable deviation in GBD-estimated population-level infertility burden was detected during 2020-2023. These findings provide global evidence that no measurable deviation in infertility burden trends was observed during the study period, while highlighting the need for continued surveillance and equitable access to reproductive healthcare.
RESEARCH QUESTION:What is the prognostic value of first complete IVF cycle outcomes on live birth rates in the second cycle, and does this differ by age group in contemporary IVF practice? DESIGN:Retrospective cohort study using Swiss national IVF registry data. Included were 1,860 women who completed two complete consecutive IVF cycles between 2018 and 2023. An historical cohort comprising 2,162 women whose first and second complete IVF cycles were both initiated between 2014 and 2017 was analysed using identical methods to compare the contemporary findings with an earlier treatment period. Outcomes of the first complete cycle (no pregnancy, biochemical pregnancy, clinical miscarriage, live birth) were used to predict live birth in the second complete cycle, analyzed with multivariable logistic regression adjusted for age and ovarian response and grouped by age (<38 vs. ≥ 38 years). RESULTS:Second-cycle live birth showed a graded association: 31.8 % (no pregnancy), 36.6 % (biochemical), 43.1 % (miscarriage), 42.7 % (live birth; p < 0.001). Clinical pregnancy/live birth in first cycle increased odds vs. no pregnancy (aOR 1.41, 95 %CI 1.07-1.86, p = 0.010), with a stronger effect in women < 38 years; age was the predominant prognostic factor in those ≥ 38 years. Comparison with the historical 2014-2017 cohort demonstrated stronger prognostic effects. CONCLUSIONS:First complete IVF cycle outcomes stratify prognosis for subsequent success, particularly in women < 38 years, while age overtakes as predominant predictor in older women. Biochemical pregnancy was not confirmed as an independent predictor in the main multivariable model. These findings support cautious, individualised counselling after the first complete IVF cycle in contemporary practice, while underscoring that prognostic estimates are conditional on completing a second cycle and should be validated in larger, independent cohorts.
Study question What are the diagnostic roles of hysteroscopy and endometrial biopsy in the evaluation of chronic endometritis (CE), and how is CE associated with reproductive outcomes in women undergoing in vitro fertilization (IVF) or embryo transfer? Summary answer Chronic endometritis was associated with lower clinical pregnancy rates and higher miscarriage risk following IVF or embryo transfer, whereas treated/resolved CE was associated with more favorable reproductive outcomes than persistent disease, based predominantly on observational evidence.Hysteroscopy demonstrated variable diagnostic performance and should be considered an adjunct to histopathological assessment rather than a standalone diagnostic test. What is known already Chronic endometritis is increasingly recognized as a potential contributor to infertility, recurrent implantation failure, and recurrent pregnancy loss. Histopathological identification of endometrial stromal plasma cells, typically supported by CD138 immunohistochemistry, represents the principal tissue-based approach to CE diagnosis. Hysteroscopy may identify characteristic endometrial abnormalities, including micropolyps, stromal oedema, and focal hyperaemia, but its diagnostic performance as a standalone test remains uncertain. Interpretation of the available evidence is complicated by substantial heterogeneity in diagnostic criteria, plasma-cell thresholds, patient populations, and assisted reproductive technology protocols. Study design, size, duration This systematic review and meta-analysis was conducted in accordance with the PRISMA 2020 Statement and prospectively registered in PROSPERO (CRD420251130136). MEDLINE, Embase, Scopus, Web of Science Core Collection, and CENTRAL were searched from database inception to February 2026. Thirty-nine studies met the predefined eligibility criteria. Participants/materials, setting, methods Eligible studies included infertile women undergoing IVF or embryo transfer in whom CE was evaluated by hysteroscopy with or without endometrial biopsy. Histopathological assessment, with or without CD138 immunohistochemistry according to study-specific protocols, served as the reference standard, where applicable. Primary outcomes included live birth or ongoing pregnancy, clinical pregnancy, and miscarriage, whereas secondary outcomes included implantation rate and the diagnostic performance of hysteroscopy. Random-effects meta-analyses were performed to estimate pooled odds ratios (ORs) with 95% confidence intervals (CIs). Prespecified subgroup analyses evaluated treatment status and inflammatory burden according to CD138 plasma-cell thresholds. The certainty of evidence for all critical reproductive outcomes was assessed using the GRADE approach. Main results and the role of chance Compared with women without CE, live birth or ongoing pregnancy tended to be lower (44.0% vs 50.6%; OR 0.77, 95% CI 0.53–1.11; I2 = 57%), although the pooled estimate did not reach statistical significance. Clinical pregnancy rates were lower (54.3% vs 60.1%; OR 0.55, 95% CI 0.42–0.74; I2 = 77%), whereas miscarriage rates were higher (16.4% vs 11.9%; OR 1.43, 95% CI 1.13–1.82; I2 = 48%). Compared with persistent chronic endometritis, treated or resolved disease was associated with higher live birth or ongoing pregnancy rates (OR 2.72, 95% CI 1.94–3.82; I2 = 62%), higher clinical pregnancy rates (OR 2.45, 95% CI 1.72–3.50; I2 = 75%), and lower miscarriage rates (OR 0.40, 95% CI 0.20–0.81; I2 = 35%). No statistically significant differences were observed according to higher versus lower CD138 plasma-cell thresholds. Across diagnostic studies, hysteroscopic sensitivity ranged from 22% to 86%, whereas specificity was generally moderate to high when compared with histopathological assessment. Limitations, reasons for caution The available evidence was derived predominantly from observational studies and was affected by substantial clinical and methodological heterogeneity, including differences in patient populations, CE definitions, CD138 thresholds, hysteroscopic interpretation, antibiotic regimens, embryo-transfer protocols, and outcome definitions. These limitations preclude causal inference, and the certainty of evidence was low or very low across the principal reproductive outcomes, reflecting the predominantly observational evidence base together with outcome-specific concerns regarding risk of bias, inconsistency, imprecision, and potential small-study effects. Wider implications of the findings Current evidence supports an association between CE and less favorable reproductive outcomes following IVF or embryo transfer but does not establish that treatment itself improves live birth. Hysteroscopy should be considered an adjunctive diagnostic tool interpreted together with histopathological assessment rather than a definitive diagnostic test. Routine CE screening before a first IVF cycle cannot currently be recommended on the basis of the available evidence. Instead, a targeted rather than universal approach to CE evaluation may be considered in selected women, particularly those with recurrent implantation failure, recurrent pregnancy loss, or otherwise unexplained infertility.Future adequately powered prospective studies and randomized controlled trials using standardized diagnostic criteria, uniform CD138-positive plasma-cell thresholds, and live birth as the primary patient-important outcome are required to clarify whether targeted diagnosis and treatment of CE improve reproductive outcomes. Registration number PROSPERO CRD420251130136.
