Background: Gestational Diabetes Mellitus(GDM) and thyroid dysfunction (TD) are the two most prevalent endocrinopathies during pregnancy. Methods: The observational cross-sectional study was conducted in an outpatient clinic from May 2024 to May 2025. 72 patients with GDM (study group) and 40 volunteers (control group) were selected to participate in the study. Anthropometric data (body mass – BM, body mass index – BMI) and an oral glucose tolerance test were carried out for all participants during all three trimesters of pregnancy. Thyroid function (thyroid-stimulating hormone – TSH, thyroid antibodies) was assessed in the first trimester of pregnancy. A special structured questionnaire was developed for socio-economic and anamnesis data. Odds ratio (OR) and 95% Confidence intervals (95%CI) were assessed for factorial analysis. Results: DM in the first trimester was manifested in 13 patients (18.1%), in the second trimester – in 42 patients (58.3%), in the third trimester – in 17 patients (23.6%). The presence of TD was a significant factor for GDM – the TD was revealed in 55 patients (76.4%) of the study group and 26 patients (54.2%) of the control group – OR = 2.74, 95%CI – 1.25-6.01, p=0.012. The percentage of patients with TSH more than 4 mcU/l was significantly higher in the study group compared to the control group (38.8% vs. 18.8%; OR=2.76, 95%CI – 1.16-6.56, p=0.022). It should also be noted that GDM in patients with TD was manifested significantly earlier than in patients without TD – 19.6±6.2 weeks vs. 24.8±4.4 weeks, t-test=3.21, p=0.002. Body mass gain at the end of the third trimester was also significantly higher in GD patients with TD compared to GDM patients without TD – 14.4±2.5 kg vs. 12.6±2.1 kg, t-test=2.69, p=0.009. The pregnancy in 30 patients (41.7%) with TD in the study group was achieved through IVF; IVF was used in 24 cases with TD (50.0%) in the control group. The difference was not significant. Therefore, the combination of IVF and TD cannot be considered a risk factor for GDM. Conclusion: TD may be considered a noteworthy factor in the development of GDM. GDM may manifest earlier, and the patient’s body mass gain may be higher if TD is present during pregnancy. The combination of IVF and TD cannot be considered a risk factor for GDM.
Background: The diagnosis of infertility and its subsequent prolonged medical procedures induce a severe psycho-emotional crisis within couples. While clinical focus predominantly shifts toward reproductive disorders, their evaluation, and treatment, statistics indicate that over 50% of couples face serious sexual problems in their intimate lives. This article aims to elucidate the bidirectional “vicious cycle” between infertility and sexological disorders, exploring the underlying mechanisms and offering strategic interventions to address these challenges. Results: The aforementioned issue must be reviewed through two primary dimensions: 1. Sexological Barriers as a Cause of Infertility: In women, conditions such as vaginismus and dyspareunia physically impede penetration and intravaginal ejaculation. In men, erectile dysfunction, anejaculation, retrograde ejaculation, and premature ejaculation obstruct sperm transport to the oocyte, while hypoactive sexual desire reduces the probability of timing the brief “fertile window.” 2. Infertility Stress as a Cause of Sexual Dysfunction: Scheduled or “calendar-driven” intercourse eliminates spontaneity. In men, this triggers “performance anxiety”, an adrenaline cascade that constricts blood vessels, causing erectile failure; also, in the future, it causes a decrease in libido. In women, hyper-control inhibits the parasympathetic nervous system, disrupting vaginal lubrication and causing anorgasmia. This state is further compounded by a damaged body image and associated psychological complexes. Conclusion: Breaking this vicious cycle requires a comprehensive, multidisciplinary approach: diversifying intimacy (establishing “non-reproductive” days to alleviate penetration pressure), reframing communication to mitigate individual guilt, and integrating sexological counseling alongside reproductive therapies. Maintaining sexual health during infertility treatments is paramount to preserving partnership cohesion and is frequently a vital prerequisite for overcoming the core issue of infertility itself.
Background: Artificial intelligence (AI) is rapidly becoming an important component of modern in vitro fertilization (IVF), offering opportunities to standardize embryo assessment, reduce subjectivity, and efficiently analyze static and time-lapse imaging data. Methods: A focused narrative review synthesized 17 publications from 2021 through 2025 on AI-assisted embryo ranking, viability and euploidy prediction, workflow optimization, quality assurance, and implementation: 1 randomized clinical trial, 1 systematic review, 2 conference abstracts, and 13 other journal publications. Four named embryo-assessment systems were profiled. Separately, published aggregate GGRC data were synthesized to illustrate a practice-based application of AI in IVF laboratory quality management. Results: ERICA, iDAScore, FiTTE, and IVFvision. ai provided automated embryo ranking or outcome prediction. Most supporting evidence was retrospective or simulation-based. In the only included multicenter randomized trial (n = 1,066), iDAScore did not establish noninferiority to standard morphology-based selection for clinical pregnancy; however, embryo assessment was approximately tenfold faster. The GGRC evidence demonstrated a complementary quality-management application rather than image-based embryo ranking: a KPI-based clinical pregnancy model was externally validated using 3,888 Georgian treatment cycles within a two-center dataset of 10,128 cycles, yielding a mean AUC of 0. 73. In Q2 2024, predicted and observed clinical pregnancy rates were 58. 9% and 59. 1%, and no statistically significant between-embryologist differences were detected. These findings support AI-assisted calibration and laboratory audit but do not demonstrate improved pregnancy or live-birth outcomes. Conclusion: AI’s strongest current contribution is human-supervised decision support and laboratory governance. The GGRC experience demonstrates practical value for calibration, KPI surveillance, troubleshooting, and targeted audits, but it does not yet prove that AI increases pregnancy or livebirth rates. Thoughtfully implemented AI can strengthen standardization, workflow, training, quality control, and evidence-based IVF care. However, it should not replace embryologists or be presented as a guarantee of euploidy, pregnancy, or live birth.
Background: Breast cancer diagnosed during pregnancy (PrBC) represents a rare but increasingly prevalent clinical scenario, driven by delayed childbearing and increasing breast cancer incidence among premenopausal women. PrBC is characterized by distinct biological features – including a predominance of hormone receptor-negative, poorly differentiated, and lymph node-positive tumors – and poses unique therapeutic constraints. Surgery constitutes the cornerstone of locoregional management; however, evidence-based guidance remains limited to observational data and expert consensus, because randomized controlled trials are ethically precluded in this population. Methods: A narrative review of the current literature was conducted, incorporating prospective cohort studies, systematic reviews, meta-analyses, and major international guidelines – including the 2023 ESMO Expert Consensus Statements, the 2025 ASCO Sentinel Lymph Node Biopsy Guideline Update, the 2025 RCOG Green-top Guideline No. 12 on Pregnancy and Breast Cancer, and the NCCN Clinical Practice Guidelines in Oncology for Breast Cancer (Version 2.2026) – to synthesize evidence on all aspects of surgical care for breast cancer diagnosed during gestation. Results: Surgery can be performed safely at any stage of pregnancy. The optimal procedure – breast-conserving surgery (BCS) or mastectomy – is determined by tumor biology, gestational age, and the feasibility of adjuvant radiotherapy, which must be deferred until the postpartum period. Sentinel lymph node biopsy (SLNB) using technetium-99m is considered safe and endorsed by most current guidelines as the standard axillary staging approach in clinically node-negative PrBC, while blue dye agents such as isosulfan blue and methylene blue are discouraged. Venous thromboembolism (VTE) prophylaxis with low-molecular-weight heparin represents a critical yet historically underemphasized component of perioperative care, given the compounded thrombotic risk conferred by pregnancy, malignancy, and surgery. Conclusion: Definitive surgical treatment of PrBC, delivered within a dedicated multidisciplinary framework, can achieve locoregional control comparable to that in non-pregnant patients. Therapeutic conservatism at the expense of oncological adequacy must be avoided. Prospective registry data and validation of novel axillary staging approaches – including targeted axillary dissection – in the PrBC setting remain important research priorities.
Background: Polyendocrine Metabolic Ovarian Syndrome (PCOS/PMOS) represents a complex metabolic-endocrine disorder in obese, hyperinsulinemic, and insulin-resistant women with a family history of diabetes. Myo-inositol (MI) and D-chiro-inositol (DCI) act as insulin-sensitizing agents, while alpha-lipoic acid (ALA) may provide additional metabolic benefits. However, comparative evidence regarding their combined effects in this high-risk population remains limited. Objective of the article is to compare the metabolic, hormonal, and clinical effects of MI, MI+DCI, and MI+DCI+ALA in obese, hyperinsulinemic women with PCOS/PMOS and a family history of diabetes. Methods: In this randomized, double-blind, parallel-group clinical trial, 96 women aged 20–38 years with obesity (BMI ≥30 kg/m²), Rotterdam criteria-defined PCOS/PMOS, hyperinsulinemia, and insulin resistance were randomized to control, MI, MI+DCI (40:1), or MI+DCI+ALA groups. Participants were evaluated at baseline and after 12 and 24 weeks. Metabolic, hormonal, and clinical parameters, including insulin sensitivity, glucose metabolism, androgen status, lipid profile, anthropometric measures, and menstrual regularity, were assessed. Results: After 24 weeks, all three treatment groups demonstrated improvements in metabolic and hormonal parameters compared with controls. The MI+DCI combination produced greater improvements in insulin resistance and glucose metabolism than MI alone, while the addition of ALA resulted in further improvement. Androgen levels decreased, and SHBG increased, accompanied by improved gonadotropin balance. Menstrual regularity was restored most frequently with MI+DCI+ALA, followed by MI+DCI and MI alone. Anthropometric and lipid parameters also improved, with the most pronounced overall metabolic effects observed with the triple combination. Improvements in hepatic insulin extraction and liver-related parameters were particularly evident following ALA addition. Conclusions: In obese women with PCOS/PMOS, hyperinsulinemia, insulin resistance and a family history of diabetes, MI+DCI supplementation was associated with greater metabolic, hormonal and clinical benefits than MI alone, while the addition of ALA provided further improvement across key metabolic outcomes. These findings support the potential role of combined inositol and ALA therapy in managing PCOS/PMOS phenotypes characterized by increased metabolic risk.
