OBJECTIVE:To demonstrate the step-by-step application of intraluminal indocyanine green (ICG) in endometriosis and adenomyosis surgery, including mucosa-sparing shaving of deep bladder and rectal nodules and excision of superficial tubal endometriosis. DESIGN:Description of surgical technique with narrated video footage. SUBJECTS:First case was a 36-year-old patient with chronic pelvic pain, urinary frequency, and dysuria. Preoperative magnetic resonance imaging revealed a bladder endometriosis nodule measuring 1.7 cm × 1.5 cm. The patient underwent robotic-assisted excision of endometriosis with total hysterectomy. Second case was a 34-year-old patient with chronic pelvic pain and dyschezia. Preoperative magnetic resonance imaging revealed a rectal endometriosis nodule measuring 2.7 cm × 1.8 cm, located 8 cm from the anal verge. The patient underwent robotic-assisted excision of endometriosis with total hysterectomy. Additional applications of intraluminal ICG highlighted in the video include superficial tubal endometriosis and intrauterine ICG use during adenomyosis excision. EXPOSURE:In the first case, cystoscopy was performed to exclude bladder mucosal involvement. The bladder was backfilled with diluted ICG, and mucosa-sparing shaving of the bladder nodule was performed under fluorescence guidance. In the second case, ICG was administered transrectally, and the rectal nodule was shaved using monopolar energy under fluorescence guidance. In the third case, ICG was used for real-time identification of the tubal lumen during excision of tubal endometriosis. In the fourth case, intrauterine ICG was used to guide the depth of excision during adenomyosis resection. MAIN OUTCOME MEASURES:Demonstration of robotic-assisted excision of endometriosis and adenomyosis using intraluminal ICG guidance. RESULTS:All procedures were completed without intraoperative or postoperative complications, and patients were discharged on the same day of surgery. Bladder mucosal integrity was preserved, allowing avoidance of prolonged catheterization. A voiding trial was successfully completed before discharge. At 6-week follow-up, patients reported no complaints. CONCLUSION:Intravenous ICG is well established for assessing bowel perfusion and anastomotic viability (1). Its use for ureteral perfusion has been described in limited reports, whereas pelvic nerve visualization has only been reported in isolated case reports (2, 3). Intraluminal injection of ICG into the ureters is commonly used to aid ureteral identification (4). In this video, we highlight intraluminal ICG as a valuable adjunct in advanced endometriosis and adenomyosis surgery. When combined with the advantages of robotic surgery, it enables precise mucosa-sparing excision of deep endometriotic lesions and may reduce surgical morbidity.

INTRODUCTION:Minimally invasive surgery is preferred over laparotomy due to shorter hospital stays, faster recovery, and reduced risk of complications. Despite these advantages, studies indicate an increased risk of vaginal cuff dehiscence (VCD) after laparoscopic and especially robotic-assisted total hysterectomy (RA-TLH). Over the past decades, the use of laparoscopic and robotic surgery has increased in the Western world, including the Nordic countries. It remains unclear who is at higher risk of VCD. This study aims to identify patient-related and surgical risk factors for VCD following RA-TLH. MATERIAL AND METHODS:A retrospective review of medical records of women who underwent RA-TLH at Trondheim University Hospital, Norway, from 2010 to 2021. Women experiencing VCD were identified and compared to women without VCD. Demographic and surgical data were compared between the groups using univariate and multivariate logistic regression analyses to identify risk factors for VCD. RESULTS:Out of 1549 eligible women, 684 (44.2%) consented to participate. Twenty-eight women (4.2%) were diagnosed with VCD at a median of 73 days (range 28-278) after surgery. Vaginal intercourse was identified as the triggering event in 23 (82%) women. Younger age, lower BMI, longer surgery duration, and higher uterine weight were associated with an increased risk of VCD in univariate analyses. Multivariate analysis showed that each unit increase in BMI reduced the odds, aOR 0.87 (95% CI 0.78-0.97), whereas each 100 g increase in uterine weight increased the odds, aOR 1.30 (95% CI 1.06-1.60). CONCLUSIONS:VCD occurred in 4.2% of included women. Vaginal intercourse was the most common trigger of VCD. High BMI protected against VCD after RA-TLH. Women with a large uterus had an increased risk of VCD. Our findings underline the importance of preoperative counseling, discussing the advantages and risks of different surgical approaches according to each woman's risk factors.

Deep infiltrating endometriosis (DIE) is a severe form of endometriosis, with endometriotic implants that can invade several anatomical structures. The urinary tract is the second most common site for deep endometriosis with ureteral endometriosis (UE) the most challenging to manage. Multidisciplinary surgery along with hormonal therapy is the corner stone for the treatment of DIE. Here we describe, with a video, a surgical technique using robotic-assisted surgery along with retrograde injection of indocyanine green (ICG) in the ureter for resection of parametrial endometriosis and ureterolysis using near-infrared fluorescence. The case was a 29-year-old nullipara with a history of severe dysmenorrhea and chronic pelvic pain. The patient was discharged after 48 hrs. The advantages of robotic surgery and the use of ICG in the ureter, in selected cases with UE, enables careful ureterolysis as ICG can even be absorbed in the ureteral mucosa/wall when no stent is left behind during surgery.

Importance Thoracic endometriosis syndrome (TES) is a rare form of endometriosis affecting the diaphragm, pleura, or lung parenchyma. Its heterogeneous presentation, frequent right-sided involvement, and limited sensitivity of imaging contribute to underdiagnosis and delayed treatment. Objective To systematically review current evidence on the epidemiology, pathogenesis, diagnosis, management, and outcomes of TES. Evidence Review This systematic review followed PRISMA guidelines. PubMed/MEDLINE, Ovid MEDLINE, Embase, and Scopus were searched for English-language, peer-reviewed studies published from January 1, 2010 to July 31, 2025. Studies addressing TES or diaphragmatic endometriosis were included. Study selection, data extraction, and quality assessment were performed in duplicate. Evidence strength was graded using CEBM and GRADE frameworks. Findings Thirty-four studies met inclusion criteria. MRI showed moderate sensitivity for diaphragmatic disease but often underestimated disease extent. Management was predominantly minimally invasive. Laparoscopy allowed comprehensive evaluation of diaphragmatic and pelvic disease, while video-assisted thoracoscopic surgery (VATS) enabled targeted treatment of pleural and pulmonary lesions. Combined laparoscopic and VATS approaches improved disease control in patients with dual-compartment involvement. Recurrence rates ranged from <10% to 40%, depending on surgical technique, disease distribution, and follow-up duration. Several studies reported improved outcomes with postoperative hormonal suppression. Conclusion and Relevance TES remains under-recognized. Multidisciplinary management is essential, and combined minimally invasive surgery with postoperative hormonal therapy appears most effective in selected patients. Further prospective studies are needed to standardize diagnosis and reduce recurrence.

The integration of robotic systems into minimally invasive surgery offers significant advantages, including enhanced precision, reduced invasiveness, and improved patient outcomes. However, sustaining these benefits requires optimization of operational efficiency to justify the substantial resource investment associated with robotic technologies. This review examines strategies to enhance efficiency in robotic-assisted surgery using a four-pillar framework: (1) team structure and leadership; (2) organization of care; (3) procedural standardization; and (4) parallel task overlap. Evidence from the literature and practice-informed observations suggests that well-coordinated multidisciplinary teams, structured perioperative planning, and optimized operating room organization can reduce delays and improve workflow efficiency. Standardization of equipment setup and surgical steps further enhances procedural predictability, while parallel tasking minimizes downtime and improves operating room capacity. When combined with continuous training and iterative process evaluation, these strategies may optimize robotic surgical performance, improve cost efficiency, and support high-quality, patient-centered care.

Fertility preservation (FP) has become an essential dimension of modern medicine, reflecting the paradigm shift from survival alone to survivorship. Once confined to oncology, FP now spans a broad spectrum of medical, social, and technological contexts. Surgical innovations, including fertility-sparing surgery and ovarian transposition, allow reproductive potential to be safeguarded without compromising oncological safety. Cryobiology has been transformed by the transition from slow-freezing to vitrification, establishing oocyte and embryo cryopreservation as gold-standard approaches with outcomes comparable to fresh cycles. Alongside onco-fertility, "social freezing" has emerged as a tool of reproductive autonomy, though it raises counselling and ethical challenges related to age, expectations, and equity of access. Resilience in FP also requires psychosocial support: while emotional distress is common, evidence shows that interventions such as mindfulness and structured counselling improve mental health even if conception outcomes remain unchanged. In parallel, ovarian tissue cryopreservation for patients unable to undergo stimulation and immature testicular tissue banking extend possibilities, with early clinical successes highlighting future translational pathways. Uterus transplantation has emerged as the first-line treatment of congenital absence of a uterus and can restore fertility after a hysterectomy performed for cervical cancer. Looking ahead, regenerative approaches, including stem-cell-based strategies, 3D bio-printing of genital tissues, tissue engineering, and artificial uterus systems, signal the next frontier, while underscoring the need for further research as well as robust ethical, legal, and safety frameworks. FP thus represents a multidisciplinary and rapidly evolving field that integrates oncology, reproductive medicine, gynaecology, transplantation surgery, psychology, and laboratory disciplines. Its trajectory is defined by both technological innovation and the imperative to align medical progress with patient autonomy, equity, and long-term quality of life.

Assisted reproductive technology (ART) is increasingly utilized worldwide, yet concerns remain regarding its potential association with breast and gynecological malignancies and the safety of fertility-preservation strategies in cancer survivors. Ovarian stimulation exposes women to supraphysiologic hormone levels, raising questions about cancer risk, particularly for hormone-sensitive tumors. Current evidence, however, is largely reassuring. Registry-based studies and meta-analyses demonstrate no consistent increase in breast or endometrial cancer following ART, although endometrial cancer risk remains inconclusive despite large new cohorts. Cervical cancer has not been linked to ART exposure. For ovarian cancer, risk appears primarily driven by underlying infertility, parity, and endometriosis rather than ART itself, and no excess risk is observed among BRCA mutation carriers. In parallel, fertility preservation (FP) has become an integral component of gynecologic oncology care for reproductive-aged women. Strategies including cryopreservation of oocytes, embryos, or ovarian tissue, as well as fertility-sparing surgery or hormonal therapy, can be safely pursued in carefully selected early-stage cancers. Pregnancy and livebirth rates vary by diagnosis: outcomes are favorable after breast and cervical cancers, more limited in endometrial cancer due to endometrial receptivity challenges, and possible but less predictable in ovarian cancer, where stage and histology guide feasibility. Available observational evidence does not suggest a clear increase in recurrence risk among carefully selected patients, although evidence remains limited and long-term follow-up is needed. Overall, current data suggest ART is safe when individualized to patient and tumor characteristics, highlighting the importance of proactive fertility counseling, modified stimulation protocols, and multidisciplinary care to optimize oncologic and reproductive outcomes.

Minimally invasive surgery is preferred over laparotomy due to shorter hospital stays, faster recovery, and reduced risk of complications. Despite these advantages, studies indicate an increased risk of vaginal cuff dehiscence (VCD) after laparoscopic and especially robotic-assisted total hysterectomy (RA-TLH). Over the past decades, the use of laparoscopic and robotic surgery has increased in the Western world, including the Nordic countries. It remains unclear who is at higher risk of VCD. This study aims to identify patient-related and surgical risk factors for VCD following RA-TLH. A retrospective review of medical records of women who underwent RA-TLH at Trondheim University Hospital, Norway, from 2010 to 2021. Women experiencing VCD were identified and compared to women without VCD. Demographic and surgical data were compared between the groups using univariate and multivariate logistic regression analyses to identify risk factors for VCD. Out of 1549 eligible women, 684 (44.2%) consented to participate. Twenty-eight women (4.2%) were diagnosed with VCD at a median of 73 days (range 28–278) after surgery. Vaginal intercourse was identified as the triggering event in 23 (82%) women. Younger age, lower BMI, longer surgery duration, and higher uterine weight were associated with an increased risk of VCD in univariate analyses. Multivariate analysis showed that each unit increase in BMI reduced the odds, aOR 0.87 (95% CI 0.78–0.97), whereas each 100 g increase in uterine weight increased the odds, aOR 1.30 (95% CI 1.06–1.60). VCD occurred in 4.2% of included women. Vaginal intercourse was the most common trigger of VCD. High BMI protected against VCD after RA-TLH. Women with a large uterus had an increased risk of VCD. Our findings underline the importance of preoperative counseling, discussing the advantages and risks of different surgical approaches according to each woman's risk factors.

OBJECTIVES:Adverse pregnancy outcomes such as miscarriage and stillbirth have been increasingly recognized as potential early indicators of cardiovascular risk in women. However, evidence remains inconsistent, particularly regarding age-specific patterns and cumulative exposure. This study aimed to investigate the associations between pregnancy loss (miscarriage, stillbirth, and termination) and incident cardiovascular disease (CVD) in the UK Biobank cohort. STUDY DESIGN:Prospective population-based cohort study. METHODS:We analyzed 128,869 women without prior CVD at baseline (2006-2010). Pregnancy loss was self-reported and categorized as miscarriage, stillbirth, or termination. Incident CVD events, including hypertension, diabetes, coronary artery disease (CAD), myocardial infarction (MI), ischemic stroke, and heart failure, were identified through linked hospital records. Multivariable Cox proportional hazards models estimated hazard ratios (HRs) with 95% confidence intervals (CIs), adjusted for sociodemographic, behavioral, and clinical covariates. Analyses were stratified by age group and number of pregnancy losses. RESULTS:Over a median follow-up of 11.9 years, pregnancy loss was associated with increased risk of hypertension (HR 1.14; 95% CI 1.08-1.21), particularly among women aged <50 and >60 years. Stillbirth was associated with hypertension (HR 1.27; 95% CI 1.09-1.48) and diabetes in younger women (HR 2.15; 95% CI 1.02-4.52). Miscarriage was associated with CAD (HR 1.12; 95% CI 1.02-1.37). No significant associations were observed for termination. Limited dose-response patterns were identified for recurrent stillbirth. CONCLUSIONS:Pregnancy loss, especially stillbirth and miscarriage, was independently associated with selected cardiovascular outcomes. Reproductive history may improve cardiovascular risk assessment in women.

The debate around colorectal surgery for endometriosis has been ongoing, but to date no meta-analysis has investigated the impact of the different surgical approaches on the pregnancy rate. The aim of this meta-analysis study was to determine in women with deep infiltrating rectal endometriosis, how does colorectal resection surgery compare to other surgical techniques (e.g., rectal shaving, disc excision) in terms of pregnancy rates. We searched PubMed, Web of Science, Cochrane library and Clinical Trials for relevant studies published from inception to December 2024. We performed a systematic review and meta-analysis of all English language full-text articles addressing colorectal resection compared with other management of deep infiltrating rectal endometriosis and presenting pregnancy outcomes. We included a study when it (i) provided data on surgical management (shaving, disc excision, and/or colorectal resection) and (ii) detailed the pregnancy outcomes in each subgroup. Four authors independently performed the initial search to evaluate the eligibility criteria. Four authors extracted the data and a fifth author checked this extraction. Of the 113 full-text articles assessed for eligibility, we included 13 in the meta-analysis. These studies represented a total of 3,248 patients. Pregnancy information was available for 2,131 patients: 1073 colorectal resection, 502 shaving, 172 disc excisions, and 384 other practices (expectant management). Colorectal resection was associated with a lower pregnancy rate compared with the other techniques (N = 2,131, odds ratio [OR] = 0.64 [95% confidence interval 0.52-0.79], p < 0.001, I2 = 35%). There were similar results when comparing colorectal resection with rectal shaving (N = 952, OR = 0.51 [95% confidence interval 0.36-0.73], p < 0.001, I2 = 0%), but not when comparing colorectal resection with disc excision (N = 432, OR = 0.65 [95% confidence interval 0.37-1.13], p = 0.13). Conclusions Rectal resection for endometriosis is associated with a lower pregnancy rate compared with other type of surgery, such as shaving. Trial registration: PROSPERO registration number CRD42024512328.

Adenomyosis, a condition characterized by the infiltration of endometrial tissue into the myometrium, poses significant challenges in reproductive medicine, particularly regarding its impact on fertility (Moawad, 2022). We present a novel robotic-assisted surgical approach for uterine-sparing management of adenomyosis (Moawad 2024), aimed at preserving reproductive potential while alleviating symptomatic burdens. We perform a minimally invasive technique, which demonstrated significant symptomatic relief and improved reproductive outcomes, that is evidenced by a 75% pregnancy rate in patients post-operatively (Smith et al., 2023). The robotic approach offers enhanced precision in tissue resection, reducing intraoperative complications and postoperative recovery time compared to traditional methods (Jones & Lee, 2022). These findings underscore the potential of robotic surgery as a pivotal intervention for managing adenomyosis, warranting further investigation into long-term reproductive outcomes and quality of life.

Background:Uterine malformations are congenital anomalies arising from abnormal Müllerian duct development during embryogenesis. These can be linked to vaginal cysts, resulting in complex malformations. One rare form is the unicornuate uterus, where only one duct develops, leading to complications like severe pain due to a rudimentary, non-communicating horn. Objectives:To describe a combined approach using ultrasound, hysteroscopy, and robotic-assisted laparoscopy for complex uterine anomalies. Participant:A 30-year-old nulliparous woman with unilateral kidney agenesis and acute pelvic pain referred to our centre. Intervention:2D ultrasound suggested a complex malformation. 3D ultrasound and magnetic resonance imaging confirmed a U4a uterus. Hysteroscopy revealed a hemicavity with one tubal ostium. Robotic-assisted laparoscopy enabled right salpingectomy and removal of the rudimentary horn while preserving the ovary. Intraoperative ultrasonography guided the drainage of vaginal cysts. As a result, vaginal cysts were drained, and the rudimentary horn was removed with ovarian preservation. The patient was discharged without complications and spontaneously conceived a healthy pregnancy 8 months later. Conclusions:Unicornuate uterus with non-communicating horn and renal agenesis is a rare condition. A combined approach using ultrasound, hysteroscopy, and robotic-assisted laparoscopy allows comprehensive evaluation and treatment. What is New?:This is the first reported case of simultaneous and synergistic use of hysteroscopy and robotic-assisted laparoscopy for complex genital malformations under ultrasonographic guidance.

Myomectomy using laparoscopic approach offers patients reduced abdominal scars, better post surgical rehabilitation. However, bleeding control may pose a challenge in spite of techniques already described [1,2]. Our objective is to show a reproducible technique of bleeding control during mini invasive myomectomy. We performed a mini-invasive myomectomy using with robotic surgery, with Da Vinci, X. We describe the case of a 35 year-old women, gesta 0 para 0, who presented with menorrhagia, avec pelvic pain, because of a fibroma FIGO 2-5 of 8 cm. She had a desire of pregnancy. We show tips and tricks to control bleeding: (a) two ways of accessing to uterine artery for its occlusion, using either a vascular clamp or a metallic clip; (b) sub serous infiltration with 20 mL of xylocaine with 1% adrenalin, diluated in 100 mL of NaCl serum using a oocyte punction needle; (c) suture with barbed suture. Blood loss was <200 mL.

Endometriosis is a debilitating disease that affects millions worldwide [...]

Pregnancies following Assisted Reproductive Technology (ART) are associated with increased risk for adverse maternal and neonatal outcomes. However, it is not clear if these associations are derived from infertility or fertility treatment itself. The goal of this review is to investigate if there are differences in maternal and neonatal outcomes between pregnancies conceived through either intrauterine insemination (IUI) or in vitro fertilization (IVF) to obtain an estimate of the effect of the fertility treatment. We retrospectively reviewed the literature for original studies comparing maternal and neonatal outcomes in pregnancies following IUI to those following IVF. To reduce confounding, our synthesis focuses on singleton gestations, while excluding donor sperm and multifetal pregnancies. Findings are interpreted alongside recent ART vs. non-ART evidence to contextualize potential treatment-related effects. Most studies suggest no difference in maternal outcomes, but outcomes were inconsistently reported between studies. Neonatal outcomes were more consistently reported, and there was less variation between results. Current evidence does not suggest a large difference in neonatal outcomes between IVF and IUI. However, almost all studies have significant limitations that hinder clear conclusions. To summarize, even though the current literature does not suggest significant differences in maternal and neonatal outcomes following IVF and IUI, further high-quality studies are needed to establish a definite correlation.

Objective: To demonstrate a step-by-step approach in two cases of diffuse adenomyosis using different surgical techniques depending on the disease's extent. The video also highlights surgical tips to minimize blood loss and maximize the excision of the adenomyotic disease. Design: Description of technique and narrated surgical video footage. Subjects: The patients included in this video gave consent for the publication of the video and posting of the video online, including social media, the journal website, scientific literature websites (e.g., PubMed, ScienceDirect, and Scopus), and other applicable sites. First case: A 38-year-old nulligravid patient with a history of chronic pelvic pain, dysmenorrhea, and infertility for 2 years had previously undergone two unsuccessful in vitro fertilization (IVF) cycles. During her first IVF cycle, five embryos were produced; one embryo was transferred, and the remaining embryos were frozen. In the second attempt, one frozen embryo was transferred after endometrial preparation as per protocol. However, both cycles were unsuccessful, resulting in implantation failure. Preoperative magnetic resonance imaging revealed diffuse adenomyosis in the posterior wall of the uterus, measuring 8.7 x 6.0 cm, with a thickened junctional zone (>12 mm). Second case: A 36-year-old G2P1 patient with a history of cesarean section and secondary infertility had two IVF cycles: the first resulted in early pregnancy loss at 6 weeks, and in the second cycle, she was premedicated with gonadotropin-releasing hormone for 3 months; however, it was unsuccessful. Preoperative magnetic resonance imaging identified diffuse adenomyosis involving both the anterior and posterior uterine walls, with a thickened junctional zone (>12 mm). Exposure: In the first case, a classic excisional technique was performed to remove the adenomyosis from the posterior uterine wall. In the second case, a double flap approach was used to excise adenomyosis from both the anterior and posterior uterine walls. Intracavitary diluted indocyanine green dye was used to maximize the precise excision of adenomyosis tissue while maintaining an adequate myometrial residual around the cavity. Main Outcome Measures: Robotic-assisted excision of adenomyosis tissue while sparing adequate myometrium and reconstructing uterine walls. Results: Both procedures were completed without complications, and patients were discharged on the same day of surgery. Patients were seen at 6 weeks for postoperative follow-up with no complaints. The plan is to obtain imaging before resuming IVF treatment. Patients were advised to wait 6 months after surgery before attempting conception to allow for recovery. Conclusion: Uterus-sparing surgical techniques for diffuse adenomyosis are advisable in selected cases where medical management and/or repeated IVF cycles fail. Preoperative imaging is crucial for precisely mapping the disease and applying the appropriate surgical technique. Different techniques have been proposed using an open or a minimally invasive approach. The use of a robotic platform, in conjunction with indocyanine green dye, can facilitate these surgical techniques and potentially improve outcomes. (c) 2024 by American Society for Reproductive Medicine.

Digital twins - the term for virtual representations of biological systems - are emerging as promising tools in reproductive medicine. They offer personalized simulations for optimizing fertility, assisted reproductive technology (ART) and pregnancy outcomes. However, their use remains limited and fragmented across diverse applications. A systematic search was conducted in PubMed, EMBASE, Scopus and IEEE Xplore up to July 2025 for this review of the current evidence on digital twins in fertility, ART and pregnancy, identifying applications, outcomes, challenges and future prospects. Original studies that applied digital twins to fertility, ART or pregnancy in human or in-silico models were included in this review. Eight original studies were included, complemented by nine mechanistic or conceptual works. Applications encompassed embryo selection, IVF procedure modelling, placental physiology, pregnancy pharmacokinetics, and intrapartum monitoring. Most studies were predictive or descriptive in nature, static or batch-coupled, and at early stages of validation. Risk of bias ranged from moderate to high due to study design and external validity concerns. Only two studies fulfilled strict digital twin criteria, and the exclusion of borderline studies did not change the overall conclusions. Digital twins hold substantial promise for personalized reproductive care. However, their clinical utility remains largely theoretical. Future work must improve modelling accuracy, data integration and ethical implementation to unlock their full potential.

Background:The dynamic interplay of ovarian hormones is central to reproductive physiology, yet the complexity of their cyclic variations poses challenges for analysis, simulation, and teaching. This study presents a framework for generating physiologically constrained, multi-hormone synthetic time series that capture intra- and inter-individual variability across phenotypes. Methods:We developed a semi-mechanistic mathematical framework to generate synthetic multi-hormone profiles (estradiol, FSH, LH, AMH, testosterone, GnRH) using parametric equations embedding known physiological feedbacks (e.g., estradiol-LH delay, estradiol suppression of FSH). Stochastic components were calibrated to reported physiological ranges. Eumenorrheic and PCOS-like phenotypes were defined through parameter adjustments. Data were analysed using Principal Component Analysis (PCA) for phenotype separation, and evaluated in a supervised setting using logistic regression with stratified train/test splitting, reporting accuracy, sensitivity, specificity, and ROC AUC. Results:Eumenorrheic profiles displayed classical mid-cycle estradiol and LH peaks, biphasic FSH, and stable AMH and testosterone levels. In contrast, PCOS profiles showed elevated LH and testosterone, high AMH, blunted estradiol, and dysregulated GnRH pulsatility. PCA revealed clear separation between phenotypes (PC1 +PC2 = 82 % variance), and k-means clustering (k = 2) accurately grouped individuals without label information. PCA showed clear separation between phenotypes, consistent with known endocrine patterns. Logistic regression achieved 100 % accuracy, sensitivity, and specificity, with an AUC of 1.00, confirming robust, phenotype-discriminative features in the synthetic dataset. Conclusion:This simulation framework reproduces physiologically accurate hormone dynamics and discriminates ovulatory from anovulatory cycles, offering applications in AI training, phenotype discovery, and medical education.

[This corrects the article DOI: 10.1016/j.csbj.2025.08.013.].