Hysteroscopy is not a standard diagnostic procedure for infertility. The objective was to present and compare obstetric outcomes in women undergoing office hysteroscopy (OH) in the course of diagnostic evaluation and ineffective treatment of infertility due to various underlying factors. Obstetric outcomes, including rates of live births, clinical and biochemical pregnancies, and time to conception, were retrospectively compared within four preoperative diagnosis groups (idiopathic infertility, uterine polyp, uterine factors other than polyps, and other conditions) and four postoperative diagnosis groups (uterine polyp, clinical features of chronic endometritis (CE), uterine factors, and other findings), while taking into account the immunohistochemical status of CE, defined by the presence or absence of plasma cells as positive, negative, or unknown if not examined. The study included 334 women with a mean age of 35.39 (± 4.51) years, comprising 161 (48.20

OBJECTIVE:To evaluate clinical and laboratory parameters associated with the severity of ovarian hyperstimulation syndrome (OHSS) and to assess pregnancy outcomes in women hospitalized with moderate or severe OHSS. Several risk factors, including elevated antral follicle count (AFC), anti-Mullerian hormone (AMH), and serum estradiol (E2) levels, increase the risk of OHSS. METHODS:We studied 71 women with a median age of 32.7 years and a body mass index (BMI) of 22.8 kg/m2 with moderate (n=38) and severe (n=31) OHSS. We measured E2, hemoglobin (Hb), hematocrit (Hct), creatinine, albumin (Alb), total protein (TP), D-dimer (DD), and alanine aminotransferase (ALT) levels on the day of hospitalization and every second day until discharge. Data on the length of hospitalization, along with pregnancy outcomes, were recorded. RESULTS:There were no intergroup differences between women with moderate and severe OHSS in terms of age and BMI. The total pregnancy rate in both moderate (18/38) and severe (9/31) OHSS was 27/69; however, in women with severe OHSS, the positive pregnancy outcome was approximately half that observed in the moderate OHSS group and was accompanied by longer hospitalization (2.9-fold). All women with OHSS had elevated initial E2 levels (>6910pg/mL). Women with severe OHSS had higher initial E2 (p=0.001) and Hct (p=0.006) levels, together with lower Alb and TP concentrations (both p<0.001), compared with those with moderate OHSS. CONCLUSION:Elevated estradiol concentration is an associated factor for OHSS in women undergoing COH. Basal serum albumin concentration, together with total protein level and hematocrit, are predictive factors for OHSS severity.

Objective: To assess whether patients with NIH (National Institutes of Health) phenotypes of PCOS (polycystic ovary syndrome) differ from those with non-NIH phenotypes in terms of trait anxiety, state anxiety, and self-esteem. Additionally, we investigated the variables influencing the sense of physical attractiveness in both study groups. Materials and Methods: Forty-nine patients with NIH phenotypes of PCOS and 27 patients with non-NIH phenotypes were enrolled in the study. Each patient underwent gynecological and endocrinological diagnostic evaluation. For psychological assessment, we used the State-Trait Anxiety Inventory and the Multidimensional Self-Esteem Inventory. Results: Patients with NIH phenotypes presented higher trait-anxiety scores (p=0.021). The groups did not differ in global self-esteem. However, patients with NIH phenotypes had lower scores on the identity integration (p=0.010) and body appearance (p=0.033) scales. NIH patients also had lower scores on the lovability (p=0.053) and competence (p=0.050) scales; however, these findings approached statistical significance. In the NIH group, trait anxiety (beta=-0.428, p=0.001) and BMI (beta=-0.345, p=0.009) were statistically significant negative predictors of the sense of physical attractiveness, while in the non-NIH group only trait anxiety (beta=-0.670, p<0.001) was found to be a negative predictor of this aspect of self-esteem. Discussion: Patients with NIH phenotypes of PCOS presented higher trait-anxiety scores and lower scores in some aspects of self-esteem. These differences may stem, at least in part, from the more pronounced symptomatology among patients with NIH phenotypes. Conclusions: Differences in self-esteem and anxiety among patients with different PCOS phenotypes should guide the development of more personalized treatment programs.

Cervical cancer prevention has undergone a major shift with the implementation of human papillomavirus (HPV)-based screening, which offers high sensitivity but limited specificity due to the detection of transient infections. This has created a need for triage methods capable of identifying infections associated with clinically meaningful disease. Primary HPV testing provides a high level of reassurance when negative; however, individuals with a positive result require additional evaluation using triage methods that effectively identify precancerous lesions while avoiding unnecessary colposcopy referrals. This review addresses the role of p16/Ki-67 dual-stain (DS) immunocytochemistry as a biomarker of transforming HPV infection, with a focus on HPV-based screening settings. We discuss its biological basis and diagnostic performance in comparison with cytology, with particular attention to the principles and practical aspects of DS interpretation in routine cytopathological practice. We also summarize current evidence, including data from national studies and routine clinical practice, demonstrating that DS can be effectively integrated into screening pathways and support more informed clinical decision-making. Its increasing use reflects the broader transition toward biologically informed cervical cancer prevention.

Ovarian stimulation (OS) and pregnancy were shown to be associated with a prothrombotic state. We sought to determine whether a positive pregnancy outcome is related to fibrin clot properties and thrombin generation in women with unexplained infertility (UI) after OS followed by intrauterine insemination (IUI). We studied 70 women with UI, aged 30.7 ± 3.5 years, BMI 24.7 ± kg/m2 together with 70 controls who had healthy births matched for age and weight. We measured thrombin generation capacity, plasma fibrin clot permeability (Ks), and fibrinolytic potential (clot lysis time, CLT). In women with UI, after OS followed by IUI, pregnancy outcomes were recorded. UI women had prolonged lag time (+ 10.0

PurposeTo compare health-related quality of life (HRQoL) in women with normogonadotropic ovulatory dysfunction, specifically polycystic ovary syndrome (PCOS) and hypothalamic-pituitary-ovarian axis dysfunction (HPOD), to that of regularly menstruating women, and to evaluate the impact of selected clinical and biochemical parameters on HRQoL.MethodsHRQoL across nine domains was compared using the RAND 36-Item Health Survey among women with regular and irregular menstruation. Correlations between clinical parameters and HRQoL scores were examined, along with correlations between biochemical parameters and HRQoL scores in anovulatory women.ResultsHRQoL in the domains of Role Limitations Due to Physical Health (p = 0.024), Role Limitations Due to Emotional Problems (p < 0.001), Energy/Fatigue (p = 0.006), Emotional Wellbeing (p = 0.01), Social Functioning (p = 0.007), General Health (p < 0.001), and Health Change (p = 0.005) was significantly better in regularly menstruating women. No significant differences were observed in HRQoL between women with PCOS and those with HPOD (all p > 0.05). Women with PCOS phenotype D had a better Physical Functioning score compared to those with PCOS A and B (p = 0.017). Significant negative correlations were observed between Ferriman-Gallwey and Ludwig scale scores and HRQoL aspects in the entire cohort, and between dysmenorrhea, heavy menstrual bleeding, BMI, CRP concentrations, dyslipidemia, and insulin resistance and HRQoL in anovulatory women. Testosterone concentrations did not correlate with HRQoL.ConclusionHRQoL in women with ovulatory dysfunction was worse than that of women with regular ovulation in most HRQoL domains, with no differences between PCOS and HPOD. Significant correlations were identified between clinical and biochemical health indicators and the assessed HRQoL domains.

To evaluate metabolic and hormonal profile in teenagers and young adults with PCOS. In this case-control study, conducted from Jan 2023 and Feb 2025, we enrolled adolescents (below 20 years of age) and young adults (≤ 25 yrs) with PCOS. The assessment of glucose and insulin (Ins) in oral glucose tolerance test (OGTT) along with lipid profile and hormonal variables including free androgen index (FAI), total testosterone (TT), sex-hormone binding globulin (SHBG) and dehydroepiandrosterone sulfate (DHEA-S]) was performed among these women. Both teenagers and young adults with PCOS and with FAI > 5 showed unfavorably changed metabolic profile reflected by higher Ins levels in OGTT along with lower high-density lipoprotein cholesterol (HDL-C) levels in contrary to the remaining group. Adolescents and young adults with overweight/obesity showed insulin resistants reflected by HOMA-IR (4.45 and 4.26, respectively) compared to women with PCOS and with BMI within ranges (1.68 and 1.89, respectively, all p < 0.05). Teenagers with higher BMI showed unfavourable lipid profile reflected by higher triglycerides (TS) and lower HDL-C. Regarding hormonal profile, overweight/obesity was related to increased FAI in teenagers and lower SHBG and DHEA-S in young adults. Both adolescents and young women with PCOS represent unfavorable metabolic profile related to elevated FAI and higher BMI.

Background/Objectives: The informative value of integrating high-risk human papillomavirus (HR-HPV) genotyping with cytology and p16/Ki67 dual-stain biomarker results, using limited and two types of extended genotyping assays, has not yet been evaluated. Methods: A total of 32,724 screening test results between 2015 and 2024 were included. Limited HPV genotyping was performed using the Abbott RealTime High Risk HPV assay. Extended genotyping was performed using two assays: the Alinity m HR HPV and BD Onclarity HPV Assay. Trends in age-specific, cytology-specific, and p16/Ki67-specific HR-HPV prevalence and distribution were observed, and differences between limited and extended genotyping were examined. Results: The overall HR-HPV positivity rate was 15.0%. HR-HPV prevalence was 13.9% in the limited genotyping group, 17.8% in in the Onclarity group 1, and 17.2% in the Alinity group 2, with a statistically significant difference in the proportions of positive/negative cases (p < 0.0001). No statistically significant difference was observed between extended genotyping groups (p = 0.706). In the Onclarity group: the highest p16/Ki67 positivity was observed for HPV 33/58 (100.0%) and HPV 31 (58.8%), while the lowest was for HPV 45 (18.2%), HPV 18 (25.0%) and HPV 59/56/66 (28.9%). In the Alinity group: the highest p16/Ki67 positivity was observed for HPV 16 (66.7%) and HPV 31/33/52/58 (58.8%). Conclusions: Based on ten years of HPV-based cervical cancer screening data, this study demonstrates that genotype-specific HR-HPV information obtained through extended genotyping provides clinically relevant risk stratification when interpreted together with cytology and p16/Ki67 dual-stain results. These findings support an integrated screening approach combining molecular HPV testing, cytology, and immunocytochemical biomarkers to improve risk-based triage in cervical cancer screening.

PurposeTo investigate the impact of subclinical hypothyroidism (SCH) and thyroid autoimmunity (TAI) on systemic inflammatory activity in women with normogonadotropic anovulation, comparing polycystic ovary syndrome (PCOS) and hypothalamic-pituitary-ovarian dysfunction (HPOD), and to examine the correlations of inflammatory parameters with thyroid, metabolic, and ovarian indices.MethodsConcentrations of C-reactive protein (CRP), tumor necrosis factor-α (TNF-α), interleukin-6, interleukin-1β, and interleukin-10 were prospectively measured in anovulatory women and compared between those with PCOS and HPOD, considering the influence of SCH and TAI. Multiple regression analysis was performed to evaluate the relationships among thyroid dysfunction, inflammatory parameters, and indices of both metabolic and ovarian function.ResultsBoth SCH and TAI independently increased TNF-α concentrations across the entire cohort (p=0.005 and p=0.018) and within the PCOS arm (p=0.018 and p=0.039). TAI significantly elevated the IL-1β/IL-10 ratio in the entire cohort (p=0.009) and in PCOS arm (p=0.005), with significant interaction effects between SCH and TAI in both groups (p=0.026 and p=0.017). No significant associations were found in the HPOD arm. In the overall cohort, CRP concentrations, which positively correlated with BMI, insulin resistance indicators, and dyslipidemia, and negatively with estradiol, were significantly higher in SCH (p-values <0.001). In PCOS, interleukin-1β and TNF-α levels, positively correlated with some insulin resistance indicators and TNF-α with AMH, were also significantly elevated in both SCH and TAI.ConclusionsSCH and TAI independently and synergistically promoted chronic inflammation in normogonadotropic anovulation, particularly in PCOS, through elevated TNF-α and disrupted interleukin-1β/IL-10 balance, with significant implications for metabolic health and ovarian function.

Prothrombotic fibrin clot properties and increased thrombin generation were observed in obstetric antiphospholipid syndrome (OAPS), but the role of complement in the prothrombotic state is unclear. This study aimed to determine whether circulating C5a and C5b-9 levels are associated with fibrin clot phenotype and thrombin generation in women with OAPS, and to assess their prognostic value for thrombotic events and obstetric outcomes during long-term follow-up. In this retrospective study, in 57 women with OAPS, and 57 controls matched for age, weight, and the type of obstetric complications complement components including C5a and C5b-9 levels, along with endogenous thrombin potential (ETP), plasma fibrin clot permeability (KS) and clot lysis time (CLT) were determined at baseline. During a median follow-up of 54 months venous/arterial TE and live births were recorded. OAPS patients compared to controls had higher circulating C5a (+ 95.7

BACKGROUND:Persistent infection with high-risk human papillomavirus (hr-HPV) is the necessary agent of cervical cancer, yet its molecular definition remains heterogeneous. Multiple molecular approaches have been developed to characterize HPV persistence, including repeated detection of viral DNA, assessment of viral oncogene expression, and analysis of HPV-related DNA methylation. These approaches originate from different scientific traditions and reflect distinct conceptualizations of persistence. OBJECTIVE:To synthesize and compare molecular methods used to detect persistent HPV infection through a narrative review and to clarify how different biomarkers conceptualize HPV persistence and disease progression. METHODS:We conducted a narrative review in accordance with the RAMESES guidelines. Medline, Scopus, and the Cochrane Library were searched for original studies published between 2016 and 2025 investigating molecular markers of HPV persistence. An interpretive synthesis was performed to identify research traditions, underlying assumptions, and clinical implications. RESULTS:Three major molecular narratives were identified. Persistent DNA positivity defines persistence as repeated detection of the same HR-HPV genotype over time and reflects an epidemiological-virological perspective with high sensitivity but limited specificity. Persistent oncogene expression, assessed by E6/E7 mRNA detection, conceptualizes persistence as active viral oncogenic activity and shows improved specificity for clinically relevant lesions. Persistent epigenetic imprint, measured by DNA methylation of viral and host genes, captures cumulative biological effects of long-term infection and is strongly associated with high-grade lesions and cervical cancer. These narratives represent complementary stages along a continuum of molecular persistence. CONCLUSIONS:Molecular markers of HPV persistence reflect the evolving understanding of cervical carcinogenesis, progressing from repeated viral DNA detection to oncogenic activity and stable epigenetic alterations. These complementary biomarkers represent different biological stages of persistent infection and may improve risk stratification in HPV-based screening and triage strategies.

In the original publication [...].

BACKGROUND:Human papillomavirus (HPV) infection remains the most prevalent sexually transmitted viral infection worldwide and a major etiologic factor for cervical and other anogenital cancers. HPV-related precancerous lesions continue to represent a substantial clinical and epidemiological burden. OBJECTIVE:We aim to assess the effects of nine-valent HPV vaccination on viral clearance, genotype distribution, and lesion regression among HPV-positive women who were unvaccinated in childhood. METHODS:We enrolled 461 women between January 2020 and August 2025 to the study who presented with abnormal cytology, positive hrHPV tests, or abnormal colposcopic findings. Participants underwent LBC, HPV genotyping, colposcopy, and biopsy or LEEP when indicated. The vaccinated cohort (n = 351) received the Gardasil®9 series (0-2-6 months), while 110 women served as unvaccinated controls. Statistical analyses were performed using R software (v4.4.2) with a significance threshold of α = 0.05. RESULTS:Following vaccination, HPV positivity for any genotype was significantly lower in the vaccinated group than in the control group (29.3% vs 56.4%, p < .001). Clearance of Gardasil-specific genotypes occurred in 83.5% of vaccinated women compared with 63.6% in the controls. Complete remission was higher in the vaccinated group (70.7% vs 43.6% in the control group). Persistence of identical HPV genotypes was markedly reduced after vaccination (8.5% vs 27.3%). CONCLUSIONS:Nine-valent HPV vaccination significantly enhanced viral clearance and reduced persistence and recurrence of high-grade squamous intraepithelial lesions (HSIL) among previously unvaccinated HPV-positive women. These findings support extending vaccination recommendations to adult HPV-positive patients as an adjunctive strategy to surgical and cytologic management.

OBJECTIVES:To assess attachment patterns and stress coping strategies in patients with NIH and non-NIH phenotypes of PCOS. Additionally, to explore the correlations between attachment and stress coping, as well as the correlations between BMI, hirsutism, and psychological variables. METHODS:62 patients with NIH phenotypes and 32 patients with non-NIH phenotypes were enrolled into the study. Each patient underwent gynecological and endocrinological diagnostics. Attachment Styles Questionnaire was used to assess attachment, and Mini-Cope Inventory was applied to assess stress coping. RESULTS:The anxious-ambivalent attachment pattern was more pronounced in patients with "classic" NIH phenotypes. Patients with NIH phenotypes were less likely to use active coping, planning, and acceptance as coping mechanisms for stress. Furthermore, we observed a statistical trend in the differences in the following avoidance coping strategies: denial (p = 0.066), behavioral disengagement (p = 0.084), and self-blame (p = 0.066). In both phenotypes secure attachment correlated positively with seeking emotional support, whereas anxious-avoidant correlated negatively with this mechanism. In turn, anxious-ambivalent attachment in both phenotypes correlated negatively with acceptance and positively with behavioral disengagement and self-blame. Attachment patterns did not correlate with either BMI or the severity of hirsutism. CONCLUSIONS:Patients with different PCOS phenotypes differ in their attachment patterns and stress coping strategies. Attachment styles are correlated with specific coping mechanisms for stress. Personalized approach that takes into account the clinical variability of PCOS and differences in psychological functioning should be applied.

BACKGROUND This report describes the rare occurrence of a unilateral live tubal twin ectopic pregnancy, diagnosed by transvaginal ultrasound and confirmed surgically. This case is presented to emphasize diagnostic and management challenges. CASE REPORT A 29-year-old primigravid woman at 5 weeks and 6 days by last menstrual period was referred with a suspected pregnancy of unknown location. She was asymptomatic, and vital signs were within normal limits. Her medical history was unremarkable except for ovulation induction with letrozole and clomiphene. Serum beta-human chorionic gonadotropin (ß-hCG) measured 7385 mIU/mL. On examination, the uterus was slightly enlarged without palpable masses. Ultrasound revealed an inhomogeneous endometrium with a pseudogestational sac. In the right adnexa, 2 live ectopic pregnancies were identified, each with a yolk sac, crown-rump length consistent with 6 weeks of gestation, and detectable fetal cardiac activity. A small amount of free fluid was observed in the pelvis. Laparoscopy confirmed a right tubal twin ectopic pregnancy. Right salpingectomy was performed, and histopathologic examination confirmed a tubal pregnancy without additional abnormalities. The patient recovered uneventfully and was discharged on postoperative day 1 with ß-hCG level of 1962 mIU/mL. At follow-up 1 week later, examination findings were unremarkable; the ß-hCG level had declined to 237 mIU/mL. CONCLUSIONS A review of the available English-language literature confirms the rarity of live twin ectopic pregnancy. In the absence of specific management guidelines, treatment principles for singleton ectopic pregnancy should be applied. Based on published literature and our experience, laparoscopic salpingectomy is the preferred therapeutic approach.

We sought to investigate whether positive-pregnancy outcome is associated with modulation of fibrin clot properties and thrombin generation with regard to neuropeptide levels. In this prospective study, we enrolled 56 infertile women aged 32 ± 5 years, BMI 24.5 ± 5 kg/m2, treated with letrozole in the Department of Gynecological Endocrinology of a University Hospital. We measured plasma fibrin clot permeability (Ks), efficiency of fibrinolysis (clot lysis time, CLT) along with endogenous thrombin potential and serum levels of phoenixin (PNX-14), nesfatin-1 (NES-1), and dopamine (DA) together with decreased oxytocin (OT) before and after ovarian stimulation (OS) with letrozole. At baseline, women who achieved pregnancy (n = 23, 41.1.1

PurposeTo compare uterine ultrasound measurements in women with normogonadotropic anovulation, specifically those with polycystic ovary syndrome (PCOS) and hypothalamic-pituitary-ovarian dysfunction (HPOD), with those of regularly menstruating women, and to assess the influence of clinical and biochemical parameters on these measurements.MethodsUterine length, width, height, and volume, along with endometrial thickness and volume, measured using two- and three-dimensional transvaginal ultrasonography, were prospectively compared in women aged 18 to 45 from the aforementioned groups. Correlations between clinical parameters and uterine measurements, as well as between biochemical parameters and these measurements in anovulatory women, were analyzed.ResultsWomen with normogonadotropic anovulation had significantly reduced uterine and endometrial measurements compared to healthy women (all p ≤0.001). Women with PCOS showed significantly lower uterine length (p=0.045), height (p=0.004), and volume (p=0.009) than those with HPOD, with no significant endometrial differences. Among women with PCOS, those with hyperandrogenemia had thicker endometrium (p=0.036), with no significant differences in other measurements. All myometrial measurements significantly negatively correlated with anti-Müllerian hormone (AMH) and follicle-stimulating hormone (FSH), while positively correlating with estradiol and prolactin. Endometrial measurements negatively correlated with AMH and FSH concentrations, and positively with estradiol, prolactin, 17-hydroxyprogesterone, fasting insulin, and insulin resistance.ConclusionsA significant association was identified between menstrual cycle regularity and uterine morphology, influenced by hormonal, metabolic, and clinical factors. Estrogenic stimulation and metabolic status significantly affected uterine and endometrial dimensions, indicating that uterine morphology reflects the cumulative impact of reproductive and endocrine-metabolic influences, with important clinical implications for women with normogonadotropic anovulation.

Evidence indicates benefits of HPV vaccination beyond primary prevention, including for women treated for high-grade lesions (HSIL/CIN2+), immunocompromised individuals, and healthcare personnel. Despite comprehensive guidelines, clinical implementation remains inconsistent. This study evaluated the knowledge, attitudes, and practices of Polish obstetrician-gynecologists (OBGYNs) regarding HPV vaccination, with emphasis on recommendations extending beyond primary prevention. A cross-sectional online survey was conducted among Polish OBGYNs between October 2024 and June 2025 as part of a European Federation for Colposcopy initiative. The anonymous questionnaire assessed attitudes, guideline awareness, clinical practice patterns, and demographics. Descriptive statistics were applied. Respondents demonstrated broadly positive attitudes toward HPV vaccination, with nearly all reporting that they inform patients about adult vaccination options. Adherence to national regulations was high (> 97

Background: Human papillomavirus (HPV)-related diseases remain a major global health problem, with cervical intraepithelial neoplasia (CIN) representing a key precursor to cervical cancer. Identification of high-risk HPV genotypes is essential for early diagnosis and appropriate management. This study aimed to evaluate the usefulness of in situ hybridization (ISH) for detecting HPV DNA in formalin-fixed, paraffin-embedded (FFPE) cervical tissue and to compare automated signal detection with manual histopathological assessment. Methods: This prospective, non-randomized study included 83 women undergoing diagnostic procedures for abnormal cytology or confirmed CIN between 2022 and 2023. Tissue specimens obtained during a loop electrosurgical excision procedure (LEEP) were examined using two ISH probes: ISH II for low-risk HPV types 6 and 11, and ISH III for high-risk HPV genotypes. Staining patterns and distributions were evaluated and correlated with molecular HPV testing and histopathological outcomes. Results: ISH II distribution was significantly associated with the presence of HPV type 6 or 11 (p < 0.001), although stain structure itself was not. ISH III stain structure was significantly associated with high-risk HPV genotypes (p = 0.020). A positive ISH II result predicted low-risk HPV infection with a sensitivity of 62.5% and specificity of 64.0%, while ISH III predicted high-risk HPV infection with a sensitivity of 86.36% but lower specificity (23.53%). Overall diagnostic accuracy was 63.86% for ISH II and 73.49% for ISH III. Conclusions: ISH proved to be a reproducible method for detecting HPV in archived cervical tissue, enabling assessment even years after specimen collection. Although PCR-based methods remain more widely used due to higher sensitivity and less invasive sampling, ISH provides valuable morphological context and may serve as a complementary diagnostic tool, particularly when only archival tissue is available.