Reproductive Medicine

Background: The management of symptomatic uterine fibroids in women of reproductive age remains a clinical challenge, with uterine preservation being a primary objective in order to safeguard fertility. To date, no clear consensus has been established in the literature regarding the optimal treatment strategy, as therapeutic choices largely depend on individual patient characteristics. In selected cases, the use of preoperative measures aimed at minimizing the risk of major intraoperative hemorrhage has been associated with an increased likelihood of adopting a more conservative surgical approach. Case presentation: We report the case of a young patient treated at our institution who presented large uterine fibroids and underwent Preoperative Uterine Artery Embolization (PUAE) before planned open myomectomy with positive outcomes. In our case, this approach provided excellent intraoperative hemostatic control, minimizing blood loss. At post-discharge follow-up, the patient showed marked symptom relief and improved quality of life. Long-term follow-up will assess sustained treatment efficacy. Conclusions: PUAE should be considered a valuable therapeutic option in patients with symptomatic uterine fibroids at high risk of surgical bleeding. When integrated into a multidisciplinary treatment plan, PUAE may enhance surgical safety, support fertility preservation, and broaden the range of conservative options available for women with complex fibroid disease.

Background/Objectives: Serum progesterone (P) levels on the day of frozen–thawed embryo transfer (FET) appear to influence treatment success. Some studies suggest that low P levels may negatively affect pregnancy outcomes, whereas others report a detrimental impact of elevated p values. Although a threshold of 10 ng/mL is frequently cited as indicative of adequate luteal support, the optimal P cut-off on the FET day remains unclear. This study aims to identify a predictive serum p value above which pregnancy rates do not decline in artificial FET cycles. Methods: A retrospective cohort study comprising 236 women who underwent FET between November 2021 and July 2023 was conducted at the Center of Assisted Medical Procreation of Centro Materno-Infantil do Norte. Serum P levels were measured on the day of FET. Three analytical approaches were used in assessing the association between P levels and FET outcomes: (1) fixed threshold of 10 ng/mL; (2) stratification into quartiles (Q1 < 7.30; Q2: 7.30–10.26; Q3: 10.27–13.42; Q4 > 13.42 ng/mL); (3) optimal P cut-off derived from ROC analysis (9.34 ng/mL). Continuous variables were compared using T-test or One-Way ANOVA. Categorical variables were analyzed using Chi-square test or Fisher’s exact test. Associations between P levels and pregnancy outcomes were further examined using logistic regression. Results: Using the P threshold of 10 ng/mL, women with p < 10 ng/mL showed significantly lower positive β-hCG rates (p = 0.020), implantation rates (p = 0.002), and clinical pregnancy rates (CPRs) (p = 0.019). Quartile-based comparisons revealed no significant differences. Regarding the ROC-derived cut-off, women with p ≥ 9.34 ng/mL had significantly higher positive β-hCG rates (38.5% vs. 52.8%, p = 0.012), implantation rates (30.0% vs. 45.5%, p = 0.002), CPR (36.3% vs. 50.0%, p = 0.016), ongoing pregnancy rates (24.4% vs. 37.6%, p = 0.013), and live birth rates (24.4% vs. 37.6%, p = 0.013). p ≥ 9.34 ng/mL remained an independent predictor of improved pregnancy outcomes in multivariate analysis. Conclusions: Serum P levels ≥ 9.34 ng/mL on the day of FET were associated with significantly higher pregnancy success, supporting the relevance of center-specific P thresholds and suggesting potential benefit in individualized luteal phase support strategies.

We carried out a comprehensive literature search for publications on the range of vascular events that have been linked to adenomyosis. This covered vascular diseases, blood coagulation disorders, thrombosis, hypercoagulation, stroke (embolic, ischemic, thrombotic, hemorrhagic), cerebrovascular episodes, cerebral infarction, cerebral hemorrhage) and renal disease. This review covers 63 articles. Nineteen articles reported clinical manifestations of intravascular thrombosis in women with adenomyosis. Eleven publications were identified that reported on cerebral involvement and adenomyosis, including cases of ischemic stroke or infarction. Dysregulation primarily seems to occur via local factors leading to altered angiogenesis. Five case reports were identified that reported on various vascular complications attributed to the presence of adenomyosis. The search also identified reports of cerebral complications in women with adenomyosis. Through a secondary search, we identified publications dealing with a possible connection between cardiac complications and renal pathology, which the authors attributed to adenomyosis. Vascular involvement in adenomyosis is documented in rare cases by the presence of endometrial tissue in myometrial vessels both in menstrual and non-menstrual uteri. Women with adenomyosis have a higher platelet count, a shorter thrombin and prothrombin time and an activated partial thromboplastin time. These findings has been applied to attempts to identify therapies for adenomyosis based on targeting the vasculature, but the existence of a link between the two conditions is under question for several reasons: only case reports (or very small series) have been published; all published cases come from one region of the world (the Far East); the published literature does not contain objective proof of a causal relationship between the two pathologies, except for the elevation of some markers. In summary, it is not possible to conclude that the presence of adenomyosis has a pathogenetic role in causing vascular events, first and foremost because available evidence consists mostly of case reports.