Objective: Fertility preservation is a priority in oncology for female cancer patients. However, there is a lack of communication between infertility specialists and oncologists. This study aimed to evaluate infertility specialists’ perceptions and experiences regarding fertility preservation. Methods: Conduct an online survey to profile infertility specialists. Participants were infertility affiliated with the Brazilian Federation of Gynecology and Obstetrics Associations (FEBRASGO). The specialists received an online survey, which response rate were 30.9%, most of whom were in southern and southeastern. The survey consisted on 14 questions about the infertility specialists’ location, techniques in clinical practice, treatment successful rate, patients idea, etc. Results: The average experience in human reproduction were 15.5 ± 10.2 years (mean ± standard deviation, range 1-40). Among reproductive-aged female cancer patients recommended for fertility preservation, 60.3 ± 28.8% (range 10-100%) underwent preservation procedures. Main barriers were cost (41%), oncologists’ knowledge or acceptance (35%) and accessibility (9%). Most infertility specialists (58%) considered 40 years the limit for fertility preservation. Leukemia, lymphoma, breast and ovarian cancers were prioritized for fertility preservation, while lung, thyroid, gastric, and brain cancers were less relevant. Conclusion: This is the first Brazilian study about infertility specialists’ perceptions on oncology patients access to fertility preservation. These patients primarily receive treatment in the public health system, while infertility specialists mainly work in the private healthcare. This healthcare mode is currently fragmented, but integrating these experts is enhancing patient access to fertility preservation. Studies on this topic are still warranted. Objective However oncologists Methods FEBRASGO. FEBRASGO . (FEBRASGO) 309 30 9 30.9% southeastern 1 location practice idea etc Results 155 15 5 15. 102 10 2 10. mean deviation 140. 140 1-40) reproductiveaged reproductive aged 603 60 3 60. 288 28 8 28.8 10100% 10100 100% 100 10-100% procedures 41%, 41 41% , (41%) 35% 35 (35% 9%. 9% (9%) 58% 58 (58% 4 Leukemia lymphoma lung thyroid gastric relevant Conclusion system fragmented warranted (FEBRASGO 30.9 1-40 6 28. 1010 10-100 (41% (35 (9% (58 30. 1-4 101 10-10 (41 (3 (9 (5 1- 10-1 (4 ( 10-

Abstract Effective patient positioning is a critical factor influencing surgical outcomes, mainly in minimally invasive gynecologic surgery (MIGS) where precise positioning facilitates optimal access to the surgical field. This paper provides a comprehensive exploration of the significance of strategic patient placement in MIGS, emphasizing its role in preventing intraoperative injuries and enhancing overall surgical success. The manuscript addresses potential complications arising from suboptimal positioning and highlights the essential key points for appropriate patient positioning during MIGS, encompassing what the surgical team should or shouldn't do. In this perspective, the risk factors associated with nerve injuries, sliding, compartment syndrome, and pressure ulcers are outlined to guide clinical practice. Overall, this paper underscores the critical role of precise patient positioning in achieving successful MIGS procedures and highlights key principles for the gynecological team to ensure optimal patient outcomes. outcomes (MIGS field success shouldnt shouldn t do perspective sliding syndrome practice Overall

SUMMARY OBJECTIVE: Intraoperative complications of hysteroscopy, such as the creation of a false passage, cervix dilatation failure, and uterine perforation, may require suspension of the procedure. Some patients refuse a new procedure, which delays the diagnosis of a possible serious uterine pathology. For this reason, it is essential to develop strategies to increase the success rate of hysteroscopy. Some authors suggest preoperative use of topical estrogen for postmenopausal patients. This strategy is common in clinical practice, but studies demonstrating its effectiveness are scarce. The aim of this study was to evaluate the effect of cervical preparation with promestriene on the incidence of complications in postmenopausal women undergoing surgical hysteroscopy. METHODS: This is a double-blind clinical trial involving 37 postmenopausal patients undergoing surgical hysteroscopy. Participants used promestriene or placebo vaginally daily for 2 weeks and then twice a week for another 2 weeks until surgery. RESULTS: There were 2 out of 14 (14.3%) participants with complications in the promestriene group and 4 out of 23 (17.4%) participants in the placebo group (p=0.593). The complications were difficult cervical dilation, cervical laceration, and vaginal laceration. CONCLUSION: Cervical preparation with promestriene did not reduce intraoperative complications in postmenopausal patients undergoing surgical hysteroscopy. OBJECTIVE hysteroscopy passage failure perforation procedure pathology reason practice scarce METHODS doubleblind double blind 3 surgery RESULTS 1 14.3% 143 (14.3% 17.4% 174 17 (17.4% p=0.593. p0593 p p=0.593 . 0 593 (p=0.593) dilation laceration CONCLUSION 14.3 (14.3 17.4 (17.4 p059 p=0.59 59 (p=0.593 14. (14. 17. (17. p05 p=0.5 5 (p=0.59 (14 (17 p0 p=0. (p=0.5 (1 p=0 (p=0. ( p= (p=0 (p= (p

Resumo Objetivo O presente estudo avaliou a expressão do WWOX, sua associação com características clinicopatológicas e com a expressão do p53, ki-67 (proliferação celular) e CD31 (angiogênese) em pacientes com carcinoma invasivo de células escamosas do colo uterino, ou simplesmente câncer do colo uterino (CCE). Métodos Foram avaliadas prospectivamente pacientes com CCE no estágio IB (n = 20) e mulheres com mioma uterino, no grupo controle (n = 20). As pacientes com CCE foram submetidas à histerectomia radical e à linfadenectomia pélvica do tipo B-C1. As mulheres no grupo-controle foram submetidas à histerectomia vaginal. As amostras de tecido foramcoradas comhematoxilina e eosina para avaliação histológica e a expressão das proteínas foi detectada por imuno-histoquímico. Resultados A expressão do WWOX foi significativamente menor no tumor quando comparada com sua expressão no colo do útero benigno (p = 0,019). A expressão tumoral de CD31 foi inversamente associada à expressão de WWOX (p = 0,018). Sua expressão não foi associada à expressão tumoral de p53 e Ki-67 em pacientes com CCE (p = 0,464 e p = 0,360, respectivamente). Não houve associação entre a expressão de WWOX e o tamanho do tumor (p = 0,156), grau de diferenciação (p = 0,914), presença de invasão vascular linfática (p = 0,155), comprometimento do paramétrio (p = 0,421) ou metástase dos linfonodos pélvicos (p = 0,310) em pacientes com CCE. Conclusão Os resultados sugeriram que o WWOX pode estar envolvido na carcinogênese do CICECU e esse marcador foi associado à angiogênese tumoral.

Abstract Objective The current study evaluated the expression of WW domain-containing oxidoreductase (WWOX), its association with clinicopathological features and with p53, Ki-67 (cell proliferation) and CD31 (angiogenesis) expression in patients with invasive cervical squamous cell carcinoma (ICSCC). To the best of our knowledge, no other study has evaluated this association. Methods Women with IB stage-ICSCC (n = 20) and women with uterine leiomyoma (n = 20) were prospectively evaluated. Patients with ICSCC were submitted to type BC1 radical hysterectomy and pelvic lymphadenectomy. Patients in the control group underwent vaginal hysterectomy. Tissue samples were stained with hematoxylin and eosin for histological evaluation and protein expression was detected by immunohistochemistry studies. Results The WWOX expression was significantly lower in the tumor compared with the expression in thebenign cervix (p = 0.019). TheWWOXexpressionwas inversely associated with the CD31 expression in the tumor samples (p = 0.018). There was no association betweentheWWOXexpression with the p53 expression (p = 0.464)or the Ki-67expression (p = 0.360) in the samples of invasive carcinoma of the cervix. There was no association between the WWOX expression and tumor size (p = 0.156), grade of differentiation (p = 0.914), presence of lymphatic vascular invasion (p = 0.155), parametrium involvement (p = 0.421) or pelvic lymph node metastasis (p = 0.310) in ICSCC tissue samples. Conclusion The results suggested that WWOX may be involved in ICSCC carcinogenesis, and this marker was associated with tumor angiogenesis.

OBJETIVO: comparar as taxas de gravidez e as espessuras endometriais médias obtidas com a utilização de três esquemas de indução da ovulação para inseminação intra-uterina (IIU). MÉTODOS: foram avaliados retrospectivamente 110 ciclos de IIU, sendo estes divididos em três grupos, de acordo com o protocolo de indução da ovulação utilizado: 100 mg de citrato de clomifeno (CC) do 3º ao 7º dia do ciclo (grupo CC, n=24); acrescentou-se ao esquema do grupo CC 75 UI de gonadotrofina menopáusica humana (hMG) nos dias 3, 5 e 7 do ciclo (grupo CC+hMG, n=29) e hMG isolado, 75 UI do 3º ao 8º dia do ciclo (grupo hMG, n=57). Para análise estatística foi utilizado o teste t de Student para comparação entre médias e o teste c² para comparação entre proporções. RESULTADOS: a média de idade das pacientes no início do tratamento foi de 33,3 anos (23 a 40 anos), sendo similar nos três grupos. A espessura endometrial média no dia da aplicação da gonadotrofina coriônica humana (hCG) foi significativamente maior no grupo hMG (10,2±0,2 mm) em comparação à obtida nos grupos CC e CC + hMG (7,9±0,4 e 8,7±0,2 mm, respectivamente, p<0,001). A taxa de gestação clínica média foi de 18,2%, sendo semelhante nos três grupos (grupo CC=12,5%; grupo CC+hMG=24,1%; grupo hMG=19,3%). CONCLUSÃO: observou-se maior espessura endometrial média com o uso isolado de hMG em comparação ao uso isolado de CC ou à associação CC+hMG. Não foram observadas diferenças significativas entre as taxas de gestação clínica obtidas com os três esquemas de indução da ovulação utilizados (CC isolado, associação de CC e hMG e hMG isolado).

PURPOSE: to compare pregnancy rates and mean endometrial thickness obtained with three protocols for induction of ovulation in cycles of intrauterine insemination (IUI). METHODS: one hundred and ten IUI cycles were retrospectively evaluated in the study, divided into three groups, according to the used ovulation induction protocols: 100 mg clomiphene citrate (CC) on days 3 to 7 of the cycle (CC group, n=24), 100 mg/day CC on days 3 to 7 of the cycle + 75 IU/day of human menopausal gonadotrophin (hMG) on days 3, 5 and 7 of the cycle (CC+hMG group, n=29), and 75 IU/day of hMG on days 3 to 8 of the cycle (hMG group, n=57). Statistical analysis was performed using Student's t test to compare the means and the c² test to compare the rates. Results were considered statistically significant at p<0.05. RESULTS: the patients' average age at the onset of the first cycle was 2340 years (mean age, 33.3 years). There were no statistically significant differences between groups. The mean endometrial thickness on the day of the human chorionic gonadotrophin (hCG) administration was significantly higher in the hMG group (10.2±0.2 mm), as compared with the CC and CC+hMG group (7.9±0.4 and 8.7±0.2 mm, respectively, p<0.001). The overall clinical pregnancy rate was 18.2%, and there were no statistically significant differences between the groups (CC group=12.5%; CC+hMG group=24.1% and hMG group=19.3%). CONCLUSION: the results indicate higher mean endometrial thickness in the hMG group as compared with the CC group and the CC+hMG group. There were no significant differences between clinical pregnancy rates obtained with each protocol (CC, CC+hMG and hMG).