Obstetrics & Gynecology

Modified letrozole protocol improves fresh-transfer pregnancy in diminished ovarian reserve without changing cumulative live birth

This multicenter RCT randomized 318 women with diminished ovarian reserve or age 40–45 to modified letrozole vs GnRH antagonist stimulation for IVF. Cumulative clinical pregnancy and live birth rates were similar between groups in both full and per-protocol analyses. Among women with diminished ovarian reserve undergoing dual cleavage-stage fresh transfer, letrozole markedly increased clinical pregnancy (65.8% vs 36.4%; RR 1.81). Fresh-transfer live birth and pregnancy loss outcomes numerically favored letrozole but were not statistically significant. 1

Primary cesarean linked to reduced second live birth likelihood and greater ART dependence

This population cohort included 298,241 Victorian women with a first spontaneously conceived singleton birth and follow-up for second births. Compared with vaginal birth, primary cesarean was associated with an 11% lower likelihood of a second live birth (aHR 0.89, 95% CI 0.88–0.90). Among women achieving a second birth, prior cesarean was linked to 28% higher IVF use and 28% higher overall ART use for conception. Miscarriage rates were similar between modes of first birth (aRR 1.01, 95% CI 0.98–1.03). 2

Checkpoint inhibitors plus chemo/chemoradiation improve survival in advanced or recurrent cervical cancer

This meta-analysis pooled five RCTs including 3,302 patients with advanced or recurrent cervical cancer receiving chemotherapy or chemoradiotherapy with or without immune checkpoint inhibitors. Adding checkpoint inhibitors significantly improved progression-free survival (HR 0.661, 95% CI 0.599–0.731) and overall survival (HR 0.664, 95% CI 0.590–0.747). Survival benefits were concentrated in patients with PD-L1 combined positive score ≥1, with little benefit for CPS <1 disease. Objective response increased modestly, but prediction intervals indicated this was less robust. 3

Inpatient postpartum OGTT after GDM boosts completion but alters diabetes classification by criteria and timing

This single-center retrospective cohort compared traditional outpatient-only versus hybrid inpatient-plus-outpatient postpartum OGTT strategies among women with gestational diabetes. OGTT completion was substantially higher with the hybrid strategy than traditional outpatient testing (73.9% vs 31.7%, P<.001). Inpatient testing produced higher observed rates of glucose intolerance and diabetes than outpatient testing in both cohorts. Applying 2022 ADA criteria, which require two abnormal values, reclassified most ACOG-defined diabetes as glucose intolerance. 4