Title: Chronic Endometritis in female reproduction. A meta-analysis

Abstract:

Statement of the Problem: Chronic endometritis (CE) is a persistent inflammation of the endometrium, often resulting from an intrauterine infection caused by common bacteria as well as Mycoplasma e Ureaplasma spp. The actual impact of chronic endometritis (CE) on female reproduction is a still unresolved issue. The currently available studies on this matter differ regarding the definition of CE, the diagnostic methods of the condition and the reproductive disorders investigated and compared. Moreover, there are few studies in which the control population is represented by normally fertile women. The objective of this meta-analysis is to assess the possible role of CE in three major reproductive disorders: female infertility, recurrent implantation failure (RIF) and recurrent pregnancy loss (RPL).
Methods: The present meta-analysis has been carried out following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA STATEMENT 2020) (1). A systematic search of the literature in english language from January 1,1990 to February 2, 2024 has been carried out on the following database sources: Pubmed, Scopus, Web of Science, ScienceDirect and Cochrane Library. For each of them two distint search strings have been set, one for CE and RPL and an other one for CE, infertility and RIF. Combinations of relevant terms (MeSH) and key-words related to the exposition of the events of interest have been built up. Systematic reviews, meta-analyses, reviews, case reports, notes or letters, editorials, book chapters, erratums and conference abstracts were excluded. Only studies on humans were considered and those involving animals were excluded. Electronic searches and analysis of bibliographic lists were performed independently by the authors. These reviewers subsequently screened titles, abstracts, and full texts, according to the inclusion and exclusion criteria previously described. Any disagreements between the reviewers were resolved through mutual agreement. The Newcastle-Ottawa scale (NOS) for nonrandomized studies was used to evaluate the quality of the included studies (2). Quantitative analysis of the extracted data was conducted using RevMan 5.4 software. Study outcomes were expressed using an odds ratio (OR) with a 95% confidence interval (95% C.I.). A P value<0.05 was defined as indicative of a statistically significant difference in outcomes. Heterogeneity between studies was measured using the I² statistic. The degree of heterogeneity was considered low when I² is less than 30%, moderate if between 30% and 70% and high if greater 70%. If I² exceeded 70%, indicating high variability between studies, the data were not usable for meta-analysis. If the I² was between 30% and 70%, the choice model was random effects. Conversely, in the presence of I² lower than 30%, a fixed model was used.
Findings: Three thousand and four relevant publications have been found (Pubmed: 522, Scopus: 1.447, Web of Science: 692, ScienceDirect: 230, Cochrane Library: 113). After removing duplicates, the titles and abstracts of the remaining 1.511 documents wew examined. Of these 1.511, 1.495 were excluded taking into account the imposed exclusion criteria, while 16 studies were pre-selectd fot inclusion. Further 7 studies were excluded for various reasons: lack of a control group composed by healthy fertile women, CE as a prerequisite for the selection of groups, lack of reported prevalence of CE in control group. Finally, a total of nine studies were included: four prospective cohort studies, one prospective and retrospective cohort study, two retrospective cohort studies and two case-control studies. Overall, the present meta-analysis involves a population of 1.038 women, including 185 suffering from infertility, 63 with repeated implantation failure, 489 diagnosed with RPL and 486 healthy fertile women (controls).

 Cumulative results showed:

1. with regard to infertility: a positive association between infertility and CE: a higher percentage of CE was found in infertile women (36/185 [19,46%]) compared to controls (14/180 [7,7%]), fixed effects model, OR: 2,96, 95% CI: 1.53-5.72, p<0.001, I² = 0% (2 studies);

2. with regard to RIF: no association between RIF and CE, fixed effects model, OR: 1.10, 95% CI: 0.26-4.61, p = 0,90, I² = 0%; the prevalence of CE in women with RIF (4/63 [6.35%]) was not statistically different compared to controls (4/69 [5.8%]) (2 studies);

3. with regard to RPL: a positive association between CE and RPL was found: a higher percentage of CE was found in women with RPL (184/ 489 [37.6%]) compared to controls (57/346 [16.4%]), fixed effects model, OR: 3.59, 95% CI: 2.46-5.24, p<0.00001, I² = 0% (8 studies).

Conclusions and Significance: To our knowledge, the present study is the first meta-analysis carried out to investigate at the same time the prevalence of CE in infertility, RPL and RIF. The results of our study indicate that CE is more common on women with infertility and RPL compared to the control group. In contrast, no significant differences in the prevalence of CE were found between women with RIF and the control group. However, the limited number of studies and subjects involved, as well as the different diagnostic criteria of CE used in the different studies prevent drawing firm conclusions. There is urgent need to develop well-designed, controlled studies with adequate numbers of subjects involved, using uniform diagnostic criteria to definitely establish the actual role, as well as its clinical significance, of CE in female infertility, RIF and RPL.

Biography:

Carlo Ticconi is Associate Professor of Obstetrics and Gynecology - Department of Surgery – University of Rome “Tor Vergata”, Rome, Italy. Currently he works at the University Hospital Policlinico Tor Vergata – Rome as Ob/Gyn, Department of Surgery, Section of Gynecology and Obstetrics Clinical experiences: delivery room and ward, general gynecology and obstetrics, gynaecological and obstetrical endocrinology, operative gynecology, recurrent pregnancy loss Areas of research interests: Female reproduction – Pregnancy and labor – Pregnancy complications – Recurrent Pregnancy Loss. Peer reviewer in more than 20 scientific journals in the area of Ob/Gyn. Author of 243 scientific publications (national and international).

Title: Experiences of infertility among couples in Morocco

Abstract:

Infertility remains a significant public health concern in Morocco, affecting the emotional, social, and economic well-being of couples. This study explores the lived experiences, cultural challenges, and care-seeking behaviors of infertile couples across Moroccan communities. Using a qualitative, interview-based approach, the research identifies key themes such as stigma, gendered expectations, psychological distress, and barriers to accessing fertility services. Many participants reported experiencing social pressure, marital tension, and misconceptions surrounding infertility, often leading to delayed medical consultation. The findings highlight the need for culturally sensitive counseling, broader public awareness, and improved accessibility to reproductive healthcare services. By understanding the multifaceted challenges faced by couples, healthcare providers and policymakers can design more comprehensive support systems that address both the clinical and psychosocial aspects of infertility in Morocco.

Biography:

Amal Benbella is a dedicated researcher and healthcare professional at Ibn Sina University Hospital, Morocco, specializing in reproductive health and infertility studies. With a strong academic and clinical background, she focuses on understanding the cultural, social, and psychological dimensions of infertility among North African populations. Her work aims to improve patient-centered care and promote equitable access to fertility services in Morocco.

Title: The influence of myo-inositol in comparison with metformin on metabolic and endocrinological disorders in women suffering from PCOS

Abstract:

Statement of the Problem: Polycystic ovary syndrome (PCOS) is a multisystem reproductive- metabolic disorder and the most common endocrine cause of infertility. The role of insulin resistance (IR) in the development of PCOS has been extensively studied, and it is widely accepted that IR is an independent factor apart from obesity that plays a significant role in the molecular mechanisms leading to increased androgen synthesis in the ovary Among the various treatment modalities, two agents, metformin (MET) and myo-inositol (MI), have garnered substantial attention for their roles in managing PCOS The objective of our study was to determine the influence of Myo-Inositol (MI) on insulin resistance (IR), menstrual cycle regularity, and hyperandrogenism in women suffering from PCOS with normal BMI, and diagnosed IR. Methods: We performed a prospective randomized controlled trial (RCT) that included 60 participants with PCOS, who had IR and normal BMI. Two groups were formed. Group of thirty patients received MI, 4000 mg/day, and thirty patients in control group received Metformin, (MET), 1500 mg/day. Results: A statistically significant reduction of the area under the curve (AUC) of insulin concentrations during the oral glucose tolerance test (OGTT) was recorded in both examined groups after the applied therapy with MI and MET. The regularity of menstrual cycle in both groups was improved in > 90% of patients. The statistically significant decrease in androgenic hormones (testosterone, SHBG, free androgen index – FAI, androstenedione) was recorded in both groups and didn’t differ between groups. Although pregnancy within the groups of examined women was not the primary outcome of the study, we had to note that 8 women were excluded from the group that took inositol, due to pregnancy. Conclusions: Both MI and MET can be considered very effective in regulation of IR, menstrual cycle irregularities and hyperandrogenism in normal weighted women with PCOS.

Biography:

Employment Head of the Gynecological Endocrinology Department-  Clinic for Gynecology and Obstetrics, Clinical Center of Serbia (KCS); Professor of Gynecology and Obstetrics, Faculty of Medicine, University of Belgrade; President of the Serbian Association for Gynecological and Reproductive Endocrinology (SAGRE)  Education:  Specialist in gynecology and obstetrics; General Endocrinology subspecialist; Fertility and sterility subspecialist;; PhD in the field of neuroendocrinology, from the Faculty of Medicine, University of Belgrade.  Completed an International Course in Hysteroscopy, Cyprus 2004, and a laparoscopic suturing course in Leuven in 2008, organized by the European Society of Endoscopic Surgery Membership in professional associations: Member of:  the American Association of Endocrinologists: ~ Endocrine Society ~ Member of the International Association of Gynecological Endocrinology (ISGE) President of the Serbian Association for Gynecological and Reproductive Endocrinology (SAGRE) from 2018

Title: Enhancing Adherence to the Massive Transfusion Protocol in Obstetric Emergencies: A Quality Improvement Audit

Abstract:

Background: our hospital is a major obstetric hospital that performs a variety of obstetrical emergent surgeries and facing many cases require massive transfusion protocol. Maintaining a balanced ratio of blood components in addition to other recommendations is the core of MTP.
Objective: to evaluate and improve adherence to the Massive Transfusion Protocol.
Methodology: The audit was conducted in Al-Elwyia Maternity Teaching hospital. eligible cases were those had transfusion of 4 units of blood within one hour, or more than 10 units over 24 hours. The study conducted from June 2022 to July 2023 over two cycle pre and post implementation of the intervention which included multiple lectures presented on separated occasions to resident doctors, blood bank employees, anesthetist, and emergency room staff. Printed posters that included the flowchart of MTP according to Green top guidelines No. 47.
Results: Total cases included in the study 273 cases (130 in the initial cycle and 143 in second cycle). The total number of transfused PRBC units was 754 units (range 4-11 PRBC units per patient) in the first cycle and 872 units (range 4-13 PRBC units per patient) in second cycle. The total number of FFP units transfused was 220 units (range 0-4) and 664 units (range 0-8) in first and second cycles respectively. The total number of platelets transfused was 115 and 592 in first and second cycles respectively. The ratio of 1:1:1 achieved only in 42 cases (32.3%) and 97 cases (67.8%). The calcium gluconate administration after 4 units of PRBS transfusion was done in 63 cases (48.5%) and 89 cases (62.2%). Post-transfusion investigations requested in 22 cases (16.9%) and 52 cases (36.4%) in first and second cycles respectively.
Conclusion: This audit concluded that adherence to MTP improved after providing lectures to the staff in addition to placement of posters that shows the steps of this protocol.

Biography:

Dr. Sarah Al-Musawi is a dedicated professional in obstetrics and gynecology, actively contributing to research, quality improvement, and education. Her research centers on enhancing maternal and neonatal outcomes, leading to publications and serving as a reviewer for medical journals. In her NHS role, Dr. Al-Musawi has spearheaded quality improvement initiatives focused on patient safety within obstetrics and gynecology. As a mentor, she supports junior doctors and students, helping them build practical skills in women’s health. Her commitment to improving standards in OBGYN and advancing medical education highlights her impact in the field.

Title: Cell-Free DNA as a Biomarker of IVF Success

Abstract:

Cell-free DNA fragments detected in blood and in other biological fluids are released from apoptotic/necrotic cells. In this study, we analyzed cfDNA levels in follicular fluid (FF) samples from patients with infertility. Samples were collected from 178 infertile women and cfDNA was extracted and quantified by qPCR, using ALU115 and ALU247 primers, and statistical correlations were performed. We found that cfDNA concentration was significantly higher in FF pools from women aged 35 and over than in women under 35 years of age (p = 0.017). We also found that q247 cfDNA levels were significantly higher in women with an associated female factor, such as endometriosis, PCOS and POF, compared with women with no specific cause of infertility (p = 0.033). The concentration of cfDNA did not vary significantly in each group of women with an associated female factor. The concentration of cfDNA was significantly higher in the FF of women that obtained embryos with a high fragmentation rate, compared to embryos with a low fragmentation rate (p = 0.007). Finally, we found that women who did not become pregnant during IVF treatments had higher q247 cfDNA levels (p = 0.043). The quantification of cfDNA could be an important biomarker of follicular micro-environment quality to predict embryo quality and the success of IVF, making them more specific and effective.

Biography:

Ana Ramalhinho has completed his PhD in 2014 from University of Beira Interior (UBI), Covilhã, Portugal. She is Assistant Professor and Researcher at UBI and Clinical Embryologist at Assisted Reproductive Unit in Cova da Beira Local Unit of Health, Covilhã, Portugal.

Title: Unfertilized Eggs secrets Serum Albumin to Facilitate Fertilization

Abstract:

Background: Fertilization is a complex, multi-step process in which a sperm from a male meets an ovum from a female to form a zygote. After sperm is deposited in the vagina, it undergoes capacitation, a process that involves the activation of ATP enzymes in the cytosol and the destabilization of the acrosome membrane. Current understanding of fertilization is largely based on observed morphological and biochemical changes in sperm and eggs, studied using microscopic techniques, as well as cellular and biochemical analyses.  Our study aimed to determine whether the egg may release molecules that guide or assist sperm in the fertile Eggs isolated from female C57BL/6J mice were incubated in DMEM for 24 hours at 37 °C with 5% CO₂. Participants/materials, setting, methods: After incubation, the DMEM medium, following the removal of eggs, was analyzed to identify molecules secreted by the eggs.
Main results and the role of chance: Using GC-MS/MS, LC-MS/MS, and SDS-PAGE followed by Edman sequencing, we identified that unfertilized eggs incubated in DMEM produced a single molecule: serum albumin. The addition of albumin to in vitro fertilization (IVF) solutions resulted in a dose-dependent increase in fertilization rates, indicating its direct stimulatory effect on sperm-egg interaction. Interestingly, removing lipid impurities from serum albumin further enhanced fertilization rates from 76% to 95%, suggesting that lipids interfere with fertilization processes. Moreover, dose-dependent experiments revealed distinct roles of lipids in fertilization. The inclusion of free fatty acids with serum albumin in IVF solutions had an inhibitory effect on fertilization, while triglycerides acted as stimulants.

Biography:

Hee-Suk Chae is a Head Professor and Associate Professor in the Department of Obstetrics & Gynecology at Jeonbuk National University Medical School, South Korea. She holds an M.D./Ph.D. in Obstetrics & Gynecology from Jeonbuk National University, where she also completed his M.M.Sc. and M.B. degrees. Her research focuses on reproductive endocrinology, particularly the roles of matrix metalloproteinases and microRNAs in endometriosis. Dr. Chae has published extensively in peer-reviewed journals and has contributed to advancing knowledge in her field through both clinical practice and research, including a research fellowship at New York Medical College. She is currently involved in managing the Department of Obstetrics & Gynecology at Jeonbuk National University Hospital.

Title: Enhancing Maternal and Child Health: A Comprehensive Evaluation of Midwifery Practices in Urban Setting

Abstract:

Maternal and child health (MCH) remains a critical focus within healthcare systems worldwide, particularly in urban settings where disparities in access and quality of care can significantly impact outcomes. This study evaluates midwifery practices in urban areas, aiming to identify strengths, weaknesses, and opportunities for improvement. A mixed-methods approach was employed, involving quantitative surveys and qualitative interviews with midwives and mothers. The sample included 300 midwives and 500 mothers across various urban healthcare facilities. Data collection focused on aspects such as prenatal care quality, delivery practices, postnatal support, and maternal satisfaction. Preliminary findings indicate that while midwives exhibit a high level of competence and commitment, challenges such as inadequate staffing, limited resources, and lack of continuous professional development hinder optimal care delivery. Mothers reported a desire for more personalized care and better communication with healthcare providers. The study highlights the importance of enhancing midwifery training programs, improving resource allocation, and fostering collaborative practices among healthcare professionals. Recommendations include implementing regular training sessions, mentorship programs, and community engagement initiatives to empower both midwives and mothers. By addressing these critical areas, we can improve maternal and child health outcomes, ultimately contributing to healthier communities. This research underscores the pivotal role of midwives in urban healthcare and advocates for systemic changes to support their vital contributions.

Keywords:- Maternal health, Child health, Midwifery practices, Urban healthcare, Qualitative research

Biography:

Endale Haile is a dedicated academic and researcher affiliated with Mekele University, Ethiopia. He has contributed to advancing knowledge in his field through teaching, research, and community engagement. His work reflects a strong commitment to academic excellence and innovation. At Mekele University, he actively supports the development of students and collaborative projects. Endale continues to pursue impactful research that benefits both the university and the wider scientific community.

Title: Impact of Lifestyle Modification on Ovulatory Dysfunction Among Women with PCOS

Abstract:

Polycystic Ovary Syndrome (PCOS) is one of the most prevalent endocrine disorders affecting reproductive-aged women, with ovulatory dysfunction being a key contributor to infertility. Lifestyle modification—including weight management, dietary optimization, and regular physical activity—has emerged as a primary, non-pharmacological intervention for restoring ovulatory function. This study evaluates the impact of structured lifestyle changes on ovulatory parameters among women diagnosed with PCOS. Findings highlight that even modest weight reduction significantly improves menstrual regularity, enhances insulin sensitivity, and promotes spontaneous ovulation. Participants adopting a combined approach of balanced nutrition, behavioral counseling, and moderate-intensity exercise demonstrated clinically meaningful improvements compared to those receiving standard care. The results emphasize the central role of lifestyle modification as an effective, accessible, and sustainable strategy for improving reproductive outcomes in women with PCOS. Integrating lifestyle interventions into routine gynecological practice can substantially reduce long-term metabolic and reproductive complications, supporting a more holistic model of care.

Biography:

Dr. Aisha Al Mansouri is a highly respected Consultant Obstetrician and Gynecologist at the Dubai Health Authority, UAE, with extensive expertise in reproductive endocrinology, women’s health, and the management of polycystic ovary syndrome (PCOS). With over a decade of clinical experience, Dr. Al Mansouri has been at the forefront of providing patient-centered care, particularly in infertility, ovulatory disorders, and minimally invasive gynecologic procedures. She is widely recognized for her work in promoting lifestyle-based therapeutic approaches for reproductive conditions and has contributed to various clinical initiatives aimed at improving women’s health outcomes across the region. Dr. Al Mansouri actively participates in national and international conferences, sharing her insights on PCOS, metabolic health, and evidence-based gynecologic practice.