The freeze-all strategy has emerged as an alternative to fresh embryo transfer (ET) during in vitro fertilization (IVF) cycles. Although fresh ET is the norm during assisted reproductive therapies (ART), there are many concerns about the possible adverse effects of controlled ovarian stimulation (COS) over the endometrium. The supra-physiologic hormonal levels that occur during a conventional COS are associated with modifications in the peri-implantation endometrium, which may be related to a decrease in pregnancy rates and poorer obstetric and perinatal outcomes when comparing fresh to frozen-thawed embryo transfers. The main objective of this study was to assess the available literature regarding the freeze-all strategy in IVF cycles, in regards to effectiveness and safety. Although there are many potential advantages in performing a freeze-all cycle over a fresh ET, it seems that the freeze-all strategy is not designed for all IVF patients. There is a need to develop a non-invasive clinical tool to evaluate the endometrial receptivity during a fresh cycle, which enables the selection of patients that would benefit from this strategy. Today, it is reasonable to perform elective cryopreservation of all oocytes/embryos in cases with a risk of OHSS development, and in patients with supra-physiologic hormonal levels during the follicular phase of COS. It is not clear if all normal responders and poor responders may benefit from this strategy.

Adipocytokines may alter normal metabolic function and play an important role in the pathophysiology of polycystic ovary syndrome (PCOS). We prospectively evaluated a cohort of obese and non-obese women with PCOS and non-PCOS controls for both novel (chemerin and omentin-1) and established (leptin and adiponectin) adipokines. Compared with age-matched controls, non-obese women with PCOS had decreased serum omentin-1 (191.1 ng/ml versus 269.7 ng/ml, p = 0.0001), while serum chemerin was not significantly altered in women with PCOS (53.95 ng/ml versus 48.61 ng/ml, p = 0.11). The findings were similar in the entire group of women with PCOS. However, in women with PCOS, chemerin correlated with leptin (r = 0.508, p = 0.004), adiponectin (r = -0.36, p = 0.014), and the leptin/adiponectin (L/A) ratio (r = 0.605, p < 0.0001), while there were no such correlations with omentin-1. In women with PCOS, chemerin correlated with BMI (r = 0.317, p = 0.034), abdominal subcutaneous fat (r = 0.451, p = 0.0019), and insulin resistance (HOMA-IR, r = 0.428, p = 0.0034), while omentin-1 did not correlate with any parameter. These data suggest that chemerin although not significantly elevated in women with PCOS correlates with adiposity and insulin resistance, and it is the single best adipokine measured in this regard. Chemerin, through its inflammatory role as a chemo-attractant in adipose tissue, may be an important determinant of insulin resistance in PCOS.

Objective To perform a population-based analysis to compare the complications and cost of laparoscopic and robotically assisted adnexal surgery. Methods A nationwide database was utilized to analyze the use and outcomes of robotically assisted adnexal surgery from 2009–2012. Multivariable mixed effects regression models were developed to examine predictors of use of robotic surgery. After propensity score matching, complications and cost were compared between robotically assisted and laparoscopic surgery. Results 87,514 women were identified. From 2009 to 2012, performance of robotic-assisted oophorectomy increased from 3.5% (95% CI, 3.2–3.8%) to 15.0% (95% CI, 14.4–15.6%), while robotically assisted cystectomy rose from 2.4% (95% CI, 2.0–2.7%) to 12.9% (95% CI, 12.2–13.5%). The overall complication rate was 7.1% (95% CI, 4.0–10.2%) for robotically assisted vs. 6.0% (95% CI, 2.9–9.1%) for laparoscopic oophorectomy (OR=1.20; 95% CI, 1.00–1.45) (P=0.052). Robotic-assisted oophorectomy was associated with a higher rate of intraoperative complications (3.4% vs. 2.1%, OR=1.60; 95% CI, 1.21–2.13). The overall complication rate was 3.7% (95% CI −0.8–8.2%) after robotically assisted versus 2.7% (95% CI, −1.8–7.2%) for laparoscopic cystectomy (OR=1.38; 95% CI, 0.95–1.99). The intraoperative complication rate was higher for robotically assisted cystectomy (2.0% vs. 0.9%, OR=2.40; 95% CI, 1.31–4.38). Compared to laparoscopy, robotically assisted oophorectomy was associated with $2504 (95% CI, $2356–$2652) increased total costs and robotically assisted cystectomy $3310 (95% CI, $3082–$3581) higher costs. Conclusion Use of robotically assisted adnexal surgery increased rapidly. Compared to laparoscopic surgery, robotically assisted adnexal surgery is associated with substantially greater costs and a small, but statistically significant, increase in intraoperative complications.

The majority of women with stages IB1-IB2 cervical cancer undergoing radical surgery do not require adjuvant RT, have excellent oncologic outcome, and have low severe complication rates. Nearly one third of our patients required postoperative radiation, with no statistically significant increase in severe complication rate and with similar oncologic outcomes compared with the surgery-only cohort. These data support the continued practice of radical surgery with individualized postoperative radiation for these patients.