Background: Uterine fibroids are the most frequently diagnosed gynaecological tumours, and they o... more Background: Uterine fibroids are the most frequently diagnosed gynaecological tumours, and they often require surgical treatment (conventional laparoscopic myomectomy—CLM). The introduction and evolution of robotic-assisted laparoscopic myomectomy (RALM) in the early 2000s has expanded the range of minimally invasive options for the majority of cases. This study aims to compare RALM with CLM and abdominal myomectomy (AM). Methods and materials: Fifty-three eligible studies adhered to the pre-established inclusion criteria and were subsequently evaluated for risk of bias and statistical heterogeneity. Results: The available comparative studies were compared using surgical outcomes, namely blood loss, complication rate, transfusion rate, operation duration, conversion to laparotomy, and length of hospitalisation. RALM was significantly superior to AM in all assessed parameters other than operation duration. RALM and CLM performed similarly in most parameters; however, RALM was associa...
Multi-port robotic assisted (Da Vinci) laparoscopic myomectomy: a systematic review and meta-anal... more Multi-port robotic assisted (Da Vinci) laparoscopic myomectomy: a systematic review and meta-analysis of comparative clinical and fertility outcomes.
Fallopian tube pathology is a very common cause of infertility for multiple couples worldwide. Tu... more Fallopian tube pathology is a very common cause of infertility for multiple couples worldwide. Tubal patency assessment is considered a crucial component of initial infertility evaluation with several evaluation tests available, such as hysterosalpingography (HSG), hysterosalpingo-contrast sonography (HyCoSy), and hysterosalpingo-foam sonography (HyFoSy), the latest tubal patency assessment, utilizing ultrasonography and a foam-based contrast agent. An additional side-benefit of these assessment tests is a fertilityenhancing effect, best studied with the application of HSG. In this report, we present a case of a 28-year-old woman with unexplained infertility who spontaneously conceived in the same menstrual cycle that the HyFoSy exam with ExEm ® foam (ExEm Foam Inc., Nashville, Tennessee, United States) was performed, without any additional fertility enhancement interventions.
We present the case of a 54‐year‐old woman diagnosed with uterine leiomyosarcoma that produced be... more We present the case of a 54‐year‐old woman diagnosed with uterine leiomyosarcoma that produced beta‐human chorionic gonadotropin (β‐hCG), evident by both serum and immunohistologic examination. Based on this and similar cases from the available literature, β‐hCG‐producing sarcomas tend to have poorer prognosis, indicating that β‐hCG could potentially be used as a marker of disease status and response to the therapy; however, this association is inconsistent and should be further investigated.
Polycystic Ovary Syndrome - Functional Investigation and Clinical Application
Polycystic ovary syndrome (PCOS) is a common and complicated endocrine disorder, with its diagnos... more Polycystic ovary syndrome (PCOS) is a common and complicated endocrine disorder, with its diagnosis based on clinical, laboratory and imaging criteria. The latter is usually assessed via two-dimensional ultrasound; however, the advent of three-dimensional ultrasound, along with three-dimensional power Doppler (3D-PD) could offer more accurate diagnoses and further our understanding of PCOS pathophysiology. Three-dimensional ultrasound (3D-US) has already been used successfully in many fields of gynecology. It offers improved image quality with stored data that can be processed either manually or automatically to assess many parameters useful in PCOS assessment, such as ovarian volume, number of follicles and vascular indices. The examination requires minimal time as data is assessed in post-processing, thus being more tolerable for the patient. 3D-US parameters are generally increased in PCOS patients when compared to controls and 2D measurements, with studies showing improved diagn...
Clinical Research in Obstetrics and Gynecology, 2021
The coronavirus disease-19 pandemic and the consequent public and economic restrictions had a dra... more The coronavirus disease-19 pandemic and the consequent public and economic restrictions had a dramatic impact in assisted reproduction. During the first months of the pandemic, the vast majority of the treatments stopped. The impact was much stronger on the field of cross-border reproductive care (CBRC). Whereas the other assisted reproduction treatments seem to recover slowly along with the softening of public restrictions, CBRC does not. The main reasons for the cessation of CBRC seem to be travel restrictions and the fear for contamination in destination countries, particularly in those countries with a heavy virus load. To our opinion, this situation will trigger changes on the field of CBRC which will remain even after the end of the pandemic.
Journal of minimally invasive gynecology, Jan 18, 2015
This is a case report and literature review regarding early diagnosis and management of a cervica... more This is a case report and literature review regarding early diagnosis and management of a cervical heterotopic pregnancy. A 41 year old gravida 2 para 0 with premature ovarian failure was successfully treated in an in vitro fertilization program with donor oocytes. A transvaginal ultrasound scan revealed the presence of a heterotopic pregnancy; one intrauterine and one intracervical. Both embryos presented with positive heart beats. Aspiration of the cervical pregnancy was followed by Foley catheter placement and cervical cerclage suturing. Monitoring of the patient resulted in elective uncomplicated Caesarean section at 38 weeks following an uneventful pregnancy. Since no guidelines exist for the management of heterotopic cervical pregnancy, literature review is conducted suggesting the most effective method. The value of early diagnosis and management is concluded from the literature, in support of our management principles.
Aim To compare the efficacy of three methods: the levels of anti-müllerian hormone (AMH), the lev... more Aim To compare the efficacy of three methods: the levels of anti-müllerian hormone (AMH), the levels of follicle stimulating hormone (FSH) and the antral follicle count (AFC), for the prediction of the number of retrieved mature oocytes and the number of generated embryos by intracytoplasmic sperm injection (ICSI) in women stimulated with a GnRH-antagonist protocol. Materials and methods 105 women were enrolled in the study. At the day 2 of a preceding cycle, AFC was performed and FSH and AMH were measured in serum by immunoenzymatic assays. All women were stimulated with a GnRH-antagonist protocol and ovulation was induced with human chorionic gonadotropin. ICSI was performed in all retrieved mature oocytes. Embryo transfers were performed at days 2-3. According to the oocytes retrieved, patients were categorized as poor (\4), normal (4-12) or high responders ([12). Results AFC and the levels of baseline FSH and AMH were significantly different among poor, normal and high responders. The number of oocytes as well as the number of embryos was negatively correlated with baseline FSH and positively correlated with baseline AMH and AFC, whereas AFC showed the strongest correlation. Stepwise regression analysis indicated AFC and baseline AMH as the most significant parameters for the prediction of the number of oocytes; for the prediction of the number of embryos, the most significant parameter was AFC. Conclusions AFC, baseline AMH and baseline FSH are good predictors for the outcome of ovarian stimulation in GnRH-antagonist cycles. However, AFC appears to have the best predictive value.
Anti-Mullerian Hormone (AMH) was recently introduced as a marker of ovarian reserve in assisted r... more Anti-Mullerian Hormone (AMH) was recently introduced as a marker of ovarian reserve in assisted reproduction. The cutoff values of AMH for prediction of poor response have not yet been determined. Ninety women undergoing their first IVF/ICSI cycle were prospectively included in this clinical, non-interventional study. Baseline AMH, follicle stimulating hormone (FSH) and antral follicle count (AFC) were measured before starting ovarian stimulation. AMH was also measured on day 5 of stimulation and in the follicular fluid of the first aspirated follicle. The predictive value of baseline AMH, day 5 AMH and follicular fluid AMH were assessed comparatively to FSH and AFC for ovarian response. Ovarian response was defined as poor (<4 oocytes), high (>12 oocytes) or normal (≥4 oocytes and ≤12 oocytes). However, only 3 patients met the criterion for high ovarian response and thus analysis was focused on the prediction of poor response. Significant differences were present between poor responders and non-poor responders regarding FSH (p = 0.019), baseline AMH (p = 0.002), AFC (p < 0.001), day 5 AMH (p = 0.005) but not for follicular AMH (p = 0.183). The largest AUC (area under the curve) for poor ovarian response was obtained by AFC (AUC = 0.81) followed by baseline AMH (AUC = 0.70). At a level below 2.74 ng/mL, the sensitivity of the test is 69% and specificity is 70.5%. Baseline AMH is almost as good a predictor for poor ovarian response as AFC.
Background: Uterine fibroids are the most frequently diagnosed gynaecological tumours, and they o... more Background: Uterine fibroids are the most frequently diagnosed gynaecological tumours, and they often require surgical treatment (conventional laparoscopic myomectomy—CLM). The introduction and evolution of robotic-assisted laparoscopic myomectomy (RALM) in the early 2000s has expanded the range of minimally invasive options for the majority of cases. This study aims to compare RALM with CLM and abdominal myomectomy (AM). Methods and materials: Fifty-three eligible studies adhered to the pre-established inclusion criteria and were subsequently evaluated for risk of bias and statistical heterogeneity. Results: The available comparative studies were compared using surgical outcomes, namely blood loss, complication rate, transfusion rate, operation duration, conversion to laparotomy, and length of hospitalisation. RALM was significantly superior to AM in all assessed parameters other than operation duration. RALM and CLM performed similarly in most parameters; however, RALM was associa...
Multi-port robotic assisted (Da Vinci) laparoscopic myomectomy: a systematic review and meta-anal... more Multi-port robotic assisted (Da Vinci) laparoscopic myomectomy: a systematic review and meta-analysis of comparative clinical and fertility outcomes.
Fallopian tube pathology is a very common cause of infertility for multiple couples worldwide. Tu... more Fallopian tube pathology is a very common cause of infertility for multiple couples worldwide. Tubal patency assessment is considered a crucial component of initial infertility evaluation with several evaluation tests available, such as hysterosalpingography (HSG), hysterosalpingo-contrast sonography (HyCoSy), and hysterosalpingo-foam sonography (HyFoSy), the latest tubal patency assessment, utilizing ultrasonography and a foam-based contrast agent. An additional side-benefit of these assessment tests is a fertilityenhancing effect, best studied with the application of HSG. In this report, we present a case of a 28-year-old woman with unexplained infertility who spontaneously conceived in the same menstrual cycle that the HyFoSy exam with ExEm ® foam (ExEm Foam Inc., Nashville, Tennessee, United States) was performed, without any additional fertility enhancement interventions.
We present the case of a 54‐year‐old woman diagnosed with uterine leiomyosarcoma that produced be... more We present the case of a 54‐year‐old woman diagnosed with uterine leiomyosarcoma that produced beta‐human chorionic gonadotropin (β‐hCG), evident by both serum and immunohistologic examination. Based on this and similar cases from the available literature, β‐hCG‐producing sarcomas tend to have poorer prognosis, indicating that β‐hCG could potentially be used as a marker of disease status and response to the therapy; however, this association is inconsistent and should be further investigated.
Polycystic Ovary Syndrome - Functional Investigation and Clinical Application
Polycystic ovary syndrome (PCOS) is a common and complicated endocrine disorder, with its diagnos... more Polycystic ovary syndrome (PCOS) is a common and complicated endocrine disorder, with its diagnosis based on clinical, laboratory and imaging criteria. The latter is usually assessed via two-dimensional ultrasound; however, the advent of three-dimensional ultrasound, along with three-dimensional power Doppler (3D-PD) could offer more accurate diagnoses and further our understanding of PCOS pathophysiology. Three-dimensional ultrasound (3D-US) has already been used successfully in many fields of gynecology. It offers improved image quality with stored data that can be processed either manually or automatically to assess many parameters useful in PCOS assessment, such as ovarian volume, number of follicles and vascular indices. The examination requires minimal time as data is assessed in post-processing, thus being more tolerable for the patient. 3D-US parameters are generally increased in PCOS patients when compared to controls and 2D measurements, with studies showing improved diagn...
Clinical Research in Obstetrics and Gynecology, 2021
The coronavirus disease-19 pandemic and the consequent public and economic restrictions had a dra... more The coronavirus disease-19 pandemic and the consequent public and economic restrictions had a dramatic impact in assisted reproduction. During the first months of the pandemic, the vast majority of the treatments stopped. The impact was much stronger on the field of cross-border reproductive care (CBRC). Whereas the other assisted reproduction treatments seem to recover slowly along with the softening of public restrictions, CBRC does not. The main reasons for the cessation of CBRC seem to be travel restrictions and the fear for contamination in destination countries, particularly in those countries with a heavy virus load. To our opinion, this situation will trigger changes on the field of CBRC which will remain even after the end of the pandemic.
Journal of minimally invasive gynecology, Jan 18, 2015
This is a case report and literature review regarding early diagnosis and management of a cervica... more This is a case report and literature review regarding early diagnosis and management of a cervical heterotopic pregnancy. A 41 year old gravida 2 para 0 with premature ovarian failure was successfully treated in an in vitro fertilization program with donor oocytes. A transvaginal ultrasound scan revealed the presence of a heterotopic pregnancy; one intrauterine and one intracervical. Both embryos presented with positive heart beats. Aspiration of the cervical pregnancy was followed by Foley catheter placement and cervical cerclage suturing. Monitoring of the patient resulted in elective uncomplicated Caesarean section at 38 weeks following an uneventful pregnancy. Since no guidelines exist for the management of heterotopic cervical pregnancy, literature review is conducted suggesting the most effective method. The value of early diagnosis and management is concluded from the literature, in support of our management principles.
Aim To compare the efficacy of three methods: the levels of anti-müllerian hormone (AMH), the lev... more Aim To compare the efficacy of three methods: the levels of anti-müllerian hormone (AMH), the levels of follicle stimulating hormone (FSH) and the antral follicle count (AFC), for the prediction of the number of retrieved mature oocytes and the number of generated embryos by intracytoplasmic sperm injection (ICSI) in women stimulated with a GnRH-antagonist protocol. Materials and methods 105 women were enrolled in the study. At the day 2 of a preceding cycle, AFC was performed and FSH and AMH were measured in serum by immunoenzymatic assays. All women were stimulated with a GnRH-antagonist protocol and ovulation was induced with human chorionic gonadotropin. ICSI was performed in all retrieved mature oocytes. Embryo transfers were performed at days 2-3. According to the oocytes retrieved, patients were categorized as poor (\4), normal (4-12) or high responders ([12). Results AFC and the levels of baseline FSH and AMH were significantly different among poor, normal and high responders. The number of oocytes as well as the number of embryos was negatively correlated with baseline FSH and positively correlated with baseline AMH and AFC, whereas AFC showed the strongest correlation. Stepwise regression analysis indicated AFC and baseline AMH as the most significant parameters for the prediction of the number of oocytes; for the prediction of the number of embryos, the most significant parameter was AFC. Conclusions AFC, baseline AMH and baseline FSH are good predictors for the outcome of ovarian stimulation in GnRH-antagonist cycles. However, AFC appears to have the best predictive value.
Anti-Mullerian Hormone (AMH) was recently introduced as a marker of ovarian reserve in assisted r... more Anti-Mullerian Hormone (AMH) was recently introduced as a marker of ovarian reserve in assisted reproduction. The cutoff values of AMH for prediction of poor response have not yet been determined. Ninety women undergoing their first IVF/ICSI cycle were prospectively included in this clinical, non-interventional study. Baseline AMH, follicle stimulating hormone (FSH) and antral follicle count (AFC) were measured before starting ovarian stimulation. AMH was also measured on day 5 of stimulation and in the follicular fluid of the first aspirated follicle. The predictive value of baseline AMH, day 5 AMH and follicular fluid AMH were assessed comparatively to FSH and AFC for ovarian response. Ovarian response was defined as poor (<4 oocytes), high (>12 oocytes) or normal (≥4 oocytes and ≤12 oocytes). However, only 3 patients met the criterion for high ovarian response and thus analysis was focused on the prediction of poor response. Significant differences were present between poor responders and non-poor responders regarding FSH (p = 0.019), baseline AMH (p = 0.002), AFC (p < 0.001), day 5 AMH (p = 0.005) but not for follicular AMH (p = 0.183). The largest AUC (area under the curve) for poor ovarian response was obtained by AFC (AUC = 0.81) followed by baseline AMH (AUC = 0.70). At a level below 2.74 ng/mL, the sensitivity of the test is 69% and specificity is 70.5%. Baseline AMH is almost as good a predictor for poor ovarian response as AFC.
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Papers by Elias Tsakos