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  • Kapalı Erişim
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    Adenomyosis and uterine fibroids: Two distinct yet overlapping clinical entities
    (MDPI Publishing, 2026) Pecorella, Giovanni; Morciano, Andrea; Medvediev, Mykhailo; Sparic, Radmila; Bıyık, İsmail; Aydın, Gerçek; Baldini, Giorgio Maria; Malvasi, Antonio; Stojković, Marta; Tinelli, Andrea
    Adenomyosis and uterine fibroids are among the most common benign uterine disorders in women of reproductive age and represent major causes of abnormal uterine bleeding, pelvic pain, and infertility. Despite their distinct histopathological features, they frequently coexist and share several hormonal and molecular mechanisms, making diagnosis and treatment challenging. This narrative review examines the current evidence on their epidemiology, pathophysiology, clinical presentation, imaging characteristics, reproductive impact, and therapeutic management, with particular attention to the role of imaging in the differential diagnosis and management of coexisting disease. A non-systematic narrative review of the literature was conducted using PubMed/MEDLINE and Scopus. Relevant original studies, systematic reviews, meta-analyses, consensus statements, and clinical guidelines addressing adenomyosis, uterine fibroids, imaging, fertility, and treatment were considered. Additional references were identified through manual screening of the bibliographies of the retrieved articles. Although adenomyosis and uterine fibroids differ in their biological origin and morphological appearance, they commonly present with overlapping symptoms, including heavy menstrual bleeding, dysmenorrhea, chronic pelvic pain, and reproductive dysfunction. Transvaginal ultrasound remains the first-line imaging modality, whereas magnetic resonance imaging is particularly valuable in complex cases, lesion characterization, and preoperative assessment. Accurate imaging phenotyping may help distinguish isolated from coexisting disease and support individualized medical, surgical, or minimally invasive treatment planning. A structured imaging-based approach integrated with clinical findings and reproductive goals may improve disease characterization and support individualized management of adenomyosis and uterine fibroids. Further standardization of imaging criteria and validation of emerging diagnostic technologies may improve patient stratification and treatment selection.
  • Küçük Resim
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    Efficacy-oriented approach for medium-sized follicles: A perspective on stimulation, expectation, and triggering strategy in IVF cycles
    (Wiley, 2026) Aydın, Gerçek; Ergin, Elif; Araç, Merve; Bülbül, Mehmet; Çalışkan, Eray; Hatırnaz, Şafak; Dahan, Michael; Malvasi, Antonio; Tinelli, Andrea
    Objective: To assess the therapeutic significance of routinely aspirating mid-sized fol licles (14.0–16.9 mm) during oocyte pick-up (OPU) by looking at procedural efficiency and embryo usage in cycles with varied follicular cohorts. Methods: In vitro fertilization (IVF) cycles with follicles classified as large (≥17 mm) or mid-sized (14.0–16.9 mm) at the time of OPU were included in this prospective cohort. Each group's oocytes were extracted and treated independently while main taining rigorous traceability. Analysis was performed on embryologic results, opera tive time factors, and embryo transfer utilization across successive transfer attempts. Pregnancy outcomes and the length of the operation were investigated. Laboratory results pertaining to trigger strategies were assessed descriptively. Results: When measured per mature oocyte, oocytes from mid-sized follicles showed comparable fertilization and blastocyst development rates. However, only a small percentage of embryo transfers included embryos from mid-sized follicles, especially in the initial two transfer attempts. Large follicles had a longer total OPU duration, and cycles that resulted in miscarriage had significantly longer operative times among large-follicle-derived embryo transfers. For mid-sized follicles, there were no differ ences in the length of the procedure based on the pregnancy outcome. Conclusion: The contribution of mid-sized follicle-derived oocytes to embryo trans fer selection seems to be restricted in everyday practice, despite their reassuring laboratory competence. Procedural efficiency is a potentially significant factor in customized IVF care, as evidenced by the correlation between longer operating times and worse clinical outcomes. In certain clinical situations, a focused stimula tion and aspiration approach might be suitable without obviously jeopardizing cu mulative results.