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Ovulatory disorders are common causes of amenorrhea, abnormal uterine bleeding and infertility and are frequent manifestations of polycystic ovary syndrome (PCOS). There are many potential causes and contributors to ovulatory dysfunction that challenge clinicians, trainees, educators, and those who perform basic, translational, clinical and epidemiological research. Similarly, therapeutic approaches to ovulatory dysfunction potentially involve a spectrum of lifestyle, psychological, medical and procedural interventions. Collaborative research, effective education and consistent clinical care remain challenged by the absence of a consensus comprehensive system for classification of these disorders. The existing and complex system, attributed to the World Health Organization (WHO), was developed more than three decades ago and did not consider more than 30 years of research into these disorders in addition to technical advances in imaging and endocrinology. This article describes the development of a new classification of ovulatory disorders performed under the aegis of the International Federation of Gynecology and Obstetrics (FIGO) and conducted using a rigorously applied Delphi process. The stakeholder organizations and individuals who participated in this process comprised specialty journals, experts at large, national, specialty obstetrical and gynecological societies, and informed lay representatives. After two face-to-face meetings and five Delphi rounds, the result is a three-level multi-tiered system. The system is applied after a preliminary assessment identifies the presence of an ovulatory disorder. The primary level of the system is based on an anatomic model (Hypothalamus, Pituitary, Ovary) that is completed with a separate category for PCOS. This core component of the system is easily remembered using the acronym HyPO-P. Each anatomic category is stratified in the second layer of the system to provide granularity for investigators, clinicians and trainees using the 'GAIN-FIT-PIE' mnemonic (Genetic, Autoimmune, Iatrogenic, Neoplasm; Functional, Infectious and Inflammatory, Trauma and Vascular; Physiological, Idiopathic, Endocrine). The tertiary level allows for specific diagnostic entities. It is anticipated that, if widely adopted, this system will facilitate education, clinical care and the design and interpretation of research in a fashion that better informs progress in this field. Integral to the deployment of this system is a periodic process of reevaluation and appropriate revision, reflecting an improved understanding of this collection of disorders.

PurposeToday, male and female adult and pediatric cancer patients, individuals transitioning between gender identities, and other individuals facing health extending but fertility limiting treatments can look forward to a fertile future. This is, in part, due to the work of members associated with the Oncofertility Consortium.MethodsThe Oncofertility Consortium is an international, interdisciplinary initiative originally designed to explore the urgent unmet need associated with the reproductive future of cancer survivors. As the strategies for fertility management were invented, developed or applied, the individuals for who the program offered hope, similarly expanded. As a community of practice, Consortium participants share information in an open and rapid manner to addresses the complex health care and quality-of-life issues of cancer, transgender and other patients. To ensure that the organization remains contemporary to the needs of the community, the field designed a fully inclusive mechanism for strategic planning and here present the findings of this process.ResultsThis interprofessional network of medical specialists, scientists, and scholars in the law, medical ethics, religious studies and other disciplines associated with human interventions, explore the relationships between health, disease, survivorship, treatment, gender and reproductive longevity.ConclusionThe goals are to continually integrate the best science in the service of the needs of patients and build a community of care that is ready for the challenges of the field in the future.

Purpose In the accompanying article, “Survey of Fertility Preservation Options Available to Patients With Cancer Around the Globe,” we showed that specific fertility preservation services may not be offered at various sites around the world because of cultural and legal barriers. We assessed global and regional experiences as well as the legal status of third-party reproduction and adoption to serve as a comprehensive international data set and resource for groups that wish to begin oncofertility interventions. Methods We provide data on the legalities of third-party assisted reproductive technologies and other family-building options in the 28 oncofertility-practicing countries surveyed. Results We found regional and country differences that will be important in the development of tailored resources for physicians and for patient brochures that are sensitive to these local restrictions and cultural norms. Conclusion Because many patients first consult Web-based materials, the formal assessment of the availability of these options provides members of the global oncofertility community with data to which they might otherwise not have ready access to better serve their patients.

PURPOSEOncofertility practice continues to grow in developing countries despite the lack of health care services, especially those related to cancer care. The purpose of this study is to further explore oncofertility practice in these countries and identify opportunities for field-wide coalescence.METHODSWe generated a survey to learn more about oncofertility practice in nine developing countries within our Oncofertility Consortium Global Partners Network—Mexico, Colombia, Guatemala, Argentina, Chile, Nigeria, South Africa, Saudi Arabia, and India. Their responses were collected, reviewed, and discussed.RESULTSSurveyed centers from the nine developing countries continue to experience a similar set of common challenges, including a lack of awareness among providers and patients, cultural and religious constraints, lack of insurance coverage and funding to help to support oncofertility programs, and high out-of-pocket costs for patients. Despite these barriers, many opportunities exist and there is great potential for the future.CONCLUSIONThe current need is to unify the new technologies and best practices that emerge from rural communities and developing countries with those in large metropolitan cities, both domestically (US based) and abroad, into a functional unit: the Oncofertility Professional Engagement Network. The Oncofertility Professional Engagement Network will bridge the gap between domestic and international programs to establish a strong global network in which members share resources, methodologies and experiences and further build cultural competency.

Purpose Oncofertility focuses on providing fertility and endocrine-sparing options to patients who undergo life-preserving but gonadotoxic cancer treatment. The resources needed to meet patient demand often are fragmented along disciplinary lines. We quantify assets and gaps in oncofertility care on a global scale. Methods Survey-based questionnaires were provided to 191 members of the Oncofertility Consortium Global Partners Network, a National Institutes of Health–funded organization. Responses were analyzed to measure trends and regional subtleties about patient oncofertility experiences and to analyze barriers to care at sites that provide oncofertility services. Results Sixty-three responses were received (response rate, 25%), and 40 were analyzed from oncofertility centers in 28 countries. Thirty of 40 survey results (75%) showed that formal referral processes and psychological care are provided to patients at the majority of sites. Fourteen of 23 respondents (61%) stated that some fertility preservation services are not offered because of cultural and legal barriers. The growth of oncofertility and its capacity to improve the lives of cancer survivors around the globe relies on concentrated efforts to increase awareness, promote collaboration, share best practices, and advocate for research funding. Conclusion This survey reveals global and regional successes and challenges and provides insight into what is needed to advance the field and make the discussion of fertility preservation and endocrine health a standard component of the cancer treatment plan. As the field of oncofertility continues to develop around the globe, regular assessment of both international and regional barriers to quality care must continue to guide process improvements.

Objetivo: Describir las tasas de recién nacidos vivos (RNV) y embarazo de la terapia de reproducción médicamente asistida de baja complejidad del Centro de Reproducción Humana de la Universidad de Valparaíso, Chile. Método: Estudio retrospectivo de todos los ciclos de estimulación ovárica controlada con inseminación intrauterina (IIU) completados, entre los años 2011 y 2019. Se evaluaron las características clínicas basales y los resultados en IIU homólogas y heterólogas según el ciclo inseminado, la causa de infertilidad, el rango etario y el índice de masa corporal (IMC). El desenlace principal fue la tasa de RNV por ciclo inseminado. Resultados: Se estudiaron 1415 ciclos en 700 parejas. La tasa acumulativa de RNV fue del 19,6%, un 18,3% en IIU homóloga y un 39,0% en IIU heteróloga. La tasa de RNV fue del 10,0% al primer ciclo, del 5,8% al segundo ciclo y del 3,7% al tercer o más ciclos. Al separar por IIU heteróloga, esta aumenta al 24,4% al primer ciclo y al 14,6% al segundo ciclo. La tasa de RNV es significativamente mejor en pacientes menores de 35 años (23,7%) y con IMC < 29 (20,8%). Conclusiones: El tratamiento de baja complejidad en pacientes infértiles es una opción terapéutica vigente con una aceptable tasa de RNV por ciclo inseminado. Los resultados están influenciados por la edad y por el IMC.

BackgroundBurnout interventions are limited by low use. Understanding resident physician preferences for burnout interventions may increase utilization and improve the assessment of these interventions. ObjectiveThis study aims to use an econometric best-worst scaling (BWS) framework to survey internal medicine resident physicians to establish help-seeking preferences for burnout and barriers to using wellness supports by quantifying selections for 7 wellness support options and 7 barriers. MethodsInternal medicine resident physicians at our institution completed an anonymous web-based BWS survey during the 2020-2021 academic year. This cross-sectional study was analyzed with multinomial logistic regression and latent class modeling to determine the relative rank ordering of factors for seeking support for burnout and barriers to using wellness supports. Analysis of variance with Tukey honest significant difference posthoc test was used to analyze differences in mean utility scores representing choice for barriers and support options. ResultsOf the 163 invited residents, 77 (47.2% response rate) completed the survey. Top-ranking factors for seeking wellness supports included seeking informal peer support (best: 71%; worst: 0.6%) and support from friends and family (best: 70%; worst: 1.6%). Top-ranking barriers to seeking counseling included time (best: 75%; worst: 5%) and money (best: 35%; worst: 21%). ConclusionsOverall, our findings suggest that low utilization of formal mental health support is reflective of resident preferences to seek help informally and that increasing utilization will require addressing pragmatic barriers of time and cost. Assessing physician preferences for wellness-related initiatives may contribute to understanding the low utilization of formal mental health services among physicians, which can be determined using a BWS framework.

PURPOSE: Oncofertility practice continues to grow in developing countries despite the lack of health care services, especially those related to cancer care. The purpose of this study is to further explore oncofertility practice in these countries and identify opportunities for field-wide coalescence. METHODS: We generated a survey to learn more about oncofertility practice in nine developing countries within our Oncofertility Consortium Global Partners Network—Mexico, Colombia, Guatemala, Argentina, Chile, Nigeria, South Africa, Saudi Arabia, and India. Their responses were collected, reviewed, and discussed. RESULTS: Surveyed centers from the nine developing countries continue to experience a similar set of common challenges, including a lack of awareness among providers and patients, cultural and religious constraints, lack of insurance coverage and funding to help to support oncofertility programs, and high out-of-pocket costs for patients. Despite these barriers, many opportunities exist and there is great potential for the future. CONCLUSION: The current need is to unify the new technologies and best practices that emerge from rural communities and developing countries with those in large metropolitan cities, both domestically (US based) and abroad, into a functional unit: the Oncofertility Professional Engagement Network. The Oncofertility Professional Engagement Network will bridge the gap between domestic and international programs to establish a strong global network in which members share resources, methodologies and experiences and further build cultural competency.

Resumen En los últimos años, los avances médicos han mejorado sustancialmente la sobrevida de los pacientes con cáncer, generando una mayor preocupación por la calidad de vida de los sobrevivientes. En particular, se ha prestado una creciente atención a los problemas reproductivos posteriores a los tratamientos oncológicos. Las pautas internacionales sobre la preservación de la fertilidad en pacientes con cáncer, recomiendan que los equipos de salud debatan lo más pronto posible con todos los pacientes en edad reproductiva el impacto de la terapia sobre el sistema reproductor. También insta a que se disponga y facilite el acceso oportuno a técnicas de preservación de la fertilidad. El desarrollo de estas técnicas en mujeres pre y post puberales son un esfuerzo reciente, y muchos pacientes y proveedores de la salud no están familiarizados con el rápido avance en su investigación. En la presente revisión se exponen las indicaciones, resultados y riesgos de las diferentes opciones disponibles en la actualidad.

A mediados de la década de los 80, se introdujeron procedimientos que eliminan el espesor completo del endometrio como tratamiento del sangrado menstrual profuso. A pesar de que en el mundo, el número y la popularidad de estas técnicas, conocida como ablación endometrial, se ha incrementado ostensiblemente, en nuestro país continúa siendo una herramienta poco difundida y subutilizada. Este artículo aborda de manera crítica la racionalidad, indicaciones y complicaciones, de la ablación endometrial en el manejo del sangrado menstrual profuso, considerando su utilidad clínica frente a otras alternativas de tratamiento.In the mid 80's, procedures were introduced to eliminate the entire thickness of the endometrium as treatment of heavy menstrual bleeding. Although in the world, the number and popularity of these techniques, known as endometrial ablation has increased considerably, in our country remains a little known and underutilized tool. This article critically discusses the rationale, indications and complications of the endometrial ablation in the management of heavy menstrual bleeding, considering their clinical utility over other alternative treatments.

Objetivo: Dar a conocer la técnica de linfadenectomía lumboaórtica sistemática (LLS) en el cáncer de en-dometrio y ovario, así como los resultados quirúrgicos obtenidos con ella en éste grupo de pacientes. Método: Se presenta una cohorte prospectiva de pacientes portadoras de cáncer de endometrio y ovario que requieren LLS entre agosto de 2005 y marzo de 2008. Se describe la técnica empleada y los resultados obtenidos. Resultados: 76 pacientes portadoras de cáncer de endometrio y ovario son sometidas a LLS. La edad promedio es de 57 años; 40 pacientes (52,6%) presentan cáncer de endometrio y 35 (46%) cáncer de ovario. El tiempo operatorio promedio fue de 55 minutos y el sangrado estimado de 120 mi. Se obtiene un recuento ganglionar promedio de 25,4 ganglios. Fallecen 2 pacientes y otra debe ser intervenida en el postoperatorio por hemoperitoneo. Conclusión: La técnica descrita es fácilmente realizable, con mínimas complicaciones y con una adecuada exposición del retroperitoneo, lo que permite obtener un número de ganglios necesarios para la etapificación del cáncer de endometrio y ovario.Objective: To reports and describes the results of the paraaortic lymphadenectomy technique in the mana-gement of endometrial and ovarían cáncer. Methods: We report a prospective cohort of patients with diagnosis of endometrial and ovarían cáncer that required a systematic paraaortic lymphadenectomy, between August 2005 and March 2008, describing the surgical technique and the main results. Results: During this period seventy-six patients carrying endometrial or ovarían cáncer are submitted to a systematic paraaortic lymphadenectomy. The average age was 57 years; 40 patients (52.6%) diagnosed with an endometrial cáncer and 35 (46%) with an ovarían one. The average surgical time was 55 minutes, with an estimated bleeding of 120 mi. We obtained an average of 25.4 lymph nodes. Two patients deceased in this cohort and one was reintervened for a hemoperitoneum. Conclusión: The described surgical technique is feasible, with minimal complications and allows an appropriate exposure of the retroperitoneum to obtain an adequate number of lymph nodes for endometrial and ovarían cáncer staging.

Objetivo: Describir los resultados de la laparoscopia abierta para certificar el diagnóstico y evaluar la re-secabilidad tumoral de pacientes con cáncer de ovario avanzado (COA). Método: Se analizaron todas las fichas de pacientes con sospecha diagnóstica de COA entre octubre de 2005 y febrero de 2007 inicialmente manejadas con laparotomía abierta. Resultados: En 14 pacientes se certifico el diagnóstico de COA, de ellas se estimó posible la resecabilidad completa en 10 casos, lo cual se logró efectivamente en 9. En 4 casos la evaluación laparoscópica indicó irresecabilidad, derivándose las pacientes a quimioterapia neoadyu-vante para una posterior cirugía de intervalo. Conclusión: Creemos que la laparoscopia en pacientes con sospecha de COA, podría cumplir un rol importante en la evaluación de la resecabilidad así como en la confirmación diagnóstica, evitando extensas laparotomías en pacientes inoperables en primera instancia y donde el inicio de una quimioterapia precoz podría mejorar significativamente su sobrevidaObjective: To describe the results of open laparoscopy to confirm the diagnosis and to evalúate resectability in patients with advanced ovarían cáncer (AOC). Methods: Analysis of medical records of all the patients with suspected AOC between October 2005 and February 2007, initially managed with open laparoscopy. Results: In 14 patients we confirmed the diagnosis of AOC. We considered feasibility of optimal cytoreduc-tion in 10 cases and it was possible in 9 of them. The others 4 cases were judged to be inoperable and were derived to neoadjuvant chemotherapy. Conclusions: We believe than open laparoscopy in suspected AOC's patients could be and important tool in the evaluation of patients with ovarían cáncer, to confirm the diagnosis and avoid unnecessary laparotomies in inoperable patients in which neoadjuvant chemotherapy and interval cytoreduction surgery may improve survival

La rotura uterina es una complicación obstétrica infrecuente, pero potencialmente letal para la madre y el feto. Ocurre principalmente durante el segundo o tercer trimestre, asociada a factores de riesgo, entre los que destaca la cirugía uterina previa. Su aparición durante el primer trimestre es excepcional, constituyendo un desafío médico por su difícil diagnóstico diferencial y controversial manejo. Se presenta el caso de una paciente con rotura espontánea de útero grávido de 10 semanas de gestación, portadora de triple cicatriz anterior. El diagnóstico fue intraoperatorio, tras la descompensación hemodinámica de la paciente. El manejo incluyó el cierre primario de la lesión y observación posterior. Al sexto día se constata la muerte fetal y se efectúa el vaciamiento de la cavidad uterina. La falla de las medidas conservadoras obligó finalmente a realizar una histerectomía obstétrica. La histopatología informó placenta acreta.Uterine rupture is an uncommon obstetric event, but still potentially lethal for the mother and the fetus. It presents mainly during the second orthird trimester and is associated with several riskfactors, being a pre-vious uterine scarthe most important of them. Its presentation during the first trimester is exceptional, and it constitutes a medical challenge, because of its difficult differential diagnosis and controversial management. A case of a multiparous, previous triple scar woman is presented, with a spontaneous uterine rupture at 10 weeks of pregnancy. In this case the diagnosis was made during surgery, after the patient's hemodynamic decompensation. The management included primary closure of the lesión and observation; when fetal death was confirmed, dilatation and curettage of the cavity had to be performed. Because of the failure of conser-vative management, an obstetric hysterectomy was carried out. Histopathology reported placenta accreta.

Seeks to resolve certain questions pertaining to the relationship between gender and second-language vocabulary knowledge. One particular question examined was whether female and male English-as-a-Second-Language students at the University of California at Irvine differ significantly in their knowledge of academic vocabulary in English as measured by scores on the Test of Academic Lexicon. (Author/JL)

Las malformaciones del sistema nervioso central son la segunda malformación más frecuente en recién nacidos. La elección de la vía de parto es controversial. Nuestro centro ha adoptado el parto cesárea como de elección para resolver tales casos mediante laparotomía tipo Pfannenstiel y longitudinal media infraumbilical. La observación de algunas dificultades que ambas técnicas presentan nos llevó a adaptar, un abordaje extraído de la oncoginecología, a la práctica obstétrica. Presentamos 7 casos de malformaciones del sistema nervioso central resueltos satisfactoriamente mediante laparotomía de Giordano-Cherney. La cirugía se realizó en forma electiva con un tiempo promedio de 72 minutos. No se registraron complicaciones en el intra o post operatorio. El manejo del dolor se realizó en forma rutinaria. Todas las pacientes evolucionaron favorablemente. No se presentaron complicaciones en los recien nacidos atribuibles a la cirugíaThe central nervous system malformations are the second more frequent malformation in new born. The election of the way of delivery is controversial. Our center has adopted the cesarean section to resolve such cases, using either a Pfannenstiel laparotomy or a longitudinal infraumbilical section. The observation of some difficulties in both techniques carried us to adapt, a oncoginecological technique, to the obstetric practice. We present 7 cases with central nervous malformations resolved satisfactorily using a Giordano-Cherney laparotomy. The surgery was carried out in elective form, with an average time of 72 minutes. No complications were registered intra or post surgery. The pain management was carried out in routine form. All patients evolved satisfactorily. No complications in new born where attributed to surgery

Presentamos 50 pacientes portadoras de prolapso genital posterior sometidas a reparación con malla de prolene tunelizada y aplicación de cinta de prolene transelevador como profilaxis del prolapso de pared vaginal posterior, ingresadas al servicio de Ginecología del Hospital Carlos Van Buren entre Diciembre de 2004 y Febrero de 2006. El diagnóstico preoperatorio fue prolapso genital completo en 38 mujeres, prolapso de pared vaginal anterior y posterior en 8, prolapso de cúpula en 3 y prolapso de pared vaginal posterior en una. En 30 pacientes se asoció además incontinencia urinaria de esfuerzo. 92% de las pacientes evolucionan en forma satisfactoria en el seguimiento intra y postoperatorio con restauración de la anatomía del piso pelviano y sin complicaciones mayores. Creemos que es necesario un seguimiento mayor para validar en forma definitiva esta técnica, aún cuando en nuestro estudio este procedimiento resulta superior al que utiliza el "puente mucoso" para reparar la pared posteriorWe present 50 patients carrying later genital prolapse who went under repair with a prolene mesh and a posterior intravaginal sling as a prophylaxis of the posterior vaginal prolapsed wall, entered to the service of Gynecology of the Carlos Van Buren Hospital between December 2004 and February 2006. The preoperating diagnosis was complete genital prolapse in 38 women, prolapse of previous and later vaginal wall in 8, prolapse of the cupula in 3 and prolapse of the later vaginal wall in one. In 30 patients urinary incontinencia to effort was associated in addition. 92% of the patients evolve in satisfactory form in the intra and postoperative pursuit with restoration of the anatomy of the pelvian floor and without greater complications. We believe that a greater pursuit is necessary to validate this technique completely, even though in our present study this procedure is superior to which uses the "mucous bridge" to repair the later wall

Presentamos 16 pacientes sometidas a Histerectomía vaginal con o sin Plastia vaginal portadoras de IUE, en que efectuamos la técnica tipo TVT Obturador entre abril y julio de 2003 en nuestra Unidad. La edad promedio fue de 49 años. Nueve pacientes tienen IUE y 7 mixta. Diez pacientes presentan miomatosis -adenomiosis y 5 prolapso genital. Un caso corresponde a una paciente histerectomizada previamente. El tiempo operatorio promedio fue de 12 minutos. La estadía postoperatoria fue de 2,4 días. Quince pacientes relatan continencia total y una parcial. No se registraron complicaciones en ésta casuísticaWe present 16 patients that were submitted to vaginal hysterectomy with or without vaginal plastic repair, carriers of stress incontinence of urine. At the same time they had the correction of their incontinence with a tension free vaginal tape (TVT) device. This was done in between April and July of 2003. Average age was 49 years. 9 patients had germine SIU and in 5 even, was mixed. Ten had fibroid uterine or adenomyosis and five were operated for prolapse. One patient had a previous hysterectomy. Operating time was 12 minutes. Stay after surgery was of 2.4 days. Fifteen patient were completly continent and one was partially continent during the follow-up. There were no complications