Jerzy Florjański

Background: Endometriosis affects 10–15% of reproductive-aged women and is a leading cause of infertility through anatomical, inflammatory, and molecular mechanisms. Objective: This review synthesizes current evidence on the pathophysiology of endometriosis-associated infertility and evaluates medical, surgical, and ART strategies to guide individualized management. Methods: We conducted a narrative review (2000–2025; PubMed, Scopus, WoS) synthesizing RCTs, meta-analyses, and observational studies on mechanisms and treatment outcomes. Results: In rASRM stage III–IV, tubo-ovarian distortion and adhesions mechanically impair oocyte pickup and embryo transport. In superficial disease, animal models demonstrate that peritoneal inflammatory mediators and ROS can impair oocyte maturation, though direct causal evidence in humans is lacking. Epigenetic dysregulation has been identified in the eutopic endometrium and linked to progesterone resistance, though its direct causal role in infertility remains unestablished. Hormonal suppression controls pain but does not improve spontaneous conception rates. Laparoscopic surgery in stage I–II remains debated. Prospective evidence supporting fertility benefit from DIE excision without mechanical obstruction is lacking. Cystectomy consistently reduces AMH, favoring IVF over surgery unless symptoms or retrieval barriers exist. IVF/ICSI live birth rates per cycle in stage I–II are comparable to those without endometriosis; cumulative rates after ≤5 cycles reach 43–46% in treated vs. 28% in untreated stage III–IV patients. Conclusions: Management requires two sequential decisions: first, whether to perform a diagnostic laparoscopy to identify minimal disease and adhesions, and second, whether to proceed with surgery or transfer directly to ART. Age ≥ 35, infertility > 2 years, or low AMH/AFC favor immediate IVF. Post-surgical EFI guides timing: high EFI supports expectant management or IUI; low EFI should prompt ART referral. When cystectomy is necessary, tissue-sparing techniques should be prioritized and fertility preservation, including oocyte cryopreservation, discussed preoperatively.

Background/Objectives: Twin pregnancies have long been of interest to the scientific community. Particular attention has been paid to factors influencing the postnatal condition of newborns. However, findings related to this issue, obtained in various centres, remain inconclusive. Methods: Data from 845 pairs of twins born between 1990 and 2017 at the University Centre of Obstetrics and Gynecology in the Wroclaw Medical University were analyzed. The postnatal condition was assessed based on the Apgar score at the 5th minute after birth. The Apgar scores were categorized into three groups: 8–10 indicated a good condition, 4–7 moderate, and 0–3 poor. Pregnancies with unknown chorionicity and amnionicity, monochorionic and monoamniotic pregnancies, still births, and cases with fetal defects were excluded from the study (126 cases). Finally, data of 719 pairs of twins were included. Results: Twins with a birth weight difference of less than 15% were more likely to receive a good Apgar score compared to those with a greater weight discrepancy (p < 0.001). The second-born twin was more likely to receive a good Apgar score compared to the first-born (p < 0.001). A higher proportion of twins delivered by cesarean section received a good Apgar score compared to those delivered vaginally (p < 0.001). The method of conception, chorionicity, amnionicity and being the smaller or bigger twin in the pair did not significantly affect the perinatal outcomes. Conclusions: Delivery method, birth order, and weight discrepancy play a key role in postnatal condition of twins, highlighting the importance of understanding these factors to optimize the management of twin pregnancies.

Background/Objectives: The pubic symphysis is formed by the fusion of the right and left pubic bones. The metrics, such as breadth, length, and depth, increase during pregnancy and can be measured and analyzed using standard sonography. Obstetricians require clear and consistent criteria for standard sonography evaluation. Methods: Sonographic examinations were performed on a cohort of 225 pregnant women, aged between 23 and 41 years, as part of a prospective observational study. The parameters measured included pubic symphysis entry middle width, intertubercular distance, pubic symphysis width, and pubic symphysis depth. Results: The width of the pubic symphysis exhibited the greatest consistency, measuring between 2.2 and 11.3 mm, whereas the depth displayed the highest variability, ranging from 5.4 to 22.6 mm. The measurements most correlated with fetal weight included pubic symphysis entry width (6.5 ± 3.4 mm; p ˂ 0.001), pubic symphysis width (6.4 ± 2.9 mm; p ˂ 0.001), and depth (14.8 ± 4.8 mm; p = 0.03). The intertubercular distance exhibited the strongest correlation with maternal age (15.1 ± 5.4 mm; p = 0.03). In contrast, pubic symphysis entry width (6.4 ± 3.3 mm; p = 0.02; 6.4 ± 3.4 mm; p ˂ 0.001) and pubic symphysis width (6.3 ± 2.6 mm; p = 0.01; 6.3 ± 2.6; p ˂ 0.001) demonstrated stronger associations with maternal weight and weight gained during pregnancy, respectively. In the singular pregnancy group, the width of the pubic symphysis exhibited significant correlations with fetal weight categories: under or equal to 1000 g (4.56 ± 1.5 mm; p = 0.02), 1001–2000 g (5.51 ± 2.6 mm; p = 0.02), and more than 3000 g (7.3 ± 3.9 mm; p = 0.02). Pubic symphysis entry width is significantly correlated with fetal weight in the range of 1001–2000 g (5.5 ± 3 mm; p = 0.02) and fetal weight exceeding 3000 g (7.4 ± 3.9 mm; p = 0.02). In singular pregnancies, statistically significant differences were noted in intertubercular distance (15.9 ± 7.2 mm vs. 13.4 ± 6.2 mm; p = 0.03) when comparing fetuses weighing 2000 g or less between nulliparous and multiparous women. Conclusions: Fetal and maternal weight were the primary parameters that were positively correlated with these measurements. The term ‘pubic symphysis entry’ is proposed to describe a trapezoidal space situated superior to the pubic symphysis disc, delineated by an imaginary line connecting the bilateral pubic tubercles.