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It has been suggested that inflammatory process at the area of abnormal cesarean scar (niche) harms the endometrial environment and cause infertility, however, data is limited. The aim of this study was to compare the inflammatory characteristics of women with cesarean scar to those without. A prospective study. Hysteroscopic ambulatory clinic. Study population included women that underwent diagnostic hysteroscopy with cesarean uterine scar (study group) that were compared to those without (controls). Women six months from delivery, breastfeeding, with abnormal finding on hysteroscopy or uterine scar other than cesarean were excluded. A syringe was attached to the outlet of the diagnostic hysteroscope and the first 5 cc of 0.9% normal saline fluid used for hydro-dissection were collected. The samples were analyzed for inflammatory factors levels, including: GM-CSF, IFN-gamma, IL-1, IL-2, IL-5, IL-6, IL-7. IL-13, IL-15, IL-17, IL-17F, IL-22, IL-23, IL-31, IL-36 and TNF-alpha. Transvaginal ultrasound was performed after hysteroscopy for women in the study group to characterize the uterine scar. Primary outcome was defined as the difference in the inflammatory factors level. 80 women met inclusion criteria, of them 29(36%) had history of CD and 51(64%) had no uterine scar. Women's demographic and clinical characteristics were comparable between groups. No difference was found in the level of any of the 17 factors collected. Sub-analysis by infertility indication to perform the procedure to all other indications, found IL 33 significantly higher in the infertility group (p=0.02). While comparing only women in the CD group, IL 33 was found to be 25 times higher in the infertility group [61.23(19.84-169.44) vs. 4.61(0-33.72) pg/ml; p=0.004]. This difference was not demonstrated in women without CD (p=0.29). Women undergoing evaluation due to infertility with history of uterine scar have significantly higher level of inflammatory marker IL33. [ABSTRACT FROM AUTHOR]

Study Question: Does the administration of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) mRNA vaccine have an association with ovarian reserve as expressed by circulating anti-Müllerian hormone (AMH) levels?Summary Answer: Ovarian reserve as assessed by serum AMH levels is not altered at 3 months following mRNA SARS-CoV-2 vaccination.What Is Known Already: A possible impact of SARS-CoV-2 infection or vaccination through an interaction between the oocyte and the somatic cells could not be ruled out, however, data are limited.Study Design, Size, Duration: This is a prospective study conducted at a university affiliated tertiary medical center between February and March 2021.Participants/materials, Setting, Methods: Study population included reproductive aged women (18-42 years) that were vaccinated by two Pfizer-BioNTech Covid-19 vaccines (21 days apart). Women with ovarian failure, under fertility treatments, during pregnancy, previous Covid-19 infection or vaccinated were excluded from the study. Blood samples were collected for AMH levels before the first mRNA vaccine administration. Additional blood samples after 3 months were collected for AMH and anti-Covid-19 antibody levels. Primary outcome was defined as the absolute and percentage change in AMH levels.Main Results and the Role Of Chance: The study group consisted of 129 women who received two mRNA vaccinations. Mean AMH levels were 5.3 (±SD 4.29) µg/l and 5.3 (±SD 4.50) µg/l at baseline and after 3 months, respectively (P = 0.11). To account for possible age-specific changes of AMH, sub-analyses were performed for three age groups: <30, 30-35 and >35 years. AMH levels were significantly lower for women older than 35 years at all times (P = 0.001 for pre and post vaccination AMH levels versus younger women). However, no significant differences for the changes in AMH levels before and after vaccinations (Delta AMH) were observed for the three age groups (P = 0.46). Additionally, after controlling for age, no association was found between the degree of immunity response and AMH levels.Limitations, Reasons For Caution: Although it was prospectively designed, for ethical reasons we could not assign a priori a randomized unvaccinated control group. This study examined plasma AMH levels at 3 months after the first vaccination. It could be argued that possible deleterious ovarian and AMH changes caused by the SARS-CoV-2 mRNA vaccinations might take effect only at a later time. Only longer-term studies will be able to examine this issue.Wider Implications Of the Findings: The results of the study provide reassurance for women hesitant to complete vaccination against Covid 19 due to concerns regarding its effect on future fertility. This information could be of significant value to physicians and patients alike.Study Funding/competing Interest(s): The study was supported by Sheba Medical Center institutional sources. All authors have nothing to disclose.Trial Registration Number: The study protocol was approved by the 'Sheba Medical Center' Ethical Committee Review Board (ID 8121-21-SMC) on 8 February 2021 and was registered at the National Institutes of Health (NCT04748172). [ABSTRACT FROM AUTHOR]

Study Question: Is there a difference in the breast cancer risk among women who underwent ART treatments compared to those who underwent medically assisted reproduction (MAR) infertility treatments or women of reproductive age in the general population?Summary Answer: The risk of breast cancer among women treated by ART was similar to the risk among women treated by MAR and women who did not undergo fertility treatments.What Is Known Already: Studies investigating breast cancer risk in women who have undergone fertility treatments have provided conflicting results.Study Design, Size, Duration: A retrospective, population-based cohort study included women who underwent ART or MAR treatments and women who did not undergo fertility treatments from 1994 to 2019.Participants/materials, Setting, Methods: Women who underwent ART were matched one to one with women who underwent MAR treatments and one to one with woman from the general population of reproductive age, by year of birth and year of first delivery or nulliparity status. MAR women were also matched to ART women by treatment initiation calendar year. All included women were members of Maccabi Healthcare Services. Data regarding demographics, fertility treatments, BRCA mutation and possible confounders were obtained from the computerized database of electronic health records. The incidence of breast cancer after fertility treatments was compared to the matched controls.Main Results and the Role Of Chance: Of 8 25 721 women of reproductive age, 32 366 women who underwent ART were matched with patients treated by MAR (n = 32 366) and 32 366 women of reproductive age. A total of 984 women (1.0%) were diagnosed with breast cancer (mean follow-up period, 9.1 ± 6.3 years; interquartile range [IQR], 3.8-13.7 years). The incidence rates of breast cancer per 10 000 person-years were 11.9 (95% CI, 10.7-13.3), 10.7 (95% CI, 9.6-11.9) and 10.7 (95% CI, 9.6-12.0) in the ART group, MAR group and general population, respectively. The crude risk for breast cancer was similar in the ART group compared with the general population (hazard ratio (HR) = 1.10, 95% CI, 0.94-1.28) and in the ART group compared with the MAR group (HR = 1.00, 95% CI, 0.86-1.16). Further adjustment for age, BMI, smoking, socioeconomic status and parity did not substantially impact the hazard rates for breast cancer (ART vs general population: HR = 1.10, 95% CI, 0.94-1.28; ART vs MAR: HR = 0.99, 95% CI, 0.85-1.16). Among women diagnosed with breast cancer, the prevalence of BRCA1/2 mutations and tumour staging did not differ between the ART, MAR and general population groups. Among women who underwent ART, no correlation was found between breast cancer and the number of ART cycles or the use of recombinant medications or urine-derived medications.Limitations, Reasons For Caution: The mean age of women at the end of follow-up was only 42 years thus the study was not powered to detect potential differences in the risk of postmenopausal breast cancer. In addition, we did not sub-classify the exposed patients by the reason for infertility.Wider Implications Of the Findings: Breast cancer incidence following ART was comparable to that in the general population or following MAR. Women undergoing fertility treatments and their clinicians may be reassured about the safety of assisted reproduction technologies in terms of premenopausal breast cancer risk.Study Funding/competing Interest(s): No specific funding was used and there are no competing interests.Trial Registration Number: N/A. [ABSTRACT FROM AUTHOR]