Measuring IVF Success: Why the Field Still Lacks Unified Metrics? 2 1 140282 2 According to the latest statistics released by the International Committee for the Monitoring of Assisted Reproductive Technologies (ICMART) in 2019, a total of 3,855,694 infertility treatment cycles were started worldwide, resulting in 783,073 live births. Considering unreported clinics in the countries studied, these cycles were estimated to increase to more than 3,855,694, corresponding to over 865,914 live births. Given that Asian and African countries lack national registries for mandatory reporting of their IVF cycles data, the number of total worldwide cycles is likely much higher than the estimates and statistics of ICMART (1). Accordingly, it is reported that by 2019, between 10 and 13 million babies had been born through IVF cycles, and from 2019 to 2026, another 6 to 7 million babies will be added to this number, bringing the total to more than 20 million. Every 35 s, a baby is born as a result of assisted reproductive technologies (ARTs), which implies that more than one million babies are born via IVF every year, taking into account the unreported cases. Assuming the reported number of cycles is accurate, dividing the number of babies born by the total number of IVF cycles yields a success rate of around 22%. Is this success rate representative of the figures that IVF centers advertise to encourage couples to undergo infertility treatment? In fact, the percentages provided in their websites or advertisements are often exaggerated. The highly competitive market of private IVF clinics relies heavily on selective reports of success rate to attract and motivate patients for beginning their treatment. The lack of standard reporting criteria allows clinics to use biased metrics, such as live births per embryo transfer, without accounting for failed and cancelled cycles. Clinic websites often act as advertising platforms that present optimistic results and selection criteria with limited transparency. This approach also facilitates demand for ineffective add-on interventions and offers couples a favorable outlook of treatment while lacking transparency about costs; the patient’s actual likelihood of success is uncertain and clinics are not obliged to be held accountable if the cycle fails (2). Presenting IVF outcomes in a standardized format has always been considered elusive, as reporting "success" outcome in ARTs is a multidimensional and complex endeavor involving clinical, financial, and patient-centered perspectives. Despite the enormous revolutions that IVF has brought to the treatment of infertile couples and reproductive medicine, the field still faces serious challenges in defining standard measures of success. Different clinics and registries use different denominators (per cycle, per embryo transfer, per patient) to report their performance, making it cumbersome to compare results, counsel patients, or evaluate technologies and policies across facilities, both nationally and globally. There is currently "a great deal of variation" in how clinics choose to report their success rates. One study reviewed 142 randomized controlled trials and stated that "due to the multistage nature of IVF, there is wide variation in the choice of numerator and denominator in these trials". Over 800 different combinations of numerators and denominators were identified to report the results. This lack of global consensus makes it challenging to compare data from different registries and often leads to a distorted view of clinic performance (3). The unit of analysis critically controls how success rate is measured and interpreted. Reporting success rate based on cycles or transfers systematically underestimates the outcomes at patient-level by integration of repeated cycles, thereby over-representing poor-prognosis patients and distorting comparisons between fresh and frozen cycles. Further bias arises when embryos or oocytes are regarded as independent observations, violating statistical assumptions. In contrast, woman- or couple-based metrics, particularly intention-to-treat and cumulative live birth rate (CLBR) units relating all fresh and frozen transfers of a single cycle, provide more realistic and clinically meaningful estimates of success. The selection of an analytical unit also influences economic evaluation, as resource use and associated costs scale with procedural complexity and the number of embryos rather than with simple cycle counts (2). Currently, add-on interventions offered to couples in IVF cycles exert minimal impact on both success rates and treatment costs despite limited evidence of their clinical benefits. Most of these interventions have not been evaluated by randomized clinical trials for improving live birth outcomes, and regulatory assessments frequently classify them as lacking sufficient and conclusive evidence. Reported higher success rates often are due to selective reporting rather than proven efficacy, and some of these add-on interventions may even compromise IVF cycles through additional embryo manipulation or attrition. They significantly increase costs and laboratory resource utilization that lead to patient attrition as the result of economic burden rather than medical factors. Although add-on interventions are considered for personalization and optimization of IVF for each couple, they often increase apparent efficiency and financial burden; they shift the risk to patients, without significant progress in CLBRs (4). The Birth with Emphasis on Singleton Success at Term (BESST) standard defines IVF success as the live birth rate of a singleton at term (≥37 weeks) per initiated cycle. Through restriction of the numerator to live birth of a singleton at term and using initiated cycles as the denominator, BESST integrates efficacy and safety into a single measure and clearly excludes multiple pregnancies as adverse outcomes of IVF rather than as successful cases. This patient-centered, value-based standard shifts the emphasis from achieving pregnancy to delivery of a healthy baby, provides more meaningful benchmarking, avoids risk-increasing procedures, and improves transparency in reporting results (5). Contemporary reports of IVF success are extremely influenced by methodological choices and market forces rather than clinical efficacy. Cycle-based registries, diverse outcome definitions, and improper units of analysis thoroughly underestimate patient-level success without the possibility of comparing success rates with other clinics and at the global level. These primary limitations are exacerbated by selective reporting of success in private fertility markets, where optimistic metrics and add-on interventions are promoted despite limited evidence of their efficiency. Extensive utilization of IVF add-on interventions further inflates apparent efficiency, increases costs, and contributes to attrition of patients driven by financial rather than clinical factors. Taken together, these situations obscure the true cumulative potential of modern IVF while simultaneously transferring risk and uncertainty to patients. Patient-centered measures such as CLBR, intention-to-treat analyses, and value-based endpoints such as BESST provide more realistic, transparent, and secure assessments of treatment success. Therefore, standardizing outcome definitions, appropriate longitudinal analysis, and improving reporting transparency are essential to restore clinical meaning to IVF success rates, enable fair benchmarking, and support evidence-based patient counseling. Without such reforms, current reporting frameworks will continue to distort effectiveness, favor commercial incentives over clinical value, and undermine informed reproductive decision-making. 201 203 Mohammad Reza MR Sadeghi محمدرضا صادقی Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Reproductive Biotechnology Research Center, Avicenna Research Institute, ACECR Iran sadeghi@avicenna.ac.ir No Keyword 140282.pdf Dyer S, Chambers GM, Jwa SC, Baker VL, Banker M, de Mouzon J, et al. International committee for monitoring assisted reproductive technologies world report: assisted reproductive technology, 2019. Fertil Steril. 2025;124(4):679-93.##Griesinger G, Larsson P. Conventional outcome reporting per IVF cycle/embryo transfer may systematically underestimate chances of success for women undergoing ART: relevant biases in registries, epidemiological studies, and guidelines Hum Reprod Open. 2023;2023(2):hoad018.##Wilkinson J, Roberts SA, Showell M, Brison DR, Vail A. No common denominator: a review of outcome measures in IVF RCTs. Hum Reprod. 2016;31(12):2714-22.##Perrotta M, Hamper J. The crafting of hope: Contextualising add-ons in the treatment trajectories of IVF patients. Soc Sci Med. 2021;287:114317.##Min JK, Breheny SA, MacLachlan V, Healy DL. What is the most relevant standard of success in assisted reproduction? The singleton, term gestation, live birth rate per cycle initiated: the BESST endpoint for assisted reproduction. Hum Reprod. 2004;19(1):3-7.##

A Comparative Analysis of Culture Systems with Human Amniotic Mesenchymal Stem Cells 2 1 140285 2 Background: A “indirect co-culture using mesh” system is commonly employed to maintain spermatogenesis in cancer patients undergoing chemotherapy and radiation. This study aimed to investigate the co-culturing of mouse spermatogonial stem cells (SSCs) with human amniotic mesenchymal stem/stromal cells (hAMSCs) in an optimized environment. Methods: SSCs from 3-6-day-old mice (n=10) were indirectly co-cultured with hAMSCs via mesh for two weeks. Three groups evaluated: control, SSCs with conditioned media, and SSCs indirectly co-cultured with hAMSCs. Gene expression analyzed for Plzf, c-kit, Sycp3, and Prm1. Immunohistochemistry assessed Plzf, and flow cytometry evaluated c-kit and Plzf. Results: Showed a twofold increase in Plzf-positive cells after 14 days of culture (76.47%, P≤0.05), with a significant elevation in Plzf gene expression observed in the conditioned media group (188.1 ± 65%, P≤0.05). Conversely, the expression of the c-kit gene decreased significantly in both the conditioned media and “indirect co-culture using mesh” groups. Notably, Sycp3 and Prm1 expression levels significantly increased in the conditioned media group compared to the control. These findings suggest the potential of conditioned media as a novel feeder for promoting in vitro mouse spermatogenesis. Conclusion: Our results demonstrate that the inclusion of growth factors, such as GDNF and BMP-4, along with conditioned media and an “indirect co-culture using mesh” system utilizing meshes with SSCs, significantly enhances SSC proliferation and differentiation. The optimized conditions media provided by hAMSCs offer a superior feeder compared to traditional “indirect co-culture using mesh” systems for promoting both the proliferation and differentiation of SSCs. 2013 2025 Mahdi M Jahanbakhsh Stem Cell and Regenerative Medicine Research Center, Iran University of Medical Sciences Stem Cell and Regenerative Medicine Research Center, Iran University of Medical Sciences Iran Fatemeh F Asgari Avicenna Fertility Center, Avicenna Research Institute, ACECR Avicenna Fertility Center, Avicenna Research Institute, ACECR Iran Roya R Hassani Stem Cell and Regenerative Medicine Research Center, Iran University of Medical Sciences Stem Cell and Regenerative Medicine Research Center, Iran University of Medical Sciences Iran Morteza M Koruji Stem Cell and Regenerative Medicine Research Center, Iran University of Medical Sciences Stem Cell and Regenerative Medicine Research Center, Iran University of Medical Sciences Iran Hamid Reza HR Asgari Stem Cell and Regenerative Medicine Research Center, Iran University of Medical Sciences Stem Cell and Regenerative Medicine Research Center, Iran University of Medical Sciences Iran asgari.hr@iums.ac.ir Amniotic mesenchymal stem cellsDifferentiationPlacentaProliferation 140285.pdf Kanatsu-Shinohara M, Ogonuki N, Inoue K, Miki H, Ogura A, Toyokuni S, et al. 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The effects of poly L-lactic acid nanofiber scaffold on mouse spermatogonial stem cell culture. Int J Nanomed. 2013;8:4563-76.##Navid S, Abbasi M, Hoshino Y. The effects of melatonin on colonization of neonate spermatogonial mouse stem cells in a three-dimensional soft agar culture system. Stem Cell Res Ther. 2017;8(1):233.##Gholami K, Pourmand G, Koruji M, Sadighigilani M, Navid S, Izadyar F, et al. Efficiency of colony formation and differentiation of human spermatogenic cells in two different culture systems. Reprod Biol. 2018;18(4):397-403.##Nayernia K. Stem cells derived from testis show promise for treating a wide variety of medical conditions. Cell Res. 2007;17(11):895-7.##Fayomi AP, Orwig KE. Spermatogonial stem cells and spermatogenesis in mice, monkeys and men. Stem Cell Res. 2018;29:207-14.##Tiwari JN, Tiwari RN, Kim KS. Zero-dimensional, one-dimensional, two-dimensional and three-dimensional nanostructured materials for advanced electrochemical energy devices. 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Association of Circular RNAs with Sperm Fertility Potential: Implications for Male Infertility Diagnosis 2 1 140286 2 Background: Circular RNAs (circRNAs) are biomarkers that may play a role in the pathological processes underlying abnormal spermatogenesis. Four circRNAs present in human semen, namely STK31-hsa-circ-0133980, LRWD1-hsa-circ-0003327, circRNF17-chr13:25341410-25356082, and circBRDT-chr1:92428275-92433817, were investigated in this study and their relationship with sperm parameters was evaluated. Methods: In this analytical observational study, 45 semen samples were analyzed according to World Health Organization criteria, and were classified into the following groups: normozoospermia (control, n=9), asthenozoospermia (n=10), oligozoospermia (n=9), teratozoospermia (n=9), and oligoasthenoteratozoospermia (n=8). The expression levels of four circRNAs, along with genes related to apoptosis (BCL2, BAX, and Caspase3) and protamination (PRM1 and PRM2), were assessed using real-time polymerase chain reaction (RT-PCR). Sperm quality was additionally assessed on another portion of each semen sample using triple staining, aniline blue, toluidine blue, and eosin–nigrosin. Data were analyzed using Prism software, and the significance of the observed differences was evaluated by one-way ANOVA. Results: The results showed that changes in circRNA expression levels were significantly related to sperm morphology (all circRNAs, p<0.05), motility (circ-RNF17 and-STK31) (p<0.01), and concentration (circBRDT, p<0.05) compared to the normozoospermia group. Apoptosis and abnormal protamination were increased in all infertile groups, except the asthenozoospermia, as evidenced by upregulation of BAX and Caspase 3 and downregulation of BCL2 and PRM1&2 genes, compared to the normozoospermic group (p<0.001). Conclusion: The circRNA levels were different in the semen samples with different sperm quality. Our results provide new insights into evaluating sperm functions, supporting the potential role of circRNAs as biomarkers of male fertility. 215 224 Sara S Esmaeilzadeh Department of Biology, Faculty of Sciences, University of Guilan Department of Biology, Faculty of Sciences, University of Guilan Iran Fatemeh F Ghasemian Department of Biology, Faculty of Sciences, University of Guilan Department of Biology, Faculty of Sciences, University of Guilan Iran ghasemian@guilan.ac.ir Fatemeh F Aziziyan Department of Biochemistry, Faculty of Biological Sciences, Tarbiat Modares University Department of Biochemistry, Faculty of Biological Sciences, Tarbiat Modares University Iran Mohammad Hadi MH Bahadori Cellular and Molecular Research Center, Guilan University of Medical Sciences Cellular and Molecular Research Center, Guilan University of Medical Sciences Iran ApoptosisCircular RNAsFertilityProtaminationSperm 140286.pdf Zhou F, Chen W, Jiang Y, He Z. Regulation of long non-coding RNAs and circular RNAs in spermato-gonial stem cells. Reproduction. 2019;158(1):R15-25.##World health organisation. WHO laboratory manual for the examination and processing of human semen. 5th ed. Geneva: World Health Organisation; 2010. 271 p.##Cai Y, Lei X, Chen Z, Mo Z. The roles of cirRNA in the development of germ cells. Acta Histochem. 2020;122(3):151506.##Dong WW, Li HM, Qing XR, Huang DH, Li HG. Identification and characterization of human testis derived circular RNAs and their existence in seminal plasma. Sci Rep. 2016;66:39080.##Ge P, Zhang J, Zhou L, Lv MQ, Li YX, Wang J, et al. CircRNA expression profile and functional analysis in testicular tissue of patients with non-obstructive azoospermia. Reprod Biol Endocrinol. 2019;17(1):100.##Chioccarelli T, Manfrevola F, Ferraro B, Sellitto C, Cobellis G, Migliaccio M, et al. Expression patterns of circular RNAs in high quality and poor quality human spermatozoa. 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Dysregulated Kinase Expression in Teratozoospermia and Implications for Male Infertility: An Integrated Gene Expression Study 2 1 140289 2 Background: Teratozoospermia, characterized by abnormal sperm morphology, is a major contributor to male infertility. Kinases, enzymes that catalyze the transfer of phosphate groups to proteins, are crucial regulators of cellular signaling pathways and play significant roles in sperm development and maturation. The purpose of the current study was to identify differentially expressed genes (DEGs) between teratozoospermia and normozoospermia samples and to investigate the role of kinases in these expression changes. Methods: An integrated analysis of transcriptome data was conducted from teratozoospermia and normozoospermia samples using publicly available gene expression omnibus (GEO) datasets. Three gene expression series (GSE) profiles of teratozoospermia from one superseries were selected and combined. Differential expression analysis was performed using the limma package in R, applying linear modeling and empirical Bayes statistics to identify DEGs with a threshold of adjusted p<0.05. A comprehensive list of human kinase genes was obtained from the KinHub database, and differentially expressed kinases between the two conditions were identified. Functional enrichment analyses including gene ontology (GO) and kyoto encyclopedia of genes and genomes (KEGG) pathways were conducted. Additionally, receiver operating characteristic (ROC) curve analysis was performed to evaluate the diagnostic potential of identified kinases. Results: Our analysis identified 1,292 DEGs. Among these, 34 kinases were identified (10 upregulated and 24 downregulated). ROR1 and STK39 showed the most significant changes. ROC analysis demonstrated strong diagnostic values for these kinases. Conclusion: This study is the first comprehensive analysis integrating transcriptomic data and kinase-focused gene expression profiling specifically in teratozoospermia, suggesting that kinase dysregulation may contribute to teratozoospermia and male infertility. 224 232 Seyedeh Zahra SZ Mousavi Department of Molecular Genetics, Faculty of Biological Sciences, Tarbiat Modares University Department of Molecular Genetics, Faculty of Biological Sciences, Tarbiat Modares University Iran Morteza M Hadizadeh Physiology Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences Physiology Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences Iran Bahram B Mohammad Soltani Department of Molecular Genetics, Faculty of Biological Sciences, Tarbiat Modares University Department of Molecular Genetics, Faculty of Biological Sciences, Tarbiat Modares University Iran Mehdi M Totonchi Department of Genetics, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR Department of Genetics, Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR Iran m.totonchi@royaninstitute.org Gene expressionMicroarray analysisPhosphotransferasesTeratozoospermia 140289.pdf Sudhakaran G, Kesavan D, Kandaswamy K, Guru A, Arockiaraj J. 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The Potential Role of Chromosomal Polymorphic Variations Attributed to Male Infertility: A Retrospective Cohort Study 2 1 140291 2 Background: Infertility is a complex condition that can originate from either male or female factors, or both. Genetic factors, such as damage to the Y chromosome, gene defects, and chromosomal anomalies significantly contribute to infertility. Consequently, cytogenetic analysis is a critical component of the systematic clinical evaluation for diagnosing, managing, and monitoring infertility. The purpose of the present study was to assess the prevalence, types, and significance of chromosomal polymorphisms in the East Indian population with a clinical history of male infertility. Methods: An investigation was conducted on 650 infertile men and 150 fertile men from general population, following the Helsinki Declaration guidelines. A cytogenetic investigation was conducted using G-banding, Ag-NOR banding, and centromeric heterochromatin staining. A Chi-square test was performed to compare the prevalence of chromosomal polymorphic variants. Results: The results of this study revealed significant chromosomal anomalies among the study population. Specifically, 2.61% of these individuals exhibited numerical chromosomal anomalies, while 1.53% showed structural chromosomal anomalies. Notably, there was a statistically significant (p<0.05) increase in the occurrence of total chromosomal polymorphic variations, with 24% of the infertile males found to have total chromosomal polymorphisms. Furthermore, the prevalence of the Yqh+ variant was statistically significant among infertile males (p=0.010), while the 9qh+ variant also showed a significant prevalence (p=0.0.35). Conclusion: The increased prevalence of chromosomal polymorphic variants underscores the need to evaluate their potential role in the etiology of male infertility. 232 241 Patel P Sunny Kumar Jignesh Kumar Molecular Stress and Stem Cell Biology Group, School of Biotechnology, Kalinga Institute of Industrial Technology Molecular Stress and Stem Cell Biology Group, School of Biotechnology, Kalinga Institute of Industrial Technology India Purna PCh Mahapatra Prachi Clinic and Nursing Home Prachi Clinic and Nursing Home India Sidhartha S Sinha Prachi Clinic and Nursing Home Prachi Clinic and Nursing Home India Birendranath B Banerjee inDNA Center for Research and Innovation in Molecular Diagnostics, inDNA Life Sciences Private Limited inDNA Center for Research and Innovation in Molecular Diagnostics, inDNA Life Sciences Private Limited India biren.banerjee@indnalife.com Ag-NOR bandingCytogenetic analysisCentromeric heterochromatin stainingChromosomal polymorphic variantsMale infertilityY chromosome deletion 140291.pdf Kamel RM. Management of the infertile couple: an evidence-based protocol. Reprod Biol Endocrinol. 2010;8:21.##Dohle GR, Colpi GM, Hargreave TB, Papp GK, Jungwirth A, Weidner WE, et al. EAU guidelines on male infertility. Eur Urol. 2005;48(5):703-11.##Shah K, Sivapalan G, Gibbons N, Tempest H, Grif-fin DK. The genetic basis of infertility. Reproduc-tion. 2003;126(1):13-25.##Mascarenhas MN, Flaxman SR, Boerma T, Van-derpoel S, Stevens GA. National, regional, and global trends in infertility prevalence since 1990: a systematic analysis of 277 health surveys. PLoS Med. 2012;9(12):e1001356.##Chakraborty A, Kar S, Mohapatra PC, Banerjee B. A case–control study identifying the frequency and spectrum of chromosomal anomalies and variants in a cohort of 1000 couples with a known history of recurrent pregnancy loss in the Eastern region of India. J Hum Reprod Sci. 2021;14(4):422-30.##Srivastava P, Bamba C, Chopra S, Rohilla M, Chaudhry C, Kaur A, et al. 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Cytogenet Cell Genet. 1995;69(3-4):235-9.##Karpen GH, Endow SA, Glover D. Meiosis: chromosome behavior and spindle dynamics. In: Endow SA, Glover DM, editors. Dynamics of cell division. Oxford: Oxford University Press; 1998. p. 203-36.##Mattei MG, Luciani J. Heterochromatin, from chromosome to protein. Atlas Genet Cytogenet Oncol Haematol. 2003;7(2):135-43.##Rizzi N, Denegri M, Chiodi I, Corioni M, Val-gardsdottir R, Cobianchi F, et al. Transcriptional activation of a constitutive heterochromatic domain of the human genome in response to heat shock. Mol Biol Cell. 2004;15 (2):543-51.##Rusché LN, Rine J. Conversion of a gene-specific repressor to a regional silencer. Genes Dev. 2001;15(8):955-67.##Hong Y, Zhou YW, Tao J, Wang SX, Zhao XM. Do polymorphic variants of chromosomes affect the outcome of in vitro fertilization and embryo transfer treatment? Hum Reprod. 2011;26(4):933-40.##Li SJ, Cheng YX, Zhou DN, Zhang Y, Yin TL, Yang J. Chromosomal polymorphisms associated with reproductive outcomes after IVF-ET. J Assist Reprod Genet. 2020;37(7):1703-10.##Mierla D, Stoian V. Chromosomal polymorphisms involved in reproductive failure in the romanian population. Balkan J Med Genet. 2012;15(2):23-8.##Zhao J, Huang B, Hao J, Xu B, Li Y. Chromo-somal polymorphisms have no negative effect on reproductive outcomes after IVF/ICSI-ET/FET. Sci Rep. 2022;12(1):19052.##Shen L, Sun Q, Shen L, Zhu Y, Sun Y. Impact of chromosomal polymorphisms on pregnancy out-comes after in vitro fertilization or intracytoplas-mic sperm injection: a systematic review and meta-analysis. Pak J Med Sci. 2025;41(12):3542-57.##Xu X, Zhang R, Wang W, Liu H, Liu L, Mao B, et al. The effect of chromosomal polymorphisms on the outcomes of fresh IVF/ICSI–ET cycles in a Chinese population. J Assist Reprod Genet. 2016;33(11):1481-6.##Ou Z, Yin M, Chen Z, Sun L. 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The Association Between Mature Oocyte Proportion and IVF Success: A Retrospective Analysis of 2,565 ICSI Cycles 2 1 140290 2 Background: IVF/ICSI success depends on the proportion of fertilizable metaphase II (MII) oocytes, yet direct evidence linking mature-oocyte rate to clinical outcomes remains limited. This study aimed to assess the impact of mature oocyte rate on clinical pregnancy outcomes in a large retrospective cohort of women undergoing ICSI. Methods: A total of 2,565 women who underwent ICSI cycles at a single IVF center in Türkiye were retrospectively analyzed. Patients were stratified into three groups according to mature oocyte proportion: Group 1 (0-50%), Group 2 (51-75%), and Group 3 (76-100%). Data were analyzed per initiated ICSI cycle. Embryo transfer was performed on day 3 or day 5 post-fertilization, depending on embryo quality and patient characteristics. Logistic regression analysis was performed to assess the independent effect of mature oocyte rate on pregnancy outcomes. Statistical significance was set at p<0.05. Results: Clinical pregnancy rates were significantly lower in Group 1 (10.23%) compared to Group 2 (28.96%) and Group 3 (29.99%) (p<0.001). Live birth and implantation rates increased in the higher maturity groups (7.5% vs. 21.5% vs. 22.9% and 12.1% vs. 24.3% vs. 26.0%, respectively), whereas miscarriage rates decreased (18.9% vs. 13.4% vs. 12.8%). Logistic regression analysis confirmed that a higher mature oocyte proportion was an independent predictor of clinical pregnancy (Group 2: OR=3.4, 95%CI: 2.5-4.6; Group 3: OR=3.5, 95%CI: 2.6-4.7; p<0.001). Conclusion: This large-scale retrospective cohort analysis demonstrates that mature oocyte proportion is an important prognostic factor of IVF success. Mature oocyte proportion should be considered an essential parameter in clinical practice and patient counseling. 241 248 Oya O Korkmaz Department of Histology and Embryology, Faculty of Medicine, Malatya Turgut Özal University Department of Histology and Embryology, Faculty of Medicine, Malatya Turgut Özal University Turkey Seda S Karabulut Department of Histology and Embryology, Faculty of International Medicine, İstanbul Medipol University Department of Histology and Embryology, Faculty of International Medicine, İstanbul Medipol University Turkey sedakarabulut@medipol.edu.tr Elif E Yılmaz In Vitro Fertilization Center, İstanbul Medical Park Hospital In Vitro Fertilization Center, İstanbul Medical Park Hospital Turkey Nuri N Delikara In Vitro Fertilization Center, İstanbul Kadıköy Florence Nightingale Hospital In Vitro Fertilization Center, İstanbul Kadıköy Florence Nightingale Hospital Turkey Assisted reproductive techniquesClinical pregnancyImplantation rateLive birthOocyte maturity 140290.pdf Vander Borght M, Wyns C. Fertility and infertility: definition and epidemiology. Clin Biochem. 2018;62:2-10.##Tamrakar SR, Bastakoti R. Determinants of infertility in couples. J Nepal Health Res Counc. 2019;17(1):85-9.##Jain C, Khan W. Psychosocial concomitants of infertility: a narrative review. Cureus. 2025;17(3):e80250.##Adamson GD, Zegers-Hochschild F, Dyer S. Global fertility care with assisted reproductive technology. Fertil Steril. 2023;120(3 Pt 1):473-82.##Lou H, Li N, Guan Y, Zhang Y, Hao D, Cui S. Association between morphologic grading and implantation rate of euploid blastocyst. J Ovarian Res. 2021;14(1):18.##Krisher RL. The effect of oocyte quality on development. J Anim Sci. 2004;82 E-Suppl:E14-23.##Conti M, Franciosi F. Acquisition of oocyte competence to develop as an embryo: integrated nuclear and cytoplasmic events. Hum Reprod Update. 2018;24(3):245-66.##Parrella A, Irani M, Keating D, Chow S, Rosenwaks Z, Palermo GD. High proportion of immature oocytes in a cohort reduces fertilization, embryo development, pregnancy and live birth rates following ICSI. Reprod Biomed Online. 2019;39(4):580-7.##Nicholas C, Darmon S, Patrizio P, Albertini DF, Barad DH, Gleicher N. Changing clinical significance of oocyte maturity grades with advancing female age advances precision medicine in IVF. iScience. 2023;26(8):107308.##Moon JH, Zhao Q, Zhang J, Reddy V, Han J, Cheng Y, et al. The developmental competence of human metaphase I oocytes with delayed maturation in vitro. Fertil Steril. 2023;119(4):690-6.##Wei J, Luo Z, Dong X, Jin H, Zhu L, Ai J. Cut-off point of mature oocyte for routine clinical application of rescue IVM: a retrospective cohort study. J Ovarian Res. 2023;16(1):226.##Sunkara SK, Rittenberg V, Raine-Fenning N, Bhattacharya S, Zamora J, Coomarasamy A. Association between the number of eggs and live birth in IVF treatment: an analysis of 400 135 treatment cycles. 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The Effect of Fetal Intrauterine Blood Transfusion on Ductal Arterial Blood Flow Velocity and Cardiac Output Changes in Fetuses with Rhesus Alloimmunization-Related Anemia 2 1 140284 2 Background: Echocardiographic indicators may be useful as an alternative method to determine the appropriate time for intervention, especially when Doppler assessment of the middle cerebral artery peak systolic velocity (MCA-PSV) is inconclusive. In this study, arterial duct blood flow and cardiac output of fetuses with Rh alloimmunization-related anemia were compared before and after intrauterine transfusion (IUT). Methods: Fifty intrauterine blood transfusions were performed on anemic fetuses in this study. All cases were attributed to Rh alloimmunization, detected with MCA-PSV Doppler ultrasound imaging assessments. They all underwent intrauterine blood transfusion and echocardiographic assessments a day before and 24 hr after the procedure. The measured cardiac indices included the velocity time integral (VTI) of the aortic and pulmonary valves, the ductus arteriosus acceleration-to-ejection time (AT/ET) ratio, and the MCA-PSV. Analyses were performed in SPSS v24 (p<0.05) using paired t-tests for mean differences and Pearson’s correlation for associations between continuous variables. Results: Aortic and pulmonary valve VTI, MCA-PSV, and ductus arteriosus AT/ET ratio significantly decreased after intrauterine blood transfusion (p<0.001). The aortic valve VTI and ductus arteriosus accurately detected anemia, with areas under the receiver operating characteristic (ROC) curve of 99.9% and 98.9%, respectively. Conclusion: All the measured parameters showed significant changes after intrauterine blood transfusion. Aortic valve VTI and ductus arteriosus AT/ET ratio seem to have the highest accuracy in detecting anemia. Echocardiographic assessment can be beneficial in defining the appropriate time for intrauterine blood transfusion in cases where MCA-PSV is inefficient. 248 255 Behrokh B Sahebdel Department of Obstetrics and Gynecology, Yas Hospital complex, Tehran University of Medical Sciences Department of Obstetrics and Gynecology, Yas Hospital complex, Tehran University of Medical Sciences Iran Mohammad Nasir MN Hematian Department of Perinatology and Fetal Cardiology, Yas Hospital complex, Tehran University of Medical Sciences Department of Perinatology and Fetal Cardiology, Yas Hospital complex, Tehran University of Medical Sciences Iran Zohreh Z Heidary Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Tehran University of Medical Sciences Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Tehran University of Medical Sciences Iran Fatemeh F Rahimi-Sharbaf Department of Obstetrics and Gynecology, Yas Hospital complex, Tehran University of Medical Sciences Department of Obstetrics and Gynecology, Yas Hospital complex, Tehran University of Medical Sciences Iran Fatemeh F Golshahi Department of Obstetrics and Gynecology, Yas Hospital complex, Tehran University of Medical Sciences Department of Obstetrics and Gynecology, Yas Hospital complex, Tehran University of Medical Sciences Iran Mahboobeh M Shirazi Department of Obstetrics and Gynecology, Yas Hospital complex, Tehran University of Medical Sciences Department of Obstetrics and Gynecology, Yas Hospital complex, Tehran University of Medical Sciences Iran Nafiseh N Saedi Department of Obstetrics and Gynecology, Yas Hospital complex, Tehran University of Medical Sciences Department of Obstetrics and Gynecology, Yas Hospital complex, Tehran University of Medical Sciences Iran Faezeh F Mahdavi Omran Department of Medical Education, Faculty of Medicine, Babol University of medical sciences Department of Medical Education, Faculty of Medicine, Babol University of medical sciences Iran Zahra Z Moradi Department of Obstetrics and Gynecology, Yas Hospital complex, Tehran University of Medical Sciences Department of Obstetrics and Gynecology, Yas Hospital complex, Tehran University of Medical Sciences Iran Sodabeh S Rezaei Department of Obstetrics and Gynecology, Yas Hospital complex, Tehran University of Medical Sciences Department of Obstetrics and Gynecology, Yas Hospital complex, Tehran University of Medical Sciences Iran sodabe.rezaei80@gmail.com, sodabe.rezaei89@gmail.com Ductus arteriosusEchocardiographyIntrauterine blood transfusion 140284.pdf Koelewijn JM, Vrijkotte T, Van Der Schoot CE, Bonsel GJ, De Haas M. 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Outcome of severely anaemic fetuses treated by intrauterine transfusions. Arch Dis Child Fetal Neonatal Ed. 2009;94(3):F201-4.##Lindenburg IT, van Kamp IL, Oepkes D. Intrauterine blood transfusion: current indications and associated risks. Fetal Diagn Ther. 2014;36(4):263-71.##Mari G, Deter RL, Carpenter RL, Rahman F, Zimmerman R, Moise KJ Jr, et al. Noninvasive diagnosis by Doppler ultrasonography of fetal anemia due to maternal red-cell alloimmunization. N Engl J Med. 2000;342(1):9-14.##Oepkes D, Seaward PG, Vandenbussche FP, Windrim R, Kingdom J, Beyene J, et al. Doppler ultrasonography versus amniocentesis to predict fetal anemia. N Engl J Med. 2006;355(2):156-64.##Gravenhorst JB, Kanhai H, Meerman R, Ruys J, Eernisse J, Stroes TJ, et al. Twenty-two years of intra-uterine intraperitoneal transfusions. Eur J Obstet Gynecol Reprod Biol. 1989;33(1):71-7.##Zimmermann R, Durig P, Carpenter RJ Jr, Mari G. 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Isolated Fallopian Tube Torsion in Chronic Pelvic Pain: A Rare Case 2 1 140283 2 Background: Abdominal pain is a frequent complaint among women presenting to gynecological and surgical emergency departments. The management approach depends on the severity, nature, and possible underlying causes of the pain, ranging from observation to urgent surgical intervention. One important cause of abdominal pain in women is adnexal torsion, which may occasionally involve only the fallopian tube. This condition can present with non-specific symptoms, making diagnosis challenging. Although ultrasound can reveal features suggestive of ovarian torsion, the findings are not always definitive, and other surgical emergencies such as ectopic pregnancy or appendicitis should also be considered. Early recognition and timely surgical management are essential to preserve fertility and minimize ischemic damage. Case Presentation: The case is a 28-year-old woman, who presented with chronic pelvic pain and was diagnosed with hydrosalpinx, subsequently confirmed via laparoscopic intervention. Imaging revealed a cystic lesion near the left adnexa, initially interpreted as hydrosalpinx. During laparoscopy, the left fallopian tube was found to be twisted twice, and a salpingectomy was performed. Conclusion: Isolated fallopian tube torsion (IFTT) is an uncommon clinical condition characterized by torsion of the fallopian tube without ovarian involvement. It may result from predisposing factors such as hydrosalpinx, pelvic inflammatory disease, or congenital anomalies. Symptoms are usually not specific, and imaging results can be uncertain. Laparoscopy remains the gold standard for both diagnosis and treatment, although laparotomy may be required in certain cases. This case highlights the importance of considering IFTT in women with unexplained chronic pelvic pain. Prompt diagnosis and surgical intervention are crucial to prevent complications and preserve reproductive potential. 255 260 Seyedeh Azam SA Pourhoseini Family and the Youth of Population Support Research Center, Department of Obstetrics and Gynecology, Faculty of Medicine, Mash-had University of Medical Sciences Family and the Youth of Population Support Research Center, Department of Obstetrics and Gynecology, Faculty of Medicine, Mash-had University of Medical Sciences Iran Nona N Sabeti Department of Obstetrics and Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences Department of Obstetrics and Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences Iran Ezat E Hajmollarezaei Family and the Youth of Population Support Research Center, Department of Obstetrics and Gynecology, Faculty of Medicine, Mash-had University of Medical Sciences Family and the Youth of Population Support Research Center, Department of Obstetrics and Gynecology, Faculty of Medicine, Mash-had University of Medical Sciences Iran Hajmollarezaeie@mums.ac.ir Fallopian tube torsionChronic pelvic painHydrosalpinxLaparascopy 140283.pdf lamzouri O, Rhazi R, Ibtissam B, Taheri H, Saadi H, Mimouni A. Isolated tubal ischemia due to combined torsion and small bowel volvulus: a rare case report. Med Rep. 2025;10:100183.##Raban O, Zilber H, Hadar E, Efrat Z, Krissi H, Wiznitzer A, et al. Isolated fallopian tube torsion: a unique ultrasound identity or a serial copycat? J Ultrasound Med. 2018;37(10):2387-93.##Harmon JC, Binkovitz LA, Binkovitz LE. Isolated fallopian tube torsion: sonographic and CT features. Pediatr Radiol. 2008;38(2):175-9.##Sutton JB. Remarks on salpingitis and some of its effects. Lancet. 1890;136:1146-8.##Gross M, Blumstein SL, Chow LC. Isolated fallopian tube torsion: a rare twist on a common theme. AJR Am J Roentgenol. 2005;185(6):1590-2.##Banerjee I, Thakur Y, Mukherjee G, Jadhav J, Sahare A. Isolated fallopian tube torsion: a rare entity. Case Rep Obstet Gynecol. 2021;2021:3872201.##Baracy MG Jr, Hu J, Ouillette H, Aslam MF. Diagnostic dilemma of isolated fallopian tube torsion. BMJ Case Rep. 2021;14(7):e242682.##Duigenan S, Oliva E, Lee SI. Ovarian torsion: diagnostic features on CT and MRI with pathologic correlation. AJR Am J Roentgenol. 2012;198(2):W122-31.##Yazawa R, Yazawa H, Anjyo K, Inazuki A. Four cases of isolated fallopian tube torsion successfully treated with laparoscopic surgery:A case series. Fukushima J Med Sci. 2024;70(3):163-8.##Hayede S, Zahra A, Atossa M, Maryam K, Shervin T, Mojgan K. Isolated fallopian tube torsion: a case report and review of literature. J Fam Reprod Health. 2010;4(2):73-6.##Eslamnik P, Makari A, Rezaei H. Isolated torsion of the fallopian tube: a case report. J Clin Care Skills. 2021;2(3):109-11.##Almandeel A, Saleem HA, Elzewawi N, Al Anazi L, Al Anazi B. Isolated fallopian tube torsion with preservation of ipsilateral ovary. A case report. Case Rep Womens Health. 2023;40:e00565.##Varghese U, Fajardo A, Gomathinayagam T. Isolated fallopian tube torsion with pregnancy- a case report. Oman Med J. 2009;24(2):128-30.##Qian L, Wang X, Li D, Li S, Ding J. Isolated fallopian tube torsion with paraovarian cysts: a case report and literature review. BMC Womens Health. 2021;21(1):345.##Hagege R, Sharvit M, Hamou B, Barzilay E, Pansky M, Barel O. Isolated fallopian tube torsion: an underdiagnosed entity with debatable management. J Minim Invasive Gynecol. 2022;29 (1):158-63.##Comerci G, Colombo FM, Stefanetti M, Grazia G. Isolated fallopian tube torsion: a rare but important event for women of reproductive age. Fertil Steril. 2008;90(4):1198.e23-5.##Aziza B, Houas Y, Slimani A, Jouini R. Isolated fallopian tube torsion in young females: a case series. J Pediatr Surg Case Rep. 2025;117:102991.##Varghese S, Seldon Y, Raperport C, Rinne N, Patel K, Zaid RZ. Isolated fallopian tube torsion: a systematic review of case reports. Eur J Obstet Gynecol Reprod Biol. 2024;296:140-7.##Tamir Yaniv R, Ravid E, Halevy N, Schonman R, Markovich O, Arbib N, et al. The sonographic characteristics of isolated fallopian tube torsion. J Minim Invasive Gynecol. 2025;32(3):270-8.##Elçi E, Sayan S, Elçi G, Koç G. Isolated fallopian tubal torsion: reproductive age case series. J Obstet Gynaecol Res. 2021;47(7):2515-20.##Schwartz B, Weerasooriya N, Mercier R, Gould S, Saul D, Berman L. Factors associated with isolated fallopian tube torsion in pediatric patients. J Pediatr Surg. 2024;59(8):1538-44.##

The Role of Laparoscopy in the Diagnosis and Management of Fallopian Tube Teratomas: A Case Report 2 1 140288 2 Background: The introduction of assisted reproductive technologies (ARTs) has diminished the role of surgery in female factor tubal infertility. The assessment of tubal patency is part of the routine tests taken for the evaluation of infertile couples. Laparoscopy with chromopertubation is still the gold standard test for the evaluation of tubal patency. Case Presentation: In this article, a rare case of a mature cystic tubal teratoma was diagnosed laparoscopically as part of an infertility workup. An attempt was made to emphasize the importance of laparoscopy in the diagnosis and management of rare fallopian tube entities that may have an impact on female reproductive health. A literature search to find any prior similar cases was conducted using PubMed database. The search terms employed were tubal factor infertility, tubal teratoma, diagnosis, laparoscopy, in vitro fertilization (IVF), and hysterosalpingography (HSG). A total of 4 cases of mature cystic teratomas of the fallopian tube diagnosed laparoscopically as part of infertility workup were reviewed showing that laparoscopic surgery still has a major role in diagnosis and treatment of female infertility. Conclusion: Tubal teratoma is a rare finding in patients undergoing infertility workup. It is important to highlight the benefits of laparoscopy in confirming the tubal patency test results in patients showing no intraperitoneal spillage of contrast media on hysterosalpingography test. Laparoscopy helps visualize the tubes better aiming to diagnose entities that are difficult to diagnose with hysterosalpingography or ultrasound, while simultaneously providing an opportunity for treatment. 260 264 Rawad R Halimeh Clinical Department, The Centre for Reproductive and Genetic Health Clinical Department, The Centre for Reproductive and Genetic Health United Kingdom rawad.halimeh@gmail.com Therese Th Douaihy Department of Obstetrics and Gynaecology, Saint George Hospital University Medical Center Department of Obstetrics and Gynaecology, Saint George Hospital University Medical Center Lebanon Fatima F Ghandour Department of Pathology, Saint George Hospital University Medical Center Department of Pathology, Saint George Hospital University Medical Center Lebanon Bassem B Sawan Department of Pathology, Saint George Hospital University Medical Center Department of Pathology, Saint George Hospital University Medical Center Lebanon Reine R Nader Department of Radiology, American University of Beirut Medical Center Department of Radiology, American University of Beirut Medical Center Lebanon Elie E Snaifer Department of Obstetrics and Gynaecology, Saint George Hospital University Medical Center Department of Obstetrics and Gynaecology, Saint George Hospital University Medical Center Lebanon Fallopian tubeHysterosalpingographyIn vitro fertilizationInfertilityLaparascopyTeratoma 140288.pdf Dun EC, Nezhat CH. Tubal factor infertility: diagnosis and management in the era of assisted reproductive technology. Obstet Gynecol Clin. 2012;39(4):551-66.##Briceag I, Costache A, Purcarea VL, Cergan R, Dumitru M, Sajin M, et al. Current management of tubal infertility: from hysterosalpingography to ultrasonography and surgery. J Med Life. 2015;8(2):157-9.##Mahran A, Abdelraheim AR, Eissa A, Gadelrab M. Does laparoscopy still has a role in modern fertility practice? Int J Reprod Biomed. 2017;15(12):787-94.##Lai SF, Lim-Tan SK. Benign teratoma of the fallopian tube. Singapore Med J. 1993;34(3):274-5.##Mazzarella P, Okagaki T, Richart RM. Teratoma of the uterine tube: a case report and review of the literature. Obstet Gynecol. 1972;39(3):381-8.##Johnson C, Hansen KA. Mature cystic teratoma of the fallopian tube. Fertil Steril. 2006;86(4):995-6.##Li S, Fang X, Chen J, Xia X. Mature cystic teratoma of the fallopian tube associated with incomplete uterine mediastinum: a case report and literature review. Oncol Lett. 2013;6(1):153-5.##Fujiwara S, Yamashita Y, Yoshida Y, Terai Y, Okuda K, Ohmichi M. Mature cystic teratoma of the fallopian tube. Fertil Steril. 2010;94(7):2708-9.##Tan J, Deng M, Xia M, Lai M, Pan W, Li Y. Comparison of hysterosalpingography with laparoscopy in the diagnosis of tubal factor of female infertility. Front Med (Lausanne). 2021;8:720401.##Karande VC, Korn A, Morris R, Rao R, Balin M, Rinehart J, et al. Prospective randomized trial comparing the out-come and cost of in vitro fertilization with that of a traditional treatment algorithm as first-line therapy for couples with infertility. Fertil Steril. 1999;71(3):468-75.##Pandian Z, Akande VA, Harrild K, Bhattacharya S. Surgery for tubal infertility. Cochrane Database Syst Rev. 2008;(3):CD006415.##

Neuroendocrine Tumors Identified During Laparoscopic Endometriosis Surgery: A Report of 6 Cases 2 1 140287 2 Background: Neuroendocrine tumors (NETs) or carcinoid tumors are rare neoplasms originating from neuroendocrine cells, most commonly found in the ap-pendix. While NETs are often asymptomatic, they may present with abdominal pain, flushing, and diarrhea and are frequently discovered incidentally during surgery for other conditions. Endometriosis has been associated with an increased risk of certain malignancies; however, its relationship with NETs remains unclear. Given the high frequency of laparoscopic surgeries for endome-triosis, incidental NET findings pose unique clinical challenges. Methods: This retrospective case report was conducted at Avicenna Fertility Center, Affiliated to Avicenna Research Institute, Tehran, Iran, from 2016 to 2024. Medical records of six patients (33-55 years old) who underwent laparoscopic surgery for endometriosis, with incidental NETs found in the appendix, were analyzed. Clinical presentation, intraoperative findings, histopathology, and postoperative outcomes were reviewed. Results: Six women (mean age: 43.7 years) with endometriosis-related symptoms (dysmenorrhea, dyspareunia, and pelvic pain) underwent laparoscopic surgery with appendectomy. The NETs (2–9 mm, all G1, Ki-67 <3%) exhibited invasion into the muscularis propria in three cases and into the subserosal fat in one case; lymph nodes were not evaluated, and no metastases were detected. Immunohistochemistry confirmed neuroendocrine differentiation, with positive chromogranin and synaptophysin staining. Follow-up over 1–5 years showed no evidence of recurrence. Conclusion: Incidental NET detection during endometriosis surgery highlights the need for routine pathological examination of appendectomy specimens. While no direct link exists between NETs and endometriosis, recognizing these tumors may influence surgical decisions and postoperative management, emphasizing the importance of multidisciplinary care. 264 270 Saman S Mohammadipour Department of Surgery, Bu-Ali Hospital, Tehran Medical Branch, Islamic Azad University Department of Surgery, Bu-Ali Hospital, Tehran Medical Branch, Islamic Azad University Iran Hamidreza Hr Didar Avicenna Fertility Center, Avicenna Research Institute, ACECR Avicenna Fertility Center, Avicenna Research Institute, ACECR Iran Roya R Padmehr Reproductive Biotechnology Research Center, Avicenna Research Institute (ARI), ACECR Reproductive Biotechnology Research Center, Avicenna Research Institute (ARI), ACECR Iran Ilia I Taheri School of Medicine, Tehran University of Medical Sciences School of Medicine, Tehran University of Medical Sciences Iran Haleh H Soltanghoraee هاله سلطان قرایی Reproductive Biotechnology Research Center, Avicenna Research Institute (ARI), ACECR Reproductive Biotechnology Research Center, Avicenna Research Institute (ARI), ACECR Iran haleh53sg@yahoo.com AppendectomyCarcinoid tumorEndometriosisLaparoscopic surgeryNeuroendocrine tumors 140287.pdf Klöppel G. Neuroendocrine neoplasms: dichotomy, origin and classifications. Viscer Med. 2017;33(5):324-30.##Oronsky B, Ma PC, Morgensztern D, Carter CA. Nothing but NET: a review of neuroendocrine tumors and carcinomas. Neoplasia. 2017;19(12):991-1002.##Ahmed M. Gastrointestinal neuroendocrine tumors in 2020. World J Gastrointest Oncol. 2020;12(8):791-802.##Das S, Dasari A. Epidemiology, incidence, and prevalence of neuroendocrine neoplasms: are there global differences? Curr Oncol Rep. 2021;23(4):43.##Subash N, Papali MM, Bahadur KP, Avanthika C, Jhaveri S, Thannir S, et al. Recent advances in the diagnosis and management of carcinoid syndrome. Dis Mon. 2022;68(7):101304.##Lips CJ, Lentjes EG, Höppener JW. The spectrum of carcinoid tumours and carcinoid syndromes. Ann Clin Biochem. 2003;40(Pt 6):612-27.##Centini G, Schettini G, Pieri E, Giorgi M, Lazzeri L, Martire FG, et al. Endometriosis-related ovarian cancer: where are we now? a narrative review towards a pragmatic approach. J Clin Med. 2024;13(7):1933.##Villaescusa M, Andres MP, Amaral AC, Barbosa RN, Abrão MS. Endometriosis and its correlation with carcinoid tumor of the appendix: a systematic review. Minerva Obstet Gynecol. 2021;73(5):606-13.##Boyd CA, Riall TS. Unexpected gynecological findings during abdominal surgery. Curr Probl Surg. 2012;49(4):195-251.##Ross WT, Newell JM, Zaino R, Kunselman AR, Harkins GJ, Benton AS. Appendiceal endometriosis: is diagnosis dependent on pathology evaluation? A prospective cohort study. J Minim Invasive Gynecol. 2020;27(7):1531-7.##Parra RS, Feitosa MR, Biagi GBB, Brandão DF, Moraes MMFdS, Silvestre L, et al. Neuroendocrine appendiceal tumor and endometriosis of the appendix: a case report. J Med Case Rep. 2020;14(1):152.##Ross WT, Chu A, Li L, Kunselman AR, Harkins GJ, Deimling TA, et al. Appendectomy in the surgical management of women with endometriosis and pelvic pain. Int J Gynecol Obstet. 2021;154(3):526-31.##Rindi G, Klimstra DS, Abedi-Ardekani B, Asa SL, Bosman FT, Brambilla E, et al. A common classification framework for neuroendocrine neoplasms: an International Agency for Research on Cancer (IARC) and World Health Organization (WHO) expert consensus proposal. Mod Pathol. 2018;31(12):1770-86.##Altshuler PC, Schultze PM. Diagnosis of appendiceal neuroendocrine tumors following incidental appendectomy during benign gynecologic laparoscopic surgeries: a case series. Cureus. 2023;15(6):e41135.##Ahuja S, Joseph KA, Zaheer S. Incidental detection of an appendiceal neuroendocrine tumor in a right hemicolectomy specimen for colonic adenocarcinoma: a case report. Int J Surg Case Rep. 2024;122:110121.##