📖 Full bibliography

Congreso Nacional del Paraguay. (2016). Law No. 5777/2016 "On comprehensive protection of women against all forms of violence". Asunción, Paraguay. bacn.gov.py

Contribution: Supports the guide "Violence against women — where to go and duty to report (Paraguay)": forms of violence (art. 6), health-system duties (art. 22), protection measures (art. 43) and reporting to the Police or Justice of the Peace courts (art. 47).

Poder Ejecutivo, República del Paraguay. (2017). Decree No. 6973/2017, regulating Law No. 5777/2016. Asunción, Paraguay. baselegal.com.py

Contribution: Supports the same guide: health workers' duty to report (art. 11), receiving institutions (art. 12) and referral within 24 h (art. 13).

Ministerio de Salud Pública y Bienestar Social (MSPyBS/SPGO). (2018). Manual Nacional de Normas de Atención de las Principales Patologías Obstétricas (1st ed.). Asunción, Paraguay.

Contribution: stepwise tocolytic management protocols, magnesium sulfate neuroprotection, fetal lung maturation, treatment of intrahepatic cholestasis, and management of prolonged pregnancy and fetal demise.

Ministerio de Salud Pública y Bienestar Social (MSPyBS). (2021). Guía de Manejo de la Hemorragia Posparto: Código Rojo Obstétrico (Resolution S.G. No. 2004/2021). Asunción, Paraguay.

Contribution: standardized roles, aggressive resuscitation, hypovolemic shock, and surgical/medical response times.

Ministerio de Salud Pública y Bienestar Social (MSPyBS). (2022). Manual de Cuidados Perinatales (Resolution S.G. No. 1078/2022). Asunción, Paraguay.

Contribution: tiered ("traffic-light") preconception counseling, prenatal care, partograph, and postpartum management; also supports the mention of the tiered scheme in the Preconception screening and folic acid guide and the Preconception risk traffic light (MSPBS 2022) guide, with cut-offs and folic acid doses verified on p. 23 of the Manual.

Ministerio de Salud Pública y Bienestar Social (MSPyBS). (2023). Orientaciones Técnicas para la Atención Integral a la Mujer en Climaterio (Resolution S.G. No. 267/2023). Asunción, Paraguay.

Contribution: MRS scale, ORAI, postmenopausal endometrial thickness, and menopausal hormone therapy (MHT) regimens.

Ministerio de Salud Pública y Bienestar Social (MSPyBS). (2025). Manual Nacional de Normas de Atención de Patologías Ginecológicas (Resolution S.G. No. 050/2025). Asunción, Paraguay.

Contribution: standardized algorithms for amenorrhea, precocious and delayed puberty, fibroids under the STEP-W classification, endometriosis (Law No. 7341/2024), pelvic floor pathology, and low-complexity ovulation induction.

Programa Ampliado de Inmunizaciones (PAI) Paraguay, Ministerio de Salud Pública y Bienestar Social. HPV vaccine — official material, by-group schedule infographic. · World Health Organization, Strategic Advisory Group of Experts on Immunization (SAGE). (2022, December). Human papillomavirus vaccines: WHO position paper. Weekly Epidemiological Record.

Contribution: Paraguay's HPV vaccination schedule by age group/risk group (ages 9-14, ages 15-24, risk groups ages 15-45) and its corroboration against the international SAGE position on 1-dose schedules in the general population and 2-3 dose schedules in immunocompromised individuals — basis for the HPV Vaccination guide.

Speroff, L., & Fritz, M. A. (2019). Clinical Gynecologic Endocrinology and Infertility (9th ed.). Lippincott Williams & Wilkins.

Contribution: follicular- and luteal-phase physiology, gonadotropin (LH/FSH) surges, the endometrial implantation window, basal body temperature curves, and diagnostic criteria for functional amenorrhea.

Mihm, M., Gangooly, S., & Muttukrishna, S. (2011). The normal menstrual cycle in women. Animal Reproduction Science, 124(3-4), 229–236.

Contribution: ultrasound and endocrine characterization of dominant follicle selection and luteolysis.

Melmed, S., Casanueva, F. F., Hoffman, A. R., et al. (2011). Diagnosis and Treatment of Hyperprolactinemia: An Endocrine Society Clinical Practice Guideline. The Journal of Clinical Endocrinology & Metabolism, 96(2), 273–288.

Contribution: serum prolactin cutoffs, ruling out macroprolactin and the hook effect, cabergoline/bromocriptine dosing, and neuroimaging indications.

Vilar, L., Abucham, J., Albuquerque, J. L., et al. (2019). Results of an explicit guideline for the management of prolactinomas? A series of 285 patients. Pituitary, 22(5), 491–500.

Contribution: titration criteria, long-term efficacy, and transsphenoidal surgical management in resistance or tumor apoplexy.

Teede, H. J., Tay, C. T., Laven, J. J., et al. (2023). Recommendations from the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. Fertility and Sterility, 120(4), 767–793.

Contribution: international diagnostic criteria, phenotypes A–D, transvaginal ultrasound follicle-count thresholds, AMH use, and comprehensive management.

The Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. (2004). Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Fertility and Sterility, 81(1), 19–25.

Contribution: definition of the three classic criteria (anovulation, clinical/biochemical hyperandrogenism, and polycystic morphology).

Practice Committee of the American Society for Reproductive Medicine (ASRM). (2021). Diagnostic evaluation of the infertile female: a committee opinion. Fertility and Sterility, 116(5), 1255–1265.

Contribution: pillars of ovarian reserve testing (FSH, estradiol, AMH, AFC), hysterosalpingography, and ovulation confirmation.

World Health Organization (WHO). (2021). WHO laboratory manual for the examination and processing of human semen (6th ed.). Geneva: World Health Organization.

Contribution: minimum reference values for standard semen analysis (volume, concentration, progressive motility, vitality, and strict Kruger morphology).

Practice Committee of the American Society for Reproductive Medicine (ASRM). (2013). Use of clomiphene citrate in infertile women: a committee opinion. Fertility and Sterility, 100, 341–348.

Contribution: clomiphene citrate ovulation-induction protocols, monitoring and follicle size for the hCG trigger (higher pregnancy rates with a leading follicle of 23-28mm).

Practice Committee of the American Society for Reproductive Medicine (ASRM). (2020). Use of exogenous gonadotropins for ovulation induction in anovulatory women: a committee opinion. Fertility and Sterility, 113, 66–70.

Contribution: low-dose gonadotropin regimens, trigger at follicular maturity and cycle cancellation with more than two follicles >16mm.

Palatnik, A., Strawn, E., Szabo, A., & Robb, P. (2012). What is the optimal follicular size before triggering ovulation in intrauterine insemination cycles with clomiphene citrate or letrozole? An analysis of 988 cycles. Fertility and Sterility, 97, 1089–1094.

Contribution: higher pregnancy rates with a leading follicle of 23-28mm in clomiphene or letrozole cycles; 28mm tolerance limit.

Shalom-Paz, E., Marzal, A., Wiser, A., Hyman, J., & Tulandi, T. (2014). Does optimal follicular size in IUI cycles vary between clomiphene citrate and gonadotrophins treatments? Gynecological Endocrinology, 30(2), 107–110.

Contribution: clomiphene trigger from 20mm (leading follicle of 20.4 ± 1.2mm in conception cycles) and smaller size with gonadotropins.

Ling, L., et al. (2024). Effect of follicle size on pregnancy outcomes in patients undergoing first letrozole-intrauterine insemination. European Journal of Medical Research, 29, 184.

Contribution: optimal size of 19.1-21mm for the trigger in the first letrozole IUI cycle.

Van Oirschot, M., et al. (2025). Optimal follicle size for human chorionic gonadotropin trigger in mono-follicular growth during letrozole-induced intrauterine insemination cycles: findings from a large retrospective study. Fertility and Sterility.

Contribution: 19-23mm range for the hCG trigger in letrozole IUI cycles.

ESHRE Ovarian Stimulation Guideline Group. (2025). Ovarian stimulation for IVF/ICSI: guideline update 2025. European Society of Human Reproduction and Embryology.

Contribution: the association between follicle size and outcome has not been sufficiently studied; the trigger size is individualized.

ESHRE Guideline Group on Female Infertility. (2023). Female infertility: a guideline. Human Reproduction Open, 2023(3), hoad034.

Contribution: serial ultrasound monitoring protocol for ovulation induction, baseline and serial folliculometry criteria, and definition of induction resistance/treatment failure.

Facchinetti, F., et al. (2020). Reduction of oocyte quality and clinical outcomes using myo-inositol and D-chiro-inositol: an update. Expert Opinion on Drug Metabolism & Toxicology. · Unfer, V., et al. (2017). Myo-inositol effects in women with PCOS: a meta-analysis of randomized controlled trials. Endocrine Connections. · Cochrane. (2023 update). Inositol for subfertility associated with PCOS (Review). · ESHRE/ASRM/Monash PCOS Guideline (2023).

Contribution: mechanism, dosing (myo-inositol 2-4g/day, physiological 40:1 ratio with D-chiro-inositol), and low-to-moderate certainty evidence on improved ovulation/clinical pregnancy rates in PMOS — basis for the Myo-inositol guide (see also Chapter 8, inadvertent exposure during fertility recovery).

Poyatos-León, R., Martínez-Vizcaíno, V., Sequí-Domínguez, I., Sanabria-Martínez, G., Díez Fernández, A., & Martínez-Hortelano, J. A. (2026). The effect of myo-inositol supplementation on gestational diabetes mellitus prevention: a systematic review and meta-analysis. American Journal of Obstetrics and Gynecology, 235(5), 1024–1036. doi:10.1016/j.ajog.2026.05.020

Contribution: most recent, specific meta-analysis on myo-inositol and gestational diabetes prevention — 12 RCTs, 4,765 women without preexisting diabetes, 44% relative risk reduction for GDM, no significant differences in hypertensive disorders/cesarean/macrosomia/preterm birth/neonatal hypoglycemia; cited in the Myo-inositol guide.

World Health Organization. (2024). Guideline on haemoglobin cutoffs to define anaemia in individuals and populations. Geneva: WHO. https://www.who.int/publications/i/item/9789240088542

Contribution: anemia in non-pregnant women below 12 g/dL (mild 11–11.9; severe <8); basis for yellow between 11 and 12 in the Preconception risk traffic light.

American College of Obstetricians and Gynecologists & Society for Maternal-Fetal Medicine. (2022, reaffirmed 2025). Pregnancy at age 35 years or older. Obstetric Care Consensus No. 11. Obstetrics & Gynecology. https://www.acog.org/clinical/guidance/obstetric-care-consensus/2022/08/pregnancy-at-age-35-years-or-older

Contribution: age 35 or older as a risk factor; resolves age 35 in the MSPBS traffic light as yellow.

Centers for Disease Control and Prevention. (2026). MTHFR Gene Variant and Folic Acid Facts. https://www.cdc.gov/folic-acid/data-research/mthfr/index.html

Contribution: with an MTHFR variant, folic acid at the same dose; it is the only form of folate shown to prevent neural tube defects.

Bashford, M. T., Hickey, S. E., Curry, C. J., Toriello, H. V., & ACMG Professional Practice and Guidelines Committee. (2020). Addendum: ACMG Practice Guideline: lack of evidence for MTHFR polymorphism testing. Genetics in Medicine, 22(12), 2125. https://doi.org/10.1038/s41436-020-0843-0

Contribution: do not order MTHFR testing (2013 document reaffirmed in 2020).

American College of Radiology. (2023). O-RADS US v2022 Assessment Categories. Strachowski, M. J., et al. Radiology, 308(3), e230685. https://cs.acr.org/-/media/ACR/Files/RADS/O-RADS/US-v2022/O-RADS--US-v2022-Assessment-Categories.pdf

Contribution: O-RADS v2022 categories and management (Ovarian tumor guide).

Amor, F., Vaccaro, H., Alcázar, J. L., et al. (2009). Gynecologic imaging reporting and data system. Journal of Ultrasound in Medicine, 28(3), 285–291. https://doi.org/10.7863/jum.2009.28.3.285

Contribution: GI-RADS categories (GI-RADS guide).

Ray-Coquard, I., Morice, P., Lorusso, D., et al. (2018). Non-epithelial ovarian cancer: ESMO Clinical Practice Guidelines. Annals of Oncology, 29(Suppl 4), iv1–iv18. https://www.esmo.org/guidelines/esmo-clinical-practice-guideline-non-epithelial-ovarian-cancer

Contribution: AFP, hCG, LDH and inhibin B in germ cell and sex cord-stromal tumors (Ovarian tumors by origin and markers guide).

Ledermann, J. A., Matias-Guiu, X., Amant, F., et al. (2024). ESGO–ESMO–ESP consensus conference recommendations on ovarian cancer. Annals of Oncology, 35(3), 248–266. https://www.esmo.org/guidelines/esgo-esmo-esp-consensus-recommendations-ovarian-cancer

Contribution: BRCA/HRD, surgery and maintenance; no marker alone distinguishes benign from malignant (ovarian guides).

Prat, J. (2014). Staging classification for cancer of the ovary, fallopian tube, and peritoneum. International Journal of Gynecology & Obstetrics, 124(1), 1–5. https://doi.org/10.1016/j.ijgo.2013.10.001

Contribution: FIGO 2014 ovarian stages.

Berek, J. S., Matias-Guiu, X., Creutzberg, C., et al. (2023). FIGO staging of endometrial cancer: 2023. International Journal of Gynecology & Obstetrics, 162(2), 383–394. https://pmc.ncbi.nlm.nih.gov/articles/PMC10482588/

Contribution: FIGO 2023 endometrial stages with molecular group.

Concin, N., et al. (2025). ESGO–ESTRO–ESP guidelines for the management of patients with endometrial carcinoma: update 2025. Lancet Oncology. https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(25)00167-6/fulltext

Contribution: management by molecular risk group in endometrial cancer.

Cibula, D., Raspollini, M. R., Planchamp, F., et al. (2023). ESGO/ESTRO/ESP guidelines for the management of patients with cervical cancer – Update 2023. International Journal of Gynecological Cancer, 33, 649–666. https://pmc.ncbi.nlm.nih.gov/articles/PMC10247855/

Contribution: pelvic MRI, PET-CT and stage-based management in cervical cancer.

Harmsen, M. J., Van den Bosch, T., de Leeuw, R. A., et al. (2022). Consensus on revised definitions of MUSA features of adenomyosis. Ultrasound in Obstetrics & Gynecology, 60(1), 118–131. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9328356/

Contribution: direct and indirect features; the 12 mm junctional zone cut-off is withdrawn (Adenomyosis guide).

International Society for Gynecologic Endoscopy. (2023). Hysteroscopic myomectomy: the guidelines (STEP-W). https://isge.org/wp-content/uploads/2023/10/ISGE_Hysteroscopic_myomectomy_The_guidelines.pdf

Contribution: STEP-W score (Fibroids guide).

American College of Radiology. (2025). ACR BI-RADS® v2025 Manual. https://www.appliedradiology.com/news/acr-releases-bi-rads-v2025-manual-detailing-reporting-and-lexicon-updates-across-modalities

Contribution: split category 0 and management by category (BI-RADS guides).

ASCCP. (2024–2025). Enduring guidelines process: dual stain, self-collection and extended genotyping. https://www.asccp.org/guidelines/management-guidelines-enduring-guidelines-process/enduring-guidelines-process/

Contribution: p16/Ki-67 dual stain and HPV self-collection (ASCCP guide).

Leone, F. P., Timmerman, D., Bourne, T., et al. (2010). Terms, definitions and measurements to describe the sonographic features of the endometrium and intrauterine lesions: a consensus opinion from the International Endometrial Tumor Analysis (IETA) group. Ultrasound in Obstetrics & Gynecology, 35(1), 103–112.

Contribution: standardized endometrial thickness measurement, echogenicity classification, definition of the endometrial-myometrial junction, and vascular patterns (Color Score 1–4).

Epstein, E., Fischerova, D., Valentin, L., et al. (2018). Ultrasound characteristics of endometrial cancer as defined by International Endometrial Tumor Analysis (IETA) consensus: prospective cohort study. Ultrasound in Obstetrics & Gynecology, 51(6), 818–828.

Contribution: clinical validation of chaotic/branching Doppler flow and irregular borders for detecting malignant pathology.

American College of Obstetricians and Gynecologists (ACOG). (2018). Committee Opinion No. 734: The Role of Transvaginal Ultrasonography in Evaluating the Endometrium of Postmenopausal Patients with Abnormal Uterine Bleeding. Obstetrics & Gynecology, 131(5), e124–e129.

Contribution: ≤4mm ultrasound threshold in postmenopausal bleeding (NPV >99%) and indications for outpatient endometrial biopsy (Pipelle).

Revised American Society for Reproductive Medicine (rASRM). (1997). Revised American Society for Reproductive Medicine classification of endometriosis: 1996. Fertility and Sterility, 67(5), 817–821.

Contribution: endometriosis stages I–IV based on scoring of peritoneal implants, endometriomas, and pelvic adhesions.

Keckstein, J., Saridogan, E., Ulrich, U. A., et al. (2021). The #Enzian classification: A comprehensive directory of deep endometriosis and its associated diseases. Human Reproduction Open, 2021(4), hoab038.

Contribution: standardized mapping of deep retroperitoneal endometriosis by anatomic compartments (A, B, C, and affected organs).

Munro, M. G., Critchley, H. O., Fraser, I. S., & FIGO Menstrual Disorders Committee. (2018). The two FIGO systems for normal and abnormal uterine bleeding symptoms and classification of causes of abnormal uterine bleeding in the reproductive years, including PALM-COEIN. International Journal of Gynecology & Obstetrics, 143(3), 393–408.

Contribution: morphologic subclassification of uterine fibroids, FIGO types 0–8.

Bump, R. C., Mattiasson, A., Bø, K., et al. (1996). The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. American Journal of Obstetrics and Gynecology, 175(1), 10–17.

Contribution: pelvic organ prolapse quantification system (POP-Q) and standardized clinical staging (grades 0–IV).

Heinemann, K., Ruebig, A., Potthoff, P., et al. (2004). The Menopause Rating Scale (MRS) scale: A methodological review. Health and Quality of Life Outcomes, 2, 45.

Contribution: validation of the somatic, psychological, and urogenital domains, and severity cutoffs for menopausal syndrome.

Heinemann, L. A. J., Do, M. T., Strelow, F., Gerbsch, S., Schnitker, J., & Schneider, H. P. G. (2004). The Menopause Rating Scale (MRS) as outcome measure for hormone treatment? A validation study. Health and Quality of Life Outcomes, 2, 67. doi:10.1186/1477-7525-2-67

Contribution: severity cutoffs for the total and for each domain (no/little symptoms, mild, moderate, severe) and validation of the scale as an outcome measure for hormone treatment.

The 2022 Hormone Therapy Position Statement of The North American Menopause Society (NAMS). (2022). Menopause, 29(7), 767–794.

Contribution: window-of-opportunity criteria (age <60 or <10 years postmenopause), regimens with and without progestogen opposition, and absolute contraindications.

Stute, P., et al. (2026). 'Healthy menopause': The European Menopause and Andropause Society (EMAS) 2026 framework for precision, digital, and interdisciplinary midlife health. Maturitas, 212, 109060.

Contribution: multidisciplinary approach to healthy aging, metabolic stratification, and pharmacologic alternatives.

Anagnostis, P., Bosdou, J. K., Georgiou, T., & Goulis, D. G. (2025). Can menopausal hormone therapy be considered in postmenopausal women who are older than 60 years? Gynecological Endocrinology, 41(1), 2468957.

Contribution: safety guidance, ultra-low-dose transdermal therapy for refractory severe vasomotor symptoms, and non-hormonal preference after age 60.

Pratt, M. C., et al. (2023). Fezolinetant for the treatment of vasomotor symptoms associated with menopause. Expert Review of Clinical Pharmacology, 16(5), 389–398.

Contribution: NK3 receptor blockade at the hypothalamic level (KNDy neurons) as first-line non-hormonal therapy for hot flashes.

American College of Obstetricians and Gynecologists (ACOG). (2026). Clinical Practice Guideline No. 13 — Management of Menopause-Related Vasomotor, Sleep, and Mood Symptoms. Obstetrics & Gynecology, 148(5), e345–e364. https://pubmed.ncbi.nlm.nih.gov/42878500/

Contribution: dosing tables for systemic HRT and the tissue-selective estrogen complex (CEE+bazedoxifene), the non-hormonal options table (SSRI/SNRI, fezolinetant, elinzanetant, gabapentin) with the exact liver-monitoring cadence per drug, graded recommendations for non-pharmacologic interventions (CBT, mindfulness, exercise, clinical hypnosis, acupuncture), and an explicit non-recommendation statement on phytoestrogens/herbal supplements — basis for the MRS Scale and HRT, Fezolinetant and elinzanetant, and Climacteric — non-pharmacologic management guides.

Knapen, M. H. J., Drummen, N. E., Smit, E., Vermeer, C., & Theuwissen, E. (2013). Three-year low-dose menaquinone-7 supplementation helps decrease bone loss in healthy postmenopausal women. Osteoporosis International, 24(9), 2499–2507.

Contribution: randomized trial (n=244, 3 years) of vitamin K2 (MK-7) 180mcg/day in healthy postmenopausal women — decreased bone mineral density loss at the lumbar spine and femoral neck — basis for the Vitamin K2 (MK-7) guide.

Vossen, L. M., de Leeuw, P. W., Schurgers, L. J., et al. (2026). Two Years of Menaquinone-7 Supplementation and Coronary Artery Calcification: A Randomized Clinical Trial (VitaK-CAC). JAMA Cardiology (online, June 10, 2026).

Contribution: randomized trial (n=167, 2 years) of vitamin K2 (MK-7) 360mcg/day in patients with symptomatic coronary artery disease — modest slowing of coronary calcification progression, an effect the authors themselves describe as of still-uncertain clinical significance — basis for the Vitamin K2 (MK-7) guide.

McClung, M. R., & Clark, A. L. (2026). Preventing menopause-related bone loss (Menopause Step-by-Step). Menopause, 33(11), 1209–1211. https://doi.org/10.1097/GME.0000000000002931

Contribution: prevention of menopause-related bone loss: risk predictors, DXA in perimenopausal women with risk factors, limits of supplements and exercise, estrogen doses, management when MHT is stopped and alternatives — basis of the Prevention block of the Osteoporosis guide.

Bolland, M. J., Nisa, Z., Mellar, A., et al. (2025). Fracture prevention with infrequent zoledronate in women 50 to 60 years of age. New England Journal of Medicine, 392, 239–248. https://doi.org/10.1056/NEJMoa2407031

Contribution: infrequent zoledronic acid in women aged 50 to 60 years to prevent fractures — support for a short bisphosphonate course when estrogen is stopped.

The North American Menopause Society. (2021). Management of osteoporosis in postmenopausal women: the 2021 position statement. Menopause, 28, 973–997. https://doi.org/10.1097/GME.0000000000001831

Contribution: The Menopause Society position on postmenopausal osteoporosis management, including estrogen for prevention.

The North American Menopause Society. (2022). The 2022 hormone therapy position statement. Menopause, 29, 767–794. https://doi.org/10.1097/GME.0000000000002028

Contribution: The Menopause Society position on hormone therapy — use to prevent bone loss in high-risk women even without vasomotor symptoms.

US Preventive Services Task Force, Mangione, C. M., Barry, M. J., Nicholson, W. K., et al. (2022). Hormone therapy for the primary prevention of chronic conditions in postmenopausal persons: recommendation statement. JAMA, 328, 1740–1746. https://doi.org/10.1001/jama.2022.18625

Contribution: recommendation against hormone therapy for the primary prevention of chronic conditions — opposing position cited in the Osteoporosis guide.

Benedetto, C., Gulati, M., Khadilkar, S. S., Maas, A. H. E. M., Frezet, F., Moraes de Oliveira, G. M., Genazzani, A. R., Divakar, H., & Poppas, A., on behalf of the World Heart Federation (WHF) and the International Federation of Gynecology and Obstetrics (FIGO). (2026). Menopause hormone therapy in women with cardiovascular risk factors or established ischemic heart disease: A joint FIGO and WHF position paper. International Journal of Gynecology & Obstetrics. https://doi.org/10.1002/ijgo.71356

Contribution: joint FIGO/WHF position — cardiovascular risk-stratification algorithm before prescribing MHT (coronary artery calcium score by CT for intermediate risk), specific management in established ischemic heart disease (INOCA, MINOCA, obstructive coronary disease, spontaneous coronary artery dissection) and differentiated VTE/stroke risk by progestogen type — underpins the new MHT and cardiovascular risk (FIGO/WHF) guide.

International Society of Ultrasound in Obstetrics and Gynecology (ISUOG). Practice Guidelines (updated): performance of the routine mid-trimester fetal ultrasound scan. (2022). Ultrasound in Obstetrics & Gynecology, 59(6), 840–856. — and its predecessors, ISUOG Practice Guidelines: sonographic examination of the fetal central nervous system (2020) and fetal heart screening examination (2023).

Contribution: technical framework and system-by-system checklist for the Fetal structural morphology — 7 systems guide (CNS, face, spine, heart, abdomen, limbs).

Paladini, D., & Volpe, P. (2018). Ultrasound of Congenital Fetal Anomalies: Differential Diagnosis and Prognostic Indicators (3rd ed.). CRC Press.

Contribution: detailed diagnostic criteria and management for each structural finding (ventriculomegaly, lemon/strawberry sign, cardiac defects, CDH, wall defects).

Jeanty, P., Dramaix-Wilmet, M., Elkhazen, N., Hubinont, C., & van Regemorter, N. (1984). Measurements of fetal orbits and binocular distance in normal pregnancy. Journal of Ultrasound in Medicine, 3(6), 241–244. · Mayden, K. L., Tortora, M., Berkowitz, R. L., Bracken, M., & Hobbins, J. C. (1982). Orbital diameters: a new parameter for prenatal diagnosis and dating. American Journal of Obstetrics and Gynecology, 144(3), 289–297.

Contribution: orbital diameter (IOD/OOD) reference tables and the "rule of thirds" for hyper/hypotelorism — Face field of the Fetal structural morphology guide.

Corteville, J. E., Gray, D. L., & Crane, J. P. (1991). Congenital hydronephrosis: correlation of fetal ultrasonographic findings with infant outcome. American Journal of Obstetrics and Gynecology, 165(2), 384–388. · Corteville, J. E., Dicke, J. M., & Crane, J. P. (1992). Fetal pyelectasis and Down syndrome: is genetic amniocentesis warranted? Obstetrics & Gynecology, 79(5), 770–772.

Contribution: renal pelvis dilation cutoffs by AP diameter (GA-dependent at 33 weeks) — Abdomen field of the Fetal structural morphology guide.

CDHSG — Congenital Diaphragmatic Hernia Study Group / Jani, J., Nicolaides, K. H., Keller, R. L., et al. (2007). Observed to expected lung area to head circumference ratio in the prediction of survival in fetuses with isolated diaphragmatic hernia. Ultrasound in Obstetrics & Gynecology, 30(1), 67–71.

Contribution: O/E LHR as a severity predictor in congenital diaphragmatic hernia — Chest and heart field of the Fetal structural morphology guide.

Jauniaux, E., Bhide, A., Kennedy, A., et al. — FIGO Placenta Accreta Spectrum Expert Consensus Panel. (2018). FIGO consensus guidelines on placenta accreta spectrum disorders: Prenatal diagnosis and screening. International Journal of Gynecology & Obstetrics, 140(3), 274–280. · Jauniaux, E., Collins, S., & Burton, G. J. (2016). Placenta accreta spectrum: pathophysiology and evidence-based anatomy for prenatal ultrasound imaging. American Journal of Obstetrics and Gynecology, 215(3), 712–721.

Contribution: risk factors, 2D ultrasound signs (clear zone, lacunae, bladder-uterine interface), and the surgical/histopathological FIGO classification (grades 1-3b) — basis for the Placenta accreta spectrum (PAS) guide.

American College of Obstetricians and Gynecologists (ACOG) & Society for Maternal-Fetal Medicine (SMFM). (2018, reaffirmed 2021). Obstetric Care Consensus No. 7: Placenta Accreta Spectrum. Obstetrics & Gynecology, 132(6), e259–e275.

Contribution: management of suspected PAS (never manual placental removal, placenta left in situ + en bloc hysterectomy, Level III-IV center, planned cesarean at 34+0-35+6 weeks) — the "golden rule" of the PAS guide.

CaVeSal® clinical team (Dr. Carlos Vera Salerno). "CaVeSal Classification" — a proprietary scoring scheme combining risk factors + 2D signs + color Doppler signs to estimate Probability and Extent of accreta.

Contribution: a proprietary scheme developed by the team, NOT a published FIGO/ISUOG/ACOG score — distinct from and complementary to the FIGO Classification (surgical/histopathological confirmation) cited above.

International Society of Ultrasound in Obstetrics and Gynecology (ISUOG). Khalil, A., Sotiriadis, A., D'Antonio, F., et al. (2024). ISUOG Practice Guidelines: performance of third-trimester obstetric ultrasound scan. Ultrasound in Obstetrics & Gynecology, 63(1), 131–147. https://doi.org/10.1002/uog.27538 · Society for Maternal-Fetal Medicine (SMFM). Dashe, J. S., Pressman, E. K., & Hibbard, J. U. (2018; reaffirmed 2024). SMFM Consult Series #46: Evaluation and management of polyhydramnios. American Journal of Obstetrics and Gynecology, 219(4), B2–B8. https://doi.org/10.1016/j.ajog.2018.07.016 · Phelan, J. P., Smith, C. V., Broussard, P., & Small, M. (1987). Amniotic fluid volume assessment with the four-quadrant technique at 36–42 weeks' gestation. Journal of Reproductive Medicine, 32(7), 540–542.

Contribution: oligohydramnios and polyhydramnios criteria by AFI and DVP (ISUOG 2024), definition and grading of polyhydramnios (SMFM #46), and the lower borderline AFI zone 5.1–8.0 cm (Phelan 1987) in the amniotic fluid guides.

Cobo, T., et al. Protocolo: Rotura prematura de membranas a término y pretérmino. BCNatal — Hospital Clínic / Hospital Sant Joan de Déu, Universitat de Barcelona. · Eleje, G. U., et al. Accuracy and response time of Amnioquick duo+ in comparison to PAMG-1 in the diagnosis of PROM. · Bonet-Carne, E., et al. (2015). Quantitative ultrasound texture analysis of fetal lungs to predict neonatal respiratory morbidity. Ultrasound in Obstetrics & Gynecology, 45(4), 427–433. https://doi.org/10.1002/uog.13441 · Palacio, M., et al. (2017). Prediction of neonatal respiratory morbidity by quantitative ultrasound lung texture analysis: a multicenter study. American Journal of Obstetrics and Gynecology, 217(2), 196.e1–196.e14. https://doi.org/10.1016/j.ajog.2017.03.016

Contribution: PROM diagnosis: PAMG-1 as the reference non-invasive test in equivocal cases, AmnioQuick Duo+ comparable, current uses of amniocentesis (diagnosis with indigo carmine or fluorescein, infection, maturity) and quantusFLM as a non-invasive alternative for lung maturity.

Manning, F. A., Platt, L. D., & Sipos, L. (1980). Antepartum fetal evaluation: development of a fetal biophysical profile score. American Journal of Obstetrics and Gynecology, 136(6), 787–795. · Vintzileos, A. M., Campbell, W. A., Ingardia, C. J., & Nochimson, D. J. (1983). The fetal biophysical profile and its predictive value. Obstetrics & Gynecology, 62(3), 271–278. · Clark, S. L., Sabey, P., & Jolley, K. (1989). Nonstress testing with acoustic stimulation and amniotic fluid volume assessment. American Journal of Obstetrics and Gynecology, 160(3), 694–697. · Queenan, J. T., Spong, C. Y., & Lockwood, C. J. (Eds.). Queenan's Management of High-Risk Pregnancy: An Evidence-Based Approach (7th ed.). Wiley-Blackwell.

Contribution: the four Fetal Biophysical Profile modalities (Complete, Ultrasound-only, Abbreviated, Vintzileos) and the stepwise decision tree by score × amniotic fluid status × GA.

Ayres-de-Campos, D., Spong, C. Y., Chandraharan, E., & FIGO Intrapartum Fetal Monitoring Expert Consensus Panel. (2015). FIGO consensus guidelines on intrapartum fetal monitoring: Cardiotocography. International Journal of Gynecology & Obstetrics, 131(1), 13–24. · American College of Obstetricians and Gynecologists (ACOG). Practice Bulletin No. 229: Antepartum Fetal Surveillance (2021). · ACOG Practice Bulletin No. 106: Intrapartum Fetal Heart Rate Monitoring.

Contribution: standardized criteria for baseline FHR, variability, and reactivity (15×15/10×10) — basis for the Fetal Monitoring (NST/CTG) guide.

Caldeyro-Barcia, R., Casacuberta, C., Bustos, R., et al. (1966). Correlation of intrauterine pressure and fetal heart rate patterns. In: Proceedings of the Second International Conference on the Fetus and Newborn. Annals of the New York Academy of Sciences. · Welt, A. M., Hobbins, J. C., & Jones, O. (1984). Biphasic variable decelerations: the "W" sign. American Journal of Obstetrics and Gynecology. · Dawes, G. S., Redman, C. W. G., et al. — Oxford computerized CTG system.

Contribution: classification of Dips I/II/III decelerations, the W sign as the only verified reference among the special morphological patterns, and the distinction between shoulders (reassuring) vs. overshoot (non-reassuring) in the Fetal Monitoring guide.

Figueras, F., & Gratacós, E. (2014/2021). Stage-based management of fetal growth restriction. Fetal Diagnosis and Therapy, 36(1), 22–33 / Medicina Fetal Barcelona.

Contribution: hemodynamic classification of FGR in stages I–IV by Doppler of the uterine arteries, umbilical artery, middle cerebral artery, and ductus venosus, with standardized delivery timing.

Mari, G., Deter, R. L., Carpenter, R. L., et al. (2000). Noninvasive diagnosis by Doppler ultrasonography of fetal anemia due to maternal red-cell alloimmunization. New England Journal of Medicine, 342(1), 9–14.

Contribution: middle cerebral artery peak systolic velocity (MCA-PSV ≥1.50 MoM) for the noninvasive diagnosis of severe fetal anemia.

American College of Obstetricians and Gynecologists (ACOG). (2020). Practice Bulletin No. 216: Macrosomia. Obstetrics & Gynecology, 135(1), e18–e35.

Contribution: criteria for planned preventive cesarean delivery when estimated fetal weight is ≥5,000g in non-diabetics and ≥4,500g in diabetics.

International Society of Ultrasound in Obstetrics and Gynecology (ISUOG). (2018). ISUOG Practice Guidelines: intrapartum ultrasound. Ultrasound in Obstetrics & Gynecology, 52(4), 547–559.

Contribution: objective assessment of labor progress (angle of progression ≥120°, head-perineum distance, and fetal head direction).

Alexander EK, Pearce EN, Brent GA, et al. (2017). 2017 Guidelines of the American Thyroid Association for the diagnosis and management of thyroid disease during pregnancy and the postpartum. Thyroid, 27(3), 315–389. doi:10.1089/thy.2016.0457

Contribution: laboratory TSH range or upper limit 4.0; anti-TPO if TSH >2.5 in 1T (rec. 28) or >3.0 in 2T–3T (CaVeSal® suggestion); management table by anti-TPO status; preconception TSH <2.5 and IVF/ICSI (rec. 20). The 2.5/3.0 trimester grey zone is a CaVeSal® suggestion based on ATA 2011.

Cluver CA, Rohwer C, Rohwer AC. (2025). Calcium supplementation during pregnancy for preventing hypertensive disorders and related problems. Cochrane Database of Systematic Reviews, 12, CD001059. PubMed 41330480

Contribution: Supplementation in pregnancy: calcium with no difference in pre-eclampsia in the large trials (RR 0.92).

World Health Organization. (2012). Guideline: Daily iron and folic acid supplementation in pregnant women. OMS IRIS

Contribution: iron 30–60 mg/day prophylaxis; anaemia 120 mg/day until Hb normalises.

Middleton P, Gomersall JC, Gould JF, et al. (2018). Omega-3 fatty acid addition during pregnancy. Cochrane Database of Systematic Reviews, 11, CD003402. Cochrane Library

Contribution: omega-3 with preterm risk: 42% fewer births <34 wk.

National Institutes of Health, Office of Dietary Supplements. Dietary Supplements and Life Stages: Pregnancy. NIH ODS

Contribution: MTHFR: CDC keeps folic acid; calcium 1000 mg/day, the same as outside pregnancy (IOM 2011).

Lazarus JH, Bestwick JP, Channon S, et al. (2012). Antenatal thyroid screening and childhood cognitive function. N Engl J Med, 366(6), 493–501. doi:10.1056/NEJMoa1106104

Contribution: CATS trial: treatment from ~13 weeks did not improve IQ at 3 years (99.2 vs 100.0).

Casey BM, Thom EA, Peaceman AM, et al.; NICHD MFMU Network. (2017). Treatment of subclinical hypothyroidism or hypothyroxinemia in pregnancy. N Engl J Med, 376(9), 815–825. doi:10.1056/NEJMoa1606205

Contribution: TSH ≥4.0 treated from ~17 weeks: no difference in IQ at 5 years (97 vs 94).

Dhillon-Smith RK, Middleton LJ, Sunner KK, et al. (2019). Levothyroxine in women with thyroid peroxidase antibodies before conception. N Engl J Med, 380(14), 1316–1325. doi:10.1056/NEJMoa1812537

Contribution: TABLET trial: levothyroxine in euthyroid anti-TPO+ women did not increase live births.

Dall'Asta, A., Sen, C., Aryananda, R., et al. (2026). Antenatal diagnosis and classification for placenta accreta (adherence) spectrum: Clinical practice guideline and recommendations by the World Association of Perinatal Medicine and the Perinatal Medicine Foundation. Pregnancy (Hoboken), 2(6), e70489. https://pubmed.ncbi.nlm.nih.gov/42927239/

Contribution: WAPM/PMF guideline on antenatal PAS diagnosis: early transvaginal ultrasound after a previous cesarean (scar pregnancy), combined ultrasound in the 2nd-3rd trimester, complementary MRI and referral to a perinatal center.

Lee, A. U., Brand, M., Cabrera, M. C., et al. (2026). World Gastroenterology Organisation Practice Guidelines: Hepatitis B. Journal of Clinical Gastroenterology. doi:10.1097/MCG.0000000000002440. https://pubmed.ncbi.nlm.nih.gov/42816874/

Contribution: WGO hepatitis B guideline; supports antiviral prophylaxis to prevent mother-to-child transmission and discusses test-and-treat where viral load is unavailable.

Qaseem, A., Mackey, K., Yost, J., et al. (2026). Pharmacologic treatments for females with menopausal vasomotor symptoms: A clinical guideline from the American College of Physicians. Annals of Internal Medicine. doi:10.7326/ANNALS-26-01205. https://pubmed.ncbi.nlm.nih.gov/42832802/

Contribution: ACP guideline on pharmacologic treatment of vasomotor symptoms: 1st line HRT; 2nd SNRIs; 3rd SSRIs, gabapentin or NK antagonists.

Oderkerk, T. J., Leemans, J. C., Beelen, P., et al. (2026). Endometrial ablation plus levonorgestrel-releasing intrauterine system versus endometrial ablation alone in women with heavy menstrual bleeding (MIRA2). Lancet, 408(10566), 1828–1838. https://pubmed.ncbi.nlm.nih.gov/42906565/

Contribution: MIRA2 trial: LNG-IUS after endometrial ablation reduced hysterectomy at 2 years (4% vs. 10%).

Trainor, B. W., Osborn, J. L., Klausner, J. D., et al. (2026). Enabling ciprofloxacin resistance-guided therapy for Neisseria gonorrhoeae: Aligning diagnostics, regulation, guidelines, and reimbursement. Clinical Infectious Diseases. doi:10.1093/cid/ciag640. https://pubmed.ncbi.nlm.nih.gov/42911991/

Contribution: ARLG/CARB-X expert meeting: pathway to resistance-guided ciprofloxacin (gyrA); under study, not a guideline — ceftriaxone remains.

Benaglia, L., Vignali, M., Reschini, M., et al. (2026). IVF versus surgery for infertility in women with deep and ovarian endometriosis: A partially randomized patient preference trial. American Journal of Obstetrics and Gynecology. doi:10.1016/j.ajog.2026.10.024. https://pubmed.ncbi.nlm.nih.gov/42925945/

Contribution: partially randomized trial, stopped early: IVF outperformed surgery for live birth (RR 2.20). Preliminary evidence.

Ferrari, S., Biver, E., Gonzalez-Rodriguez, E., et al. (2026). Updated recommendations for osteoporosis treatment according to fracture risk: 2026 revision by the Swiss Association against Osteoporosis (SVGO). Swiss Medical Weekly, 156, 5700. https://pubmed.ncbi.nlm.nih.gov/42896029/

Contribution: five risk categories; anabolic-first (romosozumab/abaloparatide) for imminent or very high risk; bisphosphonates or denosumab for high risk; hip BMD treat-to-target.

International Association of Diabetes and Pregnancy Study Groups (IADPSG) Consensus Panel. (2010). International association of diabetes and pregnancy study groups recommendations on the diagnosis and classification of hyperglycemia in pregnancy. Diabetes Care, 33(3), 676–682.

Contribution: one-step protocol (75 g): fasting ≥92, 1 h ≥180, 2 h ≥153 mg/dL, one value is enough.

American Diabetes Association Professional Practice Committee. (2026). 2. Diagnosis and classification of diabetes: Standards of Care in Diabetes—2026. Diabetes Care, 49(Suppl. 1). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12690183

Contribution: Table 2.8 in force: IADPSG thresholds for one-step; two-step with 50 g ≥130/135/140 and 100 g Carpenter-Coustan; rec. 2.31b: before 15 weeks, fasting 110–125 or HbA1c 5.9–6.4% = early abnormal glucose metabolism; postpartum OGTT at 4–12 weeks.

American Diabetes Association Professional Practice Committee. (2026). 15. Management of diabetes in pregnancy: Standards of Care in Diabetes—2026. Diabetes Care, 49(Suppl. 1). https://pmc.ncbi.nlm.nih.gov/articles/PMC12690181/

Contribution: TOBOGM and early treatment by shared decision; targets <95 / <140 / <120; metformin does not prevent GDM (meta-analysis of 11 RCTs).

World Health Organization. (2013). Diagnostic criteria and classification of hyperglycaemia first detected in pregnancy (WHO/NMH/MND/13.2). Geneva: WHO. https://iris.who.int/server/api/core/bitstreams/612e0faa-04b5-4984-abcb-5fe3b1703677/content

Contribution: adopts the IADPSG thresholds (92/180/153) and early fasting 92–125 as GDM.

Salzberg, S., et al. (2016). Guías de diagnóstico y tratamiento de diabetes gestacional. ALAD 2016. Revista de la ALAD, 6, 155–169. https://www.revistasad.com/index.php/diabetes/article/view/180

Contribution: ALAD criterion: fasting 100–125 mg/dL on two occasions and/or 2 h ≥140 mg/dL on the 75 g OGTT — third protocol button. Replaces the former ALAD 2019 citation (type 2 diabetes guideline).

Ministerio de Salud Pública y Bienestar Social (MSPyBS). Manual Nacional Prenatal · Flujograma de manejo de la hiperglucemia en el embarazo. Asunción, Paraguay. https://www.mspbs.gov.py/dependencias/progsalud/adjunto/59c707-ManualNacionalPrenatal.pdf · https://informacionpublica.paraguay.gov.py/public/798580-FLUJOGRAMADEMANEJODELAHIPERGLUCEMIAENELEMBARAZOpdf-FLUJOGRAMADEMANEJODELAHIPERGLUCEMIAENELEMBARAZO.pdf

Contribution: national standard (Paraguay): fasting ≥92 at the first visit = GDM; 75 g OGTT from week 24; 2 h 140–152 = high risk of developing diabetes.

Simmons, D., Immanuel, J., Hague, W. M., et al. (2023). Treatment of gestational diabetes mellitus diagnosed early in pregnancy (TOBOGM). New England Journal of Medicine, 388(23), 2132–2144. https://www.nejm.org/doi/full/10.1056/NEJMoa2214956

Contribution: early glucose band: benefit in the higher band and possible excess SGA when treating the lower band — basis of the two readings before 15 weeks.

Sweeting, A., Hare, M. J. L., de Jersey, S. J., et al. (2025). Australasian Diabetes in Pregnancy Society (ADIPS) 2025 consensus recommendations for the screening, diagnosis and classification of gestational diabetes. Medical Journal of Australia, 223(3). https://www.mja.com.au/system/files/issues/223_03/mja252696.pdf

Contribution: Australian thresholds 95/191/162 mg/dL, mentioned in the guides as a reference.

American College of Obstetricians and Gynecologists (ACOG). (2020). Practice Bulletin No. 217: Prelabor Rupture of Membranes. Obstetrics & Gynecology, 135(3), e80–e97. https://www.acog.org/clinical/clinical-guidance/practice-bulletin/articles/2020/03/prelabor-rupture-of-membranes

Contribution: PROM management by gestational age (34-36+6: expectant management or delivery), latency regimen ampicillin/erythromycin → amoxicillin 250 mg + erythromycin 333 mg, and insufficient evidence for a rescue course of corticosteroids.

Society for Maternal-Fetal Medicine (SMFM). (2024). Consult Series #71: Management of previable and periviable preterm prelabor rupture of membranes. American Journal of Obstetrics & Gynecology, 231(4), B2–B15. doi:10.1016/j.ajog.2024.07.016 https://publications.smfm.org/publications/573-society-for-maternal-fetal-medicine-consult-series-71/

Contribution: Previable/periviable PROM: offer termination or expectant management (1C); antibiotics may be considered at 20-23+6 wk (2C) and are recommended from 24 wk (1B); corticosteroids and MgSO4 only if resuscitation is planned (1B).

American College of Obstetricians and Gynecologists (ACOG). (2025). Practice Advisory: Increased risk of maternal morbidity associated with previable and periviable preterm prelabor rupture of membranes. https://www.acog.org/clinical/clinical-guidance/practice-advisory/articles/2025/05/increased-risk-of-maternal-morbidity-associated-with-previable-and-periviable-preterm-prelabor-rupture-of-membranes

Contribution: higher maternal morbidity with expectant management before 24 weeks: composite 60.2% vs 33% and severe 12% vs 5%.

Morris, J. M., Roberts, C. L., Bowen, J. R., et al. (2016). Immediate delivery compared with expectant management after preterm pre-labour rupture of the membranes close to term (PPROMT trial). The Lancet, 387(10017), 444–452. https://pubmed.ncbi.nlm.nih.gov/26564381/

Contribution: PROM at 34-36+6: no difference in neonatal sepsis (2% vs 3%); immediate delivery had more respiratory distress and more cesareans.

Carel, J. C., Eugster, E. A., Rogol, A., Ghizzoni, L., Palmert, M. R., et al. (2009). Consensus statement on the use of gonadotropin-releasing hormone analogs in children. Pediatrics, 123(4), e752–e762.

Contribution: indication criteria, bone-age monitoring, and axis-suppression regimens with depot leuprolide acetate and triptorelin.

Speiser, P. W., Arlt, W., Auchus, R. J., Baskin, L. S., Conway, G. S., et al. (2018). Congenital Adrenal Hyperplasia Due to Steroid 21-Hydroxylase Deficiency: An Endocrine Society Clinical Practice Guideline. The Journal of Clinical Endocrinology & Metabolism, 103(11), 4043–4088.

Contribution: basal 17-OHP cutoffs, the confirmatory ACTH 250µg test with a >10ng/mL cutoff for the non-classic form, and hydrocortisone suppression.

Latronico, A. C., Brito, V. N., & Carel, J. C. (2016). Causes, diagnosis, and treatment of central precocious puberty. The Lancet Diabetes & Endocrinology, 4(3), 265–274.

Contribution: etiologic differentiation between idiopathic central precocious puberty vs. CNS lesions, and indications for sellar/brain MRI.

Badouraki, M., Christoforidis, A., Economou, I., Dimitriadis, A. S., & Katzos, G. (2008). Evaluation of pelvic ultrasonography in the diagnosis and follow-up of girls with precocious puberty. Journal of Clinical Ultrasound, 36(5), 277–282.

Contribution: ultrasound parameters of pubertal stimulation: uterine length ≥40mm, uterine volume ≥3–4mL, body-to-cervix ratio 2:1, visible endometrial line, and ovarian volume >2–3mL.

Calcaterra, V., et al. (2021). The role of pelvic ultrasound for the diagnosis and management of central precocious puberty: An update. Acta Bio-Medica, 92(5), e2021480.

Contribution: review compiling the various published cutoffs for uterine length/volume, ovarian volume, fundus-to-cervix ratio, and endometrial line on pelvic ultrasound in precocious puberty — highlights the lack of a single, universally validated cutoff.

Kim, J. H., et al. (2023). 2022 Clinical practice guidelines for central precocious puberty of Korean children and adolescents. Annals of Pediatric Endocrinology & Metabolism, 28(3), 168–177.

Contribution: Korean clinical practice guideline for central precocious puberty; considers pelvic ultrasound an ancillary tool (not diagnostic on its own) and lists uterine length ≥3.5–4cm and ovarian volume ≥2cm³ as suggestive values, with an explicit caveat about variability between studies.

Nguyen, N. N., et al. (2021). Diagnostic Accuracy of Female Pelvic Ultrasonography in Differentiating Precocious Puberty From Premature Thelarche: A Systematic Review and Meta-analysis. Frontiers in Endocrinology, 12, 735875.

Contribution: meta-analysis of 13 studies: a uterine length of 3.2cm showed pooled sensitivity of 81.8% and specificity of 82.0% for differentiating precocious puberty from premature thelarche — a reference figure, not an absolute cutoff.

Lee, S. H., et al. (2016). The Diagnostic Value of Pelvic Ultrasound in Girls with Central Precocious Puberty. Chonnam Medical Journal, 52(1), 70–74.

Contribution: describes prepubertal uterine morphology as tubular, with a fundus-to-cervix ratio ≈1, which becomes >1 with puberty; reviews various published uterine and ovarian cutoffs.

Chen, M., et al. (2015). Usefulness of pelvic ultrasonography for the diagnosis of central precocious puberty in girls. Korean Journal of Pediatrics, 58(8), 294–300.

Contribution: shows larger uterine measurements in central precocious puberty, but with considerable overlap between groups; stresses that ultrasound must be interpreted together with clinical and laboratory findings, never in isolation.

Eugster, E. A. (2015). Central Precocious Puberty: Update on Diagnosis and Treatment. Paediatric Drugs, 17(4), 281–290.

Contribution: notes that after age 8, ultrasound parameters are harder to interpret due to greater overlap between prepubertal and early-pubertal girls, and that isolated small ovarian follicles can be normal in prepubertal girls.

Greulich, W. W., & Pyle, S. I. (1959). Radiographic Atlas of Skeletal Development of the Hand and Wrist (2nd ed.). Stanford University Press.

Contribution: the standard for assessing bone maturation on hand/wrist X-ray, and the definition of a pathological advance >1.5–2 years.

Marshall, W. A., & Tanner, J. M. (1969). Variations in pattern of pubertal changes in girls. Archives of Disease in Childhood, 44(235), 291–303.

Contribution: clinical staging of breast development (M1–M5) and pubic hair (P1–P5).

Nguyen, A. T., Curtis, K. M., Tepper, N. K., et al. (2024). U.S. Medical Eligibility Criteria for Contraceptive Use, 2024. MMWR Recommendations and Reports, 73(4), 1–126. https://www.cdc.gov/mmwr/volumes/73/rr/rr7304a1.htm

Contribution: table of categories 1 to 4 by method and condition with initiation and continuation; basis of the MEC guide and the CaVeSal® GYN calculator.

Cagnacci, A., Fruzzetti, F., Bruni, V., et al. (2025). Consensus conference results on contraception in women beyond 40 years of age. The European Journal of Contraception & Reproductive Health Care, 30(6), 304–318. https://doi.org/10.1080/13625187.2025.2544754

Contribution: consensus for women over 40: venous and arterial risk, cycle control, heavy bleeding, sexuality and bone.

Faculty of Sexual and Reproductive Healthcare. (2017, amended 2023). Contraception for women aged over 40 years. FSRH

Contribution: when to stop contraception by age, method, amenorrhea and FSH, and combination with MHT.

ANMAT. (2025). Disposición DI-2025-79202301-APN-ANMAT: ampliación del período de uso de IMPLANON NXT (etonogestrel 68 mg) a cinco años. Ministerio de Salud de Neuquén

Contribution: etonogestrel 68 mg implant approved for 5 years.

World Health Organization. (2025). Medical eligibility criteria for contraceptive use (6th ed.). Geneva: World Health Organization. · World Health Organization. (2025). Family planning/contraception methods. WHO Fact Sheet (updated July 3, 2025).

Contribution: medical eligibility categories (1 to 4) by clinical condition, and the general classification of contraceptive methods and their mechanisms of action.

Manhart, M. D., Duane, M., Lind, A., Sinai, I., & Golden-Tevald, J. (2013). Fertility awareness-based methods of family planning: a review of effectiveness for avoiding pregnancy using SORT. Osteopathic Family Physician, 5(1), 2–8. · Peragallo Urrutia, R., Polis, C. B., Jensen, E. T., Greene, M. E., Kennedy, E., & Stanford, J. B. (2018). Effectiveness of Fertility Awareness-Based Methods for Pregnancy Prevention: A Systematic Review. Obstetrics & Gynecology, 132(3), 591–604.

Contribution: comparative effectiveness of fertility awareness-based methods (FABM) with perfect use vs. typical use.

Trussell, J. (2011). Contraceptive failure in the United States. Contraception, 83(5), 397–404.

Contribution: master comparative-effectiveness table (perfect use/typical use) for all contraceptive methods — a classic reference still in use.

World Health Organization. Intrauterine devices, fact sheet (updated) · U.S. Food and Drug Administration. (2026). Updated labeling and extended-use approval, Nexplanon 68 mg (January 2026) — accessdata.fda.gov · U.S. Food and Drug Administration. Statistical review of efficacy (NDA 021529/S-028) — fda.gov · Organon & Co. (2026). FDA approval announcement, Nexplanon extended duration of use — organon.com · Medicines and Healthcare products Regulatory Agency (MHRA), United Kingdom. Extended-use approval (21 May 2026) — organon.com/uk · Administración Nacional de Medicamentos, Alimentos y Tecnología Médica (ANMAT), Argentina. Disposición DI-2025-79202301-APN-ANMAT (Implanon NXT, Certificate No. 56.310) — source: Ministerio de Salud de Neuquén (Aug 13, 2025) — salud.neuquen.gob.ar · Agência Nacional de Vigilância Sanitária (ANVISA), Brazil. Resolução RE No. 4.184/2026 (Oct 26, 2026) — gov.br/anvisa · Kyleena/Mirena/Liletta/Jaydess-Skyla labeling (FDA).

Contribution: approved use windows by LARC device (subdermal implant and copper or levonorgestrel IUD/IUS). Etonogestrel implant: extension from 3 to 5 years now approved by the FDA, MHRA, ANMAT, and ANVISA (the latter also authorized immediate postpartum/post-abortion insertion, 1st and 2nd trimester), based on trial MK-8415-060 (NCT04626596): 0 pregnancies in years 4 and 5, Pearl Index 0.0 (95% CI 0-0.69), no difference by BMI.

McNicholas, C., Maddipati, R., Zhao, Q., Swor, E., & Peipert, J. F. (2015). Use of the etonogestrel implant and levonorgestrel intrauterine device beyond the U.S. FDA-approved duration. Obstetrics & Gynecology, 125(3), 599–604. https://doi.org/10.1097/AOG.0000000000000690 · McNicholas, C., Swor, E., Wan, L., & Peipert, J. F. (2017). Prolonged use of the etonogestrel implant and levonorgestrel intrauterine device: 2 years beyond FDA-approved duration. American Journal of Obstetrics and Gynecology, 216(6), 586.e1–586.e6. https://doi.org/10.1016/j.ajog.2017.01.036 — PubMed · Ali, M., et al. (2016). Extended use up to 5 years of the etonogestrel-releasing subdermal contraceptive implant. Human Reproduction, 31(11), 2491–2498 — PMC.

Contribution: independent evidence (CHOICE project and others) of prolonged etonogestrel implant use beyond 3 years — McNicholas 2015: 123 users completed year 4 and 34 year 5, 0 pregnancies. McNicholas 2017: 291 users, 444 woman-years, 0 pregnancies (year-4 failure: 0 [97.5% CI 0-1.48], year-5: 0 [0-2.65]); median serum etonogestrel >90 pg/mL (anovulation threshold) across all BMI categories. Ali 2016: 390 women with extended use, 0 pregnancies in years 4 and 5.

Ministerio de Salud Pública y Bienestar Social (MSPBS), Paraguay. Manual Nacional de Normas de Planificación Familiar para Mujeres y Hombres (3rd ed., 2021; RM S.G. No. 695/2021) — fundacionrassmuss.org · MSPBS. Eficacia del implante subdérmico es de casi el cien por ciento — mspbs.gov.py.

Contribution: ⚠️ the current Paraguayan national guideline (2021) still states a 3-year duration for Implanon/Nexplanon, with earlier replacement if BMI ≥30 — it has not incorporated the internationally approved 5-year extension (FDA/MHRA/ANMAT/ANVISA). No evidence was found of a 2023-2024 MSPBS update on this point.

World Health Organization. (2025). Selected practice recommendations for contraceptive use (4th ed.). · World Health Organization. (2026). Guidelines on expanding contraceptive options (Sept. 23, 2026) — incorporation of mifepristone as an emergency contraception option.

Contribution: emergency contraception regimens (Yuzpe, levonorgestrel, ulipristal, mifepristone, copper IUD) and their windows of efficacy.

Viroga, S. (2025). Un nuevo estrógeno: estetrol. Boletín Farmacológico, 16(2), 1–3. · Creinin, M. D., et al. (2021). Contraception, 104(3), 222–228. · Gemzell-Danielsson, K., et al. (2022). BJOG, 129(1), 63–71. · Douxfils, J., et al. (2020). Contraception, 102, 396–402. · Agencia Española de Medicamentos y Productos Sanitarios (AEMPS). Product label, code 1211547001 (cima.aemps.es).

Contribution: estetrol (E4) 15mg + drospirenone 3mg — a natural estrogen of fetal origin with tissue-selective activity, Pearl Index 1.52, and surrogate markers of smaller hepatic/procoagulant impact than ethinylestradiol (SHBG, thrombin generation) without a confirmed comparative VTE risk figure yet existing — basis for the Estetrol (E4) guide.

Cagnacci, A., Fruzzetti, F., Bruni, V., Gambera, A., Guida, M., Bonaccorsi, G., Londero, A. P., & for the Italian Society of Contraception (S.I.C.). (2025). Consensus conference results on contraception in women beyond 40 years of age. The European Journal of Contraception & Reproductive Health Care, 30(6), 304–318. https://doi.org/10.1080/13625187.2025.2544754

Contribution: Italian Society of Contraception consensus on hormonal contraception after 40 — venous and arterial cardiovascular safety by method, cycle control, efficacy ranking for heavy menstrual bleeding, effects on sexuality and bone — basis of the new guide Contraception after 40.

Teede, H. J., Bahri Khomami, M., Moran, R., et al. (2026). Polyendocrine metabolic ovarian syndrome, the new name for polycystic ovary syndrome: a multistep global consensus process. The Lancet (May 12, 2026).

Contribution: global consensus renaming PCOS → PMOS (Polyendocrine Metabolic Ovarian Syndrome), the terminological basis adopted in this medical record (see also Teede et al. 2023 and the diagnostic criteria in Chapter 3).

Azziz, R., Carmina, E., Chen, Z., Dunaif, A., Laven, J. S. E., Legro, R. S., et al. (2016). Polycystic ovary syndrome. Nature Reviews Disease Primers, 2, 16057. · Escobar-Morreale, H. F. (2018). Polycystic ovary syndrome: definition, aetiology, diagnosis and treatment. Nature Reviews Endocrinology, 14(5), 270–284. · Carmina, E., & Longo, R. A. (2026). Journal of Clinical Medicine (July 2, 2026).

Contribution: metabolic phenotype of PMOS and its link to insulin resistance and fertility recovery; cohort of 96 women with PMOS treated with semaglutide (52.5% ovulatory recovery) — basis for the PMOS/metabolic phenotype and GLP-1/fertility recovery guides.

U.S. Food and Drug Administration. Prescribing information: ZEPBOUND/MOUNJARO (tirzepatide) and WEGOVY (semaglutide), revised 2026 · European Medicines Agency. Mounjaro (tirzepatide), Summary of Product Characteristics · Eli Lilly and Company. Mounjaro (tirzepatide) SmPC.

Contribution: prescribing information for tirzepatide and semaglutide — dosing, titration, contraception during treatment, and the preconception washout schedule by molecule (GLP-1/GIP), including the EMA vs. FDA regulatory divergence on tirzepatide's preconception window.

Imbroane, M., LeMoine, K., Nau, C., et al. (2025). AJOG, 233(2), 116.e1-e7 — observational preconception cohort of 8,534 women with GLP-1/GIP exposure.

Contribution: documents the clinical context of fertility recovery under GLP-1/GIP that supports proactive contraceptive counseling (Contraception during tirzepatide guide), and finds no signal of increased risk of adverse pregnancy outcomes associated with periconceptional exposure (Preconception washout by molecule guide) — observational evidence, cited as background reassurance, not as a change in recommended practice.

Brown, M. E., et al. (2026). GLP-1 Receptor Agonist Use During the Periconceptional Period. Annals of Internal Medicine — target trial emulation, n=3,572. · D'Antonio, F., et al. (2026). Periconceptional and early pregnancy exposure to GLP-1/GIP receptor agonists and obstetric/neonatal outcomes. Med — meta-analysis, n=2,118,215. · AJOG (2024 review), PII S0002-9378(24)00864-0.

Contribution: no consistent signal of major congenital malformations or adverse obstetric/neonatal outcomes associated with periconceptional GLP-1/GIP exposure — basis for the Inadvertent pregnancy during GLP-1/tirzepatide guide; observational evidence that does not change the recommendation to stop the drug upon confirming pregnancy nor the planned preconception washout.

American Diabetes Association Professional Practice Committee. (2026). Standards of Care in Diabetes—2026. Diabetes Care. · NICE Guideline NG3. Diabetes in pregnancy. · Rowan, J. A., Hague, W. M., Gao, W., et al. (2008). Metformin versus insulin for the treatment of gestational diabetes (MiG Trial). New England Journal of Medicine, 358(19), 2003–2015. · Rowan, J. A., et al. Offspring follow-up of the MiG Trial at 2 and 7–9 years (MiG TOFU). Diabetes Care (2011) / BMJ Open Diabetes Research & Care (2018).

Contribution: use of metformin in pregnancy by indication (gestational vs. pre-gestational diabetes) and medium-term offspring safety.

National Library of Medicine. Drugs and Lactation Database (LactMed®) — metformin, semaglutide, tirzepatide. · Diab, H., Fuquay, T., Datta, P., Bickel, U., Thompson, J., & Krutsch, K. (2024). Subcutaneous Semaglutide during Breastfeeding: Infant Safety Regarding Drug Transfer into Human Milk. Nutrients, 16(17), 2886. · ZEPBOUND (tirzepatide) injection — Prescribing Information, DailyMed, section 8.2 (Lactation).

Contribution: breastfeeding compatibility and transfer into breast milk of metformin/GLP-1/tirzepatide during the postpartum period.

Federación Latinoamericana de Sociedades de Obstetricia y Ginecología (FLASOG). (2026). Recommendations on Vitamin D in Reproductive Health. Ginecología y Obstetricia de México, 94, e11309. · Demay, M. B., Pittas, A. G., Bikle, D. D., et al. (2024). Vitamin D for the Prevention of Disease: An Endocrine Society Clinical Practice Guideline. The Journal of Clinical Endocrinology & Metabolism.

Contribution: tissue associations of Vitamin D and supplementation schemes in reproductive health.

Comité de Biotecnología, Ministry of Health of the Province of Neuquén. (2026). Vitamin D Bulletin (September 2026), citing USPSTF/NICE/CONETEC/Endocrine Society.

Contribution: ongoing controversy over population-level Vitamin D screening — FLASOG recommends testing in at-risk populations, while other positions (USPSTF/NICE) discourage universal asymptomatic screening.

Holick MF, Binkley NC, Bischoff-Ferrari HA, et al. (2011). Evaluation, treatment, and prevention of vitamin D deficiency: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab, 96(7), 1911–1930. doi:10.1210/jc.2011-0385

Contribution: range reported by laboratories: <20 deficiency, 20–29 insufficiency, ≥30 ng/mL sufficient.

Ross AC, Manson JE, Abrams SA, et al. (2011). The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine: what clinicians need to know. J Clin Endocrinol Metab, 96(1), 53–58. doi:10.1210/jc.2010-2704

Contribution: IOM criterion: <12 ng/mL at risk of deficiency, 12–19 possibly inadequate, ≥20 sufficient.

Bouillon R. (2017). Comparative analysis of nutritional guidelines for vitamin D. Nat Rev Endocrinol, 13(8), 466–479. doi:10.1038/nrendo.2017.31

Contribution: comparison of cutoffs across societies; there is no single threshold.

World Health Organization. (2020). WHO antenatal care recommendations for a positive pregnancy experience. Nutritional interventions update: vitamin D supplements during pregnancy. Geneva: WHO. https://www.who.int/publications/i/item/9789240008120

Contribution: no routine vitamin D supplementation in pregnancy; supplement if deficiency is documented or suspected.

Demay MB, Pittas AG, Bikle DD, et al. (2024). Vitamin D for the prevention of disease: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab, 109(8), 1907–1947. doi:10.1210/clinem/dgae290

Contribution: empirical supplementation in pregnancy (trials 600–5000 IU/day, mean ~2500); no routine 25(OH)D testing; no longer endorses sufficiency cutoffs.

Austin, G. O., et al. (2023). Frontiers in Molecular Biosciences, 10, 1170181. · Davies, M., et al. (2021). The Lancet, 397(10278), 971–984. · Rubino, D., et al. (2021). Effect of Continued Weekly Subcutaneous Semaglutide vs Placebo on Weight Loss Maintenance (STEP 4). JAMA, 325(14), 1414–1425. · Aronne, L. J., et al. (2024). Continued Treatment With Tirzepatide for Maintenance of Weight Reduction (SURMOUNT-4). JAMA, 331(1), 38–48.

Contribution: non-response rates (<5% weight loss) by pivotal semaglutide/tirzepatide trial, and evidence that maintaining weight loss requires continued treatment (weight regain when switched to placebo in STEP 4/SURMOUNT-4) — basis for the corresponding section of the GLP-1/GIP Analogs guide.

Motuhifonua, S. K., Lin, L., Alsweiler, J., Crawford, T. J., & Crowther, C. A. (2023). Antenatal dietary supplementation with myo-inositol for preventing gestational diabetes. Cochrane Database of Systematic Reviews, CD011507.pub3. https://doi.org/10.1002/14651858.CD011507.pub3

Contribution: 7 RCTs and 1,319 women; gestational diabetes 6 RCTs and 1,140 (RR 0.53, very low certainty); hypertensive disorders 5 RCTs and 1,052 (RR 0.34, low certainty). Myo-inositol guide.

Wilding, J. P. H., Batterham, R. L., Davies, M., et al. (2022). Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension. Diabetes, Obesity and Metabolism, 24(8), 1553–1564. https://doi.org/10.1111/dom.14725

Contribution: n=327: after −17.3% at week 68, regain of 11.6 percentage points by week 120 after stopping (about two-thirds). GLP-1/GIP analogues guide.

European Medicines Agency. Bydureon (exenatide, extended-release). Summary of Product Characteristics, section 4.6. https://www.ema.europa.eu/en/documents/product-information/bydureon-epar-product-information_en.pdf

Contribution: Stop at least 3 months before a planned pregnancy. Preconception washout by molecule guide.

U.S. Food and Drug Administration. SAXENDA (liraglutide) prescribing information. Revised 2026. https://www.accessdata.fda.gov/drugsatfda_docs/label/2026/206321s025lbl.pdf

Contribution: No preconception interval: stop when pregnancy is recognized. Preconception washout by molecule guide.

Eli Lilly and Company. Mounjaro (tirzepatide) KwikPen. Summary of Product Characteristics (UK), revised 29/08/2026. https://www.medicines.org.uk/emc/medicine/44434/spc

Contribution: Stop ≥1 month before a planned pregnancy; in breastfeeding it "could be considered". Washout and Puerperium and breastfeeding guides.

Castaneda, R., Bechenati, D., Tama, E., Rivera Gutierrez, R., Espinosa, M. A., Villamarin, J., Rajjo, T. I., Acosta, A., Faubion, S., Shufelt, C., & Hurtado Andrade, M. D. (2026). The role of menopause hormone therapy in modulating tirzepatide-associated weight loss in postmenopausal women with overweight or obesity: a retrospective cohort study. The Lancet Obstetrics, Gynaecology, & Women's Health, 2(2), e118–e128. doi:10.1016/S3050-5038(25)00145-1.

Contribution: propensity-matched retrospective cohort (Mayo Clinic, n=120, 40 on HRT vs. 80 without) — at 15 months, greater total body weight loss with concomitant HRT and tirzepatide (35% relative difference) plus additional cardiometabolic improvements; observational, not causal, evidence. The preliminary ENDO 2025 figure (~17% vs. 14%) differs from this final publication, which is the source used. Basis for the GLP-1+HRT synergy note in the GLP-1/GIP Analogs guide.

Valentinuzzi, G., Müller-Wieland, D., Holm, J. C., et al. (2026). Framework for the pharmacological treatment of obesity and its complications from the European Association for the Study of Obesity (EASO): 2026 update. Nature Medicine.

Contribution: EASO decision algorithm guiding drug choice (tirzepatide, semaglutide, liraglutide, phentermine-topiramate, naltrexone-bupropion, orlistat) by the outcome being targeted (OSAS, knee osteoarthritis, prediabetes, type 2 diabetes, cardiovascular disease, heart failure, MASLD/MASH) — basis for the EASO 2026 guide.

AMMR (Asociación Mexicana de Medicina de la Reproducción). "The Incretin Pipeline" — Fig. 2: Current GLP-1 agonist anti-obesity medications and expected upcoming anti-obesity medications. Information from clinicaltrials.gov and/or company websites; presentation by Dr. Eduardo W. Goicochea.

Contribution: landscape of incretin agonists in development beyond the 3 already approved (orforglipron, CagriSema, survodutide, mazdutide, maridebart cafraglutide, retatrutide, and others) — basis for the Incretin development pipeline guide.

Uysal, N., Horoz, E., Gungor, M., Timarci, I., Sozmen, M. K., Karadas, B., et al.; Kaplan, Y. C. (2026). Pregnancy outcomes following maternal GLP-1 receptor agonist exposure: a systematic review and meta-analysis. Scientific Reports, 16, 31416. · Liu, X., Xiong, B., Yang, R., Wang, H., & Liu, Y. (2026). Periconceptional use of GLP-1 receptor agonists and the risk of major congenital malformations: a systematic review and meta-analysis. Endocrine Connections, 15(7). doi:10.1530/EC-26-0280 · Maya, J., Pant, D., Fu, Y., James, K., Batlle, C., Hsu, S., et al.; Powe, C. E. (2025). Gestational Weight Gain and Pregnancy Outcomes After GLP-1 Receptor Agonist Discontinuation. JAMA, 334(24), 2186–2196. doi:10.1001/jama.2025.20951 · Pondugula, N., Culhane, J. F., Lundsberg, L. S., Partridge, C., & Merriam, A. A. (2026). Gestational Weight Gain and Hypertensive Disorders of Pregnancy With Prepregnancy and Early Pregnancy Glucagon-Like Peptide-1 Receptor Agonist Exposure. Obstetrics & Gynecology, 147(3), 293–302. doi:10.1097/AOG.0000000000005995

Contribution: counterpoint to the reassuring evidence from Brown ME/D'Antonio/Imbroane — Uysal et al. (7 cohorts, >40,000 exposed pregnancies) find no signal for malformations overall (OR 1.11) but an isolated signal for urinary malformations (OR 1.24; likely residual confounding); Liu et al. (largest sample-size meta-analysis, n=286,599, 43,577 exposed) likewise find no signal for major malformations (RR 1.02; 95% CI 0.96-1.08); Maya et al. (Mass General Brigham cohort, n=448 vs. 1,344) find greater gestational weight gain and a higher risk of preterm delivery (RR 1.34), gestational diabetes (RR 1.30), and hypertensive disorders of pregnancy (RR 1.29) after periconceptional exposure — a different maternal/metabolic perspective from the malformation studies; Pondugula et al. (independent cohort, Yale, n=243) finds no signal for hypertensive disorders (adjusted OR 0.72-0.83) — Maya et al.'s figures should not be attributed to Pondugula et al., these are two distinct cohorts. Basis for the expanded section of the Inadvertent pregnancy during GLP-1/tirzepatide guide.

World Health Organization. (2025). Guideline for the prevention, diagnosis and treatment of infertility. Geneva: WHO. https://www.who.int/publications/i/item/9789240115774

Contribution: first global infertility guideline (40 recommendations): mid-luteal progesterone, HSG/HyCoSy, repeat semen analysis at 11 weeks, expectant management in unexplained infertility, letrozole in PMOS.

World Health Organization. (2021). WHO laboratory manual for the examination and processing of human semen (6th ed.). Geneva: WHO. https://www.who.int/publications/i/item/9789240030787

Contribution: lower reference limits for semen analysis.

Practice Committee of the American Society for Reproductive Medicine. (2026). Fertility evaluation of infertile women: a committee opinion. https://www.asrm.org/practice-guidance/practice-committee-documents/fertility-evaluation-of-infertile-women-a-committee-opinion-2026

Contribution: when to evaluate; HyCoSy equivalent to HSG; postcoital test, TSH/prolactin without indication, thrombophilia and karyotype not routine.

Practice Committee of the American Society for Reproductive Medicine. (2020). Testing and interpreting measures of ovarian reserve: a committee opinion. Fertility and Sterility, 114(6), 1151–1157. https://doi.org/10.1016/j.fertnstert.2020.09.134

Contribution: AMH and AFC predict oocyte yield, not pregnancy; not to deny treatment.

Practice Committee of the American Society for Reproductive Medicine. (2021). Role of tubal surgery in the era of assisted reproductive technology: a committee opinion. Fertility and Sterility, 115(5), 1143–1150. https://www.sciencedirect.com/science/article/pii/S0015028221000844

Contribution: salpingectomy or proximal occlusion of hydrosalpinx before IVF.

Brannigan, R. E., Hermanson, L., Kaczmarek, J., et al. (2024). Updates to Male Infertility: AUA/ASRM Guideline (2024). Journal of Urology. https://www.auajournals.org/doi/10.1097/JU.0000000000004180

Contribution: karyotype, Y microdeletions, CFTR, azoospermia workup and TMSC for IUI.

ESHRE Guideline Group on Unexplained Infertility, Romualdi, D., Ata, B., et al. (2023). Evidence-based guideline: unexplained infertility. Human Reproduction. https://www.eshre.eu/-/media/sitecore-files/Guidelines/UI/UI-guideline_-Final.pdf

Contribution: workup and management of unexplained infertility: expectant with good prognosis; stimulated IUI; IVF.

Royal College of Physicians of Ireland, Institute of Obstetricians and Gynaecologists. (2023). National Clinical Practice Guideline: Fertility Investigation and Management in Secondary Care. https://www.rcpi.ie/Portals/0/Document%20Repository/Institute%20of%20Obstetricians%20and%20Gynaecologists/National%20Clinical%20Guidelines/2023/Full%20guidelines/IOG_NCPG_Fertility%20Investigation%20Guideline_2023.pdf

Contribution: IUI for cervical factor and sexual dysfunction.

Teede, H. J., Tay, C. T., Laven, J. J. E., et al. (2023). Recommendations from the 2023 International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome. Journal of Clinical Endocrinology & Metabolism, 108(10), 2447–2469. https://academic.oup.com/jcem/article/108/10/2447/7242360

Contribution: criteria, adolescents, exclusions, OGTT when planning pregnancy, insulin not routine, letrozole first line.

ESHRE Guideline Group on POI, Panay, N., Anderson, R. A., et al. (2024). Evidence-based guideline: premature ovarian insufficiency. Human Reproduction Open, 2024(4), hoae065. https://academic.oup.com/hropen/article/2024/4/hoae065/7918369

Contribution: POI diagnosis with one FSH >25 IU/L.

Esteves, S. C., Andersen, C. Y., Fischer, R., et al. (2021). Editorial: POSEIDON's Stratification of 'Low Prognosis' Patients in ART: The WHY, the WHAT, and the HOW. Frontiers in Endocrinology, 12, 719647. https://pmc.ncbi.nlm.nih.gov/articles/PMC8276236/

Contribution: POSEIDON low-reserve criteria (AFC <5, AMH <1.2 ng/mL).

Sammaritano, L. R., Bermas, B. L., Chakravarty, E. E., et al. (2020). 2020 American College of Rheumatology Guideline for the Management of Reproductive Health in Rheumatic and Musculoskeletal Diseases. Arthritis & Rheumatology, 72(4), 529–556. https://doi.org/10.1002/art.41191

Contribution: lupus: 6 months inactive, hydroxychloroquine, stopping teratogens, aspirin; APS and aPL.

Society for Maternal-Fetal Medicine. (2023). SMFM Consult Series #64: Systemic lupus erythematosus in pregnancy. American Journal of Obstetrics & Gynecology. https://publications.smfm.org/publications/462-society-for-maternal-fetal-medicine-consult-series-64/

Contribution: lupus and APS in pregnancy: aspirin, prophylactic or therapeutic heparin.

Teede, H. J., Bahri Khomami, M., Morman, R., et al. (2026). Polyendocrine metabolic ovarian syndrome, the new name for polycystic ovary syndrome: a multistep global consensus process. The Lancet, 407, 2329–2339. https://doi.org/10.1016/S0140-6736(26)00717-8

Contribution: name change PCOS → PMOS without changing diagnostic criteria.