The end-of-treatment process in medically assisted reproduction: a qualitative study of healthcare professionals' views

In the medically assisted reproduction (MAR) pathway, one of the most complex phases is the end of the treatment. Unlike other medical contexts, there is no biological endpoint in the MAR setting. This absence makes the decision to end MAR treatment extremely challenging for both patients and healthcare professionals. Accordingly, our research aimed to examine the process related to the end of MAR treatment, as devised by healthcare professionals. Our sample included physicians, biologists, and psychologists aged ≥18 years with specialised training in assisted reproduction. Data were collected through four focus groups (in February-May 2023), focusing on the topic of the end of treatment (EoT) and its definition. Data were collected and analysed according to the principles of Grounded Theory. The findings shed light on the attributes and components related to the end of the treatment process. The central category "the end of treatment" consists of a definition of what is considered the end of treatment and the associated decision-making process. In the phase leading up to the EoT, the process is influenced by contextual and proximal factors, which interact and influence each other. To cope with and manage the EoT, healthcare providers adopt spontaneous strategies that lead to positive or negative outcomes. End-of-treatment management is a key facet of clinical practice. This contribution increased knowledge about EoT and highlighted healthcare professionals' perspectives, which should be considered for the implementation of best practice points and respect for patients' rights to the highest attainable standard of mental and physical health.

The canine blood-brain barrier in health and disease: focus on brain protection

This review examines the role of the canine blood-brain barrier (BBB) in health and disease, focusing on the impact of the multidrug resistance (MDR) transporter P-glycoprotein (P-gp) encoded by the ABCB1/MDR1 gene. The BBB is critical in maintaining central nervous system homeostasis and brain protection against xenobiotics and environmental drugs that may be circulating in the blood stream. We revise key anatomical, histological and functional aspects of the canine BBB and examine the role of the ABCB1/MDR1 gene mutation in specific dog breeds that exhibit reduced P-gp activity and disrupted drug brain pharmacokinetics. The review also covers factors that may disrupt the canine BBB, including the actions of aging, canine cognitive dysfunction, epilepsy, inflammation, infection, traumatic brain injury, among others. We highlight the critical importance of this barrier in maintaining central nervous system homeostasis and protecting against xenobiotics and conclude that a number of neurological-related diseases may increase vulnerability of the BBB in the canine species and discuss its profound impacts on canine health.

Permeable cryoprotectants-free vitrification of human TESE, PESA and OAT spermatozoa: clinical outcomes

Cryopreservation of testicular and epididymal spermatozoa is more challenging in comparison to ejaculated spermatozoa due to lower sperm concentration and motility, and higher sperm sensitivity to cryoprotectants. Sperm vitrification without the use of potentially toxic permeable cryoprotectants is an attractive freezing alternative for testicular and epididymal spermatozoa, as well as oligoasthenoteratozoospermia (OAT) samples. Our study is a retrospective analysis of outcomes in IVF cycles involving a total of 70 testicular, 77 epididymal and 69 ejaculated OAT samples vitrified in a closed double-straw device using mHTF medium supplemented with protein and sucrose, without any permeable cryoprotectant. In total, 71 frozen samples were used for intracytoplasmic sperm injection (ICSI). Results were compared to fresh samples (26 testicular, 53 epididymal and 63 ejaculated OAT samples) that served as controls. Elective single frozen embryo transfers of euploid or unknown-ploidy blastocysts were performed. While sperm motility is expected to diminish following slow sperm freezing and thawing, our data demonstrated that vitrification of testicular, epididymal and OAT samples had a mean motility rate comparable to fresh samples. No statistically significant differences (p > 0.05) were observed between vitrified versus fresh TESE in fertilization (64.1% vs. 59.5%), blastocyst development (54.9% vs. 56.7%), blastocyst euploidy (36.4% vs. 33.3%), clinical pregnancy (47.8% vs. 36.4%) and live birth rates (43.5% vs. 24.2%). Similarly, vitrified versus fresh PESA showed no statistically significant differences (p > 0.05) in the analyzed results respectively: (69.4% vs.74.9%; 62.6% vs. 59.7%; 40.5% vs. 48.1%; 36.0% vs.37.7%; and 32.0% vs. 27.5%). For vitrified OAT samples, there was a significant difference in blastocyst development and euploidy rates when compared to the control group. Our results demonstrate that human testicular, epididymal spermatozoa and samples with OAT can be successfully vitrified in small volumes in a closed system without using any permeable cryoprotectants, allowing utilization of this technique in clinical settings.

Genetic variants in QRICH2 gene among Jordanians with sperm motility disorders

Sperm motility, a key determinant of male fertility, is often impaired by genetic variations affecting flagellar formation. The glutamine-rich protein 2 (QRICH2) gene encodes a protein essential for sperm flagella biogenesis and structural integrity. This study investigates genetic variations within exon 3 of the QRICH2 gene, identifying novel heterozygous variants associated with sperm tail-specific abnormalities and motility impairments. Among 34 individuals diagnosed with asthenozoospermia (ASZ) and 26 individuals with normal sperm parameters (NZ) from Jordan, eight unique heterozygous variants (c.123 G>T, c.133 G>C, c.138A>G, c.170A>C, c.189C>G, c.190T>C, c.195A>T, and c.204A>T) were exclusive to the ASZ group, while four variants (c.136 G>A, c.145A>C, c.179T>G, and c.180T>G) were found only in NZ. These variants were absent from major genetic databases, suggesting their potential novelty, while two variants (c.206C>T and c.189C>T) were linked to known SNP cluster IDs rs73996306 and rs1567790525, respectively. Four non-synonymous SNPs (c.136 G>A, c.145A>C, c.170A>C, and c.204A>T) were predicted to be functionally and structurally damaging, underscoring their significance. Additionally, five variants overlapped with previously reported mutation sites, indicating potential mutation hotspots. Statistical analysis revealed a significant association between QRICH2 mutations and tail defects (p < 0.021). These findings highlight the critical role of heterozygous QRICH2 mutations in mild-to-moderate ASZ, even in NZ individuals. Despite some carriers meeting WHO criteria for NZ, notable morphological abnormalities suggest the need for refined diagnostic benchmarks. Screening for QRICH2 mutations is essential for accurate molecular diagnosis and should be integrated into genetic counseling, particularly in regions like Jordan. Further research into the cumulative effects of heterozygous mutations and their environmental interactions is needed to expand our understanding of idiopathic male infertility and to enhance diagnostic and therapeutic strategies for male infertility.

Analysis of emotional fluctuations in infertile women during ART treatment: the impact of ovarian hyperstimulation

BACKGROUND

Infertility affects many reproductive-aged couples, with assisted reproductive technology (ART) offering hope but also significant emotional stress due to invasive procedures, hormonal fluctuations, uncertainty, and financial and emotional burden of repeated cycles. Ovarian hyperstimulation syndrome (OHSS), a common ART complication, may further aggravate psychological distress, yet its mental health impact remains understudied.

METHODS

This longitudinal study included 1,429 women undergoing their first ART cycle at a reproductive center in China. Psychological assessments were conducted at four critical time points: before ART, post-surgery (early pregnancy), mid-pregnancy and late pregnancy. Validated scales (SAS, CES-D, CPSS, PSQI) measured anxiety, depression, stress, and sleep quality. OHSS was diagnosed per clinical guidelines. Generalized estimating equations (GEEs) assessed changes over time and the moderating effects of OHSS, adjusting for age, education level and income.

RESULTS

OHSS occurred in 9.2% of participants, who tended to be younger and have higher socioeconomic status. Anxiety peaked after surgery and remained elevated; stress declined steadily; sleep quality improved; depression rebounded slightly in late pregnancy. OHSS significantly intensified anxiety and stress but had no clear impact on depression or sleep.

CONCLUSIONS

Emotional responses during ART are dynamic. OHSS amplifies anxiety and stress, warranting integrated psychological support within ART programs, particularly for OHSS-affected women.

Role of doubling rate of hCG in predicting early pregnancy loss: a retrospective analysis

OBJECTIVE

This study aims to explore whether the human chorionic gonadotropin (hCG) doubling rate every 48 h (HDR) predicts early pregnancy outcomes in women with pregnancy loss.

METHODS

The early clinical pregnancy outcomes in 257 women with a history of pregnancy loss were analyzed in this retrospective study. The optimal cutoff value of HDR was determined by the receiver operating characteristic (ROC) curve and the Youden index. The primary outcome was pregnancy loss occurring before 12 weeks of gestation.

RESULTS

A total of 257 patients were enrolled in this study. According to the pregnancy outcome at 12 weeks of gestation, the patients were divided into ongoing pregnancy (N = 198) and early pregnancy loss (EPL) groups (N = 59). In the total study population, the HDRs in ongoing pregnancy group were significantly higher than those in EPL group at specific intervals of hCG levels: 150-400 mIU/ml, 400-800 mIU/ml, and 3200-6400 mIU/ml. The corresponding thresholds were 1.855, 2.219, and 1.730, respectively (p < 0.05). A similar result was observed among patients with recurrent pregnancy loss (RPL) across the intervals of 400-800 mIU/ml, 800-1600 mIU/ml, 3200-6400 mIU/ml, and 20000-30000 mIU/ml, with corresponding thresholds of 2.219, 1.812, 1.730, and 1.450, respectively.

CONCLUSIONS

HDR may serve as an evaluative tool for predicting the risk of EPL in women with pregnancy loss. Differences in the intervals showing predictive value between women with and without RPL imply that individualized interpretation of HDR may be warranted in these subgroups. However, given the limited sample size, especially within the EPL group, these findings should be interpreted with caution.

Comparison of the efficacy of vaginal micronised progesterone tablet and gel for in vitro fertilisation

BACKGROUND

Luteal phase support (LPS) with progesterone is a generally accepted practice after controlled ovarian stimulation, although the best protocols for LPS have been debated. We aimed to compare the efficacy of vaginal micronised progesterone tablets and 8% vaginal progesterone gel for LPS using real-world data.

METHODS

This retrospective study included 459 in vitro fertilisation/intracytoplasmic sperm injection cycles performed at a university hospital from 2005 to 2019. All cycles were followed by fresh day 3 embryo transfer (ET). Either progesterone tablets or gel was used for LPS. To control the conditional probability of progesterone tablets or gel use, doubly robust inverse probability weighting composed of inverse-probability-of-treatment weighting (IPTW) and regression adjustment (RA). IPTW was performed based on the covariate balancing propensity score (CBPS).

RESULTS

Progesterone tablets were administered in 65 cycles, and progesterone gel was administered in 394 cycles. Women who used progesterone tablets were more likely to be older (36 vs. 34 years), have primary infertility (78.5% vs. 61.4%), use gonadotropin-releasing hormone antagonist (60.0% vs. 43.2%), and have fewer retrieved oocytes (seven vs. nine) and transferred embryos (two vs. three) than participants who used progesterone gel. After IPTW-CBPS and RA analysis for the above covariates, the adjusted odds for clinical pregnancy in women who used progesterone tablets were 1.10 times compared with women who used progesterone gel; however, the 95% confidence interval did not reach statistical significance (0.96-1.26).

CONCLUSIONS

Clinical pregnancy was comparable between vaginal micronised progesterone tablets and vaginal progesterone gel for LPS in fresh day 3 ET cycles.

DNA damage in prepared semen is negatively associated with semen quality and fertilisation rate in assisted reproduction technology (ART) treatment

Sperm DNA contains strand breaks and base damage that can potentially affect reproductive health. This study aims to determine to what extent sperm DNA integrity and alkylation is associated with semen quality and assisted reproduction technology (ART) treatment outcomes, in particular fertilisation and cleavage rates. Male partners of couples attending for infertility treatment were recruited. DNA integrity (% tail DNA, sperm with either low (LDD) or high (HDD) damage levels) was measured by a neutral Comet assay and N7-methyldeoxyguanosine (N7-MedG) DNA levels by an immunoslotblot in sperm prepared by density gradient centrifugation. Associations between DNA damage, semen quality and ART treatment outcomes were assessed. N7-MedG levels were lower and the proportion of LDD sperm higher in prepared than in neat sperm samples. The proportion of HDD sperm and % tail DNA were significantly negatively associated and the proportion of LDD sperm positively associated with semen quality. Fertilisation, but not cleavage, rate nor live birth, was significantly negatively associated with N7-MedG levels, the proportion of HDD sperm and % tail DNA and was positively associated with the proportion of LDD sperm. These results confirm that DNA damage, even in prepared sperm, is associated with adverse semen quality and suggest that sperm DNA damage affects the early stages of embryo formation.

Prevention of ovarian hyperstimulation syndrome (OHSS): British Fertility Society policy and practice guideline

This British Fertility Society (BFS) Policy and Practice guideline aims to support clinicians in preventing ovarian hyperstimulation syndrome (OHSS) in patients undergoing gonadotropin ovarian stimulation. A systematic literature search of the medical databases was performed. The Guideline Development Group (GDG) identified the risk factors of OHSS before and during ovarian stimulation. The relation of different pre-treatment measures and different ovarian stimulation protocols with OHSS was evaluated. The optimal monitoring during treatment was assessed. The current evidence on preventive strategies during and after ovarian stimulation and the available adjuvant preventive agents were examined. Based on this, the GDG developed evidence-based, graded recommendations for clinical practice. The evidence was evaluated within context, considering the effectiveness, cost and practical problems of assisted reproductive technology for patients and healthcare providers. Early identification and application of preventive measures identified in this guideline may reduce the incidence of OHSS or reduce its severity. Suggestions for future research on OHSS prevention are provided.

Evaluation of the evidence-based practices for the management of PCOS in the Latin America context: the consensus of the Latin American Association of Gynecological Endocrinology (ALEG)

OBJECTIVES

Polycystic Ovary Syndrome (PCOS) is a complex condition affecting approximately 1 in 10 women of reproductive age. However, limited data are available regarding the specific characteristics and needs of women with PCOS in Latin America. This consensus sought to evaluate the evidence-based practices for the management of PCOS for Latin American populations, consolidate regional insights, identify eventual gaps in implementation and identify key research opportunities.

METHODS

Using the Delphi strategy, experts from various Latin American countries selected and reviewed a subset of recommendations from the 2023 International Evidence-Based Guideline (EBG) for the Assessment and Management of PCOS. Virtual and in-person meetings facilitated discussions on the selected recommendations, followed by voting rounds to achieve consensus.

RESULTS

A total of 33 recommendations for PCOS diagnosis and treatment were evaluated. In the initial voting round, 25 recommendations achieved strong agreement (80%-100% support), while eight received less than 80% agreement. After further discussions on their relevance and potential to influence behavior change among health professionals and public health policies, the remaining recommendations achieved near-unanimous support in the second round.

CONCLUSIONS

This consensus underscored evidence-based practices for PCOS diagnosis and treatment deemed appropriate for the Latin American context. It also highlighted implementation barriers such as cost and accessibility, while identifying opportunities for research to improve PCOS management and address regional challenges. These findings aim to enhance clinical care and inform public health strategies tailored to the needs of Latin American women living with PCOS.

Navigating the practical challenges and ethical dilemmas of surplus cryopreserved human embryos

Cryopreservation, the use of very low temperatures to preserve structurally intact living cells and tissues, has seen exponential growth in the field of in vitro fertilization (IVF). In the last decade, cryopreservation of embryos and freeze-all protocols have become an essential aspect and a prerequisite for a successful IVF outcome. Moreover, vitrification, which is a fast and safe cryopreservation method, has proved to be an effective choice for cryopreserving gametes and embryos. The increasing number of cryopreserved embryos worldwide in cryobanks and IVF clinics is an undisputable fact that raises important physiological, ethical, and moral considerations that merit careful examination and discussion. Many couples utilizing assisted reproduction will have a surplus of cryopreserved embryos, in other words they already have completed their family without exhausting all the embryos that were created and cryopreserved during the process. Additionally, the global IVF market has also experienced significant growth due to various factors, including advancements in technology, increased awareness about infertility treatments, and changing societal norms towards delayed parenthood. Thus, for the foreseeable future the number of cryopreserved embryos, and the phenomenon of surplus embryos will likely remain unresolved. In the present review, following a description of the cryopreservation method and the physiological changes during the cryopreservation of embryos, the bioethical issues raised by the surplus cryopreserved embryos will be discussed alongside possible solutions for resolving this phenomenon.

Correlation between lipid metabolism and endometriosis: a meta-analysis

To analyze and evaluate the correlation between different lipid metabolism levels and endometriosis. The literatures on lipid metabolism and endometriosis published in databases were searched and collected. The search was conducted up to December 2023. The meta-analysis was conducted using Review Manager 5.4.1 software, with odds ratios (ORs) or standardized mean difference (SMD), confidence intervals (CIs), and heterogeneity (I2) being calculated. The literature bias was evaluated by drawing funnel plot. Five hundred and eighty-four literatures were retrieved, and finally, 7 literatures were included in this study. Meta-analysis showed that the level of total cholesterol (TC) in endometriosis groups was higher than control group [SMD = 1.70, 95%CI (0.60-2.80), p = 0.003], while triglyceride (TG) [SMD=-0.24, 95%CI (-0.68-0.21), p = 0.300], low-density lipoprotein (LDL) [SMD = 0.22, 95%CI (-0.34 - 0.78), p = 0.440] and high-density lipoprotein (HDL) [SMD = 0.06, 95%CI (-0.14 - 0.25), p = 0.550] was not statistically significant. Sensitivity analysis indicated that the combined effect size results were stable and reliable [SMD = 1.70, 95%CI (0.60-2.80), p = 0.030]. Funnel plot results showed publication bias. Patients with endometriosis have abnormal blood lipid level, and higher TC level may be a risk factor for endometriosis. The impact of blood lipid metabolism on endometriosis may provide new insights into the pathogenesis and treatment prognosis of endometriosis.

Immunotoxicological disruption of pregnancy as a new research area in immunotoxicology

Immune mechanisms associated with normal pregnancy have only been being substantively investigated since the early 1990s. In parallel with the progress in that area of research, in the past few years it has become increasingly clear that several xenobiotics - including a variety of environmental chemicals, pharmaceuticals, and metals are considered to be both generally immunotoxic and specifically able to affect pregnancy. Among these, there is intense interest regarding potential effects from synthetic cannabinoids, immune checkpoint inhibitors, nanometals, and microplastics, with immunotoxic events that impact on pregnancy being shown for these agents. For instance, phytocannabinoids have been shown to interfere with reproduction in mice through effects on the endocannabinoid system. Because of effects of immune enhancement, as a requirement for regulatory submission, co-inhibitory immune checkpoint molecule inhibitors were also evaluated for effects on pregnancy. Similarly, because of increasing use and concerns about incidental environmental exposures, nanometals, and micro-plastics have also been examined for effects. Several studies in humans or mice showed that exposures to each during gestation increased the risk/rate of fetal loss, in part, by disruption of the placenta-associated immune system. Furthermore, signaling by endogenous danger molecules and/or impairment of physiological intercellular mediators may have contributed to the pregnancy loss. As there are clearly a variety of immunotoxic effects that can impact on a pregnancy, this review attempts to briefly introduce immune mechanisms associated with pregnancy as well as reasons for its loss, and proposes that 'immunotoxicological disruption of pregnancy' be accepted as a new research area in immunotoxicology.

Risk of adverse pregnancy outcomes after abnormal hysterosalpingography

OBJECTIVE

To investigate the association between an abnormal hysterosalpingogram (HSG) and obstetrical and neonatal outcomes.

DESIGN

A retrospective cohort study comparing outcomes between women with normal versus abnormal tubal patency and uterine cavity on HSG.

RESULTS

Among 2181 women included in the study, 494 (22.6%) had an abnormal HSG. Of these, 207 (42%) presented with uterine abnormalities, 336 (68%) with tubal abnormalities and 49 (10%) with both. The study identified 232 clinical pregnancies in the abnormal HSG group and 814 pregnancies in controls. Women with abnormal HSG showed higher rates of preterm labour (PTL) compared to controls (13.6% vs. 7.7%, p < 0.05, n = 1687). Multivariate analysis revealed that any HSG abnormality was associated with an increased risk of PTL (aOR 2.39, 1.04-5.51). When analysing by type of abnormality, uterine abnormalities increased the risk of preeclampsia (aOR 2.86, 1.06-7.7) and low birthweight (aOR 2.31, 1.0-5.35), while tubal abnormalities were specifically associated with increased risk of PTL (aOR 3.87, 1.63-9.19).

CONCLUSION

An abnormal HSG study was associated with adverse obstetrical outcomes. Specifically, uterine abnormalities increased the risk of preeclampsia and birthweight below 10th percentile, while tubal abnormalities were associated with a heightened risk of PTL.

GnRH ability to release FSH and LH in women with functional hypothalamic amenorrhea: a retrospective cohort study about women with and without polycystic ovarian morphology

Nearly 50% of women with functional hypothalamic amenorrhea (FHA) reveal polycystic ovarian morphology (PCOM), a known risk factor for ovarian hyperstimulation syndrome. However, gonadotropin releasing hormone-agonist (GnRH-a) triggers are not recommended in FHA, since an inadequate endogenous surge in luteinizing hormone (LH) is expected. We aimed to challenge this concept and evaluated LH levels after GnRH stimulation in FHA-women with and without PCOM. In a retrospective cohort study, 82 women with FHA, who underwent a GnRH stimulation test, were included. Thirty-five women revealed PCOM (42.7%). Twenty minutes after GnRH stimulation, there was an increase of serum LH levels in FHA-PCOM (median basal: 2.7 mIU/mL, IQR 1.1-4.6 versus median stimulated: 13.5 mIU/mL, IQR 7.8-21.6, p < 0.001) and in FHA-nonPCOM patients (median basal: 2.5 mIU/mL, IQR 0.5-3.9 versus median stimulated: 5.7 mIU/mL, IQR 2.4-13.9, p < 0.001). Overall, positive correlations (p < 0.001) were found between basal and stimulated LH levels. In FHA-PCOM patients, 42.9% of patients revealed stimulated LH levels >15 mIU/mL, while this was the case in 19.1% of FHA-nonPCOM patients (p = 0.034). In women with FHA-PCOM, ovulation induction with a GnRH-a trigger might be feasible. Future research should focus on the prediction of an adequate response to GnRH triggers in the IVF setting.

Visualized hysteroscopic artificial intelligence fertility assessment system for endometrial injury: an image-deep-learning study

OBJECTIVE

Asherman's syndrome (AS) is a significant cause of subfertility in women from developing countries. Over 80% of AS cases in these regions are linked to dilation and curettage (D&C) procedures following pregnancy. The incidence of AS in patients with infertility and recurrent miscarriage can be as high as 10%, while the pregnancy rate in cases of moderate to severe adhesions can be as low as 34%. We aimed to establish a hysteroscopic artificial intelligence system using image-deep-learning algorithms for fertility assessment.

METHODS

This diagnostic study included 555 cases with 4922 hysteroscopic images from a Chinese intrauterine adhesions cohort clinical database (NCT05381376). The study evaluated two image-deep-learning algorithms' effectiveness in predicting pregnancy within one year, using AUCs and decision curve analysis. The models' performance was evaluated for two-year prediction via concordance index and cumulative time-dependent ROC. A quantifiable visualization panel of the system was established.

RESULTS

The proportional hazard CNN system accurately predicted conception, with AUCs of 0.982, 0.992, and 0.990 in three randomly assigned datasets, superior to the InceptionV3 framework, and achieved a net benefit of 69.4% for subfertility assessment. The system fitted well with c-indexes of 0.920-0.940 and was time-stable. The quantifiable visualization panel displayed four intrauterine pathologies intuitively. The performance was comparable to senior hysteroscopists, with a kappa value of 0.84-0.89.

CONCLUSIONS

The CNN based on the proportional hazard approach accurately assesses fertility postoperatively. The quantifiable visualization panel could assist in intrauterine pathologies assessment, optimize treatment strategies, and achieve individualized and cost-efficient practices.

Obstetric and perinatal outcomes in singleton pregnancies following medicated, stimulated and natural, frozen embryo transfer cycles: an updated systematic review and meta-analysis

Frozen embryo transfer (FET) has been associated with higher risks of hypertensive disorders of pregnancy (HDP), large for gestational age and high birth weight. This systematic review and meta-analysis evaluates obstetric and perinatal outcomes in medicated, stimulated and natural FET cycles. A literature search was performed using MEDLINE, EMBASE, CINAHL and the Cochrane Library database; 152,590 FET cycles were analysed from 31 included studies. Risk ratios (RR) and 95% confidence intervals (CI) were calculated using fixed and random effects models determined by the heterogeneity (I2). There was significantly higher risk of obstetric and perinatal complications, including HDP (RR 1.84, CI:1.48-2.29, I2 87%) and low birth weight (LBW) (RR 1.25, CI:1.12-1.39, I2 57%) following medicated compared to natural FET cycles. A higher risk of HDP (RR 1.50, CI:1.33-1.64, I2 32%) and macrosomia (RR 1.28, CI:1.17-1.40, I2 37%) was noted following medicated compared to stimulated cycles. Natural demonstrated lower risk of HDP (RR 0.77, CI:0.60-0.99, I2 32%), gestational diabetes (RR 0.78, CI:0.68-0.89, I2 43%), LBW (RR 0.78, CI:0.64-0.95, I2 48%) and small for gestational age (RR 0.83, CI:0.70-0.98, I2 12%) than stimulated cycles. These findings indicate that medicated FET cycles convey greater risks of obstetric and perinatal complications than natural or stimulated cycles.

The genetic basis of male and female infertility

This review provides a comprehensive overview of the genetic factors underlying male and female infertility. Infertility affects an estimated one in six couples worldwide, with both male and female factors contributing equally to its prevalence. Approximately, 50% of infertility cases are attributed to genetic causes. We explore three main categories of genetic causes: chromosomal abnormalities, monogenic disorders, and syndromic conditions. Chromosomal causes, including numerical and structural aberrations, are discussed with a focus on their impact on gametogenesis and reproductive outcomes. We review key monogenic causes of infertility, highlighting recent discoveries in genes critical for gonadal development, gametogenesis, and hormonal regulation. Syndromic conditions affecting fertility are examined, highlighting their impact on reproductive function. Throughout the review, we address the challenges in identifying genetic mechanisms of infertility, particularly focusing on the intricate processes involved in oogenesis and spermatogenesis. We also discuss how advancements in genetic testing, such as next-generation sequencing (NGS) and genome-wide association studies (GWAS), have significantly enhanced our understanding of idiopathic infertility and promise further insights in the future. We also discuss the clinical implications of genetic diagnoses, including the role of preimplantation genetic testing (PGT) and genetic counseling in reproductive medicine. This review synthesizes current knowledge on the genetic basis of infertility, providing a comprehensive overview of chromosomal, monogenic, and syndromic causes. It aims to offer readers a solid foundation for understanding the complex genetic factors underlying reproductive disorders.

Effects of gonadotropin-releasing hormone antagonist (GnRH-ant) cessation on trigger day in a GnRH-ant protocol: a meta-analysis

BACKGROUND

The gonadotropin-releasing hormone antagonist (GnRH-ant) protocol is associated with few oocytes retrieved, few mature oocytes and poor endometrial receptivity. Omission of GnRH-ants on trigger day seems unlikely to induce preovulation and may improve outcomes in the GnRH-ant protocol. This study aimed to systematically evaluate the effects of GnRH-ant cessation on trigger day on in vitro fertilisation outcomes following the GnRH-ant protocol.

METHODS

We searched PubMed, Ovid/MEDLINE, Wanfang, VIP, CNKI and ClinicalTrials.gov databases. The last search was conducted on 10 December 2023 in English or Chinese, without time limitations on the collection of studies from the databases. The references in these articles were manually searched. Randomised controlled trials (RCTs) and cohort studies aimed at assessing the effects of GnRH-ant cessation on trigger day using the GnRH-ant protocol were included. The eligible studies included at least one of the main outcomes: number of oocytes retrieved, proportion of mature oocytes, implantation rate or clinical pregnancy rate.

RESULTS

Three studies with 1449 cycles were included. Cessation of GnRH-ant on trigger day improved the proportion of mature oocytes (odds ratio [OR] = 1.26, 95% confidence interval [CI] = 1.09-1.45, I2 = 0%) but did not affect the number of oocytes retrieved (mean difference [MD] = 0.50, 95% CI = -0.07 to 1.07, I2 = 47%), implantation rate (OR = 0.95, 95% CI = 0.69-1.30, I2 = 0%), clinical pregnancy rate (OR = 1.06, 95% CI = 0.71-1.58, I2 = 0%), endometrial thickness (MD = -0.09, 95% CI = -0.27 to 0.10, I2 = 0%) or cycle cancellation rate (OR = 0.64, 95% CI = 0.15-2.74, I2 = 0%).

CONCLUSIONS

Cessation of GnRH-ant on trigger day of the GnRH-ant protocol is suggested because it could improve the proportion of mature oocytes. However, further RCTs are required.

Awareness, burden and treatment of uterine fibroids: a web-based Italian survey

Uterine fibroids (UFs) are the most common benign tumors in women of reproductive age and one of the leading causes of hysterectomy in Italy. This survey aimed to report how Italian women perceive and approach UFs, in order to raise healthcare professionals (HCPs)', institutions' and women's awareness of UFs and their treatment options. 1508 Italian women aged 30-50 years completed a web-based survey, answering a structured questionnaire focused on UF prevalence, symptomatology and impact, management and awareness. UF self-reported prevalence was 28.8%. Most UF-diagnosed women had symptom(s) before diagnosis (79.0%), and more than a half of UF-diagnosed participants were symptomatic post-diagnosis (55.8%). The most common symptoms after diagnosis were heavy menstrual bleeding (73.1%), dysmenorrhea (50.4%) and pelvic pain (36.8%). UFs negatively affected the quality of life of most symptomatic women, as well as sexuality and employment. Private gynecologists were the key reference HCPs for consultation and UF diagnosis. The most common UF treatments for symptomatic women were surgery (49.2%), followed by oral contraceptives (39.3%). Surgery was also performed for 22.9% of asymptomatic participants. UF-diagnosed participants were not involved in therapeutic choices in 37.6% of cases. Women's knowledge about UFs was mostly superficial (58.7% of all participants), with gynecologists and family/friends as main information sources. Patient-physician communication was rather unsatisfactory, especially about UF therapeutic options and disease impact on sexuality, fertility and lifestyle. This survey highlights that there is still a need to promote patient's knowledge about UFs and empowerment in treatment decision.

Diagnostic accuracy of plasma microRNA as a potential biomarker for detection of endometriosis

Endometriosis is a complex condition with a wide range of clinical manifestations, presenting significant challenges, particularly for young women. Its diverse and often perplexing presentations pose difficulties within the medical community. Laparoscopy remains the gold-standard diagnostic tool for endometriosis. However, alternative diagnostic methods are valuable for monitoring disease progression, assessing the likelihood of recurrence, reducing the need for surgical procedures, and facilitating timely decisions regarding fertility concerns. Recent research highlights the potential of microRNAs (miRNAs) as an alternative diagnostic test for endometriosis. A case-control study was conducted at the infertility unit of Arash Women's Hospital, involving 50 female participants, 25 with endometriosis and 25 without it. Plasma samples were collected and analyzed for the expression levels of 16 miRNAs using quantitative reverse transcription polymerase chain reaction (qRT-PCR). Diagnostic accuracy measures were evaluated to establish a reliable and comparable diagnostic framework. Compared to the control group, downregulation of 11 miRNAs and upregulation of 5 miRNAs were observed in the case group. Regarding expression patterns, evidence from this study indicates that half of the evaluated miRNAs fall into the high-agreement category with similar studies. Sensitivity (SN) of the evaluated miRNAs ranged from 64.0% to 88.0%, while specificity (SP) ranged from 56.0% to 88.0%. The area under the curve (AUC) was reported between 0.619 (miR-135a) and 0.846 (miR-340). These findings suggest that the evaluated miRNAs demonstrate moderate to acceptable diagnostic accuracy for endometriosis.

Burden of female infertility in 204 countries and territories, 1990-2021: results from the Global Burden of Disease Study 2021

OBJECTIVE

To explore the global burden of female infertility from 1990 to 2021 by examining trends in prevalence and years lived with disability (YLD).

METHODS

Data from the Global Burden of Disease Study 2021 (GBD 2021) were analyzed with a focus on the prevalence and YLD of female infertility in women aged 15-49 years. Statistical models were used to estimate ASPRs and YLD across regions and countries.

RESULTS

The global prevalence of female infertility was 110.1 million in 2021, with an age-standardized rate of 2,764.6 per 100,000 population. The YLD for infertility in 2021 was 601,134, which represented a 33.1% increase since 1990. Regionally, East Asia and Eastern Europe had the highest rates of infertility, whereas Australasia had the lowest rate.

CONCLUSIONS

The study highlights a significant rise in the burden of female infertility, particularly in high-income regions. Study findings emphasize the need for targeted public health strategies and healthcare interventions to address this growing issue.

Investigation of testis proteome alterations associated with male infertility in Dcaf17-deficient mice

Disruption of Dcaf17 in mice resulted in male infertility with severe spermatogenesis defects. To investigate the molecular basis of infertility phenotype, we examined testicular proteomes of wild-type (WT) and Dcaf17-/- mice using a mass spectrometry-based approach. We identified 727 and 525 differentially expressed proteins (DEPs) in 3- and 8-week old testes of Dcaf17-/- mice, respectively, with an adjusted p-value cut-off of ≤ 0.05. Among these, 299 and 298 DEPs had fold change of ≥ 1.5 between WT and Dcaf17-/- testes at -3- and 8-week old, respectively. In the 3-week old Dcaf17-/- testes, 59.5% of the DEPs were up-regulated, while 40.5% were down-regulated. Similarly, in the 8-week old Dcaf17-/- testes, 83.9% and 16.1% DEPs were up-regulated and down-regulated, respectively. Functional annotation and network analyses highlighted that many DEPs were associated with key biological processes, including ubiquitination, RNA processing, translation, protein folding, protein stabilization, metabolic processes, oxidation-reduction processes and sper-matogenesis. Subsequent immunohistochemistry and immunoblotting analyses showed higher ubiquitin levels in Dcaf17-/- testes compared to WT, suggesting potential impairment in ubiquitin proteasome system (UPS) due to DCAF17 loss of function. Our data provide a basis for further work to elucidate the molecular function(s) of DCAF17 in spermatogenesis and male fertility.

Preeclampsia pathogenesis and prediction - where are we now: the focus on the role of galectins and miRNAs

Preeclampsia is a complex, progressive multisystem hypertensive disorder during pregnancy that significantly contributes to increased maternal and perinatal morbidity and mortality. Two screening algorithms are in clinical use for detecting preeclampsia: first-trimester screening, which has been developed and validated for predicting early-onset preeclampsia but is less effective for late-onset disease; and the sFlt-1:PlGF biomarker ratio (soluble tyrosine kinase and placental growth factor) used in suspected cases of preeclampsia. This ratio has a high negative predictive value, allowing for the reliable exclusion of the disease. Both of these screening tests have not met expectations. This review attempts to summarize the current knowledge on the pathogenesis and prediction of preeclampsia and to draw attention to novel biomarkers with a focus on microRNAs and galectins. Although these molecules belong to two distinct biological classes, they functionally converge in regulating placental and immune pathways. Ample evidence supports their involvement in the molecular mechanisms underlying preeclampsia. Based on current knowledge, galectin-13, C19MC members, and miRNA-210 are associated with the trophoblast/placenta and conditions of placental ischemia or hypoxia. Their levels differ significantly in pregnant women at risk of preeclampsia as early as the late first and early second trimester, making them potential markers for predicting preeclampsia.

Overview of infertility

Having a child is an innate trait in animals, including humans, and is required for the continued existence of all animal species. Therefore, for most women, the inability to conceive or to do so in a timely fashion - termed infertility - to enable the continuation of the family line can be emotionally distressing. The definition of infertility is controversial because of its separation into primary and secondary. This is further complicated by the loosely used term subfertility, which relates to couples who have reduced ability because they take longer than the natural time to conceive, as opposed to those who are infertile and are entirely unable to conceive after 6 to 12 months, depending on age. Infertility evaluation requires a thorough male and female history, physical examination of both partners, and targeted investigation to determine the cause of infertility in a particular couple. Various treatments apply to infertile couples depending on the age of the female partner, the results of investigations, the reason for infertility, the presence of inheritance of abnormal genes, the pregnancy rates the couple is happy with, the resources available, how desperate the couple is to achieve a live birth, and how much they want to commit to treatment. Infertility treatment could include counseling and expectant management only, intrauterine insemination in a natural or stimulated cycle, and IVF and or ICSI. Men with azoospermia will need surgical options to retrieve sperm for IVF/ ICSI, but rarely for IUI. This review overviews infertility's etiology, diagnosis, investigations, and treatment.

Improvement of endocrine and metabolic conditions in patients with polycystic ovary syndrome through acupuncture and its combined therapies: a systematic review and meta-analysis

BACKGROUND

Polycystic Ovary Syndrome (PCOS) is a common endocrine disorder among women of reproductive age that significantly impacts their reproductive health. Acupuncture and its combined therapies may have beneficial effects on the endocrine and metabolic states of women with PCOS. This systematic review and meta-analysis evaluated the treatment effects and potential mechanisms of acupuncture and its combined therapies compared to oral metformin in treating PCOS patients.

METHODS

The evaluation focused on three sets of outcomes: hormonal indicators, metabolic indicators, and body weight indicators. Studies that involved additional therapies beyond the specified interventions or included patients with other diseases were excluded. Additionally, data mining methods were used, including frequency statistics to analyze the frequency of acupuncture points and the meridians involved, and the Apriori algorithm to perform association rule analysis for the most effective interventions.

RESULTS

The study included 46 articles (51 studies) involving six interventions: acupuncture combined with metformin, acupuncture treatment, acupuncture with Chinese herbal medicine and metformin, acupuncture with Chinese herbal medicine, acupuncture combined with cupping, and auricular acupuncture combined with metformin showed significant improvements in all evaluated indicators. Data mining revealed the Stomach meridian of foot yangming was the most frequently used, and the most commonly used combination of points included CV4, SP6, and ST36.

CONCLUSIONS

This study suggests that acupuncture and its combined therapies may benefit PCOS. However, risk of bias and heterogeneity observed were noted. Future high-quality, rigorously designed randomized controlled trials are needed to confirm these findings and provide stronger clinical recommendations for acupuncture in PCOS treatment.

Efficacy of focused ultrasound ablation surgery in patients with adenomyosis and coexisting pelvic adhesions

OBJECTIVE

The objective of this study was to assess the efficacy of focused ultrasound ablation surgery (FUAS) in treating patients with adenomyosis and coexisting pelvic adhesions.

MATERIALS AND METHODS

A total of 396 patients diagnosed with adenomyosis and who underwent FUAS between January 2014 and December 2022 were enrolled. Pelvic adhesions were evaluated using magnetic resonance imaging (MRI), and the patients were categorized into either adhesive group or non-adhesive group. The aim was to investigate the comparative efficacy between the two groups.

RESULTS

Among the 396 patients, pelvic adhesions were detected in 123 (31.06%) women. Compared to the non-adhesive group, patients in the adhesive group exhibited a higher preoperative dysmenorrhea score (7 vs. 6, p  < 0.001), a lower short-term clinical success rate (74.80% vs. 84.62%, p = 0.025), and a higher long-term cumulative recurrence rate (log-rank p = 0.009). The adhesive group exhibited a high incidence of anal discomfort during the procedure compared to the non-adhesive group (18.70% vs. 7.69%, p = 0.002). Additionally, patients with severe adhesion demonstrated a lower ratio of non-perfused volume ratio (NPVR) (38.81% vs. 46.58%, p = 0.009). Multivariate binary logistic regression analysis revealed that pelvic adhesion independently increased the risk of dysmenorrhea (OR = 4.730, 95%CI: 2.026-11.044, p < 0.001), while severe pelvic adhesion was identified as an independent risk factor for NPVR (OR = 2.226, 95%CI: 1.181-4.196, p = 0.013).

CONCLUSION

The preoperative assessment of pelvic adhesions plays a crucial role in predicting intraoperative adverse events of FUAS in patients with adenomyosis, as well as determining both short-term and long-term efficacy, thereby providing valuable guidance for the development of comprehensive treatment.

The influence of male smoking on success rates after IVF/ICSI

OBJECTIVE

It has been established that male cigarette smoking has a negative effect on the semen quality and that it can induce DNA damage leading to worsening of reproductive outcomes. The aim of our large retrospective study is to determine the influence of male cigarette smoking on assisted reproduction, more specifically in IVF and ICSI outcomes.

MATERIALS AND METHODS

Our study included all consecutive infertile couples (with a nonsmoking female partner) having their first IVF/ICSI cycle. All patients had smoking assessment. Smokers were further classified into mild (1-10 cigarettes/day), moderate (11-20 cigarettes/day) or heavy smokers (>20 cigarettes/day). The primary outcome was live birth rates (LBR).

RESULTS

The overall number of patients analyzed was 4004 and among them 433 (10.8%) were smokers. Baseline characteristics, such as female age and BMI differed significantly between nonsmokers and smokers. The crude analysis showed higher positive hCG and LBR in smokers (positive hCG 28.34% in nonsmokers vs 33.95% in smokers, p = 0.015; LBR 23.55% in nonsmokers vs 28.64% in smokers, p = 0.019) However after adjustment for relevant confounders (female age, BMI, cause of infertility, number of oocytes retrieved, insemination procedure, number of embryos transferred and day of embryo transfer) the smoking status was not significantly associated with fresh LBR (OR = 1.16, CI = 0.92-1.48; p = 0.2). The results were replicated after classification of smoking into mild/moderate/heavy [OR for nonsmokers (reference category) vs. mild vs. moderate vs. heavy= 1, 1.17, 1, 2.99; p = 0.18)].

CONCLUSION

Male smoking does not seem to impair live birth rates in patients undergoing IVF/ICSI treatment.

How do coping strategies influence fertility-related information seeking/avoidance?

Despite the rise in discussions around fertility and reproductive health, recent evidence indicates that women's fertility awareness (FA) remains low, with many avoiding essential fertility-related information (FRI). Existing research has linked low awareness to demographic factors, yet psychological and behavioural determinants have received less attention. This study, therefore, explores the influence of coping strategies (avoidant and problem-focused) on FRI-seeking and avoidance behaviours and their effect on FA. A cross-sectional survey gathered data from 216 UK-based female participants aged 18-68 (M = 31.69, SD = 10.42), measuring demographics, FA, FRI-seeking and avoidance, and coping strategies. Data underwent multiple regression and moderation analyses. The average FA score was 17.87/29 (62%). FRI-seeking positively predicted FA (p < 0.001), while FRI-avoidance negatively predicted FA (p < 0.001). Avoidant coping significantly predicted increased FRI-avoidance (p < 0.001), moderating the relationship between FRI-avoidance and FA (p < 0.001). Problem-focused coping significantly predicted FRI-seeking (p < 0.001), moderating the relationship between FRI-seeking and FA (p < 0.001). Results suggest that coping strategies influence motivation to seek and avoid FRI. Future FRI and fertility education should be tailored to suit women's coping strategies to facilitate active engagement, which may enhance awareness and support more informed fertility decision-making.

Association of cannabis use with female infertility based on NHANES

BACKGROUND

With the gradual legalisation of recreational cannabis, associated health effects have received widespread attention, but their association with female infertility remains unclear. The aim of this study was to explore the association between cannabis use and infertility among females of childbearing age in the United States.

METHODS

Data were obtained from the National Health and Nutrition Examination Survey 2013-2018; 1694 female participants aged 18-45 years were included. The association between cannabis use and female infertility was analysed by logistic regression analysis. All data were weighted before analysis.

RESULTS

After adjusting for all covariates, former cannabis users demonstrated significantly elevated odds of infertility compared with never-users (odds ratio: 2.04, 95% confidence interval: 1.21-3.43, P = 0.012), whereas current cannabis users exhibited no significant difference in infertility odds relative to never-users. In subgroup analysis, former users aged 18-35 years exhibited higher odds of infertility than never-users (odds ratio: 2.37, 95% confidence interval: 1.11-5.04, P = 0.027); but former cannabis users aged 36-45 years demonstrated no significant difference in infertility odds compared with never-users. Among former cannabis users aged 18-35 years, those with sustained abstinence exceeding 3 years demonstrated significantly elevated odds of infertility compared with never-users (odds ratio: 2.94, 95% confidence interval: 1.29-6.71, P = 0.005). In contrast, individuals with shorter abstinence durations (<3 years) showed no significant difference in infertility odds relative to never-users.

CONCLUSIONS

Among females of childbearing age, the odds of infertility was not elevated among current cannabis users compared with never-users, while the odds of infertility was elevated among former users. This relationship between cannabis use and female fertility is more often reflected in the distant term (>3 years of cessation), and this adverse association is more pronounced among females in the most active reproductive years (18-35).

Switching to intracytoplasmic sperm injection provides no benefit in couples of poor embryonic development in the previous in vitro fertilization cycle

This study aimed to evaluate the effectiveness of changing the insemination method in women who experienced poor embryonic development during the preceding cycle. A total of 15,886 conventional IVF in 9,311 women, performed between August 2015 and June 2023, were included in this study. Of these, 270 couples experienced IVF failure due to poor embryonic development in the first oocyte retrieval (OR) cycle, which was cancelled before transfer. The patients were stratified based on whether or not they switched to ICSI for subsequent attempts. Cumulative live birth rates (CLBRs) and a series of secondary outcomes were compared. The embryo utilization, high-quality embryo, blastocyst formation, implantation, cumulative clinical pregnancy, CLBR and miscarriage rates were comparable between the two groups, whereas the fertilization rate per oocyte retrieved was significantly lower in the ICSI group during the second OR cycle (60.76% vs. 70.42%, p < 0.001) and all OR cycles (60.02% vs. 71.69%, p < 0.001). Furthermore, the CLBRs in the ICSI and IVF groups after up to seven OR cycles were 41.35% and 36.84%, respectively. Most patients achieved live births during the second OR cycle (58.33%, ICSI vs. 62.86%, IVF). ICSI did not improve clinical or embryonic outcomes in women who experienced poor embryonic development in their preceding cycle.

Evaluation of the psychosocial impact and received care in patients with gestational trophoblastic disease - a qualitative interview based study

The diagnosis gestational trophoblastic disease (GTD) is known to have a significant psychological impact on women. Our objective was to provide insight in the psychological and physical consequences of women with GTD, while also reflecting on their coping strategies and their experiences of received care. A qualitative study was carried out using semi-structured interviews among women recently diagnosed with GTD. Interviews were audio-recorded, transcribed verbatim and analyzed using a thematic network approach. Eight interviews were analyzed. The abruptness of the diagnosis resulted in women feeling sad, uncertain and powerless. Coping strategies included seeking emotional support, accurate information, peer connections and distraction. Women were generally satisfied with care, emphasizing personalization, empathy, medical expertise and feeling heard as important aspects. They appreciated offered psychological support from specialized nurses. Nevertheless, aspects such as provided information, communication and logistical issues need improvement. The results of this study emphasize the importance of comprehensive patient information, the need for personalized psychological support and more frequent consultations at reference centers, while treatment is conducted locally.

Tetramethylpyrazine Confers Protection Against Oxidative Stress and NLRP3-Dependent Pyroptosis in Rats with Endometriosis

Tetramethylpyrazine (TMP) has been confirmed to suppress inflammation in endometriosis (EMs). Herein, this study investigated whether and how TMP affected NLRP3 inflammasomes and oxidative stress in EMs. After establishment of an EMs rat model, rats were treated with different concentrations of TMP. The size of endometriotic lesions and the latency and frequency of torsion in rats were recorded, followed by the measurement of relevant indicators (TNF-α, IL-6, IL-2, IL-10, MDA, SOD, GSH, CAT, ROS, NLRP3, ASC, GSDMD, caspase-1, Nrf2, and HO-1). The study experimentally determined that TMP treatment markedly decreased the size of endometriotic lesions and improved torsion in rats with EMs. The levels of inflammatory proteins, oxidative stress markers, NLRP3 inflammasome, and pyroptotic proteins were elevated in rats with EMs, all of which were reversed upon TMP treatment. Additionally, the activities of SOD, GSH, and CAT were lowered in rats with EMs, which were partly abrogated by TMP treatment. Furthermore, the downregulation of Nrf2 and HO-1 was counteracted by TMP treatment. To sum up, TMP represses excessive oxidative stress, NLRP3 inflammasome activation, and pyroptosis in rats with EMs. Additionally, TMP may activate the Nrf2/HO-1 pathway.

Simvastatin-loaded liposomal nanoparticles as treatment for adenomyosis in a patient-derived xenograft mouse model: a pilot study

BACKGROUND

Adenomyosis is a common gynaecological condition where ectopic endometrial glands and stroma grow within the myometrium. This condition has a high clinical burden impacting those afflicted with debilitating symptoms including heavy painful periods. Simvastatin is an oral hydroxymethylglutaryl-coenzyme A (HMG-CoA) reductase inhibitor, typically used to treat hyperlipidaemia. Simvastatin has recently shown promise for treating gynaecological conditions such as endometriosis and uterine fibroids with nanoliposomal formulations demonstrating improved efficacy. In this pilot study, we tested simvastatin-loaded liposomal nanoparticles on xenografted adenomyosis tissues in a patient-derived mouse model.

METHODS

We surgically inserted oestrogen/progesterone pellets into mice, followed by adenomyosis tissue xenografts 15 days later. Mice were then randomised into three groups: control, simvastatin, and simvastatin-loaded liposomal nanoparticles (simvastatin-NP). We quantified the changes in adenomyosis xenograft size weekly using a calliper as well as ultrasound imaging 28 days after treatment, prior to sacrifice. We also measured the proliferation of biomarker Ki67 in the xenografted tissues using immunohistochemistry after animal sacrifice.

RESULTS

Treatment with simvastatin-NP significantly reduced volume and weight of adenomyosis xenografts while attenuating Ki67 expression when compared to the control and simvastatin groups. Conclusions: This pilot study demonstrates promising improved efficacy of simvastatin delivered via liposomal nanoparticles. However, larger studies are needed to fully explore the potential of simvastatin-NP in adenomyosis.

Medical treatment for adenomyosis: long term use of progestins

BACKGROUND

Adenomyosis is a uterine disorder causing menstruation-related symptoms such as dysmenorrhea, heavy menstrual bleeding (HMB) and dyspareunia. A long-term management of the disease is required. Hormonal drugs are the most used, including a variety of progestins, even though few data are available on their long-term use in adenomyosis.

OBJECTIVE

To evaluate the long-term efficacy of different progestins, including progestin-only pills (POP), for the management of adenomyosis-related symptoms.

METHODS

A total of 140 patients (18-45 years) with adenomyosis were treated with progestins for at least three years. The treatment groups included dienogest (2 mg, n = 71), levonorgestrel-releasing intrauterine device (52 mg, n = 25), desogestrel (75 mcg, n = 20), and drospirenone (4 mg, n = 24). Symptoms were assessed using the Visual Analogue Scale (VAS) for pain and the Pictorial Blood Assessment Chart (PBAC) method for bleeding.

RESULTS

Dienogest significantly reduced dysmenorrhea, dyspareunia, and HMB, with efficacy maintained over three years in most patients. However, after the first year 49% of patients required a switch to other treatments due to side effects or contraception need. The levonorgestrel-releasing intrauterine device also effectively managed HMB and pain, with 15% of patients switching treatment due to side effects. Both drospirenone and desogestrel improved HMB and dysmenorrhea, but desogestrel had a higher discontinuation rate due to reduced long-term efficacy. Norethisterone acetate was used as a second-line treatment in cases of intolerance or inadequate response.

CONCLUSION

Progestins are effective for the long-term management of adenomyosis symptoms. The flexibility in switching between different progestins or routes of administration may help in optimizing outcomes.

Prevalence and risk factors of gestational diabetes mellitus among pregnant women in northern Vietnam: a cross-sectional study

BACKGROUND

Gestational diabetes mellitus (GDM) increases adverse neonatal and maternal outcomes. Understanding the prevalence and risk factors of GDM is necessary to plan health care interventions and policy.

OBJECTIVE

To determine the prevalence and risk factors of GDM in Thai Binh, Vietnam.

METHODS

A cross-sectional study was conducted in two health facilities in Thai Binh, Vietnam, with the participation of 1,106 pregnant women. Women were recruited at their first antenatal care visit where face-to-face interviews about socioeconomic and reproductive factors were performed. A 2-hour 75 g oral glucose tolerance test was conducted at 24-28 weeks of gestation. GDM was diagnosed according to the World Health Organization 2013 criteria. Logistic regression analyses were used to assess the factors associated with GDM.

RESULTS

The prevalence rate of GDM was 27.1%. Multivariate logistic regression analysis showed maternal age from 25 to 34 (adjusted OR 2.0; 95%CI 1.3-2.9), maternal age ≥ 35 (adjusted OR 3.0; 95%CI 1.7-5.4), pregestational body mass index ≥ 23 (adjusted OR 1.6; 95%CI 1.1-2.3), family history of diabetes (adjusted OR 1.9; 95%CI 1.3-2.9), fertility treatment (adjusted OR 2.3; 95%CI 1.3-3.8), and previous GDM (adjusted OR 3.1; 95%CI 1.4-6.9) were associated with increased odds of GDM.

CONCLUSIONS

More than one-fourth of pregnant women in Thai Binh, Vietnam, may have GDM. Advanced maternal age, high pregestational body mass index, family history of diabetes, and previous GDM were associated with increased risk of GDM. Additionally, fertility treatment appears to be strongly associated with an increased risk of GDM.

Increased paternal age adversely affects live birth rates in oocyte recipient cycles

This retrospective cohort study was conducted in a single center to investigate the influence of paternal age on oocyte recipient cycles. 320 IVF/ICSI oocyte recipient cycles resulting in embryo transfers between 01/2015- 06/2022 and meeting the inclusion criteria: donors ≤35 years, endometrial thickness 6mm and normal endometrial cavity were analyzed. Donor or surgically retrieved sperm or PGT-A cycles were excluded. Paternal and recipient ages were grouped according to previous literature for comparability. Primary outcome was live birth rate, and secondary outcomes were clinical pregnancy and miscarriage rates. The median recipient, paternal and donor ages were 42 (IQR: 19-50), 43 (IQR: 38-46) and 26 years (IQR: 23-29). 55.6% [N=178] of the cycles were fresh and 44.3% [N=142] were frozen embryo transfers. Univariate and multivariate logistic regression, adjusted for semen WHO criteria, recipient age, IVF/ICSI and fresh/frozen cycles highlighted reduced odds of live birth by 79%, OR 0.21 [95%CI 0.11 to 0.38]; P<0.0001, clinical pregnancy by 58%, OR 0.42 [95%CI 0.31 to 0.89]; P<0.0001 and increased odds of miscarriage by 108%, OR 2.08 [95%CI 1.91 to 3.01]; P<0.0001 in those of paternal age 51 years compared to fathers ≤35 years. Our study identifies the negative impact of advanced paternal age.

Integrated pharmacoanalysis, bioinformatics analysis, and experimental validation to identify the ingredients and mechanisms of Xiao-Luo-Wan in uterine fibroids treatment

CONTEXT

Xiao-Luo-Wan (XLW), a classical prescription in traditional Chinese medicine, has therapeutic effects on uterine fibroids (UFs). Herein, its anti-UF effects were examined using a systematic pharmacological method.

OBJECTIVE

To explore the active ingredients of XLW via mass spectrometry and its potential effects on UFs by network pharmacology, molecular docking, and experimental validation.

MATERIALS AND METHODS

A mass spectrometer was used to scrutinize the composition of the XLW drug-containing serum. The critical targets and potential mechanisms of XLW against UFs were predicted by network pharmacology and molecular docking. Next, human uterine leiomyoma cells (UMCs) were treated with 20%, 30%, or 40% XLW serum for 24 h, 48 h or 72 h. Cell viability was analyzed via a CCK-8 assay, and cell apoptosis and the cell cycle were examined via flow cytometry. The predicted targets were further identified by RT-PCR and western blotting.

RESULTS

There were 16 chemical components identified in XLW drug-containing serum, with 53 target genes predicated in the treatment of UFs. The molecular binding of core targets, including TRIM9, NF-κB and p38MAPK, was relatively stable to components, especially buergerinin B, cedrol and ent-15B-16-epoxy- kauan-17-ol. The in vitro experiments revealed that the IC50 of XLW in UMCs was 63.21%, and the anti-UF effects of XLW may be closely associated with targets that inhibit cell proliferation and promote cell apoptosis by regulating TRIM9, NF-κB and p38MAPK expression.

DISCUSSION AND CONCLUSIONS

The integration of mass spectrometry, network pharmacology, molecular docking and biological experiments revealed the key constituents of XLW and its pharmacological mechanism in UFs, which may help in the discovery of therapeutic agents for treating UFs.

Dietary supplementation of male mice with inorganic, organic or nanoparticle selenium preparations: evidence supporting a putative gut-thyroid-male fertility axis

Selenium (Se) is linked to physiological homeostasis. Male mice (n = 8/group) were fed control (AIN93G) or diets enriched in sodium selenite (NaSe, 5.6 ppm), methylselenocysteine (Met, 4.7 ppm), diphenyl diselenide (DPDS, 14.2 ppm), or nanoselenium (NanoSe, 2.7 ppm); dietary Se ascertained by inductively-coupled plasma mass spectrometry. At 4 weeks testes, sperm, thyroids, blood and stool were collected to assess histoarchitecture, circulating hormones (thyroxine, T4; triiodothyronine, T3; thyroid stimulating hormone, TSH) and gut microbiome (16S rRNAV3-V4 amplicon sequencing). Supplemented NaSe, Met, and NanoSe increased plasma testosterone and testis glutathione peroxidases (GPx-1/4) while testicular superoxide dismutase and catalase increased slightly in the NanoSe group indicating a selective antioxidant response. Overall, NanoSe and NaSe enhanced male reproductive factors. All thyroids isolated from Se-supplemented mice contained marginal vacuoles and a lower follicle area vs control. Nano-Se enhanced thyroidiodothyronine deiodinase-1 (DIO1) expression however, thyroid GPx-1/4 remained unchanged. Supplemented NaSe and DPDSl increased plasma T3/T4 ratio, while plasma TSH was unchanged. Microbiome analyses showed that NanoSe was most efficacious in altering composition (judged by α-diversity, Shannon index and taxon richness) while the NaSe diet showed the greatest overall change in α-diversity. Dietary Se supplementation, particularly encapsulated NanoSe, may improve male fertility factors by enhancing the gut-thyroid-fertility axis.

Retrospective case control study on the evaluation of the impact of augmented reality in gynecological laparoscopy on patients operated for myomectomy or adenomyomectomy

The objective of this study is to evaluate the safety of using augmented reality (AR) in laparoscopic (adeno)myomectomy, defined as an increase in operating time shorter than 15 min. A total of 17 AR cases underwent laparoscopic myomectomy or adenomyomectomy with the use of AR and 17 controls without AR for the resection of (adeno)myomas. The non-inferiority assumption was defined by an operative overtime not exceeding 15 min, representing 10% of the typical operative time. The 17 AR cases were matched to 17 controls. The criteria used in matching the two groups were the type of lesions, the size and the placement. The mean operative time was 135 ± 39 min for AR cases and 149 ± 62 min for controls. The margin of non-inferiority was expressed as a difference in operative time of 15 min between the case and control groups. The mean difference observed between AR cases and controls was -14 min with 90% CI [-38.3;11.3] and was significantly lower than the non-inferiority margin of 15 min (p = 0.03). This negative time difference means that the operative time is shorter for the AR cases group. Intraoperative data revealed a volume of bleeding ≤200 mL in 82.3% of AR cases and in 75% of controls (p = 0.62). No intra or postoperative complications were reported in the groups. The use of augmented reality in laparoscopic (adeno)myomectomy does not introduce additional constraints for the surgeon. It appears to be safe for the patients, with an absence of additional adverse events and of significantly prolonged operative time.

Prostatitis and male infertility

Infertility is a pressing reproductive health issue in modern society, with male factors accounting for approximately 50% of all cases. However, most research on male infertility has primarily focused on the testis, often ignoring the critical role of the prostate. As the largest male reproductive gland, the prostate plays a vital role in semen quality. Prostatic fluid, a major component of semen, significantly influences sperm function and overall male fertility. Prostatitis, the most common prostate disorder among men, particularly with advancing age, can severely impair reproductive health. This article aims to explore the fundamental physiological functions of the prostate, the etiology of prostatitis, and its impact on sperm health. It also discusses potential treatment strategies for prostatitis. Through this review, we hope to deepen understanding of the prostate's crucial role in male infertility.

Factors influencing premature ovarian insufficiency: a systematic review and meta-analysis

BACKGROUND

Premature ovarian insufficiency (POI) has multiple contributing factors. This study aims to systematically evaluate these factors and their mechanisms, identify high-risk groups, support early intervention, and provide a basis for future research.

METHODS

Following the PRISMA guidelines, a search was conducted across 11 Chinese and English databases, including PubMed, Embase, and the Cochrane Library, up to January 2024. Observational studies on patients with ovarian insufficiency were included. A meta-analysis using Stata 14 was performed to calculate odds ratios (OR) and 95% confidence intervals (CIs) for factors influencing POI.

RESULTS

A total of 38 studies with 4,968 cases and 5,158 controls were included. The following factors were identified as risk factors for POI: abnormal menstruation (OR = 2.707, 95% CI: 1.705-4.299), hair dyeing (OR = 4.725, 95% CI: 2.914-7.660), chemical exposure (OR = 3.314, 95% CI: 2.283-4.811), Type A personality (OR = 6.106, 95% CI: 4.696-7.939), survival stress (OR = 3.292, 95% CI: 2.380-4.555), sleep deprivation (OR = 3.340, 95% CI: 2.363-4.721), bad mood (OR = 4.654, 95% CI: 2.783-7.781), smoking history (OR = 2.748, 95% CI: 1.928-3.917), family history of POI (OR = 4.338, 95% CI: 2.422-7.768), history of mumps (OR = 5.802, 95% CI: 3.460-9.730), number of abortions (OR = 2.292, 95% CI: 1.887-2.785), and history of pelvic surgery (OR = 4.836, 95% CI: 3.066-7.628). Physical exercise (OR = 0.270, 95% CI: 0.106-0.692) and vegetable intake (OR = 0.434, 95% CI: 0.337-0.560) were protective factors. Sensitivity analysis and publication bias tests confirmed robustness.

CONCLUSIONS

POI is related with abnormal menstruation, hair dyeing, chemical exposure, Type A personality, survival stress, sleep deprivation, bad mood, smoking history, family history of POI, history of mumps, number of abortions, and history of pelvic surgery. Physical exercise and vegetable intake may provide protection. These findings inform clinical strategies for early identification and management.

Role of B7H4 and Fas in regulation of trophoblast cells and development of pre-eclampsia: a cross-sectional study

BACKGROUND

This study aimed to investigate the role of B7H4 and Fas in pre-eclampsia (PE) occurrence and development and reveal its potential mechanisms.

METHODS

Thirty healthy individuals and 60 patients with PE were enrolled in the study. In addition, the clinical characteristics of all participants were collected, including age, gestational weeks at delivery, gestational time, number of births, systolic blood pressure, diastolic blood pressure and foetal weight. The chi-square test was used to evaluate differences in clinical characteristics between the high- and low-expression groups. The expression levels of B7H4 and Fas were analysed using western blotting and real-time quantitative polymerase chain reaction (RT-qPCR). The upstream regulators of B7H4 in trophoblasts were predicted and estimated using a luciferase reporter assay. The proliferation and motility of trophoblasts were assessed using CCK8 and transwell assays, respectively.

RESULTS

B7H4 and Fas were upregulated in PE (p < 0.05) and showed diagnostic potential with insufficient sensitivity and specificity [B7H4: area under curve (AUC) = 0.790, sensitivity = 65%, specificity = 83.33%; Fas: AUC = 0.717, sensitivity = 68.34%, specificity = 73.33%]. B7H4 and Fas were closely associated with increased blood pressure in patients with PE (p < 0.05), and the combination of B7H4 and Fas increased the diagnostic efficacy (AUC = 0.864), sensitivity (73.33%) and specificity (86.67%). In trophoblast cells, miR-4319 negatively regulated B7H4 and Fas expression as well as cell proliferation, migration and invasion (p < 0.05). Overexpression of B7H4 alleviated the inhibitory effects of miR-4319, which were reversed by Fas knockdown (p < 0.05).

CONCLUSIONS

miR-4319 mediates the progression of trophoblast progression by negatively regulating the expression of B7H4 and Fas. Therefore, B7H4 and Fas may serve as potential biomarkers for the prediction and treatment of PE.

In vitro maturation of oocytes (IVM): historical landmarks, current status and future perspectives

One of the major advancements in in vitro fertilization (IVF) has been the development of culture media that enhance gamete maturation in vitro and sustain embryo development up to the blastocyst stage. The deep understanding of the mechanisms involved in gametogenesis and the complex sequence of events surrounding nuclear and cytoplasmic maturation has also enabled the development of efficient in vitro maturation (IVM) protocols. This review outlines the major landmarks in the history of in vitro maturation of oocytes, the advantages and importance of its clinical application in human, especially in patients with Polycystic Ovary Syndrome (PCOS), Resistant Ovary Syndrome, high antral follicle count or oncology patients, as well as the safety and efficacy of the technique. IVM has not been shown yet to be as effective as controlled ovarian stimulation in terms of maturation rates, fertilization rates, and clinical outcome, possibly owing to a dysfunctional or asynchronous nuclear/cytoplasmic maturation process. A confusing set of IVM clinical protocols may also have contributed to the slow incorporation of the technology into routine IVF practice. However, recent improvements have led to comparable live birth rates between IVM and IVF, in women with high antral follicle count. The current status of IVM in the Assisted Reproductive Technology (ART) laboratory and its future perspectives, aiming to provide maximum fertility care to patients will be discussed.

Frontiers of premature ovarian insufficiency research: an analysis from the top 100 most influential articles in the field

Objectives: Premature ovarian insufficiency (POI) is a serious condition that affects women worldwide, In recent years, the number of research publications on POI has increased over the last decades because of the advancement of cutting-edge research in gynecology and the deepening of disciplinary interactions. At the same time, there is a more urgent need to systematically analyze and review existing studies to generalize the research paradigm and disciplinary structure of the field under technological changes.

Materials and methods: We selected the top 100 most cited papers in the Web of Science (WOS) SCI-Expanded database. Knowledge graphs were constructed through the VOS viewer, Cite Space, and Scimago Graphica software, and then relevant information retrieved from the literature was edited using Excel to assess research priorities and trends in the field.

Results: A total of 53 periodicals from 34 different nations and regions published the 100 most-cited publications between 1999 and 2024. The Journal of Clinical Endocrinology & Metabolism published the majority of the papers, while The Lancet had the highest average number of citations per piece. The United States of America produced the highest contribution in terms of publications, with China and France closely trailing after. In terms of total publications, Erasmus MC, Shanghai Jiao Tong University, and Shandong University each contributed the highest number of papers. The main categories were obstetrics and gynecology, endocrinology and metabolism, and reproductive biology. The top five keywords were: failure, women, ANTI-MULLERIAN HORMONE, NATURAL MENOPAUSE, and AGE. The study of HERITAGE AND GENETICS, CARDIOVASCULAR DISEASES, and CELL BIOLOGY AND IMMUNOGENETICS is becoming more and more popular in POI, as shown by cluster analysis.

Conclusions: Bibliometric analysis enables POI researchers to efficiently and visibly pinpoint the cutting-edge areas and focal points of their study. Potential topics of future study may include genetic and molecular biological pathways, cardiovascular pathology, and immunology.

Nano-sized titanium dioxide exposure induces non-hyperandrogenic polycystic ovarian syndrome in rats by increasing aromatase and apoptosis in granulosa cells

Polycystic ovarian syndrome (PCOS) is a frequently encountered disease with hormonal and metabolic dysfunction in women of reproductive age. Nano-sized titanium dioxide (nTiO2) has been widely used in skin care products, paints, food, and cosmetics. In this study, we found a substantial elevation of Ti in the follicular fluid of females diagnosed with non-hyperandrogenic PCOS (non-HA PCOS). Therefore, we orally subjected female rats to nTiO2 at 10 and 100 mg/kg body weight for 10 weeks. We found that nTiO2 triggered non-HA PCOS-like symptoms, including the increase of cystic follicles, estrous cycle disorder, and abnormal ovulation, but without high testosterone. By transcriptome sequencing, we identified that nTiO2 exposure inhibited the steroid hormone synthesis and activated the pro-apoptotic pathways. Upon validating these altered pathways, we discovered that aromatase (Cyp19a1) overexpression contributed to the decline in testosterone/estradiol ratio. Meanwhile, the apoptosis of granulosa cells was increased by nTiO2 exposure, which might result in the disorder of follicular development. This study presents the evidences revealing a pronounced correlation between nTiO2 exposure and the emergence of non-HA PCOS, urging people to promote the safe utilization of nTiO2.

Advances in fertility preservation and pregnancy care for transplant patients

Fertility preservation and pregnancymanagement are critical considerations for patients undergoing organtransplantation. Innovations in assisted reproductive technologies, hormonalmodulation, and personalized medicine have expanded options for these patients, who face unique challenges due to immunosuppressive therapy and organ functionconcerns. This mini-review explores advancements in cryopreservationtechniques, pre-conception counseling, and multidisciplinary strategies forsafe pregnancies post-transplantation. Emphasis is placed on balancing maternalhealth, graft function, and fetal outcomes. The integration of reproductive andtransplant medicine is paving the way for improved quality of life andreproductive autonomy for this patient population.

Acupuncture-assisted embryo transfer techniques: Research frontiers and future directions

BACKGROUND

Acupuncture, an ancient practice, is gaining recognition as a complementary and alternative medicine, especially in assisted reproductive technology. It plays a crucial role in enhancing embryo transfer success rates. Research indicates that acupuncture can improve blood flow, increase endometrial receptivity regulate pressure, and affect neuroendocrine activities in the ovaries and uterus during embryo implantation, therefore improving pregnancy outcomes.

AIM

To highlight recent developments related to acupuncture's influence on embryo transfer and elucidating the precise mechanisms by which acupuncture influences embryo transfer.

METHODS

We searched database including PubMed, Cochrane Library up to September 2024 for relevant studies and patents to evaluate the effects of acupuncture on women undergoing in vitro fertilization (IVF). The experimental design included an intervention group using needling, and a control group consisting of no needling or sham needling. The main outcome is clinical pregnancy rate (CPR), while secondary includes live birth rate (LBR) and biochemical pregnancy rate (BPR). We examined the influence of adjunctive needling on pregnancy outcomes by analyzing variations in the main outcomes.

RESULTS

A total of 145 randomized controlled trials involving 27748 participants were analyzed. Data revealed that the overall CPR was significantly elevated in all acupuncture cohorts compared to the control group [relative risk (RR): 1.21, 95%CI: 1.07-1.38, P = 0.01]. In contrast, the aggregated LBR did not exhibit a corresponding increase, and notable statistical heterogeneity was observed among the studies. Acupuncture-assisted frozen-thawed embryo transfer enhanced the BPR (RR: 1.51, 95%CI: 1.21-1.89, P = 0.03) and improved endometrial morphology (RR: 1.41, 95%CI: 1.13-1.75, P = 0.01). Furthermore, IVF outcomes were significantly superior in the acupuncture group when acupuncture was administered during controlled ovarian hyperstimulation (RR: 1.71, 95%CI: 1.08-2.13, 95%CI: 1.08-4.21, P = 0.03).

CONCLUSION

We find that acupuncture positively influences pregnancy rates in women receiving IVF treatment. Nonetheless, there are no established guidelines for optimal acupuncture protocols. Considering the methodological limitations identified in current research, there is a need for larger, methodologically rigorous studies.

Computer-aided precise hapten design strategy for the monospecific detection of altrenogest: Experimental validation and analysis of the molecular recognition mechanism

Altrenogest is one of the most commonly used steroid hormones; however, there are currently no relevant reports on monospecific molecular recognition elements and immunoassay methods for altrenogest. Herein, a computer-aided precise hapten design strategy was proposed for monospecific monoclonal antibodies (mAb) preparation. Based on this strategy, a monospecific and sensitive mAb-D7 was prepared for the first time. The mAb-D7 has the 50 % inhibitory concentration (IC50) of 0.12 ng/mL for altrenogest and does not cross-react with other common steroid hormones. Additionally, a single-chain variable fragment (scFv) for altrenogest was constructed for the first time, which exhibits an IC50 of 1.7 ng/mL for altrenogest. The molecular recognition mechanism studies showed the monospecific mAb-D7 to altrenogest originated from the amino acids PHE-94 and LEU-237, demonstrating the reliability of this strategy. Finally, two monospecific, rapid, and sensitive immunoassays were established for altrenogest in pork and pork liver for the first time.

Supplementation with lipoamide during in vitro maturation improves bovine oocyte maturation and subsequent embryonic development: potential link to PI3K/AKT signaling

Oxidative stress during oocyte in vitro maturation (IVM) is still concerned. Lipoamide (LAM) has been widely studied as an agent for alleviating various diseases associated with oxidative disruption. This work aimed to evaluate the potential effects of LAM on bovine oocyte IVM and its mechanisms. Different concentrations of LAM (0, 10, 50, 100, and 200 μmol/L) were supplemented to bovine oocyte IVM medium. The IVF derived zygote cleavage and blastocyst formation rate in the 100 μmol/L LAM treatment group was increased compared with the control group (P < 0.05).There was no statistical difference in PBI between 100 μmol/L LAM treatment and the control group, although the treatment tended to increase it (P = 0.059). Further revealed that LAM increased the expression of PI3K and phosphorylated-AKT1 (pAKT1), improved mitochondrial profile, and reduced apoptosis in bovine oocytes. Meanwhile, the reactive oxygen species (ROS) as well as the 8-Hydroxydeoxyguanosine (8-OHdG, DNA damage-specific marker) displayed lower levels accumulation in LAM-exposed oocytes. Taken together, the results show that administration of LAM (100 μmol/L) during IVM can ameliorate the developmental competence of bovine oocyte through the potential regulation of oxidative stress, apoptosis, DNA damage, and PI3K/AKT signaling.