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Abstract Background Endometriosis-related infertility is a common worldwide reproductive health concern. Despite ongoing research, the causes of infertility remain unclear. Evidence suggests that epigenetic regulation is crucial in reproduction. However, the role of N6-methyladenosine (m6A) modification of RNA in endometriosis-related infertility requires further investigation. Methods We examined the expression of m6A and methyltransferase-like 3 (METTL3) in endometrial samples taken from normal fertile women in the proliferative phase (the NP group) or the mid-secretory phase (the NS group) or from women with endometriosis-related infertility at the mid-secretory phase (the ES group). We treated primary endometrial stromal cells (ESCs) with medroxyprogesterone acetate and 8-Bromo-cyclic adenosine monophosphate for in vitro decidualization and detected the expression of m6A, METTL3, and decidual markers. We analyzed the expression of m6A, METTL3, and forkhead box O1 (FOXO1) in ESCs from normal fertile women (the ND group) or women with endometriosis-related infertility (the ED group). We also assessed the expression of m6A, METTL3, and decidual markers, as well as the embryo adhesion rate, upon METTL3 overexpression or knockdown. Additionally, we investigated the role of METTL3 in embryo implantation in vivo by applying mice with endometriosis. Furthermore, we performed RNA stability assays, RNA immunoprecipitation (RIP), and methylated RIP assays to explore the mechanisms underlying the regulation of FOXO1 by METTL3-mediated m6A. Results The expression of m6A and METTL3 was reduced only in the NS group; the NP and ES groups demonstrated increased m6A and METTL3 levels. m6A and METTL3 levels decreased in ESCs with prolonged decidual treatment. Compared to the ND group, m6A and METTL3 levels in the ED group increased after decidual treatment, whereas the expression of FOXO1 decreased. METTL3 overexpression suppressed the expression of decidual markers and embryo implantation in vitro; METTL3 knockdown exhibited the opposite effect. Inhibition of METTL3 promoted embryo implantation in vivo. Furthermore, we observed that METTL3-mediated m6A regulated the degradation of FOXO1 mRNA through YTHDF2, a m6A binding protein. Conclusions METTL3-regulated m6A promotes YTHDF2-mediated decay of FOXO1 mRNA, thereby affecting cellular decidualization and embryo implantation. These findings provide novel insights into the development of therapies for women with endometriosis-related infertility.

Background: Hysteroscopic adhesiolysis effectively restores the anatomical integrity of the uterine cavity in cases of intrauterine adhesions (IUA). However, there is ongoing debate regarding the factors influencing the reproductive outcomes of hysteroscopic adhesiolysis in women with IUA. Methods: One-hundred and thirty-seven patients with IUAs who wanted to become pregnant were enrolled. All patients underwent hysteroscopic adhesiolysis performed by a single experienced surgeon at a tertiary University-affiliated hospital between February 2019 and July 2021. Subsequently, these patients attempted to conceive within the following two years. Patients with concurrent intrauterine diseases such as polyps, submucosal myoma, or IUAs attributed to tuberculosis were excluded from the study. General clinical data were collected and analyzed using univariate and multivariable logistic regression analyses. Results: The clinical pregnancy rate for patients with IUA was 60.6% (83/137), and the live birth rate was 51.8% (71/137). The clinical pregnancy and live birth rates were similar between the in vitro fertilization (IVF) group and the spontaneous conception group. Multivariable logistic regression analysis revealed that patients aged 37 years or older (Odds ratio (OR) 3.928, 95% confidence interval (CI) 1.214–12.710, p = 0.022) or with severe IUA (OR 4.579, 95% CI 1.811–11.578, p = 0.002) were significantly more likely to have a lower clinical pregnancy rate. Similarly, patients aged 37 years or older (OR 3.919, 95% CI 1.147–13.388, p = 0.029) or with severe IUA (OR 5.8, 95% CI 2.129–15.806, p = 0.001) were more likely to have a lower birth rate. Conclusions: Patients’ age and severity of IUA can potentially predict the reproductive outcomes of IUA treatment.

Background Polycystic ovary syndrome (PCOS) is the most common endocrine disorder with complex pathophysiological mechanism. It is reported that even a modest weight loss of 5–10% substantially may improve the reproductive and metabolic profile. This study aims to assess the efficacy of the low dose of liraglutide (0.6 mg QD) combined with metformin (0.85 mg BID) in weight loss in Chinese Han women with PCOS.Methods We included clinical data of 102 obese/overweight (≥18 years, body mass index ≥28 kg/m2 or ≥24 kg/m2) women who were diagnosed with PCOS from October 2016 to March 2018 in Wuhan Union Hospital initially. They were treated with dinae-35, low dose of liraglutide (0.6 mg QD) and metformin (0.85 mg BID) for 12 weeks. The demographic and clinical data were retrieved retrospectively, and weight loss was the main outcome measure. Student’s paired t-test and Wilcoxon rank sum test were used to compare the differences before and after therapy, p