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ABSTRACT Varicocele can reduce male fertility potential through various oxidative stress mechanisms. Excessive production of reactive oxygen species may overwhelm the sperm's defenses against oxidative stress, damaging the sperm chromatin. Sperm DNA fragmentation, in the form of DNA strand breaks, is recognized as a consequence of the oxidative stress cascade and is commonly found in the ejaculates of men with varicocele and fertility issues. This paper reviews the current knowledge regarding the association between varicocele, oxidative stress, sperm DNA fragmentation, and male infertility, and examines the role of varicocele repair in alleviating oxidative-sperm DNA fragmentation in these patients. Additionally, we highlight areas for further research to address knowledge gaps relevant to clinical practice.

Objective: To explore the latent profiles of distress disclosure in patients undergoing assisted reproductive technology (ART), and to analyze the influence factors among different classes. Methods: Through the convenience sampling, patients undergoing ART were recruited from Women′s Hospital of Nanjing Medical University from August to October 2023. Basic Information Questionnaire and Distress Disclosure Index(DDI) were collected. Mplus 8.0 was used for exploratory latent profile analysis, and SPSS 27.0 for univariate analysis and multinomial Logistic regression. Results: A total of 192 patients undergoing ART were finally investigated with a median DDI score 39.00 (31.00, 47.00). Distress disclosure manifested itself in 3 potential categories named low disclosure type (n=41, 21.4%), medium disclosure type (n=82, 42.7%) and high disclosure type (n=69, 35.9%). Multinomial Logistic regression showed that the education level, place of residence, number of ART treatment cycles, source of reproductive pressure, financial burden during treatment and the cause of infertility were factors influencing the latent profiles of distress disclosure in patients undergoing ART (all P<0.05). Conclusions: The distress disclosure in patients undergoing ART has obvious classification characteristics. Medical staff should identify patients and carry out the targeted interventions according to the patients with different distress disclosure characteristics to self-expression in order to reduce psychological distress. [ABSTRACT FROM AUTHOR]

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No increased risk of postpartum major depression (PPMD) was reported in women conceiving through assisted reproductive technologies (ART). However, ART may be associated with a higher risk of parenting difficulties in women with PPMD. In 359 women with a PPMD admitted to a Mother-Baby Unit (MBU), ART-women (4.2%) showed a 5-fold higher rate of parenting difficulties than those with spontaneous pregnancy (73.33% vs. 35.17%, multivariate ORa = 5.09 [1.48–17.48] p = 0.01). Specific support for mother-child relationship should be implemented in ART-women with PPMD. [ABSTRACT FROM AUTHOR]

Objective: Although several studies have investigated the clinical outcomes of assisted reproductive techniques (ARTs) and male reproductive performance during the coronavirus disease 2019 (COVID-19) pandemic, few well-designed studies have focused on female reproductive performance after a recent mild to moderate COVID-19 infection. Methods: This cohort study of 75 participants was performed at Arash Women's Hospital, Tehran, Iran. The 35 participants in the exposed group were women with infertility who visited the hospital from October 2021 to February 2022 and were prospectively followed. The 40 participants in the non-exposed matched group were selected retrospectively from hospital patients who underwent ART before the COVID-19 pandemic. Study variables were compared between the non-exposed and exposed groups. Results: The exposed group had a non-significantly smaller total of retrieved oocytes and fewer mature oocytes than the non-exposed group (p=0.26, p=0.10). The numbers of total and transferred embryos were also lower in the exposed group, but these results were not statistically significant (p=0.27, p=0.77). The rate of spontaneous abortion was higher in the exposed group (43% vs, 11%), and the ongoing pregnancy rate was lower (57% vs, 89%); however, these differences were not statistically significant. Conclusion: Recent mild to moderate COVID-19 infection seems to have no detrimental effects on female reproductive performance and embryo transfer outcomes; however, considering the small sample size of the present study, the statistically insignificant differences in the exposed group—namely, fewer embryos, fewer retrieved oocytes, a lower ongoing pregnancy rate, and a higher spontaneous abortion rate—might be important from a clinical standpoint. [ABSTRACT FROM AUTHOR]

With the advancement of vitrification freezing technology, frozen-thawed embryo transfer (FET) plays a crucial role in assisted reproductive technology by preventing ovarian hyperstimulation syndrome, reducing ectopic pregnancy rates, and enhancing cumulative pregnancy rates. The proportion of FET cycles in assisted reproduction has been increasing annually, establishing FET as a key component of reproductive technologies. The outcome of FET pregnancies is influenced by various factors, including age, embryo quality, endometrial thickness, endometrial preparation protocols, DNA fragmentation, and Y chromosome microdeletions. Age, embryo quality, and endometrial receptivity are pivotal factors determining the success of FET treatments, directly impacting embryo development, implantation, and pregnancy success rates. Therefore, identifying the influencing factors of FET pregnancy outcome, so as to implement more precise, personalized and targeted prevention to improve pregnancy rates, has become a research hotspot. This review aims to summarize the relevant factors affecting the outcome of FET pregnancies, providing a reference for clinical decision. [ABSTRACT FROM AUTHOR]

With the development of assisted reproductive technology (ART), ovarian hyperstimulation syndrome (OHSS) as a main iatrogenic complication is also inevitable, which further increases the risk of ovarian torsion. The clinical symptoms and imaging characteristics of the patient with OHSS combined with ovarian torsion are relatively atypical, which means that the early identification and diagnosis of this acute abdomen is difficult. We report a case of OHSS combined with ovarian torsion before egg retrieval during ART treatment. The conservative treatment after egg retrieval was ineffective, and ultimately surgical treatment was still inevitable. This case suggests that the understanding of OHSS complicated with ovarian torsion should be strengthened during ART treatment, so as to achieve the early identification, early diagnosis and early treatment of this acute abdomen. [ABSTRACT FROM AUTHOR]

Objective: To integrate and analyze the application of traditional Chinese medicine (TCM) with assisted reproductive technology (ART) at the different periods of the treatment from those famous TCM experts, based on a data mining. Methods: To search the related documents of the application of TCM and ART from famous TCM experts in the CNKI, CQVIP, Wanfang, CBM databases of Chinese. We aimed to establish a literature analysis database for the integration and induction to obtain the distribution of commonly used drugs. Results: This study included 112 qualified documents, involving 36 famous TCM experts. The total number of drugs in the down-regulation period was 13, with 77 flavors of related drugs and 224 cumulative frequencies of occurrence. The higher frequencies were 55.94% of "drugs for tonifying deficiency", 10.89% of "drugs for activating blood circulation and removing blood stasis", 6.44% of "heat-clearing drugs", 5.45% of "astringent drugs", and 5.45% of "water-inducing and dampness-expelling drugs". In the ovulation promotion period, the total number of drugs was 13, with 92 flavors of related drugs and 398 cumulative frequencies of occurrence. In this period, the higher frequencies were of 61.34% of "drugs for tonifying deficiency", 8.68% of "drugs for activating blood circulation and removing blood stasis", 8.40% of "astringent drugs", 5.88% of "heat-clearing drugs", 5.32% of "water- inducing and dampness-expelling drugs", etc. In the transplantation period, the total number of drugs was 14, with 70 flavors of the relevant drugs and 372 cumulative frequencies. In the transplantation period, the higher frequencies were 68.78% of "drugs for tonifying deficiency", 5.80% of "drugs for dispelling wind-dampness" and 5.52% of "drugs for activating blood circulation and removing blood stasis". The drugs used after pregnancy were confirmed to have a total of 11 categories, with 47 flavors and 182 cumulative frequencies. During pregnancy, the higher frequencies were 59.88% of "drugs for tonifying deficiency", 9.30% of "drugs for dispelling wind- dampness", 7.56% of "heat-clearing drugs" and 5.23% of "astringent drugs". The correlation analysis of drugs of the four phases showed that there were 18 drug combinations in the down-regulation period, 14 drug combinations in the ovulation promotion period, 41 drug combinations in the transplantation period and 22 drug combinations after confirmation of pregnancy. Cluster analysis of the drugs used in the four periods showed that the core drug group was obtained in the down-regulation period: codonopsis pilosulae-licorice-atractylodes macrocephala- astragalus-jujube seed, radix dipsaci-fructus lycii-prepared rehmannia root-radix angelicae sinensis-rhizoma cyperi, prepared rehmannia root-radix paeonia lactiflora-donkey hide gelatin-radix dipsaci-rehmannia root. Ovulation promotion period got the core drug group including radix dipsaci-prepared rehmannia root-Chinese yam-fructus lycii-mulberry, radix dipsaci-prepared rehmannia root-radix angelicae sinensis-fructus lycii-salvia miltiorrhiza, prepared rehmannia root-fructus corni-Chinese yam-radix dipsaci-rehmannia root. The core drug groups obtained during the transplantation period were atractylodes macrocephala-radix dipsaci-Chinese taxillus herb-codonopsis pilosula-semen cuscutae, Chinese taxillus herb-semen cuscutae-radix dipsaci-scutellaria baicalensis-donkey hide gelatin, radix angelicae sinensis-semen cuscutae-liquorice-Chinese yam-morinda officinalis. The core group of drugs obtained after confirmation of pregnancy was atractylodes macrocephala- astragalus-liquorice-codonopsis pilosulae-radix dipsaci, semen cuscutae-radix dipsaci-atractylodes macrocephalaChinese taxillus herb-donkey hide gelatin, atractylodes macrocephala-radix dipsaci-liquorice-radix boehmeriaetuchung. Conclusions: The "drugs for tonifying deficiency" are commonly used in the four periods, which belong to the liver, kidney and spleen meridian. The common drug characteristics of the four periods is "Based on tonic, laxative and tonic used together, mainly with warm, flat, sweet and bitter nature of TCM". According to the different characteristics of the four periods, TCM with different prescription drugs can be used to improve the curative effect. In the period of down regulation, preventing the agitation of qi and blood is the main focus. In the period of ovulation induction, tonifying the kidney essence is the main focus. At the same time, a small amount of warming drugs should be added. Tonifying the kidney should be combined with astringent and promotion, so as to prevent the excessive depletion of the kidney essence. After the transplantation and embryo implantation, the efficacy of TCM lies in the "stabilization of the fetus" and the tonicity of mother′s qi and blood. [ABSTRACT FROM AUTHOR]

The incidence of ectopic pregnancy (EP) has increased in recent years, owing to causes such as pelvic inflammatory diseases and assisted reproductive technologies (ART). The present study reported a case of a 33-year-old nulliparous woman with a history of previous ectopic pregnancies, who underwent pelvic ultrasound in August 2022, which revealed a double EP including a cervical pregnancy and a tubal stump pregnancy. Despite known risk factors and elevated beta-human chorionic gonadotropin (β-hCG) levels, a conservative approach, utilizing multiple doses of systemic methotrexate (MTX) injections, was employed to preserve fertility at the Regional Perinatal Center in Aktobe, Kazakhstan. Treatment efficacy was monitored through β-hCG levels and ultrasound imaging, with successful resolution of both EPs and preservation of reproductive function. The present case highlighted the safety and efficacy of MTX therapy in managing complex EP presentations, emphasizing the necessity of individualized treatment approaches in reproductive medicine, particularly in terms of preserving fertility in patients undergoing ART. Multiple high doses of MTX injections were beneficial for pregnancy with two distinct regions, fetal cardiac activity, and elevated serum β-hCG level. Further research is required to explore optimal treatment strategies for EP, considering patient-specific factors and treatment goals.

Human papilloma virus (HPV) infection is one of the most common sexually transmitted diseases, which is associated with the development of tumors in multiple organs. In recent years, the impact of HPV infection on fertility has garnered significant attention, particularly its vertical transmission through germ cells and potential effects on early embryonic development. Studies have shown that HPV infection may affect sperm quality, leading to infertility, and may also interfere with embryonic development, increasing the risk of spontaneous abortion and adversely affecting pregnancy outcomes in assisted reproductive technology. This review summarizes the research progress on the vertical transmission of HPV through sperm cells and its impact on early embryonic development, to deeply understand the potential threat of HPV to reproductive health and to provide references for clinical practice and further research. [ABSTRACT FROM AUTHOR]

Abstract Objective To compare outcomes in patients with repeated implantation failure undergoing Intracytoplasmic Sperm Injection/In vitro fertilization (IVF/ICSI) plus immunosuppressants such as prednisolone, prednisone, or cyclosporine A versus the use of IVF/ICSI alone. Data source Databases were systematically searched in PubMed, Cochrane, and Embase databases in September 2023. Study Selection Randomized clinical trials and observational studies with the outcomes of interest were included. Data collect We computed odds ratios (ORs) for binary endpoints, with 95% confidence intervals (CIs). Heterogeneity was assessed using I2 statistics. Data were analyzed using Review Manager 5.4.The main outcomes were live birth, miscarriage, implantation rate, clinical pregnancy, and biochemical pregnancy. Data synthesis Seven studies with 2,829 patients were included. Immunosuppressive treatments were used in 1,312 (46.37%). Cyclosporine A improved implantation rate (OR 1.48; 95% CI 1.01-2.18) and clinical pregnancy (1.89, 95% CI 1.14-3.14). Compared to non-immunosuppressive treatment, prednisolone and prednisone did not improve live birth (OR 1.13, 95% CI 0.88-1.46) and miscarriage (OR 1.49, 95% CI 1.07-2.09). Prednisolone showed no significant effect in patients undergoing IVF/ICSI, clinical pregnancy (OR 1.34; 95% CI 0.76-2.36), or implantation rate (OR 1.36; 95% CI 0.76-2.42). Conclusion Cyclosporine A may promote implantation and clinical pregnancy rates. However, given the limited sample size, it is important to approach these findings with caution. Our results indicate that prednisolone and prednisone do not have any beneficial effects on clinical outcomes of IVF/ICSI patients with repeated implantation failure. PROSPERO CRD42023449655

The patients undergoing the treatment of assisted reproductive technology, as a special group that is different from other groups of diseases, are prone to sleep disorders due to the impact of physiological and psychosocial factors. In this review, the current status, assessment tools, and non-pharmacological intervention of sleep disorders in patients undergoing assisted reproductive technology were introduced. The appropriate tools were used to evaluate the degree of sleep disorders effectively. The appropriate intervention measures can improve the sleep quality of patients, including digital cognitive behavioral therapy, mindfulness-based stress reduction, music therapy, aerobic and resistance exercises and progressive muscle relaxation. This review will provide a reference for the evaluation of sleep disorders and non-pharmacological intervention for those patients undergoing assisted reproductive technology for pregnancy. [ABSTRACT FROM AUTHOR]

Objective: To explore the influencing factors of hypertensive disorders of pregnancy (HDP) after frozen embryo transfer (FET) by a predictive model of HDP. Methods: The clinical data of FET cycles in the Reproductive Medicine Center of the First Hospital of Lanzhou University from January 2019 to May 2023 were included. The cycles that meet the exclusion criteria were excluded. The general clinical data, FET-related data and HDP incidence of the included patients were statistically analyzed. The least absolute shrinkage and selection operator (LASSO) regression technique was used to select the predictors. According to the ratio of 7∶3, the final 4 079 cycles were randomly assigned to the training set (n=2 855) and the validation set (n=1 224). The nomogram prediction model of HDP incidence was established by multiple Logistic regression analysis and use a nomogram to represent it. The area under the curve (AUC), Hosmer-Lemeshow goodness-of-fit test and decision curve analysis (DCA) were used to evaluate this model. Results: Seven non -zero coefficient variables were selected according to LASSO regression analysis. After multivariate Logistic regression analysis, seven factors including endometrial preparation, polycystic ovary syndrome (PCOS), endometriosis, diminished ovarian reserve, family history of hypertension, body mass index, and number of intrauterine gestational sacs were used as the predictors to establish a model and displayed in a nomogram. The AUC of the training set was 0.728, and the AUC of the validation set was 0.734. The Hosmer-Lemeshow test showed that the model fitted well (P=0.867, mean absolute error=0.004). DCA suggested that when the threshold probability of clinical pregnancy was between 7% and 64%, the application of this nomogram could increase the net benefit. Conclusions: The prediction model of HDP after FET has a certain ability to distinguish, which can provide reference for clinical practice, but further development of more effective predictive factors is still necessary. [ABSTRACT FROM AUTHOR]

Premature ovarian insufficiency (POI) is a clinical syndrome in women who develops ovarian insufficiency before the age of 40 years, which manifests itself as a weakening of reproductive and endocrine functions, and is one of the most important factors leading to female infertility, but the pathogenesis is unknown and the treatment is limited. Melatonin is a neuroendocrine hormone mainly synthesized and secreted by the pineal gland, which exerts effects in regulating circadian rhythms, antioxidant activity, and scavenging free radicals. Studies have shown that melatonin is involved in regulating ovarian steroid hormone synthesis, follicular development, ovulation and oocyte quality. Animal models for studies of POI have found that melatonin can alleviate oxidative stress, reduce apoptosis, regulate ovarian function and delay POI through the regulation of multiple signaling pathways. Clinical studies have shown that melatonin can improve ovarian function and pregnancy rate in POI patients. Its potential value in assisted reproduction provides a new direction to improve the fertility of POI patients. [ABSTRACT FROM AUTHOR]

Fertility Quality of Life Questionnaire (FertiQoL) is a specific scale to measure the quality of life in infertile population. The decline of fertility quality of life will affect the treatment enthusiasm and treatment compliance of infertile population, thus affecting the outcome of assisted pregnancy. A large number of studies have shown that all modules and dimensions of the quality of life of infertile people are impaired, and that there is no unified conclusion on the influencing factors and the influence degree of different dimensions. It is clear that the impaired quality of life of infertile population is different in China and abroad. The treatment FertiQoL is more seriously damaged in Chinese infertile people, while the core FertiQoL is more seriously damaged in foreign infertile people. Social support and psychological resilience were the protective factors of FertiQoL, while anxiety, depression, alexithymia, reproductive stress and infertility stigma were negatively correlated with FertiQoL. In addition, general characteristics such as sex, age, place of residence, education level and duration of infertility are also important influencing factors. The present research is not enough about what interventions improving the quality of life of patients, and whether the clinical pregnancy rate can be improved after intervention. [ABSTRACT FROM AUTHOR]

Nowadays, sirolimus as a popular immunosuppressant has been frequently used to shield the organ transplant recipients from immunological rejection. The immunomodulatory effects of sirolimus in the female reproductive process have been demonstrated by ongoing medical study. By blocking the immune-regulating action of mammalian target of rapamycin, sirolimus may help those patients with recurrent implantation failure, recurrent spontaneous abortion, endometriosis, chronic endometritis, polycystic ovary syndrome, and other illnesses of the reproductive system. Additionally, sirolimus can enhance the rates of embryo implantation and clinical pregnancy in individuals with aberrant immunological statuses at the mother-fetal interface, reduce ovarian hyperstimulation syndrome during assisted reproductive treatment, and improve the pregnancy outcomes. A review was conducted on the mode of action, research status and safety of sirolimus in female reproductive disorders. [ABSTRACT FROM AUTHOR]

Copyright of Die Gynäkologie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Objective To explore the safety of fertility-sparing surgery and the selection of ovulation induction protocols in patients with early-stage borderline ovarian tumors (BOTs). Methods Clinical data were collected from four patients with early-stage BOTs who underwent fertility-sparing surgery and later sought treatment for infertility with assisted reproduction and successfully delivered in Xinhua Hospital Affiliated to School of Medicine in Shanghai Jiao Tong University from January 2015 to December 2021. The postoperative follow-up and assisted reproduction of the patients were reviewed in combination with the literature. The estrogen levels of patients on HCG day were compared between antagonist protocol, agonist protocol, and letrozole mild stimulation protocol. Results Two of the four patients with early-stage BOTs relapsed after fertility-sparing surgery. The pa-thological type of relapse was BOTs without malignant transformation. No recurrence was observed during follow-up after the se-cond operation. All four patients underwent assisted reproduction and achieved delivery. One of the patients who experienced relapse underwent oocyte retrieval before the second surgery and achieved pregnancy through frozen embryo transplantation after the surgery. Three out of four patients used letrozole mild stimulation protocol (two of them achieved pregnancy, while the other patient switched to agonist protocol after failing to retrieve oocytes and subsequently became pregnant). The remaining patient used anta-gonist protocol and achieved pregnancy. Compared with the antagonist and agonist protocols, letrozole mild stimulation protocol had the lowest serum estrogen level on the HCG day. Conclusion Fertility-sparing surgery for patients with early-stage BOTs is safe and feasible. Oocyte retrieval can be considered in case of recurrence before reoperation. Letrozole mild stimulation protocol provides a relatively safe option with minimal adverse effects on the ovaries.

In assisted reproductive technology, it is very important to prevent the premature endogenous luteinizing hormone (LH) peak in process of controlled ovarian stimulation. Traditional controlled ovarian stimulation protocols with gonadotropin-releasing hormone (GnRH) analogues (GnRH agonists or antagonists) to inhibit the level of endogenous LH have many disadvantages such as high cost and inconvenient use. Progestin-primed ovarian stimulation (PPOS) protocol has been proved to achieve good clinical outcomes in various populations by the negative feedback effect of exogenous progesterone on pituitary gland to inhibit LH level, and its offspring safety has also been preliminarily confirmed. In this paper, the mechanism of PPOS, application of different exogenous progesterone drugs, application effects of different populations and offspring safety of PPOS were reviewed. [ABSTRACT FROM AUTHOR]

Twin reversed arterial perfusion sequence (TRAPS) is a rare and severe complication of monochorionic twin pregnancies, due to abnormal placental-fetal vascular anastomosis, which is characterized by absence of heart or loss of normal cardiac structure in one twin. We reported a case of triplet pregnancy complicated by TRAPS after assisted reproductive technology. Two cleavage-stage frozen embryos were transferred, one of which developed into monochorionic twin pregnology. The TRAPS was diagnosed by ultrasound at 8 +5 weeks. However, due to personal factors, the patient did not intervene in a timely manner and the pump twin died. Another single fetus developed normally until full term delivery. If the treatment is needed, as for the technique of choice to interrupt the vascular supply to the acardiac twin, the radiofrequency ablation of the intrafetal vessel is usually the preferred approach. However, the best timing of intervention is still debated. [ABSTRACT FROM AUTHOR]

Since the first successful use of oocyte cryopreservation and resuscitation, to obtain twin pregnancies, in 1986, oocyte cryopreservation has gradually become an intervention measure for iatrogenic ovarian dysfunction. In recent years, the number of patients with diminished ovarian reserve (DOR) has shown an increasing trend, and the preservation of their fertility is receiving increasing attention. The iatrogenic influencing factors of DOR mainly include reproductive system surgery, tumor radiotherapy and chemotherapy, etc. Oocyte cryopreservation is a first-line treatment option for fertility preservation, and its safety, applicability, utilization rate, and egg donation treatment in the clinical application of iatrogenic DOR patients have been confirmed by clinical data and relevant literature. However, the issues related to the timing of oocyte cryopreservation, limitations of clinical application and ethical policies cannot be ignored. Oocyte cryopreservation is of great significance for improving the pregnancy outcomes of unmarried patients with iatrogenic DOR and the reproductive autonomy of married patients. After clarifying the iatrogenic influencing factors of DOR, it is recommended to seek consultation from multiple disciplines such as oncology, gynecology and reproductive health as soon as possible to develop the personalized oocyte cryopreservation plans. [ABSTRACT FROM AUTHOR]

Epidemiologists indicate that about half of the couple’s infertility cases are due to a male factor. Despite this, the role of andrologists or endocrinologists in assisted reproductive technique (ART) centers is still underestimated. According to our literature review, this reduces the chance of a thorough clinical evaluation of the male partners, which, sometimes consists only in a mere semen analysis, usually performed by laboratory technicians. A more complete diagnostic process could lead to the identification of potentially treatable causes of infertility, the recognition of diseases that require immediate treatment, and to the discovery of genetic diseases and, therefore, transmissible to the offspring. It can also increase the success rate of ART resulting in less psychological and financial burden for both public health resources and infertile couples. The presence of medical personnel with andrological and endocrinological skills in the ART centers represents the first step in creating ‘precision medicine’. We hope that the guidelines of the various scientific societies will clearly contemplate this possibility. [ABSTRACT FROM AUTHOR]

Background Embryo anomaly is the most common cause of implantation failure and abortion in women of reproductive age. However, there is controversy about the cause of implantation failure or miscarriage that occurs after the transfer of a normal embryo screened by preimplantation genetic testing (PGT) . Objective To analyze the influencing factors affecting implantation failure and miscarriage after PGT assisted reproduction. Methods Three hundred and twenty-nine women who received PGT assisted reproduction in Reproductive Center, the First Affiliated Hospital of Anhui Medical University from December 2018 to February 2021 were enrolled, including 218 with clinical pregnancy〔175 of whom had a live birth (live birth subgroup) , and 43 had an abortion (abortion subgroup) 〕, and 111 with implantation failure. Clinical data, results of accessory examinations, ovulation induction and in vitro embryonic development were compared between women with clinical pregnancy and implantation failure, and between live birth and abortion subgroups. The influencing factors of implantation failure and abortion after PGT assisted reproduction were screened by multivariate logistic regression analysis, and predictive values of the determined factors for implantation failure and abortion were estimated using the receiver operating characteristic (ROC) analysis. Results Multivariate logistic regression analysis showed that, two or more previous abortions〔OR=4.032 0, 95%CI (2.423 0, 6.710 0) 〕 and low level of high-density lipoprotein cholesterol (HDL-C) 〔OR=3.890 0, 95%CI (1.455 0, 10.403 0) 〕were risk factors for implantation failure after PGT assisted reproduction (P

The platelet-rich plasma (PRP) is a concentrate extracted from whole blood centrifugation at a platelet concentration of up to 7 times that of circulating serum, being rich in growth factors and cytokines. Some of factors promote tissue healing and regeneration by inducing chemotaxis, cell migration and differentiation. Ovarian reserve refers to the quality and quantity of eggs retained in ovaries, which is an important indicator of female fertility potential. Based on the current basic research and clinical trials at home and abroad, it is proposed that PRP can promote ovarian vascular production, reduce apoptosis of granule cells and atresia of follicles, promote cumulus dilation, increase mitochondrial activity pathway and promote oocyte development. This review may provide a theoretical basis for the clinical practice of PRP in the assisted reproduction of those women with the reduced ovarian reserve. [ABSTRACT FROM AUTHOR]

Endocrine disrupting chemicals (EDC) are exogenous compounds, which can interfere with the hormones action and endocrine pathways, affect the development of female reproductive system and ovarian function, and therefore EDCs are associated with female infertility. Current research mainly focus on EDC exposure and its correlation with the different diseases of the endocrine axes. Studies have shown that EDCs affect female fertility by causing ovarian dysfunction, follicular development abnormality, endometrial receptivity reduction, and embryo quality decline, as well as the lowed clinical outcome of assisted reproduction in infertile women. Accumulating evidence in animal studies has provided important insights into the mechanism of EDC effects. This review summarizes some of the most common EDCs including pesticides, bisphenol A and phthalates, and the effects of EDCs on female fertility and clinical outcomes of assisted reproductive technology. [ABSTRACT FROM AUTHOR]

Cesarean scar defect (CSD) is one of the common complications after cesarean section. The clinical manifestations include abnormal uterine bleeding, pelvic pain and secondary infertility. With the evolution of fertility policy and the increase of cesarean section rate, the infertility associated with it is gradually gaining attention. There is no consensus on the treatment options of infertility secondary to CSD currently. In patients combined with small amounts of uterine cavity effusion, the prolonged GnRHa down-regulation protocol can be used to assist reproduction. While in patients with abnormal uterine bleeding or obvious endometrial cavity fluid, surgery should be considered as first-line treatment. However, there is still a lack of uniformity in the choice of surgical approach and surgical plans are usually determined based on the residual myometrial thickness on the scar. In addition, treatment options such as intrauterine ozone infusion, traditional Chinese medicine conditioning and physiotherapy, and stem cell transplantation may also have potential benefits in the treatment of secondary infertility in CSD. [ABSTRACT FROM AUTHOR]

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Whether the artificial intervention of assisted reproductive technology (ART) in the early life will bring potential risks to the long-term health and safety of the offspring has always been a key issue of human health. This article reviews the key points of ART, such as artificial insemination, in vitro fertilization -embryo transfer and its derivative technology, and summarizes and analyzes the safety of offspring from the aspects of adverse pregnancy outcomes, birth defects, long-term health problems, and genetic imprinting abnormalities. Most studies support the safety of ART and believe that children born by ART do not increase the incidence of adverse events. However, since most research data focus on infants and young children, it is still necessary to conduct the long-term health follow-up of children born by ART to obtain health data in adolescents and adulthood, and to further demonstrate the safety of children born by ART. [ABSTRACT FROM AUTHOR]

The ovarian hyperstimulation syndrome (OHSS) complicated with superior mesenteric venous thrombosis (SMVT) and portal vein thrombosis (PVT) is a rare thrombotic disease, with the continuous increase of human chorionic gonadotropin in pregnant women and the further aggravated condition. In severe cases, intestinal ischemic hemorrhage, septic shock, abortion, premature delivery and death may occur. Therefore, it is one of the serious complications in the process of in vitro fertilization -embryo transfer (IVF -ET). The early clinical manifestations and auxiliary examinations of the disease are lack of specificity, and it is easy to be misdiagnosed or missed, and to delay treatment. A case of OHSS found 10 days after IVF-ET and diagnosed with SMVT and PVT complicated with intestinal obstruction 61 days after transplantation was reported. After multidisciplinary consultation, the comprehensive treatment of oxygen inhalation, expansion of blood volume, anticoagulation, infection prevention, correction of electrolyte disorders and others was given. The effect was poor and the condition deteriorated sharply. After transferred to our hospital, the emergency resection of necrotic small intestine plus end-to-end anastomosis of residual small intestine plus thrombectomy of superior mesenteric vein and portal vein was performed. At more than 5 months of pregnancy, induction of labor was performed due to fetal death. [ABSTRACT FROM AUTHOR]

The objective of this study was to compare pregnancy rates in domestic cats using fresh semen for the bilateral intrauterine insemination (BIUI) method and the novel uterine body insemination (UBI) method. Queens received a single injection of equine chorionic gonadotropin (eCG) (200 IU; IM) to induce ovarian follicular development and, after 83 h, an injection of human chorionic gonadotropin (hCG) (100 IU; IM) for final oocyte maturation and ovulation induction. Thirty-four hours after hCG administration, 3 × 106 fresh spermatozoa were used for insemination by the BIUI (n = 8 queens) or by the UBI (n = 7 queens) techniques respectively. Pregnancy rates were 75.00% (6/8) by BIUI and 42.85% (3/7) by the UBI method. The mean litter size was 3.0 ± 0.86 for the BIUI, and 2.0 ± 1.0 for the UBI method. Spontaneous abortion occurred on day 35 of pregnancy in one queen following the UBI method. Our findings showed that the BIUI of queens with fresh semen resulted in higher pregnancy rates than the novel UBI method; also, acceptable pregnancy rates were achieved following BIUI with fresh semen in the domestic cat.

The provision of care that is responsive to the preferences, needs and values of gamete donors is key to improving their recruitment and ensuring the functioning of gamete banks. This qualitative study aimed to explore gamete donors' experiences about the facilitating and constraining human and system factors to donor-centred healthcare delivery in gamete banks. It is based on 20 semi-structured interviews with oocyte and sperm donors, recruited at the Portuguese Public Bank of Gametes, conducted from November 2017 to February 2019. Deductive content analysis was performed using the software NVivo12, following the patient-centred infertility care model. Interviewees identified facilitating factors mostly related with the human dimension of care (i.e. careful and available attitude and behaviours of health professionals, as well as their good communication skills and emotional support). Constraining factors were predominantly identified at the system level (i.e. insufficient information provision, poor coordination, and integration). Lack of privacy emerged simultaneously as a human and a system constraining factor (i.e. physical discomfort during medical-technical acts or gamete collection). There is room for improving clinical practice and the organisation of healthcare services within a context where the competence and attitude of, and relationship with, the staff are highly valued. [ABSTRACT FROM AUTHOR]

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Objective: To explore the assisted reproductive outcomes of patients with atypical endometrial hyperplasia (AEH) and early-stage endometrial cancer (EEC) who achieved complete remission after conservative treatment and to provide reference for clinical selection of appropriate conservative treatment., Method: This retrospective cohort study included seven patients with EEC and 62 patients with AEH who underwent in vitro fertilization or intracytoplasmic sperm injection at the Reproductive Center of the Third Affiliated Hospital of Zhengzhou University between August 2015 and October 2023. The authors divided the participants into two groups based on the type of fertility-sparing treatment received: the oral medication group and the levonorgestrel-releasing intrauterine system (LNG-IUS) group. The primary outcome was the cumulative clinical pregnancy rate. Secondary outcomes included clinical pregnancy rate per transfer cycle, embryo utilization rate, and high-quality embryo rate., Results: The LNG-IUS group had a significantly higher rate of usable embryos compared with the oral medication group (80.8% vs 91.1%, P = 0.005) and also had a thinner endometrial thickness on the day of embryo transfer. The cumulative clinical pregnancy rate was higher in the LNG-IUS group compared with the medication group (46.7% vs 78.9%, P = 0.037), and the difference was statistically significant., Conclusion: For patients with AEH and EEC with fertility needs, the conservative treatment method of LNG-IUS can achieve better assisted reproductive outcomes., (© 2024 International Federation of Gynecology and Obstetrics.)

As tissue and intracellular RAS have been reported in different organs and systems. there is local RAS in the ovary, called the ovarian renin-angiotensin system (OVRAS). In this study, we investigated the correlation between RAS (total renin, AngII, Ang1-7), vascular endothelial growth factor (VEGF) and E2 in dominant follicular fluid and ovarian reserve capacity and patient age. Moreover, we analyzed its predictive value for assisted reproductive technology (ART) related outcomes. We observed that the concentrations of VEGF in the follicular fluid of dominant follicles in the ≥ 38 year old group were markedly higher than those in the < 30 year old group (P < 0.05). Total renin and AngII levels were positively correlated with normal fertilization rate (P < 0.05). Ang1-7 levels were positively correlated with the number of mature oocytes, oocyte maturation rate and number of 2PN fertilized cells (P < 0.05). Expressions of VEGF were negatively correlated with number of 2PN fertilized cells, number of D3 embryos for blastocyst culture, number of blastocysts formed, number of available embryos and number of high-quality embryos (P < 0.05). Thus, the expressions of OVRAS (total renin, AngII, Ang1-7 and VEGF) in dominant follicular fluid are correlated with ART outcomes., (Copyright © 2024. Published by Elsevier B.V.)

Study Question: Is the probability of pregnancy different between women using biosimilars versus the originator of follitropin alfa for ovarian stimulation in ART?, Summary Answer: Meta-analysis of eight randomized clinical trials (RCTs) suggests that live birth, clinical, and ongoing pregnancy rates are significantly lower with biosimilars of follitropin alfa compared to the originator., What Is Known Already: All biosimilars of follitropin alfa have received regulatory approval by demonstrating non-inferiority in the number of retrieved oocytes compared to the originator. Nevertheless, the most clinically relevant outcome in ART for both clinicians and patients is live birth. A meta-analysis published in 2021 suggested that biosimilars of follitropin alfa are associated with lower live birth rates compared to the originator. Since then, more relevant RCTs have been published, and thus an updated critical synthesis of the available evidence is urgently warranted., Study Design, Size, Duration: A systematic review and meta-analysis were performed to compare biosimilars versus the originator of follitropin alfa in women undergoing ovarian stimulation for ART. A literature search was conducted until January 2024 in MEDLINE, Embase, Cochrane CENTRAL, Scopus, Web of Science, WHO, Clinicaltrials.gov, and others to identify eligible RCTs. The primary outcome was live birth. Secondary outcomes included clinical and ongoing pregnancy, duration of gonadotrophin administration and total FSH dose, number of oocytes retrieved, and ovarian hyperstimulation syndrome (OHSS)., Participants/materials, Setting, Methods: Data were extracted independently by two reviewers. Quality was assessed using the RoB-2 Tool by Cochrane, and a sensitivity analysis was performed by excluding studies having high risk of bias. Meta-analysis was performed using the random or fixed effects model depending on the presence or not of significant (>50%) statistical heterogeneity (I2). Results were combined using the intention-to-treat principle and are reported as risk ratio (RR) or weighted-mean-difference (WMD) with 95% CIs., Main Results and the Role of Chance: Eight RCTs (n = 2987) (published between 2015 and 2023) were identified, assessing seven biosimilar products of follitropin alfa. The number of patients included in the eligible studies ranged from 100 to 1100. Three of the RCTs were deemed to be at high risk of bias. The duration of gonadotrophin administration was shorter in the biosimilars group (WMD: -0.19 days, 95% CI: -0.34 to -0.05; I2 = 0%, 5 studies, n = 2081), while no difference was observed in the total dose of FSH (WMD: -34.69 IUs, 95% CI: -74.54 to 5.16; I2 = 15.53%, 5 studies, n = 2081). No difference was observed in the number of oocytes retrieved (WMD: 0.27, 95% CI: -0.43 to 0.96; I2 = 10.7%, 6 studies, n = 1527) and OHSS rates (RR: 1.17, 95% CI: 0.90-1.52; I2 = 0%, 8 studies, n = 2986) between the two groups. A significantly lower live birth rate was observed using the biosimilars of follitropin alfa compared to the originator in women undergoing ovarian stimulation for ART (RR: 0.83, 95% CI: 0.72-0.96; I2 = 0%, 6 studies, n = 2335; moderate certainty of evidence). Similarly, clinical pregnancy (RR: 0.82, 95% CI: 0.73-0.92; I2 = 0%, 7 studies, n = 2876; low certainty of evidence) and ongoing pregnancy rates (RR: 0.81, 95% CI: 0.70-0.94; I2 = 0%, 7 studies, n = 1886; low certainty of evidence) were lower in the biosimilars group. These results were not materially altered in the sensitivity analyses performed where studies deemed at high risk of bias were excluded., Limitations, Reasons for Caution: This meta-analysis included RCTs evaluating seven different biosimilars of follitropin alfa; however, pooled data appeared to be homogeneous. No data were available comparing biosimilars of follitropin alfa with the originator regarding cumulative live birth rate per aspiration or the probability of live birth in frozen thawed cycles. The population examined in the eligible RCTs includes mainly normal responders and no RCTs were identified focusing on poor or high responders., Wider Implications of the Findings: Clinicians should be informed that although biosimilars of follitropin alfa produce similar number of oocytes with the originator, pregnancy rates after a fresh transfer are likely to be lower. Future research should focus on optimizing the production and use of biosimilars of follitropin alfa, so that they lead to pregnancy rates comparable to the originator., Study Funding/competing Interest(s): No external funding was used for this study. K.I.K. and A.S. have no competing interest to disclose. E.M.K. reports personal fees and non-financial support from Merck, Ferring, IBSA, and Vianex. B.W.M. has been supported by an investigator grant from NHMRC, has received consulting fees from Organon, Merck, and Norgine, research support and non-financial support from Merck KGaA, Darmstadt, Germany. B.W.M. also reports having stocks from OBsEva. C.A.V. reports grants, personal fees, and non-financial support from Merck KGaA, Darmstadt, Germany, personal fees, and non-financial support from Merck, Sharpe and Dohme, personal fees and non-financial support from Organon, grants and non-financial support from Ferring, personal fees from IBSA, and personal fees and non-financial support from Gedeon Richter and Vianex., Registration Number: Protocol for the systematic review registered in The International Prospective Register of Systematic Reviews (PROSPERO; CRD42024498237)., (© The Author(s) 2024. Published by Oxford University Press on behalf of European Society of Human Reproduction and Embryology.)

Context: Over the past few years, there has been an increasing amount of scholarly literature suggesting a connection between the nutritional status of pregnant mothers and early fetal development, as well as the long-term health consequences of their offspring. Multiple studies have documented that alterations in dietary patterns prior to conception have the potential to affect the initial stages of embryonic development., Objectives: The aim of this study was to perform a comprehensive review of the research pertaining to the correlation between phytochemicals ( specifically, polyphenols, carotenoids and phytoestrogens) and assisted reproductive technology (ART)., Data Sources: PubMed, Scopus, Web of Science, and Clinical Trials databases were searched from January 1978 to March 2023., Study Selection: This study comprised observational, randomized controlled, and cohort studies that examined the effects of phytochemicals on ART results. The study's outcomes encompass live birth rate, clinical pregnancy, and ongoing pregnancy., Data Extraction: The assessment of study quality was conducted by 2 researchers, independently, using the Quality Criteria Checklist for Primary Research., Results: A total of 13 studies were included, of which there were 5 randomized controlled studies, 1 nonrandomized controlled study, 6 prospective cohort studies, and 1 retrospective cohort study., Conclusion: This research focused on investigating the impact of phytochemicals on ART and has highlighted a dearth of articles addressing that topic. Collaboration among patients, physicians, and nutritionists is crucial for doing novel research., Systematic Review Registration: PROSPERO registration no. CRD42023426332., (© The Author(s) 2024. Published by Oxford University Press on behalf of the International Life Sciences Institute. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Purpose: Prior sperm DNA fragmentation index (DFI) thresholds for diagnosing male infertility and predicting assisted reproduction technology (ART) outcomes fluctuated between 15 and 30%, with no agreed standard. This study aimed to evaluate the impact of the sperm DFI on early embryonic development during ART treatments and establish appropriate DFI cut-off values., Methods: Retrospectively analyzed 913 couple's ART cycles from 2021 to 2022, encompassing 1,476 IVF and 295 ICSI cycles, following strict criteria. The WHO guidelines directed the semen analysis, while the acridine orange test (AOT) determined the DFI. Male factors (age, BMI, DFI, infertility duration, sperm parameters) and female parameters (age, BMI, AMH, retrieved oocytes) were evaluated. We also assessed embryological parameters like fertilization rate, cleavage rate, and blastocyst quality. Correlations between DFI and embryo quality were examined and DFI cut-off values were established using ROC analysis., Results: The Sperm DFI demonstrated a positive correlation with male age and a negative correlation with sperm motility, concentration, and normal morphology, while showing no relation to BMI. No connection between DFI and embryological parameters in only IVF and ICSI groups was found, but a negative correlation with fertilization rate was seen in all ART cycles. ROC curve analysis revealed a DFI cut-off value of 21.15% having 36.7% sensitivity and 28.9% specificity in predicting high fertilization rate (≥ 80%)., Conclusion: Sperm DFI had a negative correlation with fertilization rate, but limited predictive efficacy and no significant link to other embryological parameters. DFI assessments may improve early embryo development prediction during ART treatments, particularly in older males or those exhibiting poor sperm quality., Competing Interests: Declarations. Ethics approval and consent to participate: This study was approved by the Ethics Committee of Zhuhai Maternal & Child Health Care (Approval No: [2018] ICE-22). Written informed consent from all enrolled patients was obtained prior to the study. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Background: The safety of the COVID-19 inactivated vaccine on pregnancy outcomes in couples undergoing assisted reproductive technology remains uncertain due to limited and speculative evidence. Existing studies primarily focus on the vaccination status of females, with scant information available regarding the vaccination status of male partners. Moreover, there is minimal research tracking live birth outcomes., Objective(s): The objective of this study was to evaluate the impact of COVID-19 inactivated vaccine administration on the outcomes of in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) cycles in infertile couples in China., Methods: This prospective cohort study involved couples undergoing IVF treatment at Sichuan Jinxin Xinan Women & Children's Hospital from August 2021 to September 2022. Based on whether they received vaccination before ovarian stimulation, the couples were divided into the vaccination group and the non-vaccination group. We compared the laboratory parameters and pregnancy outcomes between the two groups., Results: After performing propensity score matching (PSM), we observed similar live birth rates (41.23% vs. 44.08%, P = 0.555), clinical pregnancy rates (52.61% vs. 54.98%, P = 0.625), biochemical pregnancy (62.56% vs. 63.98%, P = 0.762), and ongoing pregnancy rates (49.76% vs. 51.18%, P = 0.770) between the vaccinated and unvaccinated women. Also, no significant disparities were found in terms of embryo development and laboratory parameters between the groups. Moreover, male vaccination had no impact on patients' pregnancy outcomes in assisted reproductive technology (ART) treatments (all P > 0.05). Additionally, there were no observable effects of vaccination on embryo development and pregnancy outcomes among couples undergoing ART (all P > 0.05)., Conclusion(s): The findings suggest that COVID-19 vaccination did not have a significant effect on patients undergoing IVF/ICSI with fresh embryo transfer. Therefore, it is recommended that couples should receive COVID-19 vaccination as scheduled to help mitigate the COVID-19 pandemic., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

We assessed the safety and efficacy of rhFSH-CTP, a novel long-acting FSH agent, in controlled ovarian hyperstimulation for patients undergoing ART. A multi-center, open-label, randomized, positive-control, non-inferiority clinical trial was conducted. The study consisted of a phase III randomized design, with a 1:1 ratio favoring the rhFSH-CTP group over the control group. Eligible patients in the rhFSH-CTP group received a single dose of rhFSH-CTP at 100-150 µg for the first 7d of stimulation following a gonadotropin-releasing hormone antagonist protocol. In total, 142 and 141 patients received rhFSH-CTP and rhFSH, respectively. At a confidence interval of 95%, the difference in the number of oocytes (1.13-4.22, 2.67) suggested that rhFSH-CTP was not inferior to rhFSH. Additionally, the top-quality embryos, implantation rates, and pregnancy outcomes were similar between the two groups (P > 0.05). In the rhFSH-CTP group, no cases of severe OHSS were observed, which was a significant improvement compared to the 1.4% incidence in the rhFSH group. With regard to another safety endpoint, no patients tested positive for adenosine deaminase (ADA) in the rhFSH-CTP group. The results demonstrated that the product had a comparable safety profile to pregnancy outcomes and newborn information in the control group, indicating its suitability for use., Competing Interests: Declarations. Competing interests: The authors declare no competing interests. Ethics approval and consent to participate: The studies were approved by the Ethics Committee of all the 13 Hospital in China, including The First Affiliated Hospital of Anhui Medical University (PJ2019-17-07(6)), The First Hospital of Peking University (SZSJ-2019-001), Beijing Obstetrics and Gynecology Hospital, Capital Medical University (2020-YW-013-03), Tianjin Central Obstetrics and Gynecology Hospital (2020YS007-01), The Sixth Affiliated Hospital of Sun Yat-sen University (2021ZSLYEC-427), The First Affiliated Hospital of Hainan Medical University (2021-YW-123),Wuhan Tongji Reproductive Medicine Hospital (2020(65)-3), The Third Affiliated Hospital of Guangzhou Medical University(2021 − 157), The Affiliated Hospital of Inner Mongolia Medical University (NO.SY(2022017)), Nanchang Reproductive Hospital (2021-003), Shengjing Hospital of China Medical University (2021PS117), Women’s Hospital School of Medicine Zhejiang University (IRB-20220001-D) and Suzhou municipal Hospital (Y-2021-038-H01). The patients/participants provided their written informed consent to participate in this study., (© 2025. The Author(s).)

Introduction: Endometriosis can cause of infertility, and evaluation methods for predicting clinical pregnancy outcomes are desired. Extracellular vesicles (EVs) exist in blood and it contains small non-coding RNAs (ncRNAs) that may reflect disease severity. In this study, we investigated small ncRNAs in serum EVs to identify specific biomarkers for predicting clinical pregnancy., Methods: Serum samples were collected from 48 patients who underwent assisted reproductive technology (ART). EVs were successfully isolated from serum samples and characterized using nanoparticle tracking assays, electron microscopy, and western blotting of EV's markers. We performed small RNA sequencing and analyzed microRNA (miRNA) profiles in the infertility patients with and without endometriosis to detect pregnancy-predicting biomarkers., Results: Candidate miRNAs in serum EVs were selected by comparing patients without endometriosis who became pregnant (n = 13) with those who did not (n = 21). A total of 241 miRNAs were detected; however, no trends separated the two groups. Next, EVs from patients with endometriosis were analyzed and divided into pregnant (n = 4) and non-pregnant (n = 10) cases. Among the 224 candidate miRNAs, miRNA profiles of pregnant women with endometriosis were separated from those of non-pregnant women by receiver-operating characteristics (ROC) curve analysis (area under the curve [AUC] > 0.8). In patients with endometriosis, serum EVs may be useful for predicting possible pregnancy before infertility treatment. Finally, we used small RNA sequencing of the tissue to demonstrate that pregnancy-predicting miRNAs in serum EVs were produced from endometriosis lesions. Although no predictors were found from miRNAs in serum EVs without endometriosis, miRNAs in serum EVs of patients with endometriosis could provide novel noninvasive biomarkers to predict pregnancy and have potential clinical applicability in ART., Discussion: Further studies are required to examine the functional importance of these miRNAs to elucidate the pathological mechanisms of endometriosis and pregnancy., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2025 Muraoka, Yokoi, Yoshida, Kitagawa, Bayasula, Murakami, Miyake, Sonehara, Nakamura, Osuka and Kajiyama.)

Today, accumulating evidence highlights the impact of oxidative stress (OS) on semen quality. It is considered to be a key factor contributing to the decline in male fertility. OS is detected in 30-80% of men with infertility, highlighting its strong association with impaired reproductive function and with clinical outcomes following the use of assisted reproductive technologies. Spermatozoa are particularly vulnerable to oxidative damage due to their high content of polyunsaturated fatty acids (PUFAs) and limited antioxidant defense abilities. OS arises from an imbalance between the production of reactive oxygen species and the capacity to neutralize or repair their adverse effects. Evidence indicates that OS leads to lipid peroxidation, protein oxidation, mitochondrial dysfunction, and genomic instability. Micronutrient-antioxidant therapies can play a key role in infertility improvement by neutralizing free radicals and preventing cellular damage. Many different micronutrients, including L-carnitine, L-glutathione, coenzyme Q10, selenium, and zinc, as well as vitamins complexes, are proposed to improve sperm parameters and male fertility potential. This study aims to review the impact of antioxidant supplementation on semen parameters, including sperm volume, motility, concentration, morphology, genome integrity (maturity and fragmentation), and in vitro fertilization (IVF) outcomes. Antioxidant intake and a balanced lifestyle reduce oxidative stress and mitochondrial dysfunction, enhancing the spermatogenesis and spermiogenesis processes, improving sperm quality, and protecting DNA integrity.

The judicious selection of ovulation inhibitors in ovarian stimulation protocols is crucial for the success of assisted reproductive technology (ART). Herein, we investigate the dose-dependent effects of chlormadinone acetate (CMA) and cetrorelix, two distinct ovulation inhibitors, on oocyte maturation in patients with normal ovarian reserve, using univariable and multivariable Poisson regression analyses. Patients undergoing progestin-primed ovarian stimulation (PPOS) with CMA (n = 299) or gonadotropin-releasing hormone antagonist (GnRH-ant) with cetrorelix (n = 605) during their initial in vitro fertilization cycle were enrolled at our center from March 2018 to October 2020 (N = 904). The primary and secondary outcomes were the oocyte maturation and fertilization rates, respectively. After adjusting for several covariates including age, anti-Müllerian hormone levels, total gonadotropin dose, and type of trigger, we calculated the dose-dependent adjusted relative risk (aRR) and 95% confidence interval (CI) for 1 mg of CMA or 0.25 mg of cetrorelix. In the PPOS group, the median age was 34.0 years, and the median total CMA dosage was 22 mg (interquartile range [IQR]: 18.0-32.0). In the GnRH-ant group, the median age was 35.0 years, and the median total cetrorelix dosage was 0.5 mg (IQR 0.5-0.5). The aRR of the maturation rate was 1.003 (95% CI: 0.999-1.007) with PPOS (p = 0.194) and 1.009 (95% CI: 0.962-1.059) with GnRH-ant (p = 0.717). The aRR of the fertilization rate was 1.002 (95% CI: 0.985-1.020) with PPOS (p = 0.783) and 1.022 (95% CI: 0.839-1.246) with GnRH-ant (p = 0.829). Collectively, these findings indicate that within the applied dosages, ovulation inhibitors do not significantly impact oocyte maturation or fertilization rates in patients with normal ovarian reserve. These valuable insights can be applied when designing ART protocols and may guide clinicians in optimizing infertility treatments., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2025 Handa et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Assisted reproductive technologies (ARTs) involve the laboratory manipulation of gametes and embryos to help couples with fertility problems become pregnant. One of these procedures, controlled ovarian stimulation, uses pharmacological agents to induce ovarian and follicular maturation in vivo. Despite the effectiveness in achieving pregnancy and live births, some patients may have complications due to over-response to gonadotropins and develop ovarian hyperstimulation syndrome. In vitro maturation (IVM) of oocytes has emerged as a technique to reduce the risk of ovarian hyperstimulation syndrome, particularly in women with polycystic ovary syndrome, and for fertility preservation in women undergoing oncological treatment. Although there are some limitations, primarily due to oocyte quality, recent advances have improved pregnancy success rates and neonatal and infant outcomes. Different terms have been coined to describe variations of IVM, and the technique has evolved with the introduction of hormones to optimize results. In this review, we provide a comprehensive overview of IVM relating hormonal priming, culture system and media, and clinical indications for IVM with its reproductive outcomes during ARTs., (© The Author(s) 2024. Published by Oxford University Press on behalf of Society for the Study of Reproduction. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Advancements in reproductive technology are now approaching an unprecedented frontier: the pregnancy robot, a potential artificial womb capable of carrying a fetus from fertilization to birth. This innovation, by simulating the natural uterine environment, could redefine pregnancy and parenthood, offering transformative benefits for maternal and infant health. The pregnancy robot promises safer pathways for individuals with medical risks, LGBTQ + couples, and single parents, while also reducing the risks of complications like preeclampsia and preterm birth. It builds on the foundations laid by assisted reproductive technologies (ART), aiming to make the process more accessible and inclusive. However, the introduction of such technology brings with it complex ethical and social questions, including potential impacts on maternal-child bonding, gender roles, and societal norms surrounding motherhood. Further concerns revolve around equitable access, as socioeconomic divides may restrict this technology to those with financial resources, and the risk of cultural and religious opposition. Legal, regulatory, and environmental considerations must also be addressed to responsibly integrate this technology. This article discusses the profound promise and ethical challenges of pregnancy robots, highlighting the need for thoughtful implementation and collaborative dialogue to ensure that the technology, if realized, can benefit all facets of society and pave the way for a more inclusive future in reproductive health., Competing Interests: Declarations. Ethical Approval: N/A. Competing Interests: The authors declare no competing interests., (© 2025. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Abstract: Blood lymphocyte reference ranges in non-pregnant females are established, but changes in pregnancy are less well understood. The early identification of immunological markers that could suggest an increased risk of early pregnancy loss may allow for timely intervention to improve outcomes. A lymphocytic immunophenotype provides a broad assessment of important immune parameters and potential indicators, which may be of relevance to pregnancy outcome. Comparison of immunophenotype results on the day of a positive hCG after embryo transfer between successful and failed pregnancies allows for this assessment. Baseline non-pregnant lymphocyte percentage and cell/µL profiles were established with a comprehensive panel on 93 age-matched male factor controls. Sixty-five in-vitro fertilisation (IVF) patients had an immunophenotype assessment on the day of a positive hCG, followed by further hCG tests and ultrasound monitoring as required to ultimately evaluate success (live birth) or failure (miscarriage). Thirty-one pregnancies were viable, leading to a live birth, while 34 ended in miscarriage. Total CD56, pNK, NKT, CD4 and CD8 levels were equivalent between all groups. Regardless of the outcome, B lymphocytes increased in pregnancy compared to controls. Of interest, in the later miscarriage cohort, pNK-specific CD69 was reduced (1.6 vs 5.4%, P = 0.02), while CD57+ cells were increased (45.4 vs 38.9%, P = 0.025). Corresponding changes were observed in cell/µL concentrations. Low level CD69 activation and elevated CD56dim and CD57+ NK cells were identified as markers that could potentially identify a pregnancy at risk of miscarriage, with further study needed to explore whether these changes represent cause or effect., Lay Summary: Unexplained infertility remains a difficult issue for patients and physicians alike, but despite recent diagnostic strides and innovative methods, there are no clear solutions on the horizon. Pregnancies can still occur in these challenging populations, either spontaneously or by interventions such as IVF. The early identification of various immune markers by blood sampling that may correlate with the subsequent outcome could be beneficial in identifying pregnancies at increased risk of miscarriage and perhaps allowing for timely and effective interventions.

Background: Gonadotropin-releasing hormone agonists (GnRHa) are commonly used in assisted reproduction technology (ART) cycles to prevent a luteinising hormone (LH) surge during controlled ovarian hyperstimulation (COH) prior to planned oocyte retrieval, thus optimising the chances of live birth. We compared the benefits and risks of the different GnRHa protocols used., Objectives: To evaluate the effectiveness and safety of different GnRHa protocols used as adjuncts to COH in women undergoing ART., Search Methods: We searched the following databases in December 2022: the Cochrane Gynaecology and Fertility Group's Specialised Register, CENTRAL, MEDLINE, Embase, and registries of ongoing trials. We also searched the reference lists of relevant articles and contacted experts in the field for any additional trials., Selection Criteria: We included randomised controlled trials (RCTs) comparing any two protocols of GnRHa, or variations of the protocol in terms of different doses or duration, used in in vitro fertilisation (IVF) or intracytoplasmic sperm injection (ICSI) cycles in subfertile women., Data Collection and Analysis: We used standard methodological procedures recommended by Cochrane. Our primary outcome measures were number of live births or ongoing pregnancies and incidence of ovarian hyperstimulation syndrome (OHSS) per woman/couple randomised. Our secondary outcome measures included number of clinical pregnancies, pregnancy losses, number of oocytes retrieved, amount of gonadotropins used, and cost and acceptability of the treatment protocols., Main Results: We included 40 RCTs (4148 women). The trials evaluated 10 different comparisons between protocols. The evidence is current to December 2022. Only half of the studies reported the primary outcome of live birth or ongoing pregnancy rates. We restricted the primary analysis of live birth and ongoing pregnancy to trials with low risk of selection and reporting bias. Nineteen studies compared long and short protocols. The primary analysis restricted to trials with low risk of bias included five studies reporting on live birth or ongoing pregnancy rates. Results showed little or no difference when the long protocol was compared with a short protocol (odds ratio (OR) 1.45, 95% confidence interval (CI) 0.83 to 2.52; I² = 0%; 5 studies, 381 women; low-certainty evidence). For the same comparison, there was evidence that the long protocol may improve clinical pregnancy rates when compared to the short protocol (OR 1.56, 95% CI 1.01 to 2.40; I² = 23%; 8 studies, 552 women; low-certainty evidence). No study in this comparison reported on OHSS. We are uncertain if there is a difference between groups in terms of live birth and ongoing pregnancy rates when the following GnRHa protocols were compared: long versus ultrashort (OR 1.78, 95% CI 0.72 to 4.36; 1 study, 150 women; very low-certainty evidence); long luteal versus long follicular phase (OR 1.89, 95% CI 0.87 to 4.10; 1 study, 223 women; very low-certainty evidence); GnRHa reduced-dose versus GnRHa same-dose continued in the long protocol (OR 1.59, 95% CI 0.66 to 3.87; 1 study, 96 women; very low-certainty evidence); GnRHa administration for two versus three weeks before stimulation (OR 0.88, 95% CI 0.37 to 2.05; 1 study, 85 women; very low-certainty evidence); GnRHa continued versus discontinued after human chorionic gonadotropin (HCG) administration in the long protocol (OR 0.89, 95% CI 0.49 to 1.64; 1 study, 181 women; very low-certainty evidence); and 500 µg dose versus 80 µg dose in the short protocol (OR 0.31, 95% CI 0.10 to 0.98; 1 study, 200 women; very low-certainty evidence). Clinical pregnancy rates may improve with a 100 µg dose compared to a 25 µg dose in the short protocol (OR 2.30, 95% CI 1.06 to 5.00; 2 studies, 133 women; low-certainty evidence). Only four of the 40 included studies reported adverse events. We are uncertain of any difference in OHSS rate in the GnRHa reduced-dose versus GnRHa same-dose regimen in the long protocol (OR 0.47, 95% CI 0.04 to 5.35; 1 study, 96 women; very low-certainty evidence) or when administration of GnRHa lasted for two versus three weeks before stimulation (OR 0.93, 95% CI 0.06 to 15.37; 1 study, 85 women; very low-certainty evidence). Regarding miscarriage rates, we are uncertain of any difference when the GnRHa long protocol was administered for two versus three weeks before stimulation (OR 0.93, 95% CI 0.18 to 4.87; 1 study, 85 women; very low-certainty evidence) and when a 500 µg dose was compared with an 80 µg dose in the short protocol (OR 3.15, 95% CI 0.32 to 31.05; 1 study, 131 women; very low-certainty evidence). No studies reported on cost-effectiveness or acceptability of the different treatment protocols. The certainty of the evidence ranged from low to very low. The main limitations were failure to report live birth or ongoing pregnancy rates, poor reporting of methods in the primary studies, imprecise findings due to lack of data, and insufficient data regarding adverse events. Only eight of the 40 included studies were conducted within the last 10 years., Authors' Conclusions: When comparing long and short GnRHa protocols, we found little or no difference in live birth and ongoing pregnancy rates, but there was evidence that the long protocol may improve clinical pregnancy rates overall. We were uncertain of any difference in OHSS and miscarriage rates for all comparisons, which were reported by only two studies each. There was insufficient evidence to draw any conclusions regarding other adverse effects or the cost-effectiveness and acceptability of the different treatment protocols., (Copyright © 2025 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.)

Oxidative stress (OS) is established as a key factor in the etiology of both male and female infertility, arising from an imbalance between reactive oxygen species (ROS) production and the endogenous antioxidant (AOX) defenses. In men, OS adversely affects sperm function by inducing DNA damage, reducing motility, significantly impairing sperm vitality through plasma membrane peroxidation and loss of membrane integrity, and ultimately compromising overall sperm quality. In women, OS is implicated in various reproductive disorders, including polycystic ovary syndrome, endometriosis, and premature ovarian failure, leading to diminished oocyte quality, disrupted folliculogenesis, and poorer reproductive outcomes. Antioxidant therapy represents a promising intervention to mitigate the harmful effects of ROS on reproductive health in additions to its easy accessibility, safety, and low cost. Despite several findings suggesting improvements in fertility potential with AOX therapy, the data remains inconclusive regarding optimal dosage and combination, duration of treatment, and the specific patient populations most likely to benefit. In this review, we discuss the role of AOXs in the management of infertile couples, focusing on their biological mechanisms, potential adverse effects, therapeutic efficacy, and clinical applications in improving reproductive outcomes in both natural conception and medically assisted reproduction. Additionally, we highlight the current practice patterns and recommendations for AOX supplementation during the course of infertility treatment. Further, we provide an overview on the limitations of the current research on the topic and insights for future studies to establish standardized AOX regimens and to assess their long-term impact on key outcomes such as live birth rates and miscarriage rates., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2025 Saleh, Sallam, Elsuity, Dutta, Sengupta and Nasr.)

Background: To investigate the impact of Melatonin on follicular oxidative stress and assisted reproductive technology (ART) outcomes in women with diminished ovarian reserve (DOR)., Method: We put 68 women with DOR who were going through ART into a randomized controlled trial. Starting on the fifth day of their menstrual cycle, we gave them either 3 mg of Melatonin or a placebo every day before stimulating their ovaries. We obtained follicular fluid during oocyte retrieval, assessed it for oxidative stress indicators, and documented ART outcomes., Results: Melatonin administration markedly enhanced the quantity of oocytes retrieved, fertilization rates, and embryo quality. In addition, Melatonin changed markers of oxidative stress, specifically the levels of reduced glutathione (rGSH) and total antioxidant capacity (TAC). The Melatonin group exhibited significantly elevated biochemical pregnancy rates., Conclusion: Melatonin may improve the quality of oocytes and help with reproductive technology in women with low ovarian reserves, possibly by lowering oxidative stress in the follicles., Competing Interests: Declarations. Ethics approval and consent to participate: The study was approved by the Ethics Committees of Urmia University of Medical Sciences (IR.UMSU.REC.1401.262 and IRCT20170529034209N2). Before the study, all subjects signed informed consent. This was a prospective study of patients undergoing fertility treatment at our IVF center. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)