Fertility and obstetric outcomes after fertility-sparing treatment for early-stage endometrial cancer and atypical hyperplasia: a systematic review and meta-analysis.

Re-evaluating the unknown causes of male infertility: Amebiasis as an emerging etiology.

Heat stress disrupts the ovarian microenvironment in cattle: An in vivo analysis of hormonal alterations, oxidative stress-induced apoptosis, and reduced pregnancy outcomes.

Advanced reproductive technologies are powerful tools for accelerating genetic gain because they enable both increased selection intensity and the generation of large numbers of offspring from elite animals. Among these, somatic cell nuclear transfer (SCNT) cloning offers a means to rapidly multiply elite genetics from nucleus herds into commercial populations. Genomic estimated breeding values allow for the accurate assessment of genetic merit in embryos and newborns, creating opportunities to identify elite young stock for cloning. Cloning will also be an important complement to gene-editing as a way to generate animals from cell lines carrying targeted genetic modifications. Nevertheless, the widespread application of cloning remains constrained by low efficiency and high costs, underscoring the need for continued optimisation. Zona-free cloning, also known as handmade cloning, has potential as a simpler and more scalable alternative to conventional micromanipulator-based methods to prepare cloned embryos, and has demonstrated promising improvements in pregnancy and live birth rates across several livestock species. This review summarises advances in zona-free cloning, tracing its development from the microblade to the two-pipette and micropipette methods, and evaluates their relative advantages and limitations. Approaches to improve the health and welfare of clones are examined, and potential applications of cloning in livestock breeding programmes, along with associated regulatory considerations, are discussed. Cloning may become increasingly important as a crucial bridge between lines of genetically elite and possibly gene-edited embryonic cells, and their manifestation as breeding animals in livestock improvement programs.

Early-stage cervical cancer tumours ≥2cm present a dilemma for fertility preservation, as guidelines generally discourage fertility-sparing surgery (FSS) due to oncologic risks. Neoadjuvant chemotherapy (NACT) followed by FSS has emerged as an alternative to downstage tumours. This study evaluated recurrence and pregnancy outcomes of NACT+FSS versus upfront FSS. A PROSPERO-registered (CRD42024605906) meta-analysis was conducted using PubMed, EMBASE, and Cochrane (updated Feb 26, 2025). Eligible studies included women with early-stage cervical cancer (FIGO 2018 IB2-IIA1; ≥2cm) undergoing upfront FSS or NACT+FSS. Pooled proportions with 95% confidence intervals (CIs) were calculated using a random effects model. Nineteen observational studies (n=1453) were analysed. Indirect comparison indicated significantly higher pooled pregnancy rate for NACT+FSS (31%; 95% CI: 23-41%) compared to upfront FSS (8%; CI: 1-43%; p=0.002). Pooled recurrence rate was statistically similar: 10% (CI: 5-20%) for upfront FSS and 13% (CI: 9-20%) for NACT+FSS (p=0.415). Studies generally exhibited a moderate-to-high risk of bias. NACT followed by FSS appears to enhance fertility outcomes without increasing oncologic risk compared to upfront FSS in patients with tumours ≥2cm. These findings support the personalized extension of fertility-sparing indications, though prospective validation remains necessary.

Although the number of frozen-thawed blastocysts transfer is increasing worldwide, the live birth rate following blastocyst transfer using assisted reproductive technology remains at 30-60%. Thus, improving the pregnancy rate per transfer is an urgent issue. In a previous retrospective study, we evaluated the use of granulocyte-macrophage colony-stimulating factor (GM-CSF)-containing medium for recovery culture to improve the outcomes of frozen-thawed blastocyst transfers. The results demonstrated that the live birth rates increased by approximately 10% following recovery culture in the GM-CSF-containing culture medium. This study aims to prospectively evaluate whether GM-CSF-containing blastocyst recovery culture following thawing increases live birth. This is a multicenter, randomized, parallel-group, active-controlled, single-blind trial. The recruitment target is 750 participants meeting the criteria. Enrolled patients are randomized 1:1 to the GM-CSF-containing culture medium group (test group) or the non-GM-CSF-containing culture medium group (control group). The blastocyst recovery culture after warming was defined as an intervention in this study; frozen-thawed blastocysts will be cultured for 3-7h in GM-CSF-containing medium (test group) or medium without GM-CSF (control group) followed by blastocyst transfer. The primary outcome will be live birth. We will also evaluate embryo transfer outcomes as secondary efficacy endpoints and evaluate perinatal and neonatal outcomes as a safety endpoint. This is the first large-scale prospective study to investigate the efficacy of a GM-CSF-containing medium for frozen-thawed blastocyst transfer. The study findings will provide evidence regarding the efficiency of GM-CSF-containing medium for blastocyst recovery culture after warming. Japan Registry of Clinical Trials jRCT1040240159. Registered on January 6, 2025.

About 21million teenagers became pregnant annually throughout the globe. Teen pregnancy is a serious issue in Sub-Saharan Africa, with East Africa reporting the highest rates. In the field of public health, machine learning has become an invaluable tool due to its ability to process large, complex datasets and identify trends. This study uses machine learning to predict and identify key determinants of teenage pregnancy in East Africa, utilizing DHS. A supervised machine learning approach, specifically the Random Forest algorithm, was applied to analyze relationships between predictors and teenage pregnancy outcomes. Data preprocessing included handling missing values, feature scaling, and addressing class imbalance using Tomek Links and SMOTE Model performance was evaluated using metrics such as accuracy, confusion matrix, and ROC AUC. The final model was validated on a separate test set to ensure generalizability and predictive accuracy. Random Forest demonstrated superior performance, with an AUC of 94.6, an accuracy of 89.1%, an F1 score of 89%, a recall of 88%, and a precision of 90%. Kenya had the highest rate of teenage pregnancies at 19.1%, with a 95% confidence interval of [18.12%, 20.08%]. Key predictors of teenage pregnancy in East Africa include maternal education, marital status, age at first sexual intercourse, wealth status, place of residence, distance to health facilities, and social media usage. These findings suggest that expanding reproductive health services in rural areas, with strengthened youth-friendly services; promoting education about teenage pregnancy through social media; and integrating reproductive health education into school curricula may decrease teenage pregnancy in East Africa.

Follitropin delta, using a personalized dosing regimen, is an effective treatment option for women undergoing controlled ovarian stimulation (COS) for in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI). The aim of this study was to develop a model to determine cost effectiveness of follitropin delta compared with follitropins alfa and beta for women undergoing IVF/ICSI in France. A decision-tree model was developed comparing the outcomes of treatment with follitropin delta versus other follitropins through ongoing pregnancy (OP) and live birth (LB) rates in fresh cycles. Pooled data from the pivotal clinical trials ESTHER (EU + rest of world; NCT01956110), GRAPE (Pan-Asia; NCT03296527), and STORK (Japan; NCT03228680) was used for the economic model. The analyses were stratified by age and ovarian reserve profile and reflected a single COS cycle. Costs were estimated from the healthcare perspective in France, and uncertainty was assessed through sensitivity analyses. In women with an elevated anti-Müllerian hormone level (≥15pmol/L), follitropin delta achieved a higher rate of LB (31.4% vs 25.8%, p=0.01) and a numerically higher rate of OP (35.7% vs 31.6%) compared with follitropins alfa/beta. Additionally, treatment with follitropin delta was associated with numerically fewer miscarriages (4.3% vs 5.8%) and lower ovarian hyperstimulation syndrome (OHSS) incidence (8.2% vs 11.5%). Total treatment cycle cost with/without delivery cost was €5479/€4099 for follitropin delta, €5335/€4191 for follitropin alfa, and €5387/€4243 for follitropin beta. The incremental cost-effectiveness ratio was €2579/LB for follitropin delta versus follitropin alfa. Follitropin beta was shown to be less efficient, and more costly (i.e. dominated). Excluding the delivery cost, follitropin delta was more efficient and less costly (i.e. dominant) versus other follitropins. Probabilistic sensitivity analyses supported the deterministic results, showing >76% probability of follitropin delta being dominant when assessing cost per additional OP. Similar results were observed in the overall population of women. Follitropin delta provides an effective alternative to follitropin alfa and beta with a potential cost-savings opportunity, excluding the delivery cost, due to higher OP and LB rates in the fresh cycle transfers.

Vasovasostomy (VV) is often pursued by men seeking natural conception after vasectomy. Microsurgical VV is associated with high patency rates (~95%) and moderate pregnancy rates (~40%), according to existing literature. However, long-term outcome data remain limited. This review evaluates patency and pregnancy rates at ≥12 months following microsurgical VV. A comprehensive literature search was conducted via PubMed using the terms "vasovasostomy," "patency rate," and "pregnancy rate." Studies were included if they reported patency or pregnancy outcomes ≥12 months post-VV. Data were categorized and analyzed using MedCalc, applying the Freeman-Tukey transformation for normalization. Only four clinical studies reported long-term patency data, and six studies reported long-term pregnancy rates following microsurgical VV. Patency rates ranged from 77% to 99%, with a mean follow-up of 25 months. Patency was defined as the presence of any sperm in the ejaculate in five studies, and as >1 million non-immotile sperm/mL in one study. Using the >1 million sperm definition, the patency rate was 77% at 12 months, but decreased to 33% when defined as ≥30% motile sperm in the ejaculate. Pregnancy rates across the six studies ranged from 28% to 54%, with a mean follow-up of 21 months. Long-term patency and pregnancy rates following VV vary widely due to inconsistent definitions and limited follow-up data. These findings underscore the need for standardized outcome measures and longitudinal follow-up to better understand factors influencing long-term success after VV.

Adenomyosis negatively impacts fertility treatment outcomes by lowering clinical pregnancy rates, reducing live birth rates, and increasing miscarriage rates following invitro fertilization. Hormonal suppression therapy has emerged as a preferred treatment for patients with adenomyosis, particularly before endometrial preparation for frozen-thawed embryo transfer; however, the combination therapy for individualized patients can improve the outcomes. Here we present three cases in wherein we applied a combined protocol using GnRH agonists and letrozole for endometrial preparation in patients with severe adenomyosis undergoing euploid frozen embryo transfer with a single embryo. Three women with Arabian (Emirati) ethnicity aged 31-32 year old with moderate and severe adenomyosis and histories of recurrent invitro fertilization failures and miscarriages underwent a combined protocol using GnRH agonists and letrozole and diagnostic hysteroscopy with saline instillation followed by hormonal replacement therapy for euploid frozen embryo transfer. Our three cases resulted in deliveries at 36, 38, and 40 weeks. Adenomyosis-related infertility remains a challenge. This case series supports the potential efficacy of hormonal suppression by combining GnRH agonists, aromatase inhibitors, and diagnostic hysteroscopy with saline irrigation prior to the endometrial preparation for euploid frozen embryo transfer in patients with adenomyosis. This protocol offers a promising alternative for cases unresponsive to standard treatments, although further research is warranted to refine guidelines on treatment duration and dosage.

This study aimed to evaluate the impact of cleavage stage embryo ratings on pregnancy outcomes following frozen embryo transfer (FET) and their correlation with blastocyst grades. A retrospective cohort study was conducted on 854 FET cycles from January 2018 to August 2024. Participants were women undergoing FET with cryopreserved embryos. Exclusion criteria included multiple initial in vitro fertilization (IVF) attempts, advanced age, chromosomal abnormalities, and uterine anomalies. Embryo quality was assessed at the cleavage and blastocyst stages, and FET protocols were tailored to each patient. The primary outcome was clinical pregnancy rate, defined by ultrasound-detected fetal heartbeat. Data was analyzed using SPSS 19.0, with logistic regression to adjust for confounders. The overall pregnancy rate was 53.98% (461/854). Significant differences in pregnancy rates were observed among blastocyst grades, with Grade 1 achieving the highest rate (60.37%). Lower cleavage stage embryo grades (Grade 3 and Grade 4) were associated with reduced pregnancy odds (OR = 0.63 and OR = 0.50, respectively, p < 0.05). Other factors influencing pregnancy outcomes included female age and anti-müllerian hormone (AMH) levels. The study underscores the importance of cleavage stage embryo ratings, particularly for Grade 2 embryos, in the context of FET procedures using ovulation induction cycle (OIC) and intracytoplasmic sperm injection (ICSI). Cleavage stage embryo ratings significantly affect pregnancy outcomes following FET. Higher ratings correlate with better pregnancy rates, highlighting the importance of comprehensive embryo quality assessment.

Whether aspiration of more oocytes than the antral follicle count (AFC) is beneficial for the current and future products of assisted reproductive technologies (ART) cycles. Data of the first oocyte aspiration for intracytoplasmic sperm injection performed between 2018 and 2022 in attempt to conceive (ICSI, n = 399) or for planned oocyte vitrification (fertility preservation [FP], n = 283) was retrieved. Each group was divided into 2 subgroups according to their "oocyte/AFC index" (OAFCI): <1 and ≥1. Primary measures were clinical pregnancy rates (CPR) and live birth rates (LBR). Secondary measures were oocyte maturity rates, fertilization rates, and number of cryopreserved oocytes/embryos. Oocyte maturity was unaffected by the OAFCI in the ICSI group, but was slightly lower in the FP group when OAFCI ≥1 (0.79 versus 0.84, p = .005). OAFCI ≥1 was associated with a higher number of cryopreserved embryos (ICSI, 3.9 versus 2.3, p < .001) and vitrified oocytes (FP, 13.4 versus 6.4, p < .001). The OAFCI had no impact on CPR (22.8% versus 28%, p = .27) nor LBR (19.8% versus 24.8%, p = .33). On multivariate analysis controlling for age, gonadotropin dosage, and duration of stimulation, OAFCI ≥1 was associated with a higher number of cryopreserved embryos (aOR 1.2, 95% CI 1.1-1.3, p < .001) in the ICSI group and higher vitrified oocytes (aOR 1.2, 95% CI 1.1-1.2, p < .001) and lower maturity index (aOR 0.2, 95% CI 0.05-0.75, p = .018) in the FP group. Aspirating more oocytes than the AFC does not influence the outcome of the fresh cycle but cryopreservation of more oocytes and embryos might translate into higher cumulative pregnancy rates later on.

This study aims to explore the effect of various factors, including freezing duration, on frozen embryo transfer outcomes. We analyzed 2291 frozen-thawed cycles based on embryo freezing time (<4, 4–12, and >12 months). There were no significant differences in the rates of clinical pregnancy, live birth, miscarriage, or preterm labor between the groups. The intergroup difference in the birth weight of singletons was significant (P = .012). Following cleavage-stage embryo transfer, maternal age at frozen embryo transfer (odds ratio [OR], 95% confidence interval [CI] = 0.813 [0.674–0.981], P = .030), (OR [95% CI] = 0.779 [0.635–0.955], P = .016), and number of embryos transferred (OR [95% CI] = 1.527 [1.172–1.989], P = .002), (OR [95% CI] = 1.688 [1.270–2.242], P < .001) were associated with the clinical pregnancy and live birth rates, respectively. Following blastocyst-stage embryo transfer, cycle number of transplantation (OR [95% CI] = 0.570 [0.369–0.881], P = .011), (OR [95% CI] = 0.565 [0.366–0.871], P = .010), and number of embryos transferred (OR [95% CI] = 1.734 [1.296–2.322], P < .001), (OR [95% CI] = 1.951 [1.460–2.606], P < .001) were associated with the clinical pregnancy and live birth rates, respectively. Ovarian stimulation protocol (OR [95% CI] = 1.511 [1.006–2.268], P = .047) was associated only with the clinical pregnancy rate. Embryo cryopreservation duration did not affect the clinical pregnancy or live birth rates regardless of embryo stage. Older patients could consider blastocyst embryo culture and transplantation to improve clinical pregnancy and live birth rates.

This study aims to investigate the effect of endometriosis (EMs) on fertility and to assess the causal relationship between EMs and fertility using two-sample Mendelian randomization (MR). We conducted an observational study using data from 1999 to 2006, based on the National Health and Nutrition Examination Survey database. The effect of EMs on fertility was assessed using the chi-square test or t test. The genome-wide association study collected 147,343 single-nucleotide polymorphisms associated with EMs and 7,974,415 single-nucleotide polymorphisms for the number of children. The number of children was used as the outcome variable, and EMs as the exposure factor. The inverse variance weighted method was used to evaluate the association between EMs and the number of children. The maximum likelihood ratio method, Mendelian randomization pleiotropy residual sum and outlier test, and MR-Egger regression were used for sensitivity analysis. A total of 4933 women were included in the observational study based on whether participants had EMs. There were 337 women in the EMs group and 4596 in the non-EMs group. The number of children born to women in the EMs group was 1.91 ± 1.078, which was significantly lower than that of the non-EMs group (2.26 ± 1.438; t = −4.287, P < .001). However, there did not appear to be a significant difference in the number of pregnancies and pregnancy rate between the 2 groups (P > .05). The MR study also confirmed that EMs was associated with the ratio of live births (odds ratio = 0.989, 95% confidence interval = 0.981–0.996, P < .05). MR-Egger test analysis found no pleiotropy (P > .05). EMs reduces pregnancies resulting in live births. Our results provide some reference significance for revealing the impact of EMs on fertility.

Supplementation of organelle-specific antioxidants during in vitro oocyte maturation enhances embryo development and pregnancy outcomes in bovine.

Fertility-sparing treatment (FST) is an accepted option for selected women with atypical endometrial hyperplasia (AEH) and early-stage endometrioid endometrial cancer (EC). While combined progestin therapy and hysteroscopic approaches yield the best outcomes, the surgical component has long lacked standardization. This study aimed to evaluate oncological and reproductive outcomes following a standardized hysteroscopic fertility-sparing approach. This retrospective single-center study included women of reproductive age diagnosed with AEH or grade 1-2 endometrioid EC between 2021 and 2024 at the Digital Hysteroscopic Clinic CLASS Hysteroscopy, Fondazione Policlinico A. Gemelli IRCCS, Rome. All patients were treated using a standardized hysteroscopic approach based on lesion type and disease extension, combined with progestin therapy. Oncological outcomes included complete response (CR), time to CR and recurrence. Reproductive outcomes included the clinical pregnancy rate (CPR), live birth rate (LBR), and miscarriage rate (MR). Multivariate analysis was performed to identify factors associated with CR and relapse. A total of 138 patients were included (79 AEH, 59 EC). CR rates were high and comparable between AEH (94.9%) and EC (98.2%), with a median time to response of 6 months. Recurrence rates did not differ significantly between groups (16.7% AEH vs. 26.8% EC). CPR was similar (47.5% AEH vs. 54.8% EC), with LBR exceeding 50% among women who conceived. Multivariate analysis identified age ≥ 35 years as the only factor associated with reduced response and increased relapse risk. A standardized hysteroscopic fertility-sparing approach combined with progestin therapy provides excellent oncologic control and favorable reproductive outcomes. Lesion severity did not affect outcomes when hysteroscopic removal was adequately performed, while patient age remains a key determinant of outcomes.

To investigate whether cured tuberculosis affect assisted reproductive outcomes in infertile women. A retrospective cohort study was conducted to compare assisted reproductive outcomes between cured tuberculosis and non-tuberculosis patients. The primary outcomes were compared between fresh and frozen-thaw cycles in cured tuberculosis, as well as among different types of tuberculosis in fresh cycles. In IVF and total patients, the pregnancy (P > 0.05) and live birth rates (P > 0.05) did not differ between tuberculosis and control group. However, in ICSI protocol, the pregnancy (P = 0.027) and live birth rates (P = 0.027) in tuberculosis group were lower than those in controls. The pregnancy rate in fresh cycles for tuberculosis patients was lower than in frozen-thaw cycles in each protocol (P = 0.001). The live birth rate in fresh cycles was higher than in frozen-thaw cycles in IVF patients (P = 0.008) and total patients (P = 0.015), while the live birth rate in fresh cycles was lower in ICSI patients (P = 0.011). The pregnancy rate (P > 0.05) and live birth rate (P > 0.05) among cured patients diagnosed with pelvic tuberculosis demonstrated no significant difference compared to those with pulmonary tuberculosis or other types. Cured tuberculosis did not affect the primary assisted reproductive outcomes in infertile patients using IVF protocol. However, in ICSI protocol, tuberculosis had a negative impact on pregnancy outcomes in infertile women, even with treatment. The final pregnancy outcome of frozen-thaw cycle was worse than that of fresh cycle in IVF protocol but opposite in ICSI. If treated, there were no variations in pregnancy outcomes among different tuberculosis types.

This study explores the effect of pyriform sperm heads on basic semen parameters, advanced sperm functions, and assisted reproductive technology outcomes. From 2300 patients with pyriform sperm heads in semen, a cohort of 59 couples from the Andrology Clinic of West China Second University Hospital (Sichuan University, Chengdu, China) between January 2022 and July 2024 undergoing assisted reproductive technology were studied. After 108 cycles with 81 embryos transferred, 37 couples achieved clinical pregnancy. Sperm concentration, percentage vitality, total motility, normal morphology, nuclear maturity, acrosomal integrity, acrosome reaction, and mitochondrial membrane potential were significantly lower in the pyriform sperm head group than those in the control group by propensity score matching (all P < 0.05). Non-progressive motility, immotile spermatozoa, the teratozoospermia, sperm deformity, DNA fragmentation index, and DNA stainability were higher in the pyriform sperm head group than those in the control group after propensity score matching (all P < 0.05). Nine morphometric parameters from 2805 typical pyriform sperm heads were evaluated. Cut-off values for predictive diagnostic use of 24.0%, 31.6%, 29.8%, 16.1%, 17.3%, 22.1%, and 9.2% were proposed for the proportion of pyriform sperm heads in seminal samples with abnormal DNA fragmentation index, high DNA stainability, sperm nuclear maturity, sperm acrosome integrity, acrosome reaction, acrosin activity, and mitochondrial membrane potential, respectively. High-quality embryos (35.2% vs 16.8%), clinical pregnancy (46.2% vs 43.8%), and live birth rates (21.5% vs 18.8%) were higher of spermatozoa from samples with a low proportion of pyriform sperm heads (≤38.5%) than with a high proportion of pyriform spermatozoa (>38.5%). The percentage of pyriform sperm heads could be introduced as a diagnostic evaluation parameter before treatment of sperm function and assisted reproductive technology.

Intracytoplasmic sperm injection (ICSI) with cryopreserved testicular spermatozoa retrieved via testicular sperm aspiration (TESA) or microdissection testicular sperm extraction (micro-TESE) is an effective treatment for azoospermia and cryptozoospermia. The current research on testicular sperm cryopreservation has primarily focused on comparing ICSI outcomes between fresh and frozen-thawed testicular spermatozoa. Another focus of these researches is evaluating treatment efficacy differences between ICSI using spermatozoa from patients with obstructive azoospermia (OA) versus non-obstructive azoospermia (NOA). However, few studies have investigated ICSI outcomes among patients with OA, NOA, and cryptozoospermia. This retrospective cohort study analyzed the data from 688 patients at Sichuan Human Sperm Bank (Chengdu, China) between September 2021 and April 2024, comparing cryopreservation efficacy, sperm utilization rate, ICSI outcomes, and delivery outcomes of cryopreserved testicular sperm suspensions in OA group (n = 542), NOA group (n = 114), and cryptozoospermia group (n = 32). Post-thaw analysis revealed that the median sperm viability before and after freezing, as well as the viability ratio, did not differ among the three groups (all P > 0.05). Sperm utilization in NOA group (60.5%) was significantly higher (both P < 0.0001) compared with cryptozoospermia group (31.3%) and OA group (19.9%), while no significant difference was found between OA and cryptozoospermia groups (P > 0.05). Of 162 couples undergoing ICSI, there were no differences in fertilization, clinical pregnancy, delivery, and miscarriage rates among patients with OA, NOA, and cryptozoospermia (all P > 0.05). In the cryptozoospermia group with five newborns, all were full-term with normal birth weights, but this group had the highest maternal pregnancy complication rate.

This study investigated the impact of mindfulness meditation (MM) nursing on outcomes of in vitro fertilization-embryo transfer (IVF-ET). A total of 100 infertile patients undergoing IVF-ET were randomly assigned to either a conventional care group or an MM group, with 50 patients in each. While both groups received routine nursing, the MM group received additional MM-based nursing interventions. Compared to the conventional group, the MM group showed significantly lower postoperative pain scores (VAS) and better psychological outcomes, as evidenced by improvements in anxiety (SAS), depression (SDS), sleep quality (PSQI), and overall quality of life (WHO-QOL-BREF) (all P<0.001). Moreover, the MM group had higher numbers of punctured follicles and retrieved oocytes (P<0.001), more embryos transferred on day 3 post-retrieval (P=0.047), and a higher pregnancy rate (P=0.045). These findings suggest that incorporating MM into nursing care during IVF-ET can effectively reduce psychological stress, enhance well-being, and improve clinical outcomes.