Pub Date : 2026-02-01Epub Date: 2025-08-22DOI: 10.1016/j.fertnstert.2025.08.013
Allison Eubanks M.D. , Kerry Flannagan Ph.D. , Kyle Le M.D. , Amalia Namath M.D. , Anupama Rambhatla M.D. , Jensen Reckhow M.D., M.P.H. , Atoosa Ghofranian M.D. , Jiarui Wang M.S. , Kate Devine M.D. , Matthew Connell D.O. , Phillip Romanski M.D., M.Sc. , Micah Hill D.O.
<div><h3>Objective</h3><div>To study the association between antimüllerian hormone (AMH) and antral follicle count (AFC) with embryo euploidy rates in patients undergoing in vitro fertilization (IVF) with preimplantation genetic testing for aneuploidy (PGT-A), independent of maternal age and other confounding factors.</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Subjects</h3><div>A total of 11,473 women who underwent 13,451 IVF cycles with PGT-A between October 2016 and August 2024 across a large national network of infertility clinics in the United States.</div></div><div><h3>Exposure</h3><div>Values of AMH and AFC recorded within 6 months of oocyte retrieval. Both AMH and AFC were categorized on the basis of Bologna criteria for diminished ovarian reserve: AMH <1.1, 1.1–4.0, and >4.0 ng/mL; AFC <7, 7–16, and >16.</div></div><div><h3>Main Outcome Measures</h3><div>Adjusted relative risk (RR) of embryo euploidy on the basis of AMH and AFC levels, with secondary outcomes including live birth, clinical pregnancy, and implantation rates.</div></div><div><h3>Results</h3><div>Euploidy rates were comparable across AMH categories (56.9%, 54.0%, and 55.8% for AMH <1.1, 1.1–4.0, and >4.0 ng/mL, respectively) and AFC categories (56.3%, 54.8%, and 54.9% for AFC <7, 7–16, and >16, respectively). After adjustment, euploidy was modestly higher in the lowest AMH category (RR: 1.08; 95% confidence interval [CI]: 1.05, 1.11) but similar in the highest AMH category (RR: 1.00; 95% CI: 0.98, 1.02). Euploidy rates were comparable among AFC <7 and 7–16 (RR: 1.00; 95% CI: 0.98, 1.03) but slightly lower in AFC >16 (RR: 0.96; 95% CI: 0.95, 0.98). Both AMH and AFC levels were not significantly associated with live birth, clinical pregnancy, or implantation rates.</div></div><div><h3>Conclusion</h3><div>Contrary to recent studies, lower AMH and AFC levels were not associated with a clinically significant decrease in embryo euploidy or live birth outcomes. These findings suggest that although AMH and AFC are useful for assessing ovarian reserve, they may have limited value in predicting embryo euploidy when considered independently of other factors, such as maternal age.</div></div><div><div>Más allá de los números: la hormona antimülleriana y el recuento de folículos antrales no son predictores independientes de la euploidía embrionaria en fecundación in vitro con pruebas genéticas preimplantacionales para aneuploidía.</div></div><div><h3>Objetivo</h3><div>Estudiar la asociación entre la hormona antimülleriana (AMH) y el recuento de folículos antrales (AFC) con las tasas de euploidía embrionaria en pacientes sometidas a fertilización in vitro (FIV) con prueba genética preimplantacional para aneuploidía (PGT-A), independientemente de la edad materna y otros factores de confusión.</div></div><div><h3>Diseño</h3><div>Estudio de cohorte retrospectivo.</div></div><div><h3>Sujetos</h3><div>Un total de 11.473 mu
{"title":"Beyond numbers: antimüllerian hormone and antral follicle count are not independent predictors of embryo euploidy in in vitro fertilization with preimplantation genetic testing for aneuploidy","authors":"Allison Eubanks M.D. , Kerry Flannagan Ph.D. , Kyle Le M.D. , Amalia Namath M.D. , Anupama Rambhatla M.D. , Jensen Reckhow M.D., M.P.H. , Atoosa Ghofranian M.D. , Jiarui Wang M.S. , Kate Devine M.D. , Matthew Connell D.O. , Phillip Romanski M.D., M.Sc. , Micah Hill D.O.","doi":"10.1016/j.fertnstert.2025.08.013","DOIUrl":"10.1016/j.fertnstert.2025.08.013","url":null,"abstract":"<div><h3>Objective</h3><div>To study the association between antimüllerian hormone (AMH) and antral follicle count (AFC) with embryo euploidy rates in patients undergoing in vitro fertilization (IVF) with preimplantation genetic testing for aneuploidy (PGT-A), independent of maternal age and other confounding factors.</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Subjects</h3><div>A total of 11,473 women who underwent 13,451 IVF cycles with PGT-A between October 2016 and August 2024 across a large national network of infertility clinics in the United States.</div></div><div><h3>Exposure</h3><div>Values of AMH and AFC recorded within 6 months of oocyte retrieval. Both AMH and AFC were categorized on the basis of Bologna criteria for diminished ovarian reserve: AMH <1.1, 1.1–4.0, and >4.0 ng/mL; AFC <7, 7–16, and >16.</div></div><div><h3>Main Outcome Measures</h3><div>Adjusted relative risk (RR) of embryo euploidy on the basis of AMH and AFC levels, with secondary outcomes including live birth, clinical pregnancy, and implantation rates.</div></div><div><h3>Results</h3><div>Euploidy rates were comparable across AMH categories (56.9%, 54.0%, and 55.8% for AMH <1.1, 1.1–4.0, and >4.0 ng/mL, respectively) and AFC categories (56.3%, 54.8%, and 54.9% for AFC <7, 7–16, and >16, respectively). After adjustment, euploidy was modestly higher in the lowest AMH category (RR: 1.08; 95% confidence interval [CI]: 1.05, 1.11) but similar in the highest AMH category (RR: 1.00; 95% CI: 0.98, 1.02). Euploidy rates were comparable among AFC <7 and 7–16 (RR: 1.00; 95% CI: 0.98, 1.03) but slightly lower in AFC >16 (RR: 0.96; 95% CI: 0.95, 0.98). Both AMH and AFC levels were not significantly associated with live birth, clinical pregnancy, or implantation rates.</div></div><div><h3>Conclusion</h3><div>Contrary to recent studies, lower AMH and AFC levels were not associated with a clinically significant decrease in embryo euploidy or live birth outcomes. These findings suggest that although AMH and AFC are useful for assessing ovarian reserve, they may have limited value in predicting embryo euploidy when considered independently of other factors, such as maternal age.</div></div><div><div>Más allá de los números: la hormona antimülleriana y el recuento de folículos antrales no son predictores independientes de la euploidía embrionaria en fecundación in vitro con pruebas genéticas preimplantacionales para aneuploidía.</div></div><div><h3>Objetivo</h3><div>Estudiar la asociación entre la hormona antimülleriana (AMH) y el recuento de folículos antrales (AFC) con las tasas de euploidía embrionaria en pacientes sometidas a fertilización in vitro (FIV) con prueba genética preimplantacional para aneuploidía (PGT-A), independientemente de la edad materna y otros factores de confusión.</div></div><div><h3>Diseño</h3><div>Estudio de cohorte retrospectivo.</div></div><div><h3>Sujetos</h3><div>Un total de 11.473 mu","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":"125 2","pages":"Pages 237-246"},"PeriodicalIF":7.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144899439","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<div><h3>Objective</h3><div>To present an optimized fixation method for levonorgestrel-releasing intrauterine device (LNG-IUD) in adenomyosis patients, addressing high expulsion rates and improving clinical feasibility.</div></div><div><h3>Design</h3><div>Case series with a technical surgical video demonstrating the continuously improved hysteroscopic sutureless fixation of LNG-IUD.</div></div><div><h3>Subjects</h3><div>A representative case: a 43-year-old G4P2 woman with recurrent heavy menstrual bleeding and two prior LNG-IUD expulsions, with pretreatment uterine dimensions 91×82×81 mm. The patients included in this video gave consent for the publication of the video and posting of the video online, including social media, the journal website, scientific literature websites (e.g., PubMed, ScienceDirect, and Scopus), and other applicable sites.</div></div><div><h3>Exposure</h3><div>The optimized fixation technique involves three key surgical steps: Step 1. Form Knot A: A sliding knot using the preattached polyethylene tail thread of LNG-IUD, allowing easy removal and reinsertion. Step 2. Form Knot B: A “loop knot” embedded into a 1- to 2-mm gap in the uterine fundus (depth 8 mm), designed to expand in narrow spaces for enhanced stability. Step 3. Procedure: Performed via an integrated continuous flow hysteroscope (outer diameter 5.0 mm) by a single operator.</div></div><div><h3>Main Outcome Measures</h3><div>Expulsion rate, operative time, intraoperative bleeding, ease of removal/reinsertion, and technical feasibility.</div></div><div><h3>Results</h3><div>The fixation procedure was successfully performed by a single gynecologist in 5 minutes, with the patient discharged home 30 minutes later. A total of 212 patients underwent this treatment between May 2022 and July 2024, with an expulsion rate of 1.4% (3/212). Among these cases, 159 patients had a uterine depth ≥9 cm (2 expulsions) and 45 patients had a history of expulsion (no expulsions).</div><div>Although using the hysteroscopic cold-knife surgical system yields reliable results, our surgical method offers 10 advantages, including learning curve, instrument/consumable needs, preoperative cervical preparation, delivery method, removal/reinsertion difficulty, operative time, intraoperative bleeding, physician requirements, and expulsion rate.</div></div><div><h3>Conclusions</h3><div>The optimized fixation method for LNG-IUD is effective in reducing expulsion rates in adenomyosis patients, with advantages of simplicity, ease of mastery, low instrument needs, ultralow expulsion rate, and high universality.</div></div><div><div>Método de fijación con optimización progresiva para el dispositivo intrauterino liberador de levonorgestrel</div></div><div><h3>Objetivo</h3><div>Describir un método optimizado de fijación del dispositivo intrauterino liberador de levonorgestrel (DIU-LNG) en pacientes con adenomiosis, orientado a reducir la tasa de expulsión y mejorar su viabilidad clínica.</div></div><di
目的探讨一种优化的左炔诺孕酮释放型宫内节育器（LNG-IUD）固定方法，解决子宫腺肌症患者排出率高的问题，提高临床可行性。设计案例系列与技术手术视频展示了不断改进的宫腔镜无缝线固定LNG-IUD。代表性病例：43岁G4P2女性，反复月经大出血，既往有2次LNG-IUD排出，子宫预处理尺寸91×82×81 mm。本视频中包含的患者同意发布视频并将视频发布到网络上，包括社交媒体、期刊网站、科学文献网站（如PubMed、ScienceDirect、Scopus）和其他适用的网站。优化的固定技术包括三个关键的手术步骤：形式结A：使用LNG-IUD预附聚乙烯尾线的滑动结，便于拆卸和重新插入。步骤2。形式结B：一个“环结”嵌入子宫底1- 2毫米的间隙（深度8毫米），旨在在狭窄的空间中扩展以增强稳定性。步骤3。操作步骤：由一名操作人员通过一个集成的连续流宫腔镜（外径5.0 mm）执行。主要观察指标：拔除率、手术时间、术中出血、取出/再插入的难易程度和技术可行性。结果由一名妇科医生在5分钟内完成固定手术，30分钟后出院。在2022年5月至2024年7月期间，共有212名患者接受了这种治疗，驱逐率为1.4%（3/212）。159例患者子宫深度≥9cm（2例），45例患者有子宫排物史（无排物）。虽然使用宫腔镜冷刀手术系统可以获得可靠的结果，但我们的手术方法有10个优点，包括学习曲线、器械/耗材需求、术前宫颈准备、分娩方式、取出/再插入难度、手术时间、术中出血、医生要求和排出率。结论优化后的LNG-IUD固定方法具有操作简单、易于掌握、器械需求少、排出率极低、通用性强等优点，可有效降低子宫腺肌症患者的排出率。在子宫内膜异位症患者的子宫内释放左炔诺孕酮（DIU-LNG），定向和减少子宫内膜异位症患者的子宫内释放左炔诺孕酮（DIU-LNG）通过子宫内膜异位症的生存能力expulsión通过子宫内生存能力clínica。DiseñoSerie de casos con vídeo de la tacimnica quirúrgica mostrando la mejora continua de la fijación histeroscópica in sutura del DIU-LNG。患者：caso代表性子宫内膜炎43 años (G4P2)，月经丰产复发，子宫内膜炎（DIU- lng），子宫内膜炎(DIU- lng)≥91 × 82 × 81 mm。这些文献包括：文献网vídeo、文献网、文献网、文献网、文献网、文献网、文献网、文献网、文献网、文献网、文献网等。， PubMed, ScienceDirect (Scopus)， así等。ExposiciónLa tsamicnica de fijación optimizizada requireres pasos quirúrgicos claves: Paso 1: confección del Nudo A: unnudo corredizo preinsertado利用率：unundo corredizo preinsertado利用率：unundo corredizo preinsertado利用率：unundo corredizo preinsertado利用率：unundo corredizo preinsertado利用率：unundo corediu - lng permitendo el retiy reinserción de manera fácil；Paso 2: confección del Nudo B: unnudo en lazo anclado en unespacio de 1-2 mm en el fondo uterino（深度为8 mm）， diseñado para expandirse en espacios estrechos para una mayor estabidad。第3部分：程序：实现连续flujo的组织学检查（diámetro外部5.0 mm）和único操作器。结果变量：estasa de expulsión，时间操作，sangrado操作内，设施管理reinserción，设施管理。结果：处理过程中，fijación se completó在5分钟内完成对único ginecólogo的处理，con la pacente siendo完成对único ginecólogo的处理，con la pacente siendo完成对único ginecólogo的处理，30分钟后完成对糖类的处理。共有212例患者在2022年5月至2024年7月间接受了este治疗，其中expulsión患者占1.4%（3/212）。宫内妊娠，159例tenían宫内妊娠深度≥9 cm（2例排出），45例tenían宫内妊娠expulsión前置（sin expulsión）。 虽然使用外科手术histeroscópico同该系统提供冷可靠的结果,我们的方法可以提供10优势,包括学习曲线,需要工具和编写涂片多方面撤回的程序本身,很难/重返社会,时间是手术,出血intraoperatorio经营者的需求率和驱逐。结论：优化的DIU-LNG固定方法有效地降低了腺瘤患者的排出率，其优点包括简单、易于掌握该技术、低仪器要求、非常低的排出率和普遍可用性。
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Pub Date : 2026-02-01Epub Date: 2025-09-02DOI: 10.1016/j.fertnstert.2025.08.032
Barbara Lawrenz M.D., Ph.D. , Sara Peralta M.D., Ph.D. , Erkan Kalafat M.D., Ph.D. , Laura Marqueta Marques M.D. , Laura Melado M.D., Ph.D. , Ibrahim ElKhatib M.Sc. , Raquel Del Gallego M.Sc., Ph.D. , Baris Ata M.D., M.Sc. , Human Fatemi M.D., Ph.D.
<div><h3>Objective</h3><div>To compare the impact of luteal-phase ovarian stimulation on embryo count, embryo ploidy, and embryo quality with that of follicular-phase stimulation.</div></div><div><h3>Design</h3><div>Retrospective cohort study between March 2017 and November 2024.</div></div><div><h3>Subjects</h3><div>Women who underwent ovarian stimulation, commenced either in the follicular or the luteal phase of the menstrual cycle.</div></div><div><h3>Exposure</h3><div>Luteal-phase ovarian stimulation</div></div><div><h3>Main Outcome Measures</h3><div>Counts of euploid embryos and embryo quality.</div></div><div><h3>Results</h3><div>The initial cohort included 3,524 follicular-phase cycles and 552 luteal-phase cycles. After 2:1 propensity score matching on age, body mass index, antimüllerian hormone, antral follicle count, origin of semen, stimulation medication used, 1,058 follicular-phase cycles were matched to 550 luteal-phase cycles. Luteal-phase stimulations required a significantly longer duration (median 11.0 vs. 10 days) and higher total gonadotropin dose (median 4,050 IU vs. 3,300 IU). Median counts of cumulus-oocyte-complexes (COCs), mature (MII) and fertilized oocytes, total-, biopsied-, and euploid blastocysts did not differ significantly between groups before regression adjustment. Multivariable regression analyses on the matched cohort showed adjusted incidence rate ratios (IRRs) for MII count (luteal-phase vs. follicular-phase) of 1.04 (95% confidence interval [CI]: 1.00–1.09), for blastocyst count 1.05 (95% CI: 0.99–1.11), and for euploid blastocyst count 1.04 (95% CI: 0.94–1.14). Embryo quality distribution did not differ significantly between follicular-phase (N = 3,831: 8.4% top, 49.5% good, 22.1% fair, and 20.0% poor) and luteal-phase (N = 2,110: 9.4% top, 51.1% good, 20.9% fair, and 18.6% poor) groups.</div><div>A total of 147 women with a luteal-phase and follicular-phase cycle within one year underwent a paired analysis. Again, luteal-phase cycles required significantly longer stimulation (median 11 vs. 10 days) and higher gonadotropin doses (median 4,050 IU vs. 3,600 IU). No statistically significant differences were found in the median number of COCs, MIIs, fertilized oocytes, total-, biopsied-, or euploid blastocysts between the paired luteal-phase and follicular-phase cycles for these women.</div></div><div><h3>Conclusion</h3><div>Ovarian stimulation initiated in the luteal phase has no detrimental impact on ploidy number or embryo quality. The key advantage of luteal-phase stimulation is an extended duration for initiating ovarian stimulation, which can be useful for couples with time constraints.</div></div><div><div>Resultados similares con distintos inicios: estimulación en fase lútea frente a fase folicular en la fecundación in vitro</div></div><div><h3>Objetivo</h3><div>Comparar el impacto de la estimulación ovárica en fase lútea frente a la estimulación en fase folicular, sobre el número de embriones, la ploid
目的比较黄体期卵巢刺激与卵泡期卵巢刺激对胚胎数量、胚胎倍性和胚胎质量的影响。2017年3月至2024年11月的回顾性队列研究。受试者：接受卵巢刺激的女性，在月经周期的卵泡期或黄体期开始。主要观察指标：整倍体胚胎计数和胚胎质量。结果初始队列包括3524个卵泡期周期和552个黄体期周期。根据年龄、BMI、AMH、AFC、精液来源、使用的刺激药物进行2:1的倾向评分匹配，1058个卵泡期周期与550个黄体期周期相匹配。黄体期刺激所需的持续时间明显更长（中位11.0 vs 10天，均p0.05）。结论黄体期卵巢刺激对倍性数和胚胎质量无不良影响。黄体期刺激的主要优点是可以延长卵巢刺激的起始时间，这对于时间限制的夫妇是有用的。
{"title":"Similar outcomes, different timings: luteal vs. follicular stimulation in in vitro fertilization","authors":"Barbara Lawrenz M.D., Ph.D. , Sara Peralta M.D., Ph.D. , Erkan Kalafat M.D., Ph.D. , Laura Marqueta Marques M.D. , Laura Melado M.D., Ph.D. , Ibrahim ElKhatib M.Sc. , Raquel Del Gallego M.Sc., Ph.D. , Baris Ata M.D., M.Sc. , Human Fatemi M.D., Ph.D.","doi":"10.1016/j.fertnstert.2025.08.032","DOIUrl":"10.1016/j.fertnstert.2025.08.032","url":null,"abstract":"<div><h3>Objective</h3><div>To compare the impact of luteal-phase ovarian stimulation on embryo count, embryo ploidy, and embryo quality with that of follicular-phase stimulation.</div></div><div><h3>Design</h3><div>Retrospective cohort study between March 2017 and November 2024.</div></div><div><h3>Subjects</h3><div>Women who underwent ovarian stimulation, commenced either in the follicular or the luteal phase of the menstrual cycle.</div></div><div><h3>Exposure</h3><div>Luteal-phase ovarian stimulation</div></div><div><h3>Main Outcome Measures</h3><div>Counts of euploid embryos and embryo quality.</div></div><div><h3>Results</h3><div>The initial cohort included 3,524 follicular-phase cycles and 552 luteal-phase cycles. After 2:1 propensity score matching on age, body mass index, antimüllerian hormone, antral follicle count, origin of semen, stimulation medication used, 1,058 follicular-phase cycles were matched to 550 luteal-phase cycles. Luteal-phase stimulations required a significantly longer duration (median 11.0 vs. 10 days) and higher total gonadotropin dose (median 4,050 IU vs. 3,300 IU). Median counts of cumulus-oocyte-complexes (COCs), mature (MII) and fertilized oocytes, total-, biopsied-, and euploid blastocysts did not differ significantly between groups before regression adjustment. Multivariable regression analyses on the matched cohort showed adjusted incidence rate ratios (IRRs) for MII count (luteal-phase vs. follicular-phase) of 1.04 (95% confidence interval [CI]: 1.00–1.09), for blastocyst count 1.05 (95% CI: 0.99–1.11), and for euploid blastocyst count 1.04 (95% CI: 0.94–1.14). Embryo quality distribution did not differ significantly between follicular-phase (N = 3,831: 8.4% top, 49.5% good, 22.1% fair, and 20.0% poor) and luteal-phase (N = 2,110: 9.4% top, 51.1% good, 20.9% fair, and 18.6% poor) groups.</div><div>A total of 147 women with a luteal-phase and follicular-phase cycle within one year underwent a paired analysis. Again, luteal-phase cycles required significantly longer stimulation (median 11 vs. 10 days) and higher gonadotropin doses (median 4,050 IU vs. 3,600 IU). No statistically significant differences were found in the median number of COCs, MIIs, fertilized oocytes, total-, biopsied-, or euploid blastocysts between the paired luteal-phase and follicular-phase cycles for these women.</div></div><div><h3>Conclusion</h3><div>Ovarian stimulation initiated in the luteal phase has no detrimental impact on ploidy number or embryo quality. The key advantage of luteal-phase stimulation is an extended duration for initiating ovarian stimulation, which can be useful for couples with time constraints.</div></div><div><div>Resultados similares con distintos inicios: estimulación en fase lútea frente a fase folicular en la fecundación in vitro</div></div><div><h3>Objetivo</h3><div>Comparar el impacto de la estimulación ovárica en fase lútea frente a la estimulación en fase folicular, sobre el número de embriones, la ploid","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":"125 2","pages":"Pages 298-307"},"PeriodicalIF":7.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144995659","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-08-26DOI: 10.1016/j.fertnstert.2025.08.025
Qian Feng M.Sc. , Wanlin Li M.P.H. , James Crispin M.D. , Salvatore Longobardi M.D. , Thomas D’Hooghe M.D. , Wentao Li M.D. , Ben W. Mol M.D.
<div><h3>Importance</h3><div>Live births are the “gold standard” for assessing infertility treatments but are less frequently reported than clinical pregnancy. Identifying approaches to interpret randomized controlled trials (RCTs) without live birth data is essential.</div></div><div><h3>Objective</h3><div>To evaluate the correlation between treatment effects and the consistency of statistical significance in conclusions drawn from live birth versus early-stage pregnancy endpoints (an umbrella term defined as biochemical, clinical, or ongoing pregnancy) in RCTs reporting both outcomes.</div></div><div><h3>Data Sources</h3><div>We systematically searched EMBASE, MEDLINE, and CENTRAL for RCTs in infertility from January 1, 2012 to August 30, 2023.</div></div><div><h3>Study Selection and synthesis</h3><div>Randomized controlled trials involving subfertile women reporting contingency tables for live birth and at least one early-stage pregnancy endpoint were eligible. Contingency tables on pregnancy or live births were manually extracted from the trial publications. We calculated Spearman’s rho for treatment effects between early-stage pregnancy endpoints and live birth and compared their statistical significance using Chi-square tests. The above analyses were then conducted in prespecified subgroups.</div></div><div><h3>Main Outcomes</h3><div>The correlation between treatment effects and the consistency of statistical significance in conclusions drawn from live birth versus early-stage pregnancy endpoints.</div></div><div><h3>Results</h3><div>Among 8,757 records, 1,281 infertility RCTs were eligible. The Spearman’s rho for treatment effects was 0.78 (95% confidence interval [CI]: 0.69–0.86, <em>P</em><.001; 169 RCTs) between biochemical pregnancy and live birth, 0.87 (95% CI: 0.83–0.90, <em>P</em><.01; 429 RCTs) between clinical pregnancy and live birth, and 0.96 (95% CI: 0.92–0.98, <em>P</em><.01; 138 RCTs) between ongoing pregnancy and live birth. Statistical significance between early-stage pregnancy endpoints and live birth was consistent in above 88% of trials. The correlation of treatment effects between clinical or ongoing pregnancy and live birth remained robust in subgroups of infertility treatments, including ovarian stimulation for medically assisted reproduction treatment.</div></div><div><h3>Conclusion and relevance</h3><div>A strong correlation was observed between clinical or ongoing pregnancy and live birth, supporting the rationale for using clinical or ongoing pregnancy data to assess treatment effectiveness when live birth data are limited or unavailable. However, the risk of intervention-related pregnancy loss must be considered during the assessment.</div></div><div><div>Consistencia de los efectos del tratamiento y de la significación estadística entre los desenlaces de embarazo en etapas tempranas y el nacido vivo en ensayos clínicos aleatorizados en infertilidad: un estudio metaepidemiológico sistemático</div></div><
重要性：活产是评估不孕症治疗的“黄金标准”，但比临床妊娠报告的频率要低。确定没有活产数据的随机对照试验（rct）的解释方法是至关重要的。目的：评估在报告两种结局的随机对照试验中，从活产和早期妊娠终点（一个总称，定义为生化、临床或持续妊娠）得出的结论中，治疗效果与统计学显著性一致性之间的相关性。数据来源：我们系统地检索了Embase、Medline和CENTRAL从2012年1月1日至2023年8月30日的不孕症rct。研究选择和综合：纳入报告活产意外表和至少一个早期妊娠终点的低生育能力妇女的随机对照试验。从试验出版物中手动提取有关妊娠或活产的应急表。我们计算了早期妊娠终点和活产之间治疗效果的Spearman’s rho，并使用卡方检验比较了它们的统计学显著性。然后在预先指定的亚组中进行上述分析。主要结局：从活产和早期妊娠终点得出的结论中，治疗效果的相关性和统计学意义的一致性。结果：8757例记录中，1281例不孕症随机对照试验符合条件。治疗效果的Spearman’s rho在生化妊娠和活产之间为0.78(95%可信区间[CI]: 0.69 ~ 0.86, P < 0.001； 169个rct)，在临床妊娠和活产之间为0.87 (95% CI: 0.83 ~ 0.90, P < 0.01； 429个rct)，在持续妊娠和活产之间为0.96 （95% CI: 0.92 ~ 0.98, P < 0.01； 138个rct）。早期妊娠终点和活产之间的统计学意义在88%以上的试验中是一致的。在不孕症治疗的亚组中，临床或持续妊娠与活产之间的治疗效果的相关性仍然很强，包括用于医学辅助生殖治疗的卵巢刺激。结论：观察到临床或持续妊娠与活产之间存在很强的相关性，支持在活产数据有限或不可获得时使用临床或持续妊娠数据来评估治疗效果的基本原理。然而，在评估过程中必须考虑干预相关的妊娠损失风险。
{"title":"Consistency in treatment effects and statistical significance between early-stage pregnancy endpoints and live birth in randomized controlled trials of infertility: a systematic meta-epidemiological study","authors":"Qian Feng M.Sc. , Wanlin Li M.P.H. , James Crispin M.D. , Salvatore Longobardi M.D. , Thomas D’Hooghe M.D. , Wentao Li M.D. , Ben W. Mol M.D.","doi":"10.1016/j.fertnstert.2025.08.025","DOIUrl":"10.1016/j.fertnstert.2025.08.025","url":null,"abstract":"<div><h3>Importance</h3><div>Live births are the “gold standard” for assessing infertility treatments but are less frequently reported than clinical pregnancy. Identifying approaches to interpret randomized controlled trials (RCTs) without live birth data is essential.</div></div><div><h3>Objective</h3><div>To evaluate the correlation between treatment effects and the consistency of statistical significance in conclusions drawn from live birth versus early-stage pregnancy endpoints (an umbrella term defined as biochemical, clinical, or ongoing pregnancy) in RCTs reporting both outcomes.</div></div><div><h3>Data Sources</h3><div>We systematically searched EMBASE, MEDLINE, and CENTRAL for RCTs in infertility from January 1, 2012 to August 30, 2023.</div></div><div><h3>Study Selection and synthesis</h3><div>Randomized controlled trials involving subfertile women reporting contingency tables for live birth and at least one early-stage pregnancy endpoint were eligible. Contingency tables on pregnancy or live births were manually extracted from the trial publications. We calculated Spearman’s rho for treatment effects between early-stage pregnancy endpoints and live birth and compared their statistical significance using Chi-square tests. The above analyses were then conducted in prespecified subgroups.</div></div><div><h3>Main Outcomes</h3><div>The correlation between treatment effects and the consistency of statistical significance in conclusions drawn from live birth versus early-stage pregnancy endpoints.</div></div><div><h3>Results</h3><div>Among 8,757 records, 1,281 infertility RCTs were eligible. The Spearman’s rho for treatment effects was 0.78 (95% confidence interval [CI]: 0.69–0.86, <em>P</em><.001; 169 RCTs) between biochemical pregnancy and live birth, 0.87 (95% CI: 0.83–0.90, <em>P</em><.01; 429 RCTs) between clinical pregnancy and live birth, and 0.96 (95% CI: 0.92–0.98, <em>P</em><.01; 138 RCTs) between ongoing pregnancy and live birth. Statistical significance between early-stage pregnancy endpoints and live birth was consistent in above 88% of trials. The correlation of treatment effects between clinical or ongoing pregnancy and live birth remained robust in subgroups of infertility treatments, including ovarian stimulation for medically assisted reproduction treatment.</div></div><div><h3>Conclusion and relevance</h3><div>A strong correlation was observed between clinical or ongoing pregnancy and live birth, supporting the rationale for using clinical or ongoing pregnancy data to assess treatment effectiveness when live birth data are limited or unavailable. However, the risk of intervention-related pregnancy loss must be considered during the assessment.</div></div><div><div>Consistencia de los efectos del tratamiento y de la significación estadística entre los desenlaces de embarazo en etapas tempranas y el nacido vivo en ensayos clínicos aleatorizados en infertilidad: un estudio metaepidemiológico sistemático</div></div><","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":"125 2","pages":"Pages 356-366"},"PeriodicalIF":7.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144947924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-08-29DOI: 10.1016/j.fertnstert.2025.08.029
Jason Bach J.D., M.B.E. , Jonathan Frumovitz B.A. , Dorit Barlevy Ph.D. , Rémy A. Furrer Ph.D. , Abigail Martinez B.A. , Ana Battaglino M.A. , Shai Carmi Ph.D. , Todd Lencz Ph.D. , Gabriel Lázaro-Muñoz Ph.D., J.D. , Stacey Pereira Ph.D.
<div><h3>Objective</h3><div>To investigate the perspectives of stakeholders on their attitudes toward potential regulation of polygenic embryo screening (PES), a new form of preimplantation genetic testing that is used to screen embryos for the genetic chances of developing medical conditions and nonmedical traits involving hundreds or thousands of genes.</div></div><div><h3>Design</h3><div>We conducted individual, semistructured interviews and analyzed transcripts using thematic analysis.</div></div><div><h3>Subjects</h3><div>Twenty-seven US-based reproductive endocrinology and infertility specialists and 26 patients who were currently undergoing in vitro fertilization or had within the past five years.</div></div><div><h3>Main Outcome Measures</h3><div>Repeating ideas and patterned responses were organized into themes and subthemes.</div></div><div><h3>Results</h3><div>Although most clinicians advocate for some form of regulation to ensure patient well-being, patients largely oppose restrictive measures, prioritizing procreative autonomy.</div></div><div><h3>Conclusion</h3><div>Our results highlight a tension between the welfarist approach favored by clinicians and the libertarian approach favored by patients, underscoring the complexity of developing governance frameworks for PES that satisfies multiple stakeholder groups. Ultimately, our findings call attention to the need for ongoing dialogue among stakeholders to address the ethical and practical implications of PES and any potential regulation of it.</div></div><div><div>Gobernanza del cribado embrionario poligénico: un estudio cualitativo sobre las perspectivas de clínicos y pacientes</div></div><div><h3>Objetivo</h3><div>Investigar las perspectivas de los distintos actores implicados respecto a sus actitudes ante una posible regulación del cribado embrionario poligénico (PES), una nueva modalidad de diagnóstico genético preimplantacional que se utiliza para evaluar en los embriones la probabilidad genética de desarrollar enfermedades médicas y rasgos no médicos, implicando cientos o miles de genes.</div></div><div><h3>Diseño</h3><div>Se realizaron entrevistas individuales semiestructuradas y los transcriptos se analizaron mediante análisis temático.</div></div><div><h3>Sujetos</h3><div>Veintisiete especialistas estadounidenses en endocrinología reproductiva y fertilidad, y 26 pacientes que estaban en tratamiento de fecundación in vitro o lo habían estado en los cinco años previos.</div></div><div><h3>Medidas principales de resultado</h3><div>Las ideas recurrentes y los patrones de respuesta se organizaron en temas y subtemas.</div></div><div><h3>Resultados</h3><div>Aunque la mayoría de los clínicos aboga por algún tipo de regulación para garantizar el bienestar del paciente, los pacientes se oponen mayoritariamente a medidas restrictivas, priorizando la autonomía reproductiva.</div></div><div><h3>Conclusión</h3><div>Nuestros resultados ponen de manifiesto una tensión entre el enfoque bie
{"title":"Governance of polygenic embryo screening: a qualitative study on the perspectives of clinicians and patients","authors":"Jason Bach J.D., M.B.E. , Jonathan Frumovitz B.A. , Dorit Barlevy Ph.D. , Rémy A. Furrer Ph.D. , Abigail Martinez B.A. , Ana Battaglino M.A. , Shai Carmi Ph.D. , Todd Lencz Ph.D. , Gabriel Lázaro-Muñoz Ph.D., J.D. , Stacey Pereira Ph.D.","doi":"10.1016/j.fertnstert.2025.08.029","DOIUrl":"10.1016/j.fertnstert.2025.08.029","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate the perspectives of stakeholders on their attitudes toward potential regulation of polygenic embryo screening (PES), a new form of preimplantation genetic testing that is used to screen embryos for the genetic chances of developing medical conditions and nonmedical traits involving hundreds or thousands of genes.</div></div><div><h3>Design</h3><div>We conducted individual, semistructured interviews and analyzed transcripts using thematic analysis.</div></div><div><h3>Subjects</h3><div>Twenty-seven US-based reproductive endocrinology and infertility specialists and 26 patients who were currently undergoing in vitro fertilization or had within the past five years.</div></div><div><h3>Main Outcome Measures</h3><div>Repeating ideas and patterned responses were organized into themes and subthemes.</div></div><div><h3>Results</h3><div>Although most clinicians advocate for some form of regulation to ensure patient well-being, patients largely oppose restrictive measures, prioritizing procreative autonomy.</div></div><div><h3>Conclusion</h3><div>Our results highlight a tension between the welfarist approach favored by clinicians and the libertarian approach favored by patients, underscoring the complexity of developing governance frameworks for PES that satisfies multiple stakeholder groups. Ultimately, our findings call attention to the need for ongoing dialogue among stakeholders to address the ethical and practical implications of PES and any potential regulation of it.</div></div><div><div>Gobernanza del cribado embrionario poligénico: un estudio cualitativo sobre las perspectivas de clínicos y pacientes</div></div><div><h3>Objetivo</h3><div>Investigar las perspectivas de los distintos actores implicados respecto a sus actitudes ante una posible regulación del cribado embrionario poligénico (PES), una nueva modalidad de diagnóstico genético preimplantacional que se utiliza para evaluar en los embriones la probabilidad genética de desarrollar enfermedades médicas y rasgos no médicos, implicando cientos o miles de genes.</div></div><div><h3>Diseño</h3><div>Se realizaron entrevistas individuales semiestructuradas y los transcriptos se analizaron mediante análisis temático.</div></div><div><h3>Sujetos</h3><div>Veintisiete especialistas estadounidenses en endocrinología reproductiva y fertilidad, y 26 pacientes que estaban en tratamiento de fecundación in vitro o lo habían estado en los cinco años previos.</div></div><div><h3>Medidas principales de resultado</h3><div>Las ideas recurrentes y los patrones de respuesta se organizaron en temas y subtemas.</div></div><div><h3>Resultados</h3><div>Aunque la mayoría de los clínicos aboga por algún tipo de regulación para garantizar el bienestar del paciente, los pacientes se oponen mayoritariamente a medidas restrictivas, priorizando la autonomía reproductiva.</div></div><div><h3>Conclusión</h3><div>Nuestros resultados ponen de manifiesto una tensión entre el enfoque bie","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":"125 2","pages":"Pages 338-347"},"PeriodicalIF":7.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144948226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-11-27DOI: 10.1016/j.fertnstert.2025.11.018
Mehmet Resit Asoglu M.D. , Gurkan Bozdag M.D.
{"title":"Reply of the authors: Comment on “Validity of completely omitting endocrine and ultrasound monitoring in hormone-replacement therapy protocols for frozen embryo transfer in good-prognosis patients undergoing single blastocyst transfer”","authors":"Mehmet Resit Asoglu M.D. , Gurkan Bozdag M.D.","doi":"10.1016/j.fertnstert.2025.11.018","DOIUrl":"10.1016/j.fertnstert.2025.11.018","url":null,"abstract":"","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":"125 2","pages":"Page 385"},"PeriodicalIF":7.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145611738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-06-18DOI: 10.1016/j.fertnstert.2025.06.012
David Duhamel Ph.D.
As global fertility has more than halved in the last 60 years and continues to decline, countries caught in the low fertility trap will struggle to achieve sustainable gross domestic product growth and face rising pension and health costs. Emerging economies, although not impacted yet, might encounter an even bigger crisis in a few decades. How inflation and real estate valuation will react to worsening demographic conditions is subject to debate. Finally, the demographic winter will upset economies around the world in many indirect ways, ranging from political, geopolitical, societal, and others.
{"title":"The economic consequences of a childless world","authors":"David Duhamel Ph.D.","doi":"10.1016/j.fertnstert.2025.06.012","DOIUrl":"10.1016/j.fertnstert.2025.06.012","url":null,"abstract":"<div><div>As global fertility has more than halved in the last 60 years and continues to decline, countries caught in the low fertility trap will struggle to achieve sustainable gross domestic product growth and face rising pension and health costs. Emerging economies, although not impacted yet, might encounter an even bigger crisis in a few decades. How inflation and real estate valuation will react to worsening demographic conditions is subject to debate. Finally, the demographic winter will upset economies around the world in many indirect ways, ranging from political, geopolitical, societal, and others.</div></div>","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":"125 2","pages":"Pages 197-202"},"PeriodicalIF":7.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144335336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-08-14DOI: 10.1016/j.fertnstert.2025.08.007
Marisol Doglioli M.D. , Antonio Raffone M.D. , Manuela Maletta M.D. , Ludovica Girardi M.D. , Daniele Neola M.D. , Maria Giovanna Vastarella M.D. , Lucia De Meis M.D. , Luigi Cobellis M.D. , Alexandro Paccapelo M.S. , Jacopo Lenzi Ph.D. , Renato Seracchioli M.D. , Diego Raimondo M.D.
<div><h3>Objective</h3><div>To investigate the prevalence of various ultrasound morphologies of rectosigmoid endometriosis (RSE) nodules according to the International Deep Endometriosis Analysis consensus, and their potential association with distinct clinical phenotypes of the disease.</div></div><div><h3>Design</h3><div>Pilot, single-center, observational, cross-sectional study on a prospectively collected database.</div></div><div><h3>Subjects</h3><div>Consecutive patients with a diagnosis of RSE at transvaginal ultrasound referred to our center from May 2022 to June 2023.</div></div><div><h3>Exposure</h3><div>During the study period, 273 eligible women were included. Demographic and clinical data were collected. Characteristics of RSE were evaluated using transvaginal ultrasound. Morphologies of RSE nodules were classified as regular profile outlines, “moose antler” sign, “comet” sign, “mushroom cup” sign, or “pulling sleeve” sign. Statistical analyses included χ<sup>2</sup> tests, Fisher’s exact tests, and Kruskal–Wallis tests, with <em>P</em> values adjusted using Sidak’s method. The significance level was set at .05.</div></div><div><h3>Main Outcome Measures</h3><div>Primary outcome was the prevalence of each ultrasound International Deep Endometriosis Analysis morphology of RSE nodules. Secondary outcomes were the associations between each ultrasound morphology and clinical characteristics, moderate-severe pain symptoms, altered bowel habits, and coexistence of other endometriosis localizations.</div></div><div><h3>Results</h3><div>Prevalence was: 35.9% for regular outline lesions, 28.2% for the “moose antler” sign, 24.2% for the “comet” sign lesions, 5.1% for the “pulling sleeve” sign, and 6.6% for the “mushroom cup” sign. Mean nodule diameters/volumes were significantly larger in the “moose antler,” “pulling sleeve,” and “mushroom cup” sign groups. Moderate-to-severe dysmenorrhea showed a significantly higher prevalence in “comet” sign (52.2%) and “moose antler” sign (50.0%) when compared with the prevalence in the regular outline group (22.2%). Compared with the 6.1% prevalence observed in the “comet” sign group, the rate of rectovaginal space involvement was significantly higher in the “mushroom cup” group (27.8%).</div></div><div><h3>Conclusion</h3><div>The regular profile was the most frequent morphology of RSE nodules, followed by “moose antler” and “comet” signs, which were associated with a higher incidence of moderate-to-severe dysmenorrhea. “Moose antler” and “pulling sleeve” signs, along with the “mushroom cup” sign, were the largest RSE nodules, with the latter showing a stronger association with rectovaginal space involvement.</div></div><div><div>Diferentes morfologías de ecografía de nódulos de endometriosis rectosigmoidea: un análisis exploratorio de su prevalencia y características clínicas asociadas</div></div><div><h3>Objetivo</h3><div>Investigar la prevalencia de diversas morfologías ultrasonográficas de nódulos de e
{"title":"Different ultrasound morphologies of rectosigmoid endometriosis nodules: an exploratory analysis of their prevalence and associated clinical characteristics","authors":"Marisol Doglioli M.D. , Antonio Raffone M.D. , Manuela Maletta M.D. , Ludovica Girardi M.D. , Daniele Neola M.D. , Maria Giovanna Vastarella M.D. , Lucia De Meis M.D. , Luigi Cobellis M.D. , Alexandro Paccapelo M.S. , Jacopo Lenzi Ph.D. , Renato Seracchioli M.D. , Diego Raimondo M.D.","doi":"10.1016/j.fertnstert.2025.08.007","DOIUrl":"10.1016/j.fertnstert.2025.08.007","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate the prevalence of various ultrasound morphologies of rectosigmoid endometriosis (RSE) nodules according to the International Deep Endometriosis Analysis consensus, and their potential association with distinct clinical phenotypes of the disease.</div></div><div><h3>Design</h3><div>Pilot, single-center, observational, cross-sectional study on a prospectively collected database.</div></div><div><h3>Subjects</h3><div>Consecutive patients with a diagnosis of RSE at transvaginal ultrasound referred to our center from May 2022 to June 2023.</div></div><div><h3>Exposure</h3><div>During the study period, 273 eligible women were included. Demographic and clinical data were collected. Characteristics of RSE were evaluated using transvaginal ultrasound. Morphologies of RSE nodules were classified as regular profile outlines, “moose antler” sign, “comet” sign, “mushroom cup” sign, or “pulling sleeve” sign. Statistical analyses included χ<sup>2</sup> tests, Fisher’s exact tests, and Kruskal–Wallis tests, with <em>P</em> values adjusted using Sidak’s method. The significance level was set at .05.</div></div><div><h3>Main Outcome Measures</h3><div>Primary outcome was the prevalence of each ultrasound International Deep Endometriosis Analysis morphology of RSE nodules. Secondary outcomes were the associations between each ultrasound morphology and clinical characteristics, moderate-severe pain symptoms, altered bowel habits, and coexistence of other endometriosis localizations.</div></div><div><h3>Results</h3><div>Prevalence was: 35.9% for regular outline lesions, 28.2% for the “moose antler” sign, 24.2% for the “comet” sign lesions, 5.1% for the “pulling sleeve” sign, and 6.6% for the “mushroom cup” sign. Mean nodule diameters/volumes were significantly larger in the “moose antler,” “pulling sleeve,” and “mushroom cup” sign groups. Moderate-to-severe dysmenorrhea showed a significantly higher prevalence in “comet” sign (52.2%) and “moose antler” sign (50.0%) when compared with the prevalence in the regular outline group (22.2%). Compared with the 6.1% prevalence observed in the “comet” sign group, the rate of rectovaginal space involvement was significantly higher in the “mushroom cup” group (27.8%).</div></div><div><h3>Conclusion</h3><div>The regular profile was the most frequent morphology of RSE nodules, followed by “moose antler” and “comet” signs, which were associated with a higher incidence of moderate-to-severe dysmenorrhea. “Moose antler” and “pulling sleeve” signs, along with the “mushroom cup” sign, were the largest RSE nodules, with the latter showing a stronger association with rectovaginal space involvement.</div></div><div><div>Diferentes morfologías de ecografía de nódulos de endometriosis rectosigmoidea: un análisis exploratorio de su prevalencia y características clínicas asociadas</div></div><div><h3>Objetivo</h3><div>Investigar la prevalencia de diversas morfologías ultrasonográficas de nódulos de e","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":"125 2","pages":"Pages 308-315"},"PeriodicalIF":7.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144860089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-02-01Epub Date: 2025-08-26DOI: 10.1016/j.fertnstert.2025.08.021
Prudhvi Thirumalaraju M.Tech. , Manoj Kumar Kanakasabapathy M.Tech. , Hemanth Kandula M.Tech. , Tinendra Kandula B.Tech. , Aditya Vardhan Reddy Katkuri B.Tech. , Cameron Cipriano M.Tech. , Jonas E. Malmsten Ph.D. , Nikica Zaninovic Ph.D. , Charles L. Bormann Ph.D. , Hadi Shafiee Ph.D.
<div><h3>Objective</h3><div>To evaluate the stability and reliability of artificial intelligence (AI) models and approaches in embryo selection and rank ordering for in vitro fertilization (IVF).</div></div><div><h3>Design</h3><div>A laboratory-based study evaluating the stability and consistency of single instance learning models that assess embryos individually, predicting live-birth outcomes based solely on each embryo's morphological features. Fifty replicate convolutional neural networks with varying initialization parameters were trained and tested across two independent fertility center datasets. Model performance was assessed through embryo rank ordering, critical error rates, and intermodel variability. Interpretability analyses using gradient-weighted class activation mapping and t-distributed stochastic neighbor embedding were conducted to explore decision-making discrepancies among replicate models.</div></div><div><h3>Subjects</h3><div>The study utilized retrospective embryo datasets from Massachusetts General Hospital and Weill Cornell Fertility Center, including images from 1,258 patients and 10,713 embryos from Massachusetts General Hospital, and 53 patients with 648 embryos from Cornell.</div></div><div><h3>Main Outcome Measures</h3><div>Consistency in embryo ranking (Kendall’s W), frequency of critical errors (instances where low-quality embryos were top-ranked), and intermodel variability across datasets.</div></div><div><h3>Results</h3><div>The AI models demonstrated poor consistency in embryo rank ordering (Kendall’s W approximately 0.35) and exhibited high critical error rates (approximately 15%), often ranking lower-quality embryos above viable ones. Significant intermodel variability was observed even among models with similar predictive accuracies (area under curve approximately 60%). When tested on data from a different fertility center, model instability increased (error variance delta: 46.07%<sup>2</sup>), highlighting sensitivity to distribution shifts. Interpretability analyses revealed divergent decision-making strategies among replicate models, despite identical architectures and training protocols.</div></div><div><h3>Conclusion</h3><div>Single instance learning AI models for IVF embryo selection exhibit substantial instability and inconsistency, undermining their clinical reliability. High intermodel variability and critical error rates raise concerns about their suitability for real-world deployment. This study highlights the need for more stable AI frameworks and robust evaluation metrics tailored to the clinical demands of IVF.</div></div><div><div>Estabilidad y fiabilidad de los modelos de inteligencia artificial en la selección de embriones para la fertilización in vitro.</div></div><div><h3>Objetivo</h3><div>Evaluar la estabilidad y fiabilidad de los modelos y enfoques de inteligencia artificial (IA) en la selección de embriones y orden de rango para la fertilización in vitro (FIV).</div></div><div><h3>Dise
目的：评价人工智能（AI）模型和方法在体外受精（IVF）胚胎选择和排序中的稳定性和可靠性。设计：一项基于实验室的研究，评估单实例学习（SIL）模型的稳定性和一致性，该模型单独评估胚胎，仅根据每个胚胎的形态特征预测活产结果。50个具有不同初始化参数的重复卷积神经网络（cnn）在两个独立的生育中心数据集上进行了训练和测试。通过胚胎排序、临界错误率和模型间变异性来评估模型的性能。利用梯度加权类激活映射（GradCAM）和t分布随机邻居嵌入（t-SNE）进行可解释性分析，探讨重复模型之间的决策差异。研究对象：本研究利用来自马萨诸塞州总医院（MGH）和威尔康奈尔生育中心的回顾性胚胎数据集，包括来自MGH的1,258名患者和10,713个胚胎的图像，以及来自康奈尔大学的53名患者和648个胚胎的图像。主要结果测量：胚胎排名的一致性（Kendall's W），关键错误的频率（低质量胚胎排名第一的情况），以及数据集的模型间变异性。结果：人工智能模型在胚胎排序方面表现出较差的一致性（Kendall’s W ~ 0.35），并且表现出较高的临界错误率（~ 15%），通常将低质量胚胎排在可活胚胎之上。即使在具有相似预测精度（AUC ~ 60%）的模型之间，也观察到显著的模式间变异。当对来自不同生育中心的数据进行测试时，模型不稳定性增加（误差方差δ: 46.07%2），突出了对分布变化的敏感性。可解释性分析显示，尽管相同的架构和训练协议，但复制模型之间的决策策略存在差异。结论：用于IVF胚胎选择的SIL AI模型存在很大的不稳定性和不一致性，影响了其临床可靠性。高模型间可变性和临界错误率引起了对它们在实际部署中的适用性的关注。这项研究强调需要更稳定的人工智能框架和针对试管婴儿临床需求的稳健评估指标。
{"title":"Stability and reliability of artificial intelligence models in embryo selection for in vitro fertilization","authors":"Prudhvi Thirumalaraju M.Tech. , Manoj Kumar Kanakasabapathy M.Tech. , Hemanth Kandula M.Tech. , Tinendra Kandula B.Tech. , Aditya Vardhan Reddy Katkuri B.Tech. , Cameron Cipriano M.Tech. , Jonas E. Malmsten Ph.D. , Nikica Zaninovic Ph.D. , Charles L. Bormann Ph.D. , Hadi Shafiee Ph.D.","doi":"10.1016/j.fertnstert.2025.08.021","DOIUrl":"10.1016/j.fertnstert.2025.08.021","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the stability and reliability of artificial intelligence (AI) models and approaches in embryo selection and rank ordering for in vitro fertilization (IVF).</div></div><div><h3>Design</h3><div>A laboratory-based study evaluating the stability and consistency of single instance learning models that assess embryos individually, predicting live-birth outcomes based solely on each embryo's morphological features. Fifty replicate convolutional neural networks with varying initialization parameters were trained and tested across two independent fertility center datasets. Model performance was assessed through embryo rank ordering, critical error rates, and intermodel variability. Interpretability analyses using gradient-weighted class activation mapping and t-distributed stochastic neighbor embedding were conducted to explore decision-making discrepancies among replicate models.</div></div><div><h3>Subjects</h3><div>The study utilized retrospective embryo datasets from Massachusetts General Hospital and Weill Cornell Fertility Center, including images from 1,258 patients and 10,713 embryos from Massachusetts General Hospital, and 53 patients with 648 embryos from Cornell.</div></div><div><h3>Main Outcome Measures</h3><div>Consistency in embryo ranking (Kendall’s W), frequency of critical errors (instances where low-quality embryos were top-ranked), and intermodel variability across datasets.</div></div><div><h3>Results</h3><div>The AI models demonstrated poor consistency in embryo rank ordering (Kendall’s W approximately 0.35) and exhibited high critical error rates (approximately 15%), often ranking lower-quality embryos above viable ones. Significant intermodel variability was observed even among models with similar predictive accuracies (area under curve approximately 60%). When tested on data from a different fertility center, model instability increased (error variance delta: 46.07%<sup>2</sup>), highlighting sensitivity to distribution shifts. Interpretability analyses revealed divergent decision-making strategies among replicate models, despite identical architectures and training protocols.</div></div><div><h3>Conclusion</h3><div>Single instance learning AI models for IVF embryo selection exhibit substantial instability and inconsistency, undermining their clinical reliability. High intermodel variability and critical error rates raise concerns about their suitability for real-world deployment. This study highlights the need for more stable AI frameworks and robust evaluation metrics tailored to the clinical demands of IVF.</div></div><div><div>Estabilidad y fiabilidad de los modelos de inteligencia artificial en la selección de embriones para la fertilización in vitro.</div></div><div><h3>Objetivo</h3><div>Evaluar la estabilidad y fiabilidad de los modelos y enfoques de inteligencia artificial (IA) en la selección de embriones y orden de rango para la fertilización in vitro (FIV).</div></div><div><h3>Dise","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":"125 2","pages":"Pages 277-286"},"PeriodicalIF":7.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144948336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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