Pub Date : 2026-02-01DOI: 10.1016/j.fertnstert.2025.11.013
Kentaro Iga M.D.
{"title":"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":"Kentaro Iga M.D.","doi":"10.1016/j.fertnstert.2025.11.013","DOIUrl":"10.1016/j.fertnstert.2025.11.013","url":null,"abstract":"","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":"125 2","pages":"Page 384"},"PeriodicalIF":7.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146098602","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 : 2026-02-01DOI: 10.1016/j.fertnstert.2025.10.038
Magdy P. Milad M.D., M.S., Mary Ellen Pavone M.D., M.S.C.I.
{"title":"Losing our edge: how the decline of surgery is reshaping the specialty of reproductive endocrinology and infertility","authors":"Magdy P. Milad M.D., M.S., Mary Ellen Pavone M.D., M.S.C.I.","doi":"10.1016/j.fertnstert.2025.10.038","DOIUrl":"10.1016/j.fertnstert.2025.10.038","url":null,"abstract":"","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":"125 2","pages":"Page 383"},"PeriodicalIF":7.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146098601","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 : 2026-02-01DOI: 10.1016/j.fertnstert.2025.08.031
Lillian X. Lindell M.D. , Sarah K. Holt Ph.D. , Erin Petersen M.S. , Navya Gunaje M.S.P.H. , Arash Amighi M.D. , Amanda Haack Ph.D. , Anthony Bui M.D. , Ryan Nasseri M.D. , Theodore Crisostomo-Wynne M.D. , Catherine J. Karr M.D., Ph.D. , Charles H. Muller Ph.D., H.C.L.D. , Thomas J. Walsh M.D. , Tristan M. Nicholson M.D., Ph.D.
<div><h3>Objective</h3><div>To examine the impact of smoke exposure on semen analysis parameters of intrauterine insemination (IUI) patients in the greater Seattle, Washington area, as wildfire becomes more prevalent. We hypothesized that wildfire smoke exposure was associated with a decline in total motile sperm count.</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Subjects</h3><div>Patients undergoing fertility treatments at the University of Washington from 2018 to 2022.</div></div><div><h3>Exposure</h3><div>Subjects were exposed to seasonal wildfire events in the fall of 2018, 2020, and 2022. Pre-exposure semen was a diagnostic fresh sample before each respective wildfire event, whereas post-exposure semen was taken at the time of IUI during the wildfire smoke exposure windows. All subjects acted as their own controls in a paired pre-post analysis.</div></div><div><h3>Main Outcome Measures</h3><div>Primary outcome measure was total motile sperm count; secondary outcome measures were semen volume, sperm concentration, total sperm count, total progressively motile sperm count, percent motile sperm, percent progressively motile sperm.</div></div><div><h3>Results</h3><div>Eighty-four subjects were identified who underwent IUI across the 2018 (n = 27), 2020 (n = 30), and 2022 (n = 27) wildfire smoke events. Median time between initial semen analysis and semen analysis for IUI was 4 months. We observed a decline in sperm concentration, total sperm count, total motile sperm count, and total progressively motile sperm count. We also observed an increase in percent progressively motile sperm. These trends did not differ across event years.</div></div><div><h3>Conclusion</h3><div>Our results are consistent with a prior small study demonstrating that wildfire smoke exposure is associated with declines in sperm quality. These findings highlight the need for further research on the effects of wildfire smoke exposure on human sperm and fertility treatments, especially as smoke exposures are expected to increase with climate change.</div></div><div><div>La exposición al humo de incendios forestales se asocia a la disminución de la concentración espermática y de la motilidad total de los espermatozoides.</div></div><div><h3>Objetivo</h3><div>Examinar el impacto de la exposición al humo en los parámetros de análisis de semen de pacientes con inseminación intrauterina (IIU) en el área metropolitana de Seattle, Washington, a medida que los incendios forestales se vuelven más frecuentes. Planteamos la hipótesis de que la exposición al humo de incendios forestales está asociada con una disminución en el recuento total de espermatozoides móviles.</div></div><div><h3>Diseño</h3><div>Estudio de cohorte retrospectivo.</div></div><div><h3>Sujetos</h3><div>Pacientes que se sometieron a tratamientos de fertilidad en la Universidad de Washington desde 2018 hasta 2022.</div></div><div><h3>Exposición</h3><div>Los sujetos estuvieron expu
{"title":"Wildfire smoke exposure is associated with decreased sperm concentration and total motile sperm count","authors":"Lillian X. Lindell M.D. , Sarah K. Holt Ph.D. , Erin Petersen M.S. , Navya Gunaje M.S.P.H. , Arash Amighi M.D. , Amanda Haack Ph.D. , Anthony Bui M.D. , Ryan Nasseri M.D. , Theodore Crisostomo-Wynne M.D. , Catherine J. Karr M.D., Ph.D. , Charles H. Muller Ph.D., H.C.L.D. , Thomas J. Walsh M.D. , Tristan M. Nicholson M.D., Ph.D.","doi":"10.1016/j.fertnstert.2025.08.031","DOIUrl":"10.1016/j.fertnstert.2025.08.031","url":null,"abstract":"<div><h3>Objective</h3><div>To examine the impact of smoke exposure on semen analysis parameters of intrauterine insemination (IUI) patients in the greater Seattle, Washington area, as wildfire becomes more prevalent. We hypothesized that wildfire smoke exposure was associated with a decline in total motile sperm count.</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Subjects</h3><div>Patients undergoing fertility treatments at the University of Washington from 2018 to 2022.</div></div><div><h3>Exposure</h3><div>Subjects were exposed to seasonal wildfire events in the fall of 2018, 2020, and 2022. Pre-exposure semen was a diagnostic fresh sample before each respective wildfire event, whereas post-exposure semen was taken at the time of IUI during the wildfire smoke exposure windows. All subjects acted as their own controls in a paired pre-post analysis.</div></div><div><h3>Main Outcome Measures</h3><div>Primary outcome measure was total motile sperm count; secondary outcome measures were semen volume, sperm concentration, total sperm count, total progressively motile sperm count, percent motile sperm, percent progressively motile sperm.</div></div><div><h3>Results</h3><div>Eighty-four subjects were identified who underwent IUI across the 2018 (n = 27), 2020 (n = 30), and 2022 (n = 27) wildfire smoke events. Median time between initial semen analysis and semen analysis for IUI was 4 months. We observed a decline in sperm concentration, total sperm count, total motile sperm count, and total progressively motile sperm count. We also observed an increase in percent progressively motile sperm. These trends did not differ across event years.</div></div><div><h3>Conclusion</h3><div>Our results are consistent with a prior small study demonstrating that wildfire smoke exposure is associated with declines in sperm quality. These findings highlight the need for further research on the effects of wildfire smoke exposure on human sperm and fertility treatments, especially as smoke exposures are expected to increase with climate change.</div></div><div><div>La exposición al humo de incendios forestales se asocia a la disminución de la concentración espermática y de la motilidad total de los espermatozoides.</div></div><div><h3>Objetivo</h3><div>Examinar el impacto de la exposición al humo en los parámetros de análisis de semen de pacientes con inseminación intrauterina (IIU) en el área metropolitana de Seattle, Washington, a medida que los incendios forestales se vuelven más frecuentes. Planteamos la hipótesis de que la exposición al humo de incendios forestales está asociada con una disminución en el recuento total de espermatozoides móviles.</div></div><div><h3>Diseño</h3><div>Estudio de cohorte retrospectivo.</div></div><div><h3>Sujetos</h3><div>Pacientes que se sometieron a tratamientos de fertilidad en la Universidad de Washington desde 2018 hasta 2022.</div></div><div><h3>Exposición</h3><div>Los sujetos estuvieron expu","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":"125 2","pages":"Pages 316-325"},"PeriodicalIF":7.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145212165","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 : 2026-02-01DOI: 10.1016/j.fertnstert.2025.11.026
Lorena Bori Ph.D., Marcos Meseguer Ph.D.
{"title":"The hidden gap in artificial intelligence for embryo selection: instability, variability, and their clinical implications","authors":"Lorena Bori Ph.D., Marcos Meseguer Ph.D.","doi":"10.1016/j.fertnstert.2025.11.026","DOIUrl":"10.1016/j.fertnstert.2025.11.026","url":null,"abstract":"","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":"125 2","pages":"Pages 267-268"},"PeriodicalIF":7.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145688999","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 : 2026-02-01DOI: 10.1016/j.fertnstert.2025.12.018
Philippe R. Koninckx MD, PhD
{"title":"What is the clinical importance of ultrasound imaging in managing deep endometriosis?","authors":"Philippe R. Koninckx MD, PhD","doi":"10.1016/j.fertnstert.2025.12.018","DOIUrl":"10.1016/j.fertnstert.2025.12.018","url":null,"abstract":"","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":"125 2","pages":"Pages 269-270"},"PeriodicalIF":7.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145822713","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 : 2026-02-01DOI: 10.1016/j.fertnstert.2025.12.001
Patients preparing to undergo therapies that pose a risk to their fertility or who are at risk of premature ovarian insufficiency should be provided prompt counseling regarding available options for fertility preservation. Fertility preservation can best be provided by comprehensive programs designed and equipped to confront the unique challenges facing these patients. This document replaces the document entitled “Fertility preservation in patients undergoing gonadotoxic therapy or gonadectomy: a committee opinion,” last published in 2019.
Preservación de Fertilidad en pacientes con indicaciones médicas: opinión del comité.
Preservación de la fertilidad en pacientes con indicaciones médicas: opinión del comité Comité de Práctica de la Sociedad Americana de Medicina Reproductiva, Sociedad Americana de Medicina Reproductiva, Washington, D.C., EE. UU. Los pacientes que van a someterse a terapias que implican un riesgo para su fertilidad o que presentan riesgo de insuficiencia ovárica prematura deben recibir asesoramiento oportuno sobre las opciones disponibles para la preservación de la fertilidad. La preservación de la fertilidad puede ofrecerse mejor mediante programas integrales diseñados y dotados específicamente para afrontar los desafíos únicos que afrontan estos pacientes. Este documento reemplaza al titulado «Preservación de la fertilidad en pacientes sometidos a tratamiento gonadotóxico o gonadectomía: opinión del comité», publicado por última vez en 2019.
{"title":"Fertility preservation in patients with medical indications: a committee opinion","authors":"","doi":"10.1016/j.fertnstert.2025.12.001","DOIUrl":"10.1016/j.fertnstert.2025.12.001","url":null,"abstract":"<div><div>Patients preparing to undergo therapies that pose a risk to their fertility or who are at risk of premature ovarian insufficiency should be provided prompt counseling regarding available options for fertility preservation. Fertility preservation can best be provided by comprehensive programs designed and equipped to confront the unique challenges facing these patients. This document replaces the document entitled “Fertility preservation in patients undergoing gonadotoxic therapy or gonadectomy: a committee opinion,” last published in 2019.</div></div><div><div>Preservación de Fertilidad en pacientes con indicaciones médicas: opinión del comité.</div><div>Preservación de la fertilidad en pacientes con indicaciones médicas: opinión del comité Comité de Práctica de la Sociedad Americana de Medicina Reproductiva, Sociedad Americana de Medicina Reproductiva, Washington, D.C., EE. UU. Los pacientes que van a someterse a terapias que implican un riesgo para su fertilidad o que presentan riesgo de insuficiencia ovárica prematura deben recibir asesoramiento oportuno sobre las opciones disponibles para la preservación de la fertilidad. La preservación de la fertilidad puede ofrecerse mejor mediante programas integrales diseñados y dotados específicamente para afrontar los desafíos únicos que afrontan estos pacientes. Este documento reemplaza al titulado «Preservación de la fertilidad en pacientes sometidos a tratamiento gonadotóxico o gonadectomía: opinión del comité», publicado por última vez en 2019.</div></div>","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":"125 2","pages":"Pages 247-259"},"PeriodicalIF":7.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145902563","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 : 2026-02-01DOI: 10.1016/j.fertnstert.2025.09.012
Dominique de Ziegler M.D., Ph.D. , Natascha Braumann M.D. , Sokteang Sean M.D. , James P. Toner M.D., Ph.D.
Decreasing birth rates are a worldwide phenomenon with potentially alarming consequences. This decline results either from women choosing not to have children or from couples ending up with a smaller family size than initially intended, a phenomenon called the fertility gap. In the latter case, delaying parenthood plays a key role in not achieving the desired reproductive objective. This review will examine age-related fertility decline, couple awareness, and factors contributing to the postponement of parenthood. We will also review potential strategies to prevent fertility gaps in couples wishing to conceive and how family values can be revived.
Efforts to assess current levels of fertility awareness and identify ways to improve this knowledge will be highlighted. We will critically evaluate measures implemented worldwide for enhancing fertility and explore their relative effectiveness on the basis of reported experience. Finally, we will analyze potential signs of fertility rebounds, some of which may already be emerging, and critically assess possible means to amplify these effects.
{"title":"The “Baby Bust”: awareness of the gap between desired and actual family size and review of practical options","authors":"Dominique de Ziegler M.D., Ph.D. , Natascha Braumann M.D. , Sokteang Sean M.D. , James P. Toner M.D., Ph.D.","doi":"10.1016/j.fertnstert.2025.09.012","DOIUrl":"10.1016/j.fertnstert.2025.09.012","url":null,"abstract":"<div><div>Decreasing birth rates are a worldwide phenomenon with potentially alarming consequences. This decline results either from women choosing not to have children or from couples ending up with a smaller family size than initially intended, a phenomenon called the fertility gap. In the latter case, delaying parenthood plays a key role in not achieving the desired reproductive objective. This review will examine age-related fertility decline, couple awareness, and factors contributing to the postponement of parenthood. We will also review potential strategies to prevent fertility gaps in couples wishing to conceive and how family values can be revived.</div><div>Efforts to assess current levels of fertility awareness and identify ways to improve this knowledge will be highlighted. We will critically evaluate measures implemented worldwide for enhancing fertility and explore their relative effectiveness on the basis of reported experience. Finally, we will analyze potential signs of fertility rebounds, some of which may already be emerging, and critically assess possible means to amplify these effects.</div></div>","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":"125 2","pages":"Pages 208-217"},"PeriodicalIF":7.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145059168","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 : 2026-02-01DOI: 10.1016/j.fertnstert.2025.11.025
Luce A. Kassi M.D., May-Tal Sauerbrun-Cutler M.D.
{"title":"Pelvic organ transposition: fertility preservation promise or premise?","authors":"Luce A. Kassi M.D., May-Tal Sauerbrun-Cutler M.D.","doi":"10.1016/j.fertnstert.2025.11.025","DOIUrl":"10.1016/j.fertnstert.2025.11.025","url":null,"abstract":"","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":"125 2","pages":"Pages 273-274"},"PeriodicalIF":7.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145689001","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。
{"title":"Progressively optimized fixation method for levonorgestrel-releasing intrauterine device","authors":"Xiao-wan Huang, Xiao-bo Zeng, Xi-shao Luo, Bei-bei Shi, Wei-ting Xia, Ru-ru Zheng","doi":"10.1016/j.fertnstert.2025.11.019","DOIUrl":"10.1016/j.fertnstert.2025.11.019","url":null,"abstract":"<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","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":"125 2","pages":"Pages 380-382"},"PeriodicalIF":7.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145613769","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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