Pub Date : 2026-03-01Epub Date: 2025-09-18DOI: 10.1016/j.fertnstert.2025.09.024
Yael Yagur M.D. , Rebecca J. Schneyer M.D. , Kacey M. Hamilton M.D. , Ogechukwu Ezike M.D. , Katharine Ciesielski M.D. , Margot Barker M.D. , Camelita Thrift M.D. , Kasey Fitzsimmons M.D. , Gabriel Levin M.D. , Raanan Meyer M.D. , Kelly N. Wright M.D. , Matthew T. Siedhoff M.D., M.S.C.R.
<div><h3>Objective</h3><div>To study the relationship between age and the phenotypic expression and surgical complexity of endometriosis using the American Association of Gynecologic Laparoscopists (AAGL) classification.</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Subjects</h3><div>Patients aged 18–51 years with pathology-confirmed stage III–IV endometriosis.</div></div><div><h3>Exposure</h3><div>We analyzed patients who underwent laparoscopic or robot-assisted endometriosis surgery between 2013 and 2023 at a quaternary care institution in the United States. Patients were stratified into 4 age groups (≤25, 25–35, 35–45, and >45 years).</div></div><div><h3>Main Outcome Measures</h3><div>The primary outcome was age-related differences in disease severity (AAGL classification), surgical complexity (AAGL levels A–D), the presence of endometrioma, and bowel endometriosis. Secondary outcomes included association with clinical presentation, imaging findings, and surgical complications.</div></div><div><h3>Results</h3><div>A total of 1,293 patients met inclusion criteria. The AAGL stage III–IV prevalence increased with age, peaking at 50.5% in the 35–45-year age group and then stabilizing at 47.0% in the >45-year age group. American Association of Gynecologic Laparoscopists surgical complexity continued to increase steadily with level C increasing from 21.1% (≤25 years) to 58.3% (>45 years). In multivariable regression, compared with patients aged <25 years, those aged 25–35, 35–45, and >45 years had significantly higher odds of AAGL stage III–IV disease (adjusted odds ratios [aORs], 2.47 [95% confidence interval {CI}, 1.35–4.49], 2.54 [95% CI, 1.40–4.61], and 2.84 [95% CI, 1.42–5.66], respectively). Surgical complexity (AAGL levels C–D) significantly increased beyond the age of 35 years, with aORs of 2.13 (95% CI, 1.22–3.72) for patients aged 35–45 years and 4.46 (95% CI, 2.32–8.59) for patients aged >45 years. The odds of having endometriomas was higher for all age groups than for the age of <25 years (aOR, 3.05 [95% CI, 1.73–5.39] for the ages of 25–35 years; aOR, 3.24 [95% CI, 1.84–5.70] for the ages of 35–45 years; and aOR, 2.58 [95% CI, 1.34–4.96] for the ages of >45 years). No significant association between age and bowel endometriosis was found.</div></div><div><h3>Conclusion</h3><div>Association of Gynecologic Laparoscopists disease stage peaks around the ages of 25–35 years and subsequently plateaus, whereas surgical complexity continues to increase beyond this age, reaching the highest odds in patients aged >45 years, likely reflecting cumulative fibrosis, adhesions, and anatomical remodeling. These findings highlight the importance of individualized, age-specific treatment approaches to reduce surgical complexity later in life. Future research should further refine these age-based management strategies.</div></div><div><div>¿Es la endometriosis una enfermedad progresiva? Exami
目的应用AAGL分型法研究子宫内膜异位症患者的年龄与表型表达及手术复杂度的关系。设计回顾性队列研究。患者年龄18-51岁，病理证实为III-IV期子宫内膜异位症。我们分析了2013年至2023年间在美国一家第四医疗机构接受腹腔镜或机器人辅助子宫内膜异位症手术的患者。患者分为4个年龄组（≤25岁，25-35岁，35-45岁，bb0 -45岁）。主要结局指标主要结局指标是疾病严重程度（AAGL分级）、手术复杂性（AAGL A-D级）、子宫内膜异位症和肠内膜异位症的年龄相关差异。次要结局包括与临床表现、影像学表现和手术并发症的关联。结果1293例患者符合纳入标准。AAGL III-IV期患病率随年龄增长而增加，35-45岁年龄组最高达50.5%，45岁年龄组稳定在47.0%。在多变量回归中，与45岁的患者相比，AAGL III-IV期疾病的发生率明显更高（调整后的优势比[aOR]分别为2.47,95% CI 1.35-4.49; 2.54, 95% CI 1.40-4.61; 2.84, 95% CI 1.42-5.66）。35岁以后，手术复杂性（AAGL Level C-D）显著增加，35-45岁的aOR为2.13 (95% CI 1.22-3.72)， 45岁以下的aOR为4.46 （95% CI 2.32-8.59）。与45岁的人相比，所有年龄组患子宫内膜异位瘤的几率都更高。年龄与肠道子宫内膜异位症之间没有明显的联系。结论：saagl疾病阶段在25-35岁左右达到顶峰，随后进入平稳期，而手术复杂性继续增加，在45岁以上的患者中达到最高，可能反映了累积纤维化、粘连和解剖重构。这些发现强调了个性化的、针对特定年龄的治疗方法对于减少生命后期手术复杂性的重要性。未来的研究应该进一步完善这些基于年龄的管理策略。
{"title":"Is endometriosis a progressive disease? Examining age-related trends in disease severity and surgical complexity","authors":"Yael Yagur M.D. , Rebecca J. Schneyer M.D. , Kacey M. Hamilton M.D. , Ogechukwu Ezike M.D. , Katharine Ciesielski M.D. , Margot Barker M.D. , Camelita Thrift M.D. , Kasey Fitzsimmons M.D. , Gabriel Levin M.D. , Raanan Meyer M.D. , Kelly N. Wright M.D. , Matthew T. Siedhoff M.D., M.S.C.R.","doi":"10.1016/j.fertnstert.2025.09.024","DOIUrl":"10.1016/j.fertnstert.2025.09.024","url":null,"abstract":"<div><h3>Objective</h3><div>To study the relationship between age and the phenotypic expression and surgical complexity of endometriosis using the American Association of Gynecologic Laparoscopists (AAGL) classification.</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Subjects</h3><div>Patients aged 18–51 years with pathology-confirmed stage III–IV endometriosis.</div></div><div><h3>Exposure</h3><div>We analyzed patients who underwent laparoscopic or robot-assisted endometriosis surgery between 2013 and 2023 at a quaternary care institution in the United States. Patients were stratified into 4 age groups (≤25, 25–35, 35–45, and >45 years).</div></div><div><h3>Main Outcome Measures</h3><div>The primary outcome was age-related differences in disease severity (AAGL classification), surgical complexity (AAGL levels A–D), the presence of endometrioma, and bowel endometriosis. Secondary outcomes included association with clinical presentation, imaging findings, and surgical complications.</div></div><div><h3>Results</h3><div>A total of 1,293 patients met inclusion criteria. The AAGL stage III–IV prevalence increased with age, peaking at 50.5% in the 35–45-year age group and then stabilizing at 47.0% in the >45-year age group. American Association of Gynecologic Laparoscopists surgical complexity continued to increase steadily with level C increasing from 21.1% (≤25 years) to 58.3% (>45 years). In multivariable regression, compared with patients aged <25 years, those aged 25–35, 35–45, and >45 years had significantly higher odds of AAGL stage III–IV disease (adjusted odds ratios [aORs], 2.47 [95% confidence interval {CI}, 1.35–4.49], 2.54 [95% CI, 1.40–4.61], and 2.84 [95% CI, 1.42–5.66], respectively). Surgical complexity (AAGL levels C–D) significantly increased beyond the age of 35 years, with aORs of 2.13 (95% CI, 1.22–3.72) for patients aged 35–45 years and 4.46 (95% CI, 2.32–8.59) for patients aged >45 years. The odds of having endometriomas was higher for all age groups than for the age of <25 years (aOR, 3.05 [95% CI, 1.73–5.39] for the ages of 25–35 years; aOR, 3.24 [95% CI, 1.84–5.70] for the ages of 35–45 years; and aOR, 2.58 [95% CI, 1.34–4.96] for the ages of >45 years). No significant association between age and bowel endometriosis was found.</div></div><div><h3>Conclusion</h3><div>Association of Gynecologic Laparoscopists disease stage peaks around the ages of 25–35 years and subsequently plateaus, whereas surgical complexity continues to increase beyond this age, reaching the highest odds in patients aged >45 years, likely reflecting cumulative fibrosis, adhesions, and anatomical remodeling. These findings highlight the importance of individualized, age-specific treatment approaches to reduce surgical complexity later in life. Future research should further refine these age-based management strategies.</div></div><div><div>¿Es la endometriosis una enfermedad progresiva? Exami","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":"125 3","pages":"Pages 477-487"},"PeriodicalIF":7.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145093550","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 : 2026-03-01Epub Date: 2025-10-01DOI: 10.1016/j.fertnstert.2025.09.035
Andreu Quintana-Vehí M.Sc. , Irene Miguel-Escalada Ph.D. , Debora Scaraboto M.Sc. , Filippo Zambelli Ph.D. , Daniel Mataró M.D., Ph.D. , Maria José Zamora M.Sc. , Maria Oliver-Bonet Ph.D. , Aïda Pujol Ph.D. , Amelia Rodriguez-Aranda M.D., Ph.D. , Mina Popovic Ph.D.
<div><h3>Objective</h3><div>To evaluate the impact of male body mass index (BMI) on preimplantation development and clinical outcomes in oocyte donation cycles.</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Subjects</h3><div>A total of 7,846 embryos from 1,398 oocyte donation intracytoplasmic sperm injection cycles were analyzed. Cycles utilized fresh (n = 904) or cryopreserved (n = 494), partner (n = 1,133) or donor sperm (n = 265). Cycles involving severe male factor or preimplantation genetic testing were excluded.</div></div><div><h3>Exposure</h3><div>Male BMI (kg/m<sup>2</sup>) at cycle start, categorized as normal weight (BMI<24.9, n = 699), overweight (BMI = 25.0–29.9, n = 561), or obese (BMI≥30, n = 138).</div></div><div><h3>Main Outcome Measures</h3><div>The primary outcome focused on the timing of preimplantation developmental milestones assessed through morphokinetics. Secondary outcomes included embryo quality, fertilization, blastocyst, implantation, miscarriage, and live birth rates. Outcomes of the first fresh (n = 1,110) or frozen (n = 106), cleavage (n = 366) or blastocyst stage (n = 850) transfer were included, comprising 1,001 single and 215 double embryo transfers. Univariate analyses and logistic regression were used to evaluate associations between BMI, embryo morphokinetics, and clinical outcomes.</div></div><div><h3>Results</h3><div>Embryos from obese males showed delayed cleavage-stage development (t2, t3, t4, and t5) and reduced odds of a good-quality inner cell mass in blastocysts, compared with those from normal weight males (odds ratio = 0.80; 95% confidence interval = 0.64–0.99). Fertilization (normal weight: 75.1%, overweight: 74.6%, obese: 73.1%) and blastocyst rates (normal weight: 65.1%, overweight: 63.6%, obese: 63.8%) were comparable among the BMI groups. Implantation (normal weight: 64.8%, overweight: 64.3%, obese: 58.7%) and clinical pregnancy rates (normal weight: 60.0%, overweight: 58.9%, obese: 52.9%) were also similar. However, miscarriage rates were significantly higher among couples with obese males (13.5%) compared with those with normal weight males (9.5%) (odds ratio = 1.67; 95% confidence interval = 1.27–2.19). Although not statistically significant, live birth rates followed a similar trend (normal weight: 46.7%, overweight: 43.7%, obese: 36.5%).</div></div><div><h3>Conclusion</h3><div>Male obesity impairs early embryonic development and increases miscarriage rates, identifying male BMI as a potential risk factor in oocyte donation cycles.</div></div><div><div>La obesidad masculina afecta tempranamente el desarrollo embrionario y aumenta el riesgo de aborto espontáneo en ciclos de ovodonación</div></div><div><h3>Objetivo</h3><div>Evaluar el impacto del índice de masa corporal (IMC) masculino en el desarrollo preimplantacional y los resultados clínicos en ciclos de donación de ovocitos.</div></div><div><h3>Diseño</h3><div>Estudio de cohorte retrospectivo.</di
目的探讨男性体重指数（BMI）对卵母细胞捐献周期植入前发育及临床结局的影响。设计回顾性队列研究。对1398个卵母细胞捐赠ICSI周期的7846个胚胎进行了分析。周期使用新鲜精子（n = 904）或冷冻精子（n = 494），伴侣精子（n = 1133）或供体精子（n = 265）。包括严重男性因素或植入前基因检测的周期被排除在外。周期开始时男性体重指数（BMI, kg/m2），分为正常体重（BMI < 24.9, n = 699）、超重（BMI = 25.0-29.9, n = 561）或肥胖（BMI≥30,n = 138）。主要结局指标主要结局集中于通过形态动力学评估的着床前发育里程碑的时间。次要结局包括胚胎质量、受精、囊胚、着床、流产和活产率。包括首次新鲜（n = 1136）或冷冻（n = 200）、卵裂（n = 422）或囊胚期（n = 914）移植的结果，包括1097例单胚胎移植和239例双胚胎移植。采用单因素分析和逻辑回归来评估BMI、胚胎形态动力学和临床结果之间的关系。结果与体重正常的男性相比，肥胖男性的胚胎表现为卵裂期发育（t2、t3、t4和t5）延迟，囊胚形成优质内细胞团的几率降低（OR = 0.80; 95% CI = 0.64-0.99; p = 0.04）。BMI组受精率（正常体重：75.1%，超重：74.6%，肥胖：73.1%）和囊胚率（正常体重：65.1%，超重：63.6%，肥胖：63.8%）具有可比性。着床率（正常体重：64.8%，超重：64.3%，肥胖：58.7%）和临床妊娠率（正常体重：60.0%，超重：58.9%，肥胖：52.9%）也相似。然而，男性肥胖夫妇的流产率（13.5%）明显高于男性正常体重夫妇（9.5%）（OR = 1.67; 95% CI = 1.27-2.19; p = 0.0002）。虽然没有统计学意义，但活产率也有类似的趋势（正常体重：46.7%，超重：43.7%，肥胖：36.5%）。结论男性肥胖损害早期胚胎发育，增加流产率，男性BMI是卵母细胞捐献周期的潜在危险因素。
{"title":"Male obesity impairs early embryonic development and increases miscarriage risk in oocyte donation cycles","authors":"Andreu Quintana-Vehí M.Sc. , Irene Miguel-Escalada Ph.D. , Debora Scaraboto M.Sc. , Filippo Zambelli Ph.D. , Daniel Mataró M.D., Ph.D. , Maria José Zamora M.Sc. , Maria Oliver-Bonet Ph.D. , Aïda Pujol Ph.D. , Amelia Rodriguez-Aranda M.D., Ph.D. , Mina Popovic Ph.D.","doi":"10.1016/j.fertnstert.2025.09.035","DOIUrl":"10.1016/j.fertnstert.2025.09.035","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the impact of male body mass index (BMI) on preimplantation development and clinical outcomes in oocyte donation cycles.</div></div><div><h3>Design</h3><div>Retrospective cohort study.</div></div><div><h3>Subjects</h3><div>A total of 7,846 embryos from 1,398 oocyte donation intracytoplasmic sperm injection cycles were analyzed. Cycles utilized fresh (n = 904) or cryopreserved (n = 494), partner (n = 1,133) or donor sperm (n = 265). Cycles involving severe male factor or preimplantation genetic testing were excluded.</div></div><div><h3>Exposure</h3><div>Male BMI (kg/m<sup>2</sup>) at cycle start, categorized as normal weight (BMI<24.9, n = 699), overweight (BMI = 25.0–29.9, n = 561), or obese (BMI≥30, n = 138).</div></div><div><h3>Main Outcome Measures</h3><div>The primary outcome focused on the timing of preimplantation developmental milestones assessed through morphokinetics. Secondary outcomes included embryo quality, fertilization, blastocyst, implantation, miscarriage, and live birth rates. Outcomes of the first fresh (n = 1,110) or frozen (n = 106), cleavage (n = 366) or blastocyst stage (n = 850) transfer were included, comprising 1,001 single and 215 double embryo transfers. Univariate analyses and logistic regression were used to evaluate associations between BMI, embryo morphokinetics, and clinical outcomes.</div></div><div><h3>Results</h3><div>Embryos from obese males showed delayed cleavage-stage development (t2, t3, t4, and t5) and reduced odds of a good-quality inner cell mass in blastocysts, compared with those from normal weight males (odds ratio = 0.80; 95% confidence interval = 0.64–0.99). Fertilization (normal weight: 75.1%, overweight: 74.6%, obese: 73.1%) and blastocyst rates (normal weight: 65.1%, overweight: 63.6%, obese: 63.8%) were comparable among the BMI groups. Implantation (normal weight: 64.8%, overweight: 64.3%, obese: 58.7%) and clinical pregnancy rates (normal weight: 60.0%, overweight: 58.9%, obese: 52.9%) were also similar. However, miscarriage rates were significantly higher among couples with obese males (13.5%) compared with those with normal weight males (9.5%) (odds ratio = 1.67; 95% confidence interval = 1.27–2.19). Although not statistically significant, live birth rates followed a similar trend (normal weight: 46.7%, overweight: 43.7%, obese: 36.5%).</div></div><div><h3>Conclusion</h3><div>Male obesity impairs early embryonic development and increases miscarriage rates, identifying male BMI as a potential risk factor in oocyte donation cycles.</div></div><div><div>La obesidad masculina afecta tempranamente el desarrollo embrionario y aumenta el riesgo de aborto espontáneo en ciclos de ovodonación</div></div><div><h3>Objetivo</h3><div>Evaluar el impacto del índice de masa corporal (IMC) masculino en el desarrollo preimplantacional y los resultados clínicos en ciclos de donación de ovocitos.</div></div><div><h3>Diseño</h3><div>Estudio de cohorte retrospectivo.</di","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":"125 3","pages":"Pages 432-443"},"PeriodicalIF":7.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145215570","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 : 2026-03-01Epub Date: 2025-10-10DOI: 10.1016/j.fertnstert.2025.10.008
Dong-Yun Lee M.D., Ph.D., Sung Eun Kim M.D., DooSeok Choi M.D., Ph.D.
{"title":"Effect of tamoxifen on the size of existing leiomyomas in postmenopausal women with breast cancer","authors":"Dong-Yun Lee M.D., Ph.D., Sung Eun Kim M.D., DooSeok Choi M.D., Ph.D.","doi":"10.1016/j.fertnstert.2025.10.008","DOIUrl":"10.1016/j.fertnstert.2025.10.008","url":null,"abstract":"","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":"125 3","pages":"Pages 533-535"},"PeriodicalIF":7.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145277304","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 : 2026-03-01Epub Date: 2025-12-17DOI: 10.1016/j.fertnstert.2025.12.012
José Bellver
{"title":"Beyond female body mass index to predict in vitro fertilization outcomes","authors":"José Bellver","doi":"10.1016/j.fertnstert.2025.12.012","DOIUrl":"10.1016/j.fertnstert.2025.12.012","url":null,"abstract":"","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":"125 3","pages":"Pages 421-422"},"PeriodicalIF":7.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145784561","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 : 2026-03-01Epub Date: 2025-12-29DOI: 10.1016/j.fertnstert.2025.12.020
Allison A. Eubanks M.D. , Kara N. Goldman M.D. , Elnur Babayev M.D., M.Sc. , Francesca E. Duncan Ph.D. , Eric Widra M.D.
Ovarian aging is a fundamental biological constraint on female fertility, driven by depletion of the primordial follicle pool and progressive alterations in the ovarian microenvironment. In recent years, a range of intraovarian interventions aimed at modifying ovarian aging, including platelet-rich plasma, autologous stem cell-based approaches, and mitochondrial transfer, have gained clinical and commercial attention. These strategies are supported by biologic hypotheses and early changes in surrogate markers such as antimüllerian hormone and antral follicle count, yet their clinical significance remains uncertain.
This Views and Reviews critically evaluates the evidence supporting these interventions, emphasizing the distinction between transient follicular activation and true modification of reproductive aging. Clinical data are integrated with emerging mechanistic insights from aging biology, including nutrient-sensing pathways, partial epigenetic reprogramming, and ovarian fibrosis as a modifiable determinant of ovarian function. Across modalities, improvements in surrogate outcomes have not reliably translated into gains in embryo competence, euploidy, or live birth, and safety data remain limited, with procedural and infectious risks that warrant careful consideration.
We conclude that routine clinical use of intraovarian aging-targeted interventions is premature. Future progress will require standardized protocols, adequately powered randomized trials with live birth endpoints, and rigorous assessment of both efficacy and risk.
{"title":"Influencing ovarian aging in reproductive medicine: promise, evidence, and unresolved questions","authors":"Allison A. Eubanks M.D. , Kara N. Goldman M.D. , Elnur Babayev M.D., M.Sc. , Francesca E. Duncan Ph.D. , Eric Widra M.D.","doi":"10.1016/j.fertnstert.2025.12.020","DOIUrl":"10.1016/j.fertnstert.2025.12.020","url":null,"abstract":"<div><div>Ovarian aging is a fundamental biological constraint on female fertility, driven by depletion of the primordial follicle pool and progressive alterations in the ovarian microenvironment. In recent years, a range of intraovarian interventions aimed at modifying ovarian aging, including platelet-rich plasma, autologous stem cell-based approaches, and mitochondrial transfer, have gained clinical and commercial attention. These strategies are supported by biologic hypotheses and early changes in surrogate markers such as antimüllerian hormone and antral follicle count, yet their clinical significance remains uncertain.</div><div>This Views and Reviews critically evaluates the evidence supporting these interventions, emphasizing the distinction between transient follicular activation and true modification of reproductive aging. Clinical data are integrated with emerging mechanistic insights from aging biology, including nutrient-sensing pathways, partial epigenetic reprogramming, and ovarian fibrosis as a modifiable determinant of ovarian function. Across modalities, improvements in surrogate outcomes have not reliably translated into gains in embryo competence, euploidy, or live birth, and safety data remain limited, with procedural and infectious risks that warrant careful consideration.</div><div>We conclude that routine clinical use of intraovarian aging-targeted interventions is premature. Future progress will require standardized protocols, adequately powered randomized trials with live birth endpoints, and rigorous assessment of both efficacy and risk.</div></div>","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":"125 3","pages":"Pages 387-398"},"PeriodicalIF":7.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145877432","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 investigate the impact of objectively measured physical activity and stress on programmed hormone replacement therapy (HRT) frozen embryo transfer (FET) outcomes.</div></div><div><h3>Design</h3><div>Observational cohort study</div></div><div><h3>Subjects</h3><div>Patients undergoing standard HRT FET at a single academic center.</div></div><div><h3>Exposure</h3><div>Average daily step counts before and after FET as measured by the FitBit Charge 5 wearable activity tracker.</div></div><div><h3>Main Outcome Measures</h3><div>This longitudinal study involved 82 women undergoing a programmed HRT FET. Each participant wore a FitBit Charge 5 health tracker for the duration of their FET cycle. Variables tracked included daily average steps, activity zone minutes, daily calories burned, heart rate, and sleep duration. Participants were also asked to complete the fertility problem inventory at the start of their cycle to measure infertility-related perceived stress. Lastly, 6 salivary cortisol samples were obtained at three time points 2 days before embryo transfer. We then divided patients into 2 groups by those who conceived a pregnancy from the FET (n = 51) vs. those who did not (N = 31). We compared FitBit variables and cortisol levels using Student's <em>t</em>-tests and Poisson regression analysis.</div></div><div><h3>Results</h3><div>On average, approximately 40 days of continuous health data were collected from subjects. When comparing those who conceived a pregnancy vs. those who did not, there were no differences in average daily steps for the full study period, nor before or after embryo transfer. Activity zone minutes, daily heart rate, daily calories burned, and sleep duration did not differ between the two groups before and after embryo transfer. There was no difference in awakening cortisol, 30-minute post awaking cortisol, bedtime cortisol, or average cortisol awakening response between the two groups. Perceived stress measured by the fertility problem inventory was largely the same when comparing the 2 groups.</div></div><div><h3>Conclusion</h3><div>In one of the first studies using wearable health trackers to examine in vitro fertilization outcomes, physical activity and stress did not influence the pregnancy rate in programmed HRT FET cycles.</div></div><div><div>El impacto de la actividad física y el estrés en los ciclos de transferencia de embriones congelados: el ensayo SSTEP (seguimiento de pasos y estrés para estimar el embarazo)</div></div><div><h3>Objetivo</h3><div>Investigar el impacto de la actividad física y el estrés medidos de forma objetiva en los resultados de transferencias de embriones congelados (FET) programados con terapia de reemplazo hormonal (HRT).</div></div><div><h3>Diseño</h3><div>Estudio de cohorte observacional.</div></div><div><h3>Sujetos</h3><div>Pacientes sometidas a FET con HRT estándar en un único centro académico.</div></div><div><h3>Exposición</h3><div>Promedio diario de pa
{"title":"The impact of physical activity and stress on frozen embryo transfer cycles: the step and stress tracking to estimate pregnancy (SSTEP) trial","authors":"Emily Jacobs M.D. , Karen Summers M.P.H., C.H.E.S. , Brad Van Voorhis M.D.","doi":"10.1016/j.fertnstert.2025.08.039","DOIUrl":"10.1016/j.fertnstert.2025.08.039","url":null,"abstract":"<div><h3>Objective</h3><div>To investigate the impact of objectively measured physical activity and stress on programmed hormone replacement therapy (HRT) frozen embryo transfer (FET) outcomes.</div></div><div><h3>Design</h3><div>Observational cohort study</div></div><div><h3>Subjects</h3><div>Patients undergoing standard HRT FET at a single academic center.</div></div><div><h3>Exposure</h3><div>Average daily step counts before and after FET as measured by the FitBit Charge 5 wearable activity tracker.</div></div><div><h3>Main Outcome Measures</h3><div>This longitudinal study involved 82 women undergoing a programmed HRT FET. Each participant wore a FitBit Charge 5 health tracker for the duration of their FET cycle. Variables tracked included daily average steps, activity zone minutes, daily calories burned, heart rate, and sleep duration. Participants were also asked to complete the fertility problem inventory at the start of their cycle to measure infertility-related perceived stress. Lastly, 6 salivary cortisol samples were obtained at three time points 2 days before embryo transfer. We then divided patients into 2 groups by those who conceived a pregnancy from the FET (n = 51) vs. those who did not (N = 31). We compared FitBit variables and cortisol levels using Student's <em>t</em>-tests and Poisson regression analysis.</div></div><div><h3>Results</h3><div>On average, approximately 40 days of continuous health data were collected from subjects. When comparing those who conceived a pregnancy vs. those who did not, there were no differences in average daily steps for the full study period, nor before or after embryo transfer. Activity zone minutes, daily heart rate, daily calories burned, and sleep duration did not differ between the two groups before and after embryo transfer. There was no difference in awakening cortisol, 30-minute post awaking cortisol, bedtime cortisol, or average cortisol awakening response between the two groups. Perceived stress measured by the fertility problem inventory was largely the same when comparing the 2 groups.</div></div><div><h3>Conclusion</h3><div>In one of the first studies using wearable health trackers to examine in vitro fertilization outcomes, physical activity and stress did not influence the pregnancy rate in programmed HRT FET cycles.</div></div><div><div>El impacto de la actividad física y el estrés en los ciclos de transferencia de embriones congelados: el ensayo SSTEP (seguimiento de pasos y estrés para estimar el embarazo)</div></div><div><h3>Objetivo</h3><div>Investigar el impacto de la actividad física y el estrés medidos de forma objetiva en los resultados de transferencias de embriones congelados (FET) programados con terapia de reemplazo hormonal (HRT).</div></div><div><h3>Diseño</h3><div>Estudio de cohorte observacional.</div></div><div><h3>Sujetos</h3><div>Pacientes sometidas a FET con HRT estándar en un único centro académico.</div></div><div><h3>Exposición</h3><div>Promedio diario de pa","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":"125 3","pages":"Pages 401-410"},"PeriodicalIF":7.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008732","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 : 2026-03-01Epub Date: 2025-09-16DOI: 10.1016/j.fertnstert.2025.09.016
Valeria Donno M.D. , Ana Raquel Neves M.D., Ph.D. , Sandra García-Martinez B.Sc. , Ignacio Rodriguez M.Sc. , Nikolaos P. Polyzos M.D., Ph.D.
<div><h3>Objective</h3><div>The study aimed to compare the efficacy, in terms of mature oocytes, of dual trigger vs. agonist alone in good-prognosis patients undergoing elective fertility preservation.</div></div><div><h3>Design</h3><div>Randomized, controlled, single-center, superiority clinical trial.</div></div><div><h3>Subjects</h3><div>A total of 109 women were enrolled in this study between October 2021 and April 2023 with a 1:1 allocation. Eligible patients were ≤40 years old, with an antral follicular count of <20 and antimüllerian hormone level of ≤3 ng/mL undergoing elective fertility preservation cycles.</div></div><div><h3>Intervention</h3><div>Controlled ovarian stimulation was performed using 225–300 IU/d of follitropin α or β or 15–20 μg of follitropin δ, tailored to ovarian reserve and weight. Luteinizing hormone surge was suppressed through a progestin-primed ovarian stimulation protocol, with oral administration of micronized progesterone (200 mg daily) from the beginning of ovarian stimulation until the trigger day. As soon as at least three follicles measuring ≥18 mm were observed by ultrasound, patients were randomization to the intervention group (triptorelin 0.2 mg + recombinant human chorionic gonadotropin 250 mcg) or the control group trigger with gonadotropin-releasing hormone agonist (GnRH-a) alone (triptorelin 0.2 mg).</div></div><div><h3>Main Outcome Measures</h3><div>The primary endpoint was the number of metaphase II (MII) oocytes retrieved after final oocyte maturation with dual trigger and GnRH-a trigger in patients undergoing elective fertility preservation.</div></div><div><h3>Results</h3><div>Overall, 109 patients were analyzed, 55 in the dual trigger group and 54 in the control arm (GnRH-a). No statistically significant differences were found regarding the total number of oocytes nor MII oocytes retrieved between the dual trigger and GnRH-a groups (9.22 ± 5.11 vs. 9.56 ± 5.16 [estimated mean difference, −0.34 {95% confidence interval, −2.29 to 1.61}] and 7.31 ± 4.63 vs. 7.94 ± 4.39 group [estimated mean difference, −0.64 {95% confidence interval, −2.07 to 0.80}], respectively). Likewise, no statistically significant differences were found regarding estradiol, progesterone, luteinizing hormone, and follicle-stimulating hormone levels on the day after the trigger. Notably, neither group exhibited any case of ovarian hyperstimulation syndrome.</div></div><div><h3>Conclusion</h3><div>In patients undergoing fertility preservation, adding human chorionic gonadotropin to GnRH-a for triggering final oocyte maturation is not superior to the administration of GnRH-a alone in terms of MII oocytes. Therefore, the selection of the trigger method should be based on both patients’ and clinicians’ preferences, with a focus on patients’ safety and convenience.</div></div><div><div>Inducción de ovulación dual vs. inducción de ovulación con agonista de la hormona liberadora de gonadotropinas para la preservación electiva de l
{"title":"Dual trigger vs. gonadotropin-releasing hormone agonist trigger for elective fertility preservation: a randomized controlled trial","authors":"Valeria Donno M.D. , Ana Raquel Neves M.D., Ph.D. , Sandra García-Martinez B.Sc. , Ignacio Rodriguez M.Sc. , Nikolaos P. Polyzos M.D., Ph.D.","doi":"10.1016/j.fertnstert.2025.09.016","DOIUrl":"10.1016/j.fertnstert.2025.09.016","url":null,"abstract":"<div><h3>Objective</h3><div>The study aimed to compare the efficacy, in terms of mature oocytes, of dual trigger vs. agonist alone in good-prognosis patients undergoing elective fertility preservation.</div></div><div><h3>Design</h3><div>Randomized, controlled, single-center, superiority clinical trial.</div></div><div><h3>Subjects</h3><div>A total of 109 women were enrolled in this study between October 2021 and April 2023 with a 1:1 allocation. Eligible patients were ≤40 years old, with an antral follicular count of <20 and antimüllerian hormone level of ≤3 ng/mL undergoing elective fertility preservation cycles.</div></div><div><h3>Intervention</h3><div>Controlled ovarian stimulation was performed using 225–300 IU/d of follitropin α or β or 15–20 μg of follitropin δ, tailored to ovarian reserve and weight. Luteinizing hormone surge was suppressed through a progestin-primed ovarian stimulation protocol, with oral administration of micronized progesterone (200 mg daily) from the beginning of ovarian stimulation until the trigger day. As soon as at least three follicles measuring ≥18 mm were observed by ultrasound, patients were randomization to the intervention group (triptorelin 0.2 mg + recombinant human chorionic gonadotropin 250 mcg) or the control group trigger with gonadotropin-releasing hormone agonist (GnRH-a) alone (triptorelin 0.2 mg).</div></div><div><h3>Main Outcome Measures</h3><div>The primary endpoint was the number of metaphase II (MII) oocytes retrieved after final oocyte maturation with dual trigger and GnRH-a trigger in patients undergoing elective fertility preservation.</div></div><div><h3>Results</h3><div>Overall, 109 patients were analyzed, 55 in the dual trigger group and 54 in the control arm (GnRH-a). No statistically significant differences were found regarding the total number of oocytes nor MII oocytes retrieved between the dual trigger and GnRH-a groups (9.22 ± 5.11 vs. 9.56 ± 5.16 [estimated mean difference, −0.34 {95% confidence interval, −2.29 to 1.61}] and 7.31 ± 4.63 vs. 7.94 ± 4.39 group [estimated mean difference, −0.64 {95% confidence interval, −2.07 to 0.80}], respectively). Likewise, no statistically significant differences were found regarding estradiol, progesterone, luteinizing hormone, and follicle-stimulating hormone levels on the day after the trigger. Notably, neither group exhibited any case of ovarian hyperstimulation syndrome.</div></div><div><h3>Conclusion</h3><div>In patients undergoing fertility preservation, adding human chorionic gonadotropin to GnRH-a for triggering final oocyte maturation is not superior to the administration of GnRH-a alone in terms of MII oocytes. Therefore, the selection of the trigger method should be based on both patients’ and clinicians’ preferences, with a focus on patients’ safety and convenience.</div></div><div><div>Inducción de ovulación dual vs. inducción de ovulación con agonista de la hormona liberadora de gonadotropinas para la preservación electiva de l","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":"125 3","pages":"Pages 488-495"},"PeriodicalIF":7.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145083301","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 : 2026-03-01Epub Date: 2025-09-27DOI: 10.1016/j.fertnstert.2025.09.032
Tara Ajith M.B.B.S. (Hons) , Kurt T. Barnhart M.D. , Ruth Bender Atik B.A. (Hons) , Tom Bourne Ph.D. , Krystle Chong M.B.B.S. (Hons) , George Condous M.D. , Pamela I. Causa Andrieu M.D. , Grigorios Derdelis Ph.D. , Andrew W. Horne Ph.D. , Judith A.F. Huirne Ph.D. , Davor Jurkovic Ph.D. , Emma Kirk M.D. , Ernest H.Y. Ng M.D. , Ricardo F. Savaris Ph.D. , Janneke van’t Hooft Ph.D. , Madelon van Wely Ph.D. , Liesl de Waard M.M.E.D. , Maria P. Velez Ph.D. , Jian Zhang Ph.D. , James M.N. Duffy D.Phil. , Ben W. Mol Ph.D.
<div><h3>Objective</h3><div>To determine the future priorities for ectopic pregnancy research.</div></div><div><h3>Design</h3><div>Potential research questions were collated from an initial international survey, a systematic review of clinical practice guidelines, and Cochrane systematic reviews. A rationalized list of confirmed research uncertainties was prioritized in an interim international survey. Prioritized research uncertainties were discussed during a consensus development meeting. Using a formal consensus development method, the modified nominal group technique, diverse stakeholders identified the top 10 research priorities for future ectopic pregnancy research.</div></div><div><h3>Subjects</h3><div>Healthcare professionals, people with lived experience of ectopic pregnancy, and others were brought together in an open and transparent process using formal consensus methods advocated by the James Lind Alliance.</div></div><div><h3>Exposure</h3><div>Not applicable.</div></div><div><h3>Main Outcome Measures</h3><div>Top 10 research priorities for ectopic pregnancy.</div></div><div><h3>Results</h3><div>The initial survey was completed by 855 participants from 35 countries, and 1,220 potential research questions were submitted. Three clinical practice guidelines and 43 Cochrane systematic reviews identified a further 24 potential research questions. A rationalized list of 49 confirmed research uncertainties was entered into an interim prioritization survey completed by 413 respondents from 20 countries. The top 10 research priorities were identified during a consensus development meeting involving 37 participants from 10 countries. These research priorities are diverse and seek answers to questions regarding prevention, treatment, and the longer-term impact of ectopic pregnancy.</div></div><div><h3>Conclusion</h3><div>We anticipate that the identified research priorities, developed to specifically highlight the most pressing clinical needs as perceived by healthcare professionals, people with lived experience of ectopic pregnancy, and others, will help research funding organizations and researchers to develop their future research agenda.</div></div><div><div>Las 10 prioridades de la investigación futura sobre el embarazo ectópico: desarrollo de un estudio internacional de consenso</div></div><div><h3>Objetivo</h3><div>Determinar las prioridades futuras de la investigación sobre el embarazo ectópico.</div></div><div><h3>Diseño</h3><div>Se recopilaron posibles questiones de investigación a partir de una encuesta internacional inicial, una revisión sistemática de guías de práctica clínica y revisiones sistemáticas Cochrane. Una lista depurada sobre incertidumbres investigadas fue priorizada mediante una encuesta intermedia internacional. En una reunión de desarrollo de consenso fueron discutidas las incertidumbres prioritarias de investigación. Utilizando un método formal de desarrollo de consenso, la técnica nominal de grupo modificada, divers
{"title":"Top 10 priorities for future ectopic pregnancy research: an international consensus development study","authors":"Tara Ajith M.B.B.S. (Hons) , Kurt T. Barnhart M.D. , Ruth Bender Atik B.A. (Hons) , Tom Bourne Ph.D. , Krystle Chong M.B.B.S. (Hons) , George Condous M.D. , Pamela I. Causa Andrieu M.D. , Grigorios Derdelis Ph.D. , Andrew W. Horne Ph.D. , Judith A.F. Huirne Ph.D. , Davor Jurkovic Ph.D. , Emma Kirk M.D. , Ernest H.Y. Ng M.D. , Ricardo F. Savaris Ph.D. , Janneke van’t Hooft Ph.D. , Madelon van Wely Ph.D. , Liesl de Waard M.M.E.D. , Maria P. Velez Ph.D. , Jian Zhang Ph.D. , James M.N. Duffy D.Phil. , Ben W. Mol Ph.D.","doi":"10.1016/j.fertnstert.2025.09.032","DOIUrl":"10.1016/j.fertnstert.2025.09.032","url":null,"abstract":"<div><h3>Objective</h3><div>To determine the future priorities for ectopic pregnancy research.</div></div><div><h3>Design</h3><div>Potential research questions were collated from an initial international survey, a systematic review of clinical practice guidelines, and Cochrane systematic reviews. A rationalized list of confirmed research uncertainties was prioritized in an interim international survey. Prioritized research uncertainties were discussed during a consensus development meeting. Using a formal consensus development method, the modified nominal group technique, diverse stakeholders identified the top 10 research priorities for future ectopic pregnancy research.</div></div><div><h3>Subjects</h3><div>Healthcare professionals, people with lived experience of ectopic pregnancy, and others were brought together in an open and transparent process using formal consensus methods advocated by the James Lind Alliance.</div></div><div><h3>Exposure</h3><div>Not applicable.</div></div><div><h3>Main Outcome Measures</h3><div>Top 10 research priorities for ectopic pregnancy.</div></div><div><h3>Results</h3><div>The initial survey was completed by 855 participants from 35 countries, and 1,220 potential research questions were submitted. Three clinical practice guidelines and 43 Cochrane systematic reviews identified a further 24 potential research questions. A rationalized list of 49 confirmed research uncertainties was entered into an interim prioritization survey completed by 413 respondents from 20 countries. The top 10 research priorities were identified during a consensus development meeting involving 37 participants from 10 countries. These research priorities are diverse and seek answers to questions regarding prevention, treatment, and the longer-term impact of ectopic pregnancy.</div></div><div><h3>Conclusion</h3><div>We anticipate that the identified research priorities, developed to specifically highlight the most pressing clinical needs as perceived by healthcare professionals, people with lived experience of ectopic pregnancy, and others, will help research funding organizations and researchers to develop their future research agenda.</div></div><div><div>Las 10 prioridades de la investigación futura sobre el embarazo ectópico: desarrollo de un estudio internacional de consenso</div></div><div><h3>Objetivo</h3><div>Determinar las prioridades futuras de la investigación sobre el embarazo ectópico.</div></div><div><h3>Diseño</h3><div>Se recopilaron posibles questiones de investigación a partir de una encuesta internacional inicial, una revisión sistemática de guías de práctica clínica y revisiones sistemáticas Cochrane. Una lista depurada sobre incertidumbres investigadas fue priorizada mediante una encuesta intermedia internacional. En una reunión de desarrollo de consenso fueron discutidas las incertidumbres prioritarias de investigación. Utilizando un método formal de desarrollo de consenso, la técnica nominal de grupo modificada, divers","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":"125 3","pages":"Pages 453-465"},"PeriodicalIF":7.0,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145188765","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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