Pub Date : 2026-02-01DOI: 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 : 2026-02-01DOI: 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}
Pub Date : 2026-02-01DOI: 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 : 2026-02-01DOI: 10.1016/j.fertnstert.2025.10.017
Rune Lindahl-Jacobsen Ph.D. , Astrid Linnea Beck MS.c. , Lærke Priskorn Ph.D. , Stine A. Holmboe Ph.D. , Margit Bistrup Fischer M.D. , Anna-Maria Andersson Ph.D. , Niels E. Skakkebæk M.D.
Fertility rates have fallen to unprecedentedly low levels worldwide, reflecting a widespread fertility crisis. Although this decline has often been attributed to social and economic shifts, growing evidence suggests that biological factors may also play a role. Markers of decreased fecundity are on the rise, with an increasing number of couples requiring medically assisted reproduction because of poor semen quality and/or female infertility. In addition, the number of children born after assisted reproduction is rising. Trends in pregnancies terminated by an induced abortion may also provide important information regarding fecundity. A new index, the comprehensive unassisted pregnancy rate (defined by live births and induced abortions, excluding births as a result of artificial reproductive techniques), has been developed to reflect the fecundity of a population. Recent data from a few high-income countries have shown that the comprehensive unassisted pregnancy rate has been steadily declining across successive decades. If this finding is replicated in other countries, it could indicate that patterns of changing fecundity may be emerging as a population-wide international phenomenon.
{"title":"Evidence that declining human fecundity contributes to the fertility crisis","authors":"Rune Lindahl-Jacobsen Ph.D. , Astrid Linnea Beck MS.c. , Lærke Priskorn Ph.D. , Stine A. Holmboe Ph.D. , Margit Bistrup Fischer M.D. , Anna-Maria Andersson Ph.D. , Niels E. Skakkebæk M.D.","doi":"10.1016/j.fertnstert.2025.10.017","DOIUrl":"10.1016/j.fertnstert.2025.10.017","url":null,"abstract":"<div><div>Fertility rates have fallen to unprecedentedly low levels worldwide, reflecting a widespread fertility crisis. Although this decline has often been attributed to social and economic shifts, growing evidence suggests that biological factors may also play a role. Markers of decreased fecundity are on the rise, with an increasing number of couples requiring medically assisted reproduction because of poor semen quality and/or female infertility. In addition, the number of children born after assisted reproduction is rising. Trends in pregnancies terminated by an induced abortion may also provide important information regarding fecundity. A new index, the comprehensive unassisted pregnancy rate (defined by live births and induced abortions, excluding births as a result of artificial reproductive techniques), has been developed to reflect the fecundity of a population. Recent data from a few high-income countries have shown that the comprehensive unassisted pregnancy rate has been steadily declining across successive decades. If this finding is replicated in other countries, it could indicate that patterns of changing fecundity may be emerging as a population-wide international phenomenon.</div></div>","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":"125 2","pages":"Pages 218-226"},"PeriodicalIF":7.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145311614","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.2025.08.020
Ruohua Yan Ph.D. , Xiaohang Liu B.S. , Shen Gao Ph.D. , Ruixia Liu Ph.D. , Chenghong Yin Ph.D. , Xiaoxia Peng Ph.D.
<div><h3>Objective</h3><div>To compare the perinatal outcomes between fresh and frozen embryo transfer strategies among ongoing pregnancies conceived by in vitro fertilization/intracytoplasmic sperm injection.</div></div><div><h3>Design</h3><div>A prospective cohort study. The study was conducted within the framework of a hypothetical randomized controlled trial to enhance the validity of the evidence obtained from observational data.</div></div><div><h3>Subjects</h3><div>From November 2017 to August 2021, 5,118 pregnant women who conceived by in vitro fertilization/intracytoplasmic sperm injection were recruited from 50 study sites in 17 provinces of China during their first trimester.</div></div><div><h3>Exposure</h3><div>Frozen vs. fresh embryo transfer.</div></div><div><h3>Main Outcome Measures</h3><div>The primary outcome was perinatal complications, defined as any occurrence of perinatal death or birth defects. The secondary outcomes included preterm birth, small for gestational age, large for gestational age, low birth weight, and macrosomia. The safety outcomes were abortion, pregnancy-induced hypertension, gestational diabetes mellitus, and gestational thyroid dysfunction.</div></div><div><h3>Results</h3><div>A total of 2,856 pregnant women were included in the analysis, with the allocation ratio of 1:1. The perinatal complication rate of the frozen embryo transfer group (5.0%, 72/1,428) was similar to that of the fresh embryo transfer group (4.6%, 66/1,428), with the risk ratio of 1.09 (95% confidence interval, 0.79 to 1.51). Moreover, there was no significant difference in the risks of preterm birth, small for gestational age, large for gestational age, low birth weight, and macrosomia between the two groups. However, compared with fresh embryo transfer, frozen embryo transfer was associated with an increased risk of pregnancy-induced hypertension (risk ratio, 2.18; 95% confidence interval, 1.10 to 4.62).</div></div><div><h3>Conclusion</h3><div>The risk of perinatal complications was similar between fresh and frozen embryo transfer strategies, whereas the risk of pregnancy-induced hypertension seemed to be higher for the frozen embryo transfer strategy among ongoing pregnancies. Therefore, the decision regarding fresh or frozen embryo transfer should be made with more caution, with careful consideration of the benefits and potential risks.</div></div><div><div>Complicaciones perinatales de la transferencia de embriones congelados frente a embriones frescos en embarazos en curso: Un estudio de cohortes realizado en el marco de un ensayo hipotético</div></div><div><h3>Objetivo</h3><div>Comparar los resultados perinatales entre las estrategias de transferencia de embriones frescos y congelados en embarazos en curso, concebidos mediante fecundación in vitro/inyección intracitoplasmática de espermatozoides.</div></div><div><h3>Diseño</h3><div>Estudio de cohorte prospectivo. El estudio se llevó a cabo dentro del marco de un ensayo clínico al
比较IVF/ICSI妊娠中新鲜和冷冻胚胎移植策略的围产儿结局。
{"title":"Perinatal complications of frozen vs. fresh embryo transfer among ongoing pregnancies: a cohort study conducted within the framework of a hypothetical trial","authors":"Ruohua Yan Ph.D. , Xiaohang Liu B.S. , Shen Gao Ph.D. , Ruixia Liu Ph.D. , Chenghong Yin Ph.D. , Xiaoxia Peng Ph.D.","doi":"10.1016/j.fertnstert.2025.08.020","DOIUrl":"10.1016/j.fertnstert.2025.08.020","url":null,"abstract":"<div><h3>Objective</h3><div>To compare the perinatal outcomes between fresh and frozen embryo transfer strategies among ongoing pregnancies conceived by in vitro fertilization/intracytoplasmic sperm injection.</div></div><div><h3>Design</h3><div>A prospective cohort study. The study was conducted within the framework of a hypothetical randomized controlled trial to enhance the validity of the evidence obtained from observational data.</div></div><div><h3>Subjects</h3><div>From November 2017 to August 2021, 5,118 pregnant women who conceived by in vitro fertilization/intracytoplasmic sperm injection were recruited from 50 study sites in 17 provinces of China during their first trimester.</div></div><div><h3>Exposure</h3><div>Frozen vs. fresh embryo transfer.</div></div><div><h3>Main Outcome Measures</h3><div>The primary outcome was perinatal complications, defined as any occurrence of perinatal death or birth defects. The secondary outcomes included preterm birth, small for gestational age, large for gestational age, low birth weight, and macrosomia. The safety outcomes were abortion, pregnancy-induced hypertension, gestational diabetes mellitus, and gestational thyroid dysfunction.</div></div><div><h3>Results</h3><div>A total of 2,856 pregnant women were included in the analysis, with the allocation ratio of 1:1. The perinatal complication rate of the frozen embryo transfer group (5.0%, 72/1,428) was similar to that of the fresh embryo transfer group (4.6%, 66/1,428), with the risk ratio of 1.09 (95% confidence interval, 0.79 to 1.51). Moreover, there was no significant difference in the risks of preterm birth, small for gestational age, large for gestational age, low birth weight, and macrosomia between the two groups. However, compared with fresh embryo transfer, frozen embryo transfer was associated with an increased risk of pregnancy-induced hypertension (risk ratio, 2.18; 95% confidence interval, 1.10 to 4.62).</div></div><div><h3>Conclusion</h3><div>The risk of perinatal complications was similar between fresh and frozen embryo transfer strategies, whereas the risk of pregnancy-induced hypertension seemed to be higher for the frozen embryo transfer strategy among ongoing pregnancies. Therefore, the decision regarding fresh or frozen embryo transfer should be made with more caution, with careful consideration of the benefits and potential risks.</div></div><div><div>Complicaciones perinatales de la transferencia de embriones congelados frente a embriones frescos en embarazos en curso: Un estudio de cohortes realizado en el marco de un ensayo hipotético</div></div><div><h3>Objetivo</h3><div>Comparar los resultados perinatales entre las estrategias de transferencia de embriones frescos y congelados en embarazos en curso, concebidos mediante fecundación in vitro/inyección intracitoplasmática de espermatozoides.</div></div><div><h3>Diseño</h3><div>Estudio de cohorte prospectivo. El estudio se llevó a cabo dentro del marco de un ensayo clínico al","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":"125 2","pages":"Pages 287-297"},"PeriodicalIF":7.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144924103","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.2025.11.023
Lindsay A. Hartup M.D. , Cassie L. Hobbs M.D. , Clarisa R. Gracia M.D., M.S.C.E. , Elizabeth S. Ginsburg M.D.
{"title":"Should you do ultrasound monitoring and trigger for intrauterine insemination cycles?","authors":"Lindsay A. Hartup M.D. , Cassie L. Hobbs M.D. , Clarisa R. Gracia M.D., M.S.C.E. , Elizabeth S. Ginsburg M.D.","doi":"10.1016/j.fertnstert.2025.11.023","DOIUrl":"10.1016/j.fertnstert.2025.11.023","url":null,"abstract":"","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":"125 2","pages":"Pages 228-233"},"PeriodicalIF":7.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145902562","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.2025.04.048
Robert John Aitken Ph.D. , Robert John Norman M.D.
The past half century has witnessed a dramatic decline in human fertility as reflected in the total fertility rate. This decline in total fertility rate is thought to have been triggered by an increase in resources and knowledge that precipitated a significant decline in infant mortality. This, in turn, led to a reduction in the desire of couples to have large families, supported in recent times by a series of factors including a delay in childbearing as women acquired the education and autonomy to enter the paid workforce, the progressive urbanization of advanced societies, and, for many, a seismic shift in life’s purpose away from procreation and toward self-fulfillment. Notwithstanding the power of such short-acting socioeconomic drivers, they are all potentially reversible given appropriate revisions in governmental policies and societal aspirations. However, we argue that if human societies experience subreplacement levels of fertility for a prolonged period, then there is a danger that our fundamental fecundity (ability to reproduce) will become compromised. A lack of evolutionary selection pressure on fertility, the excessive use of assisted reproductive technology, and the pervasive presence of environmental pollutants in the environment, are all relevant in this context. Addressing the causes of human fertility decline is critical if we are to manage our population rather than become its hapless victim.
{"title":"Epidemiology of falling fertility: the contribution of social, environmental, and genetic forces","authors":"Robert John Aitken Ph.D. , Robert John Norman M.D.","doi":"10.1016/j.fertnstert.2025.04.048","DOIUrl":"10.1016/j.fertnstert.2025.04.048","url":null,"abstract":"<div><div>The past half century has witnessed a dramatic decline in human fertility as reflected in the total fertility rate. This decline in total fertility rate is thought to have been triggered by an increase in resources and knowledge that precipitated a significant decline in infant mortality. This, in turn, led to a reduction in the desire of couples to have large families, supported in recent times by a series of factors including a delay in childbearing as women acquired the education and autonomy to enter the paid workforce, the progressive urbanization of advanced societies, and, for many, a seismic shift in life’s purpose away from procreation and toward self-fulfillment. Notwithstanding the power of such short-acting socioeconomic drivers, they are all potentially reversible given appropriate revisions in governmental policies and societal aspirations. However, we argue that if human societies experience subreplacement levels of fertility for a prolonged period, then there is a danger that our fundamental fecundity (ability to reproduce) will become compromised. A lack of evolutionary selection pressure on fertility, the excessive use of assisted reproductive technology, and the pervasive presence of environmental pollutants in the environment, are all relevant in this context. Addressing the causes of human fertility decline is critical if we are to manage our population rather than become its hapless victim.</div></div>","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":"125 2","pages":"Pages 187-196"},"PeriodicalIF":7.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143932972","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.2025.11.022
Elizabeth S. Ginsburg M.D.
{"title":"To ultrasound and trigger or not in intrauterine insemination cycles, that is the question","authors":"Elizabeth S. Ginsburg M.D.","doi":"10.1016/j.fertnstert.2025.11.022","DOIUrl":"10.1016/j.fertnstert.2025.11.022","url":null,"abstract":"","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":"125 2","pages":"Page 227"},"PeriodicalIF":7.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145877665","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.2025.08.024
Laura C. Gemmell M.D. , Anjali Jotwani M.D. , Jessica L. Giordano M.S., C.G.C. , Stephanie Galloway M.S., C.G.C. , Diamond Lewis B.A. , Sinem Karipcin M.D. , Eric J. Forman M.D. , Paula C. Brady M.D.
<div><h3>Objective</h3><div>To evaluate the incidence of expanded carrier screening (ECS) results with possible clinical implications on patient health and/or pregnancy-related treatment planning.</div></div><div><h3>Design</h3><div>Single academic center, retrospective, cohort study.</div></div><div><h3>Subjects</h3><div>A total of 3,136 patients underwent ECS between January 2018 and December 2020.</div></div><div><h3>Exposure</h3><div>All patients were screened using the same ECS, comprising 283 genes.</div></div><div><h3>Main Outcome Measures</h3><div>Rates of positive ECS results and carrier-carrier couples were reported, excluding carrier-carrier couples without a reproductive risk for a serious clinical outcome (i.e., alpha thalassemia single-gene deletions). Results with possible ramifications for an individual patient’s health were recorded. This included individuals identified through ECS to be potentially affected with a genetic condition due to homozygous or compound heterozygous findings, and those with heterozygous findings associated with a personal health risk, such as elevated risk for premature ovarian insufficiency, metabolic crisis, neurological disease, cardiovascular disease, or malignancy.</div></div><div><h3>Results</h3><div>Expanded carrier screening was performed and resulted in 3,136 patients; 2,280 (72.7%) carried at least one condition. Fifty-four patients (1.7%) were homozygous or compound heterozygous for a recessive genetic condition. Another 68 patients (2.2%) were high-risk heterozygote carriers of a recessive disease: Gaucher (n = 34), familial hypercholesterolemia (n = 14), fumarase deficiency (n = 9), ataxia-telangiectasia (n = 7), and fragile X premutation (n = 4). Ten female carriers of X-linked conditions were identified (0.4%). When restricting analysis to couples who both completed ECS (n = 905 couples), 58 couples (6.4%) carried the same genetic condition, although only 21 (2.3%) were considered clinically significant disease-causing combinations and recommended for preimplantation genetic testing for monogenic conditions.</div></div><div><h3>Conclusion</h3><div>A small proportion (1.7%) of total ECS results impact clinical fertility care by triggering recommendations for in vitro fertilization with preimplantation genetic testing for monogenic conditions. A larger proportion of results (3.9%) had implications for patients’ personal health, which may not be sufficiently addressed in the consent process and can affect eligibility for benefits such as life and disability insurance.</div></div><div><div>Implicaciones clínicas del tamizaje ampliado de portadores para la atención relacionada con el embarazo y la salud individual</div></div><div><h3>Objetivo</h3><div>Evaluar la incidencia de resultados del tamizaje ampliado de portadores (expanded carrier screening, ECS) con posibles implicaciones clínicas sobre la salud de los pacientes y/o la planificación del tratamiento reproductivo.</div></div><div><h3>Di
{"title":"Clinical implications of expanded carrier screening for pregnancy-related care and individual health","authors":"Laura C. Gemmell M.D. , Anjali Jotwani M.D. , Jessica L. Giordano M.S., C.G.C. , Stephanie Galloway M.S., C.G.C. , Diamond Lewis B.A. , Sinem Karipcin M.D. , Eric J. Forman M.D. , Paula C. Brady M.D.","doi":"10.1016/j.fertnstert.2025.08.024","DOIUrl":"10.1016/j.fertnstert.2025.08.024","url":null,"abstract":"<div><h3>Objective</h3><div>To evaluate the incidence of expanded carrier screening (ECS) results with possible clinical implications on patient health and/or pregnancy-related treatment planning.</div></div><div><h3>Design</h3><div>Single academic center, retrospective, cohort study.</div></div><div><h3>Subjects</h3><div>A total of 3,136 patients underwent ECS between January 2018 and December 2020.</div></div><div><h3>Exposure</h3><div>All patients were screened using the same ECS, comprising 283 genes.</div></div><div><h3>Main Outcome Measures</h3><div>Rates of positive ECS results and carrier-carrier couples were reported, excluding carrier-carrier couples without a reproductive risk for a serious clinical outcome (i.e., alpha thalassemia single-gene deletions). Results with possible ramifications for an individual patient’s health were recorded. This included individuals identified through ECS to be potentially affected with a genetic condition due to homozygous or compound heterozygous findings, and those with heterozygous findings associated with a personal health risk, such as elevated risk for premature ovarian insufficiency, metabolic crisis, neurological disease, cardiovascular disease, or malignancy.</div></div><div><h3>Results</h3><div>Expanded carrier screening was performed and resulted in 3,136 patients; 2,280 (72.7%) carried at least one condition. Fifty-four patients (1.7%) were homozygous or compound heterozygous for a recessive genetic condition. Another 68 patients (2.2%) were high-risk heterozygote carriers of a recessive disease: Gaucher (n = 34), familial hypercholesterolemia (n = 14), fumarase deficiency (n = 9), ataxia-telangiectasia (n = 7), and fragile X premutation (n = 4). Ten female carriers of X-linked conditions were identified (0.4%). When restricting analysis to couples who both completed ECS (n = 905 couples), 58 couples (6.4%) carried the same genetic condition, although only 21 (2.3%) were considered clinically significant disease-causing combinations and recommended for preimplantation genetic testing for monogenic conditions.</div></div><div><h3>Conclusion</h3><div>A small proportion (1.7%) of total ECS results impact clinical fertility care by triggering recommendations for in vitro fertilization with preimplantation genetic testing for monogenic conditions. A larger proportion of results (3.9%) had implications for patients’ personal health, which may not be sufficiently addressed in the consent process and can affect eligibility for benefits such as life and disability insurance.</div></div><div><div>Implicaciones clínicas del tamizaje ampliado de portadores para la atención relacionada con el embarazo y la salud individual</div></div><div><h3>Objetivo</h3><div>Evaluar la incidencia de resultados del tamizaje ampliado de portadores (expanded carrier screening, ECS) con posibles implicaciones clínicas sobre la salud de los pacientes y/o la planificación del tratamiento reproductivo.</div></div><div><h3>Di","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":"125 2","pages":"Pages 348-355"},"PeriodicalIF":7.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144948291","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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