Fertility and sterility最新文献

{"title":"Reimagining the funding model for reproductive endocrinology and infertility fellowship training programs","authors":"Hannah Milad M.D. , Marcelle I. Cedars M.D. , Eve C. Feinberg M.D.","doi":"10.1016/j.fertnstert.2025.08.005","DOIUrl":"10.1016/j.fertnstert.2025.08.005","url":null,"abstract":"","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":"125 2","pages":"Pages 234-236"},"PeriodicalIF":7.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144857697","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}

{"title":"Fertility preservation and reproduction in patients facing gonadotoxic therapies or gonadectomy: an Ethics Committee opinion","authors":"","doi":"10.1016/j.fertnstert.2025.12.002","DOIUrl":"10.1016/j.fertnstert.2025.12.002","url":null,"abstract":"<div><div>Patients receiving treatment that has the potential to negatively affect their gonads, including chemotherapy, surgery, and radiation therapy, should be informed of options for fertility preservation and future reproduction before initiating treatment. Reproduction in the context of fertility-affecting treatment raises a number of ethical issues related to the welfare of both patients and offspring. This document replaces the document titled, “Fertility preservation and reproduction in patients facing gonadotoxic therapies: an Ethics Committee opinion,” last published in 2018.</div></div><div><div>Preservación de la fertilidad y reproducción en pacientes tratadas con terapias gonadotóxicas: opinión del Comité Ético</div><div>Los pacientes que reciben tratamientos con el potencial de afectar negativamente sus gónadas, incluidos la quimioterapia, la cirugía y la radioterapia, deben ser informados sobre las opciones de preservación de la fertilidad y de reproducción futura antes de iniciar el tratamiento. La reproducción, en el contexto de tratamientos que afectan la fertilidad, plantea una serie de cuestiones éticas relacionadas con el bienestar tanto de los pacientes como de la descendencia. Este documento reemplaza al documento titulado “Preservación de la fertilidad y reproducción en pacientes tratadas con terapias gonadotóxicas: opinión del Comité Ético” publicado en 2018.</div></div>","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":"125 2","pages":"Pages 260-266"},"PeriodicalIF":7.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145917310","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}

{"title":"The economic consequences of a childless world","authors":"David Duhamel Ph.D.","doi":"10.1016/j.fertnstert.2025.06.012","DOIUrl":"10.1016/j.fertnstert.2025.06.012","url":null,"abstract":"<div><div>As global fertility has more than halved in the last 60 years and continues to decline, countries caught in the low fertility trap will struggle to achieve sustainable gross domestic product growth and face rising pension and health costs. Emerging economies, although not impacted yet, might encounter an even bigger crisis in a few decades. How inflation and real estate valuation will react to worsening demographic conditions is subject to debate. Finally, the demographic winter will upset economies around the world in many indirect ways, ranging from political, geopolitical, societal, and others.</div></div>","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":"125 2","pages":"Pages 197-202"},"PeriodicalIF":7.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144335336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Governance of polygenic embryo screening: a qualitative study on the perspectives of clinicians and patients","authors":"Jason Bach J.D., M.B.E. ,&nbsp;Jonathan Frumovitz B.A. ,&nbsp;Dorit Barlevy Ph.D. ,&nbsp;Rémy A. Furrer Ph.D. ,&nbsp;Abigail Martinez B.A. ,&nbsp;Ana Battaglino M.A. ,&nbsp;Shai Carmi Ph.D. ,&nbsp;Todd Lencz Ph.D. ,&nbsp;Gabriel Lázaro-Muñoz Ph.D., J.D. ,&nbsp;Stacey Pereira Ph.D.","doi":"10.1016/j.fertnstert.2025.08.029","DOIUrl":"10.1016/j.fertnstert.2025.08.029","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;To investigate the perspectives of stakeholders on their attitudes toward potential regulation of polygenic embryo screening (PES), a new form of preimplantation genetic testing that is used to screen embryos for the genetic chances of developing medical conditions and nonmedical traits involving hundreds or thousands of genes.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Design&lt;/h3&gt;&lt;div&gt;We conducted individual, semistructured interviews and analyzed transcripts using thematic analysis.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Subjects&lt;/h3&gt;&lt;div&gt;Twenty-seven US-based reproductive endocrinology and infertility specialists and 26 patients who were currently undergoing in vitro fertilization or had within the past five years.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Main Outcome Measures&lt;/h3&gt;&lt;div&gt;Repeating ideas and patterned responses were organized into themes and subthemes.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Although most clinicians advocate for some form of regulation to ensure patient well-being, patients largely oppose restrictive measures, prioritizing procreative autonomy.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;Our results highlight a tension between the welfarist approach favored by clinicians and the libertarian approach favored by patients, underscoring the complexity of developing governance frameworks for PES that satisfies multiple stakeholder groups. Ultimately, our findings call attention to the need for ongoing dialogue among stakeholders to address the ethical and practical implications of PES and any potential regulation of it.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;div&gt;Gobernanza del cribado embrionario poligénico: un estudio cualitativo sobre las perspectivas de clínicos y pacientes&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objetivo&lt;/h3&gt;&lt;div&gt;Investigar las perspectivas de los distintos actores implicados respecto a sus actitudes ante una posible regulación del cribado embrionario poligénico (PES), una nueva modalidad de diagnóstico genético preimplantacional que se utiliza para evaluar en los embriones la probabilidad genética de desarrollar enfermedades médicas y rasgos no médicos, implicando cientos o miles de genes.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Diseño&lt;/h3&gt;&lt;div&gt;Se realizaron entrevistas individuales semiestructuradas y los transcriptos se analizaron mediante análisis temático.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Sujetos&lt;/h3&gt;&lt;div&gt;Veintisiete especialistas estadounidenses en endocrinología reproductiva y fertilidad, y 26 pacientes que estaban en tratamiento de fecundación in vitro o lo habían estado en los cinco años previos.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Medidas principales de resultado&lt;/h3&gt;&lt;div&gt;Las ideas recurrentes y los patrones de respuesta se organizaron en temas y subtemas.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Resultados&lt;/h3&gt;&lt;div&gt;Aunque la mayoría de los clínicos aboga por algún tipo de regulación para garantizar el bienestar del paciente, los pacientes se oponen mayoritariamente a medidas restrictivas, priorizando la autonomía reproductiva.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusión&lt;/h3&gt;&lt;div&gt;Nuestros resultados ponen de manifiesto una tensión entre el enfoque bie","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":"125 2","pages":"Pages 338-347"},"PeriodicalIF":7.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144948226","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Consistency in treatment effects and statistical significance between early-stage pregnancy endpoints and live birth in randomized controlled trials of infertility: a systematic meta-epidemiological study","authors":"Qian Feng M.Sc. ,&nbsp;Wanlin Li M.P.H. ,&nbsp;James Crispin M.D. ,&nbsp;Salvatore Longobardi M.D. ,&nbsp;Thomas D’Hooghe M.D. ,&nbsp;Wentao Li M.D. ,&nbsp;Ben W. Mol M.D.","doi":"10.1016/j.fertnstert.2025.08.025","DOIUrl":"10.1016/j.fertnstert.2025.08.025","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Importance&lt;/h3&gt;&lt;div&gt;Live births are the “gold standard” for assessing infertility treatments but are less frequently reported than clinical pregnancy. Identifying approaches to interpret randomized controlled trials (RCTs) without live birth data is essential.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;To evaluate the correlation between treatment effects and the consistency of statistical significance in conclusions drawn from live birth versus early-stage pregnancy endpoints (an umbrella term defined as biochemical, clinical, or ongoing pregnancy) in RCTs reporting both outcomes.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Data Sources&lt;/h3&gt;&lt;div&gt;We systematically searched EMBASE, MEDLINE, and CENTRAL for RCTs in infertility from January 1, 2012 to August 30, 2023.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Study Selection and synthesis&lt;/h3&gt;&lt;div&gt;Randomized controlled trials involving subfertile women reporting contingency tables for live birth and at least one early-stage pregnancy endpoint were eligible. Contingency tables on pregnancy or live births were manually extracted from the trial publications. We calculated Spearman’s rho for treatment effects between early-stage pregnancy endpoints and live birth and compared their statistical significance using Chi-square tests. The above analyses were then conducted in prespecified subgroups.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Main Outcomes&lt;/h3&gt;&lt;div&gt;The correlation between treatment effects and the consistency of statistical significance in conclusions drawn from live birth versus early-stage pregnancy endpoints.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;Among 8,757 records, 1,281 infertility RCTs were eligible. The Spearman’s rho for treatment effects was 0.78 (95% confidence interval [CI]: 0.69–0.86, &lt;em&gt;P&lt;/em&gt;&lt;.001; 169 RCTs) between biochemical pregnancy and live birth, 0.87 (95% CI: 0.83–0.90, &lt;em&gt;P&lt;/em&gt;&lt;.01; 429 RCTs) between clinical pregnancy and live birth, and 0.96 (95% CI: 0.92–0.98, &lt;em&gt;P&lt;/em&gt;&lt;.01; 138 RCTs) between ongoing pregnancy and live birth. Statistical significance between early-stage pregnancy endpoints and live birth was consistent in above 88% of trials. The correlation of treatment effects between clinical or ongoing pregnancy and live birth remained robust in subgroups of infertility treatments, including ovarian stimulation for medically assisted reproduction treatment.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion and relevance&lt;/h3&gt;&lt;div&gt;A strong correlation was observed between clinical or ongoing pregnancy and live birth, supporting the rationale for using clinical or ongoing pregnancy data to assess treatment effectiveness when live birth data are limited or unavailable. However, the risk of intervention-related pregnancy loss must be considered during the assessment.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;div&gt;Consistencia de los efectos del tratamiento y de la significación estadística entre los desenlaces de embarazo en etapas tempranas y el nacido vivo en ensayos clínicos aleatorizados en infertilidad: un estudio metaepidemiológico sistemático&lt;/div&gt;&lt;/div&gt;&lt;","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":"125 2","pages":"Pages 356-366"},"PeriodicalIF":7.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144947924","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"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. ,&nbsp;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}

{"title":"Fertility-sparing program for young women with rectal cancer: ovarian and uterine transposition","authors":"Gemma Mancebo Ph.D. ,&nbsp;Ester Miralpeix Ph.D. ,&nbsp;Joana Vidal Ph.D. ,&nbsp;Montserrat Bonilla R.N. ,&nbsp;Marta Álvarez R.N. ,&nbsp;Josep-Maria Sole-Sedeno Ph.D. ,&nbsp;Ana Robles Ph.D. ,&nbsp;Marta Pascual Ph.D. ,&nbsp;Anna Reig M.D. ,&nbsp;Cristina Álvarez-Urturi Ph.D. ,&nbsp;Marcos Busto M.D. ,&nbsp;Reitan Ribeiro M.D.","doi":"10.1016/j.fertnstert.2025.09.034","DOIUrl":"10.1016/j.fertnstert.2025.09.034","url":null,"abstract":"","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":"125 2","pages":"Pages 367-369"},"PeriodicalIF":7.0,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145209214","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}

{"title":"Stability and reliability of artificial intelligence models in embryo selection for in vitro fertilization","authors":"Prudhvi Thirumalaraju M.Tech. ,&nbsp;Manoj Kumar Kanakasabapathy M.Tech. ,&nbsp;Hemanth Kandula M.Tech. ,&nbsp;Tinendra Kandula B.Tech. ,&nbsp;Aditya Vardhan Reddy Katkuri B.Tech. ,&nbsp;Cameron Cipriano M.Tech. ,&nbsp;Jonas E. Malmsten Ph.D. ,&nbsp;Nikica Zaninovic Ph.D. ,&nbsp;Charles L. Bormann Ph.D. ,&nbsp;Hadi Shafiee Ph.D.","doi":"10.1016/j.fertnstert.2025.08.021","DOIUrl":"10.1016/j.fertnstert.2025.08.021","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;To evaluate the stability and reliability of artificial intelligence (AI) models and approaches in embryo selection and rank ordering for in vitro fertilization (IVF).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Design&lt;/h3&gt;&lt;div&gt;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.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Subjects&lt;/h3&gt;&lt;div&gt;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.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Main Outcome Measures&lt;/h3&gt;&lt;div&gt;Consistency in embryo ranking (Kendall’s W), frequency of critical errors (instances where low-quality embryos were top-ranked), and intermodel variability across datasets.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;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%&lt;sup&gt;2&lt;/sup&gt;), highlighting sensitivity to distribution shifts. Interpretability analyses revealed divergent decision-making strategies among replicate models, despite identical architectures and training protocols.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;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.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;div&gt;Estabilidad y fiabilidad de los modelos de inteligencia artificial en la selección de embriones para la fertilización in vitro.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objetivo&lt;/h3&gt;&lt;div&gt;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).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;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}

{"title":"Different ultrasound morphologies of rectosigmoid endometriosis nodules: an exploratory analysis of their prevalence and associated clinical characteristics","authors":"Marisol Doglioli M.D. ,&nbsp;Antonio Raffone M.D. ,&nbsp;Manuela Maletta M.D. ,&nbsp;Ludovica Girardi M.D. ,&nbsp;Daniele Neola M.D. ,&nbsp;Maria Giovanna Vastarella M.D. ,&nbsp;Lucia De Meis M.D. ,&nbsp;Luigi Cobellis M.D. ,&nbsp;Alexandro Paccapelo M.S. ,&nbsp;Jacopo Lenzi Ph.D. ,&nbsp;Renato Seracchioli M.D. ,&nbsp;Diego Raimondo M.D.","doi":"10.1016/j.fertnstert.2025.08.007","DOIUrl":"10.1016/j.fertnstert.2025.08.007","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Objective&lt;/h3&gt;&lt;div&gt;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.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Design&lt;/h3&gt;&lt;div&gt;Pilot, single-center, observational, cross-sectional study on a prospectively collected database.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Subjects&lt;/h3&gt;&lt;div&gt;Consecutive patients with a diagnosis of RSE at transvaginal ultrasound referred to our center from May 2022 to June 2023.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Exposure&lt;/h3&gt;&lt;div&gt;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&lt;sup&gt;2&lt;/sup&gt; tests, Fisher’s exact tests, and Kruskal–Wallis tests, with &lt;em&gt;P&lt;/em&gt; values adjusted using Sidak’s method. The significance level was set at .05.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Main Outcome Measures&lt;/h3&gt;&lt;div&gt;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.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;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%).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusion&lt;/h3&gt;&lt;div&gt;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.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;div&gt;Diferentes morfologías de ecografía de nódulos de endometriosis rectosigmoidea: un análisis exploratorio de su prevalencia y características clínicas asociadas&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objetivo&lt;/h3&gt;&lt;div&gt;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}

{"title":"Evidence that declining human fecundity contributes to the fertility crisis","authors":"Rune Lindahl-Jacobsen Ph.D. ,&nbsp;Astrid Linnea Beck MS.c. ,&nbsp;Lærke Priskorn Ph.D. ,&nbsp;Stine A. Holmboe Ph.D. ,&nbsp;Margit Bistrup Fischer M.D. ,&nbsp;Anna-Maria Andersson Ph.D. ,&nbsp;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}