{"title":"Immature oocyte proportion may or may not compromise ICSI outcomes, but methods do: a critical appraisal.","authors":"Fatih Aktoz, Yucel Sahin","doi":"10.1093/humrep/deag012","DOIUrl":"https://doi.org/10.1093/humrep/deag012","url":null,"abstract":"","PeriodicalId":13003,"journal":{"name":"Human reproduction","volume":" ","pages":""},"PeriodicalIF":6.1,"publicationDate":"2026-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146131348","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}
Veda Sripada, Denny Sakkas, Denis Vaughan, Brittany Morse, Yuval Fouks
{"title":"Reply: immature oocyte proportion may or may not compromise ICSI outcomes, but methods do: a critical appraisal.","authors":"Veda Sripada, Denny Sakkas, Denis Vaughan, Brittany Morse, Yuval Fouks","doi":"10.1093/humrep/deag013","DOIUrl":"https://doi.org/10.1093/humrep/deag013","url":null,"abstract":"","PeriodicalId":13003,"journal":{"name":"Human reproduction","volume":" ","pages":""},"PeriodicalIF":6.1,"publicationDate":"2026-02-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146131317","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}
Karishma Patel, Denny Sakkas, Brittany Morse, Daniel W Duvall, Alan Penzias, Denis A Vaughan
<p><strong>Study question: </strong>What is the impact of endometrial fluid (EF) on single, euploid frozen embryo transfer (FET) cycles on live birth rate (LBR) and is cycle cancellation for EF a worthwhile intervention?</p><p><strong>Summary answer: </strong>The LBR of single euploid FETs was significantly lower by 20.2 percentage points when EF was persistent on the day of decision for progesterone start/trigger, but despite the lower LBR, cycle cancellation may not confer an improved chance at live birth.</p><p><strong>What is known already: </strong>The incidence of EF in cycles ranges from 3% to 8%, thus, only a few small studies have been performed to evaluate its impact. Existing literature generally concludes that the presence of EF leading up to an embryo transfer is detrimental to successful implantation, however, these studies examined untested embryos.</p><p><strong>Study design, size, duration: </strong>A retrospective cohort study was performed at a single, academically affiliated infertility center in the USA from January 2014 to December 2022. Inclusion criteria comprised patients who underwent their first IVF cycle, had pre-implantation genetic testing for aneuploidy performed by trophectoderm biopsy, had at least one euploid embryo, and were undergoing their first FET. Cycles were subdivided into three groups: no EF present in the cycle (no EF group), EF present but resolved prior to the day of decision for progesterone start/trigger (EF resolved group), and lastly, EF persistent on the day of decision for progesterone start/trigger (EF persistent group). Clinical outcomes were compared between the groups. In a secondary analysis, all single, euploid FET cycles that were cancelled due to EF were identified. The first subsequent completed single, euploid FET during the same study period was identified and analyzed.</p><p><strong>Participants/materials, setting, methods: </strong>Four thousand three hundred eight FET cycles met inclusion criteria. Four thousand one hundred forty documented no EF, 108 documented EF that resolved, and 60 documented EF that persisted. The primary outcome was LBR per ET. A logistic regression analysis was performed adjusting for baseline characteristics (age, BMI, gravidity, parity, reason for infertility) and cycle characteristics (method of fertilization, protocol, endometrial thickness achieved during FET, embryo grade/day cryopreserved). In our secondary analysis, 90 single, euploid FET cycles were identified as cancelled specifically due to the presence of EF. Following these 90 cancelled cycles, there were 58 cycles that were identified as the first subsequent completed FET after cancellation. For the first subsequent completed single, euploid FET after index cycle cancellation, the presence of EF and overall LBR were recorded.</p><p><strong>Main results and the role of chance: </strong>When EF was present, but resolved prior to decision for progesterone start/trigger, the LBR was 9.4 percentage
研究问题:子宫内膜液(EF)对单、整倍体冷冻胚胎移植(FET)周期对活产率(LBR)的影响是什么? EF的周期取消是否值得干预?总结回答:单倍体fet的LBR在决定启动/触发孕酮的当天持续EF显著降低20.2个百分点,但尽管LBR较低,周期取消可能不会提高活产的机会。已知情况:EF在周期内的发生率在3%至8%之间,因此,仅进行了几项小型研究来评估其影响。现有文献普遍认为,胚胎移植前EF的存在不利于成功植入,然而,这些研究检查了未经测试的胚胎。研究设计、规模、持续时间:2014年1月至2022年12月,在美国一家学术附属不孕不育中心进行了一项回顾性队列研究。纳入标准包括接受第一次体外受精周期,通过滋养外胚层活检进行非整倍体植入前基因检测,至少有一个整倍体胚胎,并且正在接受第一次FET的患者。将周期细分为三组:周期内无EF(无EF组),EF在孕激素启动/触发决定当天出现但消退(EF消退组),最后,EF在孕激素启动/触发决定当天持续(EF持续组)。比较两组临床结果。在二次分析中,发现了所有因EF而取消的单倍体、整倍体FET周期。在同一研究期间,鉴定并分析了第一个随后完成的单个整倍体FET。参与者/材料、环境、方法:43,308个FET周期符合纳入标准。4140份文件没有记录EF, 108份文件解决了EF, 60份文件持续记录EF。主要结局是每胎率。对基线特征(年龄、BMI、妊娠、胎次、不孕原因)和周期特征(受精方法、方案、FET期间达到的子宫内膜厚度、胚胎等级/天冷冻保存)进行logistic回归分析。在我们的二次分析中,由于EF的存在,90个单一的整倍体FET周期被确定为取消。在这90个被取消的周期之后,有58个周期被确定为取消后第一个后续完成的FET。对于指数周期取消后的第一个完整的单倍体FET,记录了EF和总体LBR的存在。主要结果和机会的作用:当EF存在,但在决定开始/触发黄体酮之前解决时,LBR比无EF组低9.4个百分点,但这没有达到统计学意义(49.1%对58.5%,aOR 0.71 (95% CI 0.47, 1.05))。在决定黄体酮启动/触发的当天,超声持续EF组的LBR比不EF组显著降低20.2个百分点(38.3% vs 58.5%, aOR 0.50 (95% CI 0.28, 0.88))。在初始FET取消后确定的58个后续FET周期中,23个显示EF复发(但未取消)。所有58个后续周期的总LBR为39.7%,与EF持续性组无显著差异(aOR 0.99 (95% CI 0.38, 2.64))。局限性,谨慎的原因:回顾性、单中心设计可能限制通用性。只分析整倍体胚胎会引入选择偏差。研究EF的挑战包括EF的病因不确定和未知,以及EF的数量/测量文件不统一。考虑到EF的低发病率,EF组的样本量很小,但与以前的研究规模相似。进行了功率分析,为了达到80%的机会发现10%的LBR差异,每组需要385名患者。鉴于实际LBR差异为20.2个百分点(58.5% vs 38.3%),我们EF组60例患者的样本量提供了88%的机会发现统计学上显著的差异。研究结果的更广泛含义:EF消退时,LBR降低9.4个百分点,EF持续时,LBR降低20.2个百分点。我们确定了一个小队列,在初始周期取消后的后续周期中,这些周期中获得的LBR与指数转移周期中的LBR相似,如果在黄体酮开始/触发时持续EF的情况下进行转移;也许如果EF持续,周期取消可能不会带来LBR的改善。总的来说,许多EF病例可能是由潜在的子宫内膜病理引起的。患者应得到相应的指导。研究资金/竞争利益:本研究未使用任何资金。 作者没有利益冲突。试验注册号:无。
{"title":"The impact of endometrial fluid on single euploid frozen embryo transfers, to cancel or not?","authors":"Karishma Patel, Denny Sakkas, Brittany Morse, Daniel W Duvall, Alan Penzias, Denis A Vaughan","doi":"10.1093/humrep/deag010","DOIUrl":"https://doi.org/10.1093/humrep/deag010","url":null,"abstract":"<p><strong>Study question: </strong>What is the impact of endometrial fluid (EF) on single, euploid frozen embryo transfer (FET) cycles on live birth rate (LBR) and is cycle cancellation for EF a worthwhile intervention?</p><p><strong>Summary answer: </strong>The LBR of single euploid FETs was significantly lower by 20.2 percentage points when EF was persistent on the day of decision for progesterone start/trigger, but despite the lower LBR, cycle cancellation may not confer an improved chance at live birth.</p><p><strong>What is known already: </strong>The incidence of EF in cycles ranges from 3% to 8%, thus, only a few small studies have been performed to evaluate its impact. Existing literature generally concludes that the presence of EF leading up to an embryo transfer is detrimental to successful implantation, however, these studies examined untested embryos.</p><p><strong>Study design, size, duration: </strong>A retrospective cohort study was performed at a single, academically affiliated infertility center in the USA from January 2014 to December 2022. Inclusion criteria comprised patients who underwent their first IVF cycle, had pre-implantation genetic testing for aneuploidy performed by trophectoderm biopsy, had at least one euploid embryo, and were undergoing their first FET. Cycles were subdivided into three groups: no EF present in the cycle (no EF group), EF present but resolved prior to the day of decision for progesterone start/trigger (EF resolved group), and lastly, EF persistent on the day of decision for progesterone start/trigger (EF persistent group). Clinical outcomes were compared between the groups. In a secondary analysis, all single, euploid FET cycles that were cancelled due to EF were identified. The first subsequent completed single, euploid FET during the same study period was identified and analyzed.</p><p><strong>Participants/materials, setting, methods: </strong>Four thousand three hundred eight FET cycles met inclusion criteria. Four thousand one hundred forty documented no EF, 108 documented EF that resolved, and 60 documented EF that persisted. The primary outcome was LBR per ET. A logistic regression analysis was performed adjusting for baseline characteristics (age, BMI, gravidity, parity, reason for infertility) and cycle characteristics (method of fertilization, protocol, endometrial thickness achieved during FET, embryo grade/day cryopreserved). In our secondary analysis, 90 single, euploid FET cycles were identified as cancelled specifically due to the presence of EF. Following these 90 cancelled cycles, there were 58 cycles that were identified as the first subsequent completed FET after cancellation. For the first subsequent completed single, euploid FET after index cycle cancellation, the presence of EF and overall LBR were recorded.</p><p><strong>Main results and the role of chance: </strong>When EF was present, but resolved prior to decision for progesterone start/trigger, the LBR was 9.4 percentage","PeriodicalId":13003,"journal":{"name":"Human reproduction","volume":" ","pages":""},"PeriodicalIF":6.1,"publicationDate":"2026-02-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146118928","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}
<p><strong>Study question: </strong>In the context of donating surplus frozen eggs (SFE) to research, what level of information disclosure, and associated consent model, do the public believe most effectively allows donors to make an informed decision, exercise autonomy, and be treated morally?</p><p><strong>Summary answer: </strong>The public supports the information disclosure requirements of both a specific and broad consent model in this context, with the latter considered to better enhance autonomy and facilitate the moral treatment of SFE donors.</p><p><strong>What is known already: </strong>Despite research indicating that many individuals' first preference is to donate their SFEs to research, donation rates remain low. One possible reason for this is the way consent processes for the donation of SFEs to research are currently regulated, specifically that their high information requirements limit opportunities to donate. There is a notable lack of research on how consent processes should operate, and more specifically, how much information a person should be provided before providing consent, in the context of donating SFEs to research.</p><p><strong>Study design, size, duration: </strong>An online experimental survey of 225 participants was conducted. The survey assessed the impact of two variables-Information Disclosure and Preference Fulfilment-on participants' views towards whether a consent process allowed for informed, autonomous consent and the moral treatment of donors.</p><p><strong>Participants/materials, setting, methods: </strong>A nationally representative sample of the UK public was recruited using the online platform Prolific. The survey consisted of a vignette-based experimental design, one free-text question, and demographic data collection. Quantitative data were summarized using descriptive statistics and the relationship between variables was tested using ANOVAs and t-tests, where appropriate. Inductive content analysis through manual coding was performed on the free-text question.</p><p><strong>Main results and the role of chance: </strong>Participants considered both specific and broad information disclosure as sufficient for informed consent (mean Consent Judgements M = 6.49/7 and M = 5.79/7, respectively). The ability to fulfil disposition preferences was critical to the public's assessment of whether a consent process enabled donors to act autonomously and be treated morally. Participants agreed that a potential donor was able to make an autonomous decision if their preference to donate their SFEs to research was fulfilled (mean Autonomy Judgement M = 5.46/7, mean Moral Judgement M = 5.63/7), but not when it was not (mean Autonomy Judgement M = 3.96/7, mean Moral Judgement: M = 4.76/7).</p><p><strong>Limitations, reasons for caution: </strong>Ecological validity of online surveys is limited, and data may be subject to response biases. Additionally, the sample size was relatively small. Finally, since the sample pop
{"title":"Public attitudes towards consent for the donation of surplus frozen eggs to research.","authors":"J Langford, J Demaree-Cotton, M Johnston","doi":"10.1093/humrep/deag007","DOIUrl":"https://doi.org/10.1093/humrep/deag007","url":null,"abstract":"<p><strong>Study question: </strong>In the context of donating surplus frozen eggs (SFE) to research, what level of information disclosure, and associated consent model, do the public believe most effectively allows donors to make an informed decision, exercise autonomy, and be treated morally?</p><p><strong>Summary answer: </strong>The public supports the information disclosure requirements of both a specific and broad consent model in this context, with the latter considered to better enhance autonomy and facilitate the moral treatment of SFE donors.</p><p><strong>What is known already: </strong>Despite research indicating that many individuals' first preference is to donate their SFEs to research, donation rates remain low. One possible reason for this is the way consent processes for the donation of SFEs to research are currently regulated, specifically that their high information requirements limit opportunities to donate. There is a notable lack of research on how consent processes should operate, and more specifically, how much information a person should be provided before providing consent, in the context of donating SFEs to research.</p><p><strong>Study design, size, duration: </strong>An online experimental survey of 225 participants was conducted. The survey assessed the impact of two variables-Information Disclosure and Preference Fulfilment-on participants' views towards whether a consent process allowed for informed, autonomous consent and the moral treatment of donors.</p><p><strong>Participants/materials, setting, methods: </strong>A nationally representative sample of the UK public was recruited using the online platform Prolific. The survey consisted of a vignette-based experimental design, one free-text question, and demographic data collection. Quantitative data were summarized using descriptive statistics and the relationship between variables was tested using ANOVAs and t-tests, where appropriate. Inductive content analysis through manual coding was performed on the free-text question.</p><p><strong>Main results and the role of chance: </strong>Participants considered both specific and broad information disclosure as sufficient for informed consent (mean Consent Judgements M = 6.49/7 and M = 5.79/7, respectively). The ability to fulfil disposition preferences was critical to the public's assessment of whether a consent process enabled donors to act autonomously and be treated morally. Participants agreed that a potential donor was able to make an autonomous decision if their preference to donate their SFEs to research was fulfilled (mean Autonomy Judgement M = 5.46/7, mean Moral Judgement M = 5.63/7), but not when it was not (mean Autonomy Judgement M = 3.96/7, mean Moral Judgement: M = 4.76/7).</p><p><strong>Limitations, reasons for caution: </strong>Ecological validity of online surveys is limited, and data may be subject to response biases. Additionally, the sample size was relatively small. Finally, since the sample pop","PeriodicalId":13003,"journal":{"name":"Human reproduction","volume":" ","pages":""},"PeriodicalIF":6.1,"publicationDate":"2026-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146112912","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}
Sahar Shahali, Sharon T Mortimer, Robert McLachlan, Moira K O'Bryan, Deirdre Zander-Fox, David Mortimer, Klaus Ackermann, Adrian Neild, Reza Nosrati
<p><strong>Study question: </strong>Can precise trajectory smoothing improve extraction of sperm motility features, and can deep learning on raw trajectory data enable accurate classification of sperm motility patterns?</p><p><strong>Summary answer: </strong>We present an approach that enhances the precision of motility parameter extraction through frequency-domain smoothing and enables accurate classification of sperm motility patterns using a deep learning model trained on raw trajectory data.</p><p><strong>What is known already: </strong>Conventional computer-aided sperm analysis (CASA) systems estimate motility parameters by applying basic smoothing algorithms to derive an average path, which can result in over- or under-smoothing, leading to inaccuracies in key parameters such as beat cross frequency (BCF) and amplitude of lateral head displacement (ALH). Since the identification of hyperactivated spermatozoa relies heavily on these kinematic metrics, such inaccuracies can contribute to misclassification.</p><p><strong>Study design, size, duration: </strong>This cross-sectional study analysed 2326 sperm trajectories (1931 progressive, 395 hyperactivated) recorded at 60 frames per second, derived from five individual samples, to develop and evaluate improved motility parameter extraction methods and trajectory-based classification models.</p><p><strong>Participants/materials, setting, methods: </strong>We compared Gaussian Process Regression (GPR), moving average, and Discrete Cosine Transform (DCT) smoothing to improve average path estimation. A novel metric, path average width (PAW), was introduced to quantify lateral head displacement. An ensemble of InceptionTime models was trained on (x, y) coordinate sequences to classify spermatozoa as progressive or hyperactivated. Additional classification of motility grades was performed using trajectory endpoints.</p><p><strong>Main results and the role of chance: </strong>The DCT model retaining 12 frequency components (DCT-12) produced the most consistent and symmetric average paths, leading to improved accuracy in the calculation of BCF and ALH. Our introduced PAW metric effectively distinguished between hyperactivated spermatozoa (5.5 ± 1.5 μm) and progressive spermatozoa (2.0 ± 1.3 μm). The InceptionTime-based classification model achieved 89% accuracy in differentiating progressive and hyperactivated trajectories, and 78% accuracy for predicting motility grades.</p><p><strong>Limitations, reasons for caution: </strong>Models were trained on sperm trajectories recorded in low-viscosity media. Since sperm selection for ICSI is performed in viscous environments like low concentrations of polyvinylpyrrolidone, future training on such data is essential to improve clinical translation. Additionally, the model for classifying progressive and hyperactivated sperm was trained on a single-centre dataset (5 individuals, total of 790 trajectories) and, despite cross-validation and data augmentation, stil
{"title":"Refined trajectory smoothing and deep learning classification of human sperm motility.","authors":"Sahar Shahali, Sharon T Mortimer, Robert McLachlan, Moira K O'Bryan, Deirdre Zander-Fox, David Mortimer, Klaus Ackermann, Adrian Neild, Reza Nosrati","doi":"10.1093/humrep/deag005","DOIUrl":"https://doi.org/10.1093/humrep/deag005","url":null,"abstract":"<p><strong>Study question: </strong>Can precise trajectory smoothing improve extraction of sperm motility features, and can deep learning on raw trajectory data enable accurate classification of sperm motility patterns?</p><p><strong>Summary answer: </strong>We present an approach that enhances the precision of motility parameter extraction through frequency-domain smoothing and enables accurate classification of sperm motility patterns using a deep learning model trained on raw trajectory data.</p><p><strong>What is known already: </strong>Conventional computer-aided sperm analysis (CASA) systems estimate motility parameters by applying basic smoothing algorithms to derive an average path, which can result in over- or under-smoothing, leading to inaccuracies in key parameters such as beat cross frequency (BCF) and amplitude of lateral head displacement (ALH). Since the identification of hyperactivated spermatozoa relies heavily on these kinematic metrics, such inaccuracies can contribute to misclassification.</p><p><strong>Study design, size, duration: </strong>This cross-sectional study analysed 2326 sperm trajectories (1931 progressive, 395 hyperactivated) recorded at 60 frames per second, derived from five individual samples, to develop and evaluate improved motility parameter extraction methods and trajectory-based classification models.</p><p><strong>Participants/materials, setting, methods: </strong>We compared Gaussian Process Regression (GPR), moving average, and Discrete Cosine Transform (DCT) smoothing to improve average path estimation. A novel metric, path average width (PAW), was introduced to quantify lateral head displacement. An ensemble of InceptionTime models was trained on (x, y) coordinate sequences to classify spermatozoa as progressive or hyperactivated. Additional classification of motility grades was performed using trajectory endpoints.</p><p><strong>Main results and the role of chance: </strong>The DCT model retaining 12 frequency components (DCT-12) produced the most consistent and symmetric average paths, leading to improved accuracy in the calculation of BCF and ALH. Our introduced PAW metric effectively distinguished between hyperactivated spermatozoa (5.5 ± 1.5 μm) and progressive spermatozoa (2.0 ± 1.3 μm). The InceptionTime-based classification model achieved 89% accuracy in differentiating progressive and hyperactivated trajectories, and 78% accuracy for predicting motility grades.</p><p><strong>Limitations, reasons for caution: </strong>Models were trained on sperm trajectories recorded in low-viscosity media. Since sperm selection for ICSI is performed in viscous environments like low concentrations of polyvinylpyrrolidone, future training on such data is essential to improve clinical translation. Additionally, the model for classifying progressive and hyperactivated sperm was trained on a single-centre dataset (5 individuals, total of 790 trajectories) and, despite cross-validation and data augmentation, stil","PeriodicalId":13003,"journal":{"name":"Human reproduction","volume":" ","pages":""},"PeriodicalIF":6.1,"publicationDate":"2026-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146112927","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}
F Giangrazi, J A Sugrue, V M Sularea, A A I Brugman, M Horan, M Wingfield, D A Crosby, L E Glover, C O'Farrelly
<p><strong>Study question: </strong>Is the endometrial microbiome altered in women who fail to get pregnant after ART and do microbial-derived metabolites influence endometrial cellular mechanisms important for embryo implantation?</p><p><strong>Summary answer: </strong>The endometrial microbiome in women who fail to get pregnant after ART is more diverse and has fewer lactobacilli species than the endometrial microbiomes of women who become pregnant; the short-chain fatty acid butyrate, a common metabolite found in the presence of increased microbial diversity, diminishes endometrial epithelial barrier function and increases the expression of inflammatory markers.</p><p><strong>What is known already: </strong>Shifts in the endometrial microbial community structure have been linked to fertility and pregnancy complications although the underlying mechanisms are poorly understood. Microbial metabolites at other mucosal surfaces, such as the gut, act as important modulators of immune and barrier function, particularly in epithelial cells. Effects of changes in local bacterial microbial populations on fertility, and how their metabolites might influence endometrial cell function have not been explored.</p><p><strong>Study design, size, duration: </strong>In this prospective longitudinal study of ART outcomes, 29 nulliparous women with unexplained infertility were recruited between October 2016 and February 2018. Endometrial tissue samples were taken for microbiome analysis and endometrial transcriptomics prior to ART. For primary cell culture studies, endometrial biopsies were obtained from fertile women of reproductive age undergoing laparoscopic surgical investigation between February 2021 and September 2023. In vitro models of implantation were established using endometrial cell lines and primary endometrial stromal cells.</p><p><strong>Partcipants/materials, setting, methods: </strong>Microbiome 16S sequencing analysis was performed on bacterial DNA isolated from endometrial biopsies and correlated with receptivity markers. Endometrial RNA sequencing data from women undergoing ART were used to analyse differential gene expression of receptivity and decidualization markers in women who had a positive or negative ART cycle outcome. In vitro models, using both established endometrial cell lines and primary human endometrial epithelial cells and stromal cells, were developed to investigate the effects of microbial-derived metabolites. An in vitro model of peri-implantation was used to test the effect of butyrate on endometrial epithelial receptivity and stromal cell decidualization.</p><p><strong>Main results and the role of chance: </strong>Endometrial microbiome 16S sequencing revealed a lower abundance of Lactobacillus spp. and significantly higher abundance of pathogenic species such as Prevotella spp. and Corynebacterium spp. in women who did not become pregnant after ART. Endometrial microbiota from women who had positive ART outcomes showed si
{"title":"Contribution of endometrial microbiome to inflammation-mediated infertility in women undergoing ART.","authors":"F Giangrazi, J A Sugrue, V M Sularea, A A I Brugman, M Horan, M Wingfield, D A Crosby, L E Glover, C O'Farrelly","doi":"10.1093/humrep/deaf252","DOIUrl":"https://doi.org/10.1093/humrep/deaf252","url":null,"abstract":"<p><strong>Study question: </strong>Is the endometrial microbiome altered in women who fail to get pregnant after ART and do microbial-derived metabolites influence endometrial cellular mechanisms important for embryo implantation?</p><p><strong>Summary answer: </strong>The endometrial microbiome in women who fail to get pregnant after ART is more diverse and has fewer lactobacilli species than the endometrial microbiomes of women who become pregnant; the short-chain fatty acid butyrate, a common metabolite found in the presence of increased microbial diversity, diminishes endometrial epithelial barrier function and increases the expression of inflammatory markers.</p><p><strong>What is known already: </strong>Shifts in the endometrial microbial community structure have been linked to fertility and pregnancy complications although the underlying mechanisms are poorly understood. Microbial metabolites at other mucosal surfaces, such as the gut, act as important modulators of immune and barrier function, particularly in epithelial cells. Effects of changes in local bacterial microbial populations on fertility, and how their metabolites might influence endometrial cell function have not been explored.</p><p><strong>Study design, size, duration: </strong>In this prospective longitudinal study of ART outcomes, 29 nulliparous women with unexplained infertility were recruited between October 2016 and February 2018. Endometrial tissue samples were taken for microbiome analysis and endometrial transcriptomics prior to ART. For primary cell culture studies, endometrial biopsies were obtained from fertile women of reproductive age undergoing laparoscopic surgical investigation between February 2021 and September 2023. In vitro models of implantation were established using endometrial cell lines and primary endometrial stromal cells.</p><p><strong>Partcipants/materials, setting, methods: </strong>Microbiome 16S sequencing analysis was performed on bacterial DNA isolated from endometrial biopsies and correlated with receptivity markers. Endometrial RNA sequencing data from women undergoing ART were used to analyse differential gene expression of receptivity and decidualization markers in women who had a positive or negative ART cycle outcome. In vitro models, using both established endometrial cell lines and primary human endometrial epithelial cells and stromal cells, were developed to investigate the effects of microbial-derived metabolites. An in vitro model of peri-implantation was used to test the effect of butyrate on endometrial epithelial receptivity and stromal cell decidualization.</p><p><strong>Main results and the role of chance: </strong>Endometrial microbiome 16S sequencing revealed a lower abundance of Lactobacillus spp. and significantly higher abundance of pathogenic species such as Prevotella spp. and Corynebacterium spp. in women who did not become pregnant after ART. Endometrial microbiota from women who had positive ART outcomes showed si","PeriodicalId":13003,"journal":{"name":"Human reproduction","volume":" ","pages":""},"PeriodicalIF":6.1,"publicationDate":"2026-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146112862","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}
Esra Cetin, Leen Oyoun Alsoud, Yassine El Mahi, Hang-Soo Park, Begum Mathyk, Mervat M Omran, Sana M Salih, Ayman Al-Hendy, Farzana Begum Liakath Ali
Fertility preservation remains a significant concern for individuals undergoing gonadotoxic treatments. While traditional fertility preservation techniques are well-established, these methods can be time-consuming and limited by various medical or logistical barriers. In recent years, the potential of mesenchymal stem cell (MSC)-derived extracellular vesicles (EVs) has emerged as a promising, paradigm-shifting approach in fertility preservation. Preclinical studies have demonstrated the protective and regenerative properties of EVs in chemotherapy-induced ovarian and testicular damage in animal models. EVs provide a cell-free therapy that can potentially preserve ovarian function in females and spermatogenesis in males without the need for surgery or delay in cancer treatment. Additionally, using MSC-derived EVs offers advantages over traditional stem cell therapies, such as a reduced risk of immune rejection, targeted treatment, and avoidance of safety concerns associated with stem cell-based therapies. Future directions include enhancing the therapeutic potential of MSC-derived EVs through genetic engineering or cell priming techniques to target specific tissues and further optimize their utilization in fertility preservation. Given the potential of MSC-derived EVs to protect fertility in both females and males, this approach could revolutionize treatment in oncofertility. Further research, including clinical trials, is necessary to confirm the safety and efficacy of MSC-derived EVs, focusing on premature ovarian insufficiency. Looking ahead, MSC-derived EVs could revolutionize fertility preservation, offering hope for cancer patients and individuals exposed to various environmental risks affecting reproduction, including in space exploration, where protection from cosmic radiation is essential.
{"title":"Role of extracellular vesicles in fertility preservation before gonadotoxic exposures to the ovaries and testes.","authors":"Esra Cetin, Leen Oyoun Alsoud, Yassine El Mahi, Hang-Soo Park, Begum Mathyk, Mervat M Omran, Sana M Salih, Ayman Al-Hendy, Farzana Begum Liakath Ali","doi":"10.1093/humrep/deag004","DOIUrl":"https://doi.org/10.1093/humrep/deag004","url":null,"abstract":"<p><p>Fertility preservation remains a significant concern for individuals undergoing gonadotoxic treatments. While traditional fertility preservation techniques are well-established, these methods can be time-consuming and limited by various medical or logistical barriers. In recent years, the potential of mesenchymal stem cell (MSC)-derived extracellular vesicles (EVs) has emerged as a promising, paradigm-shifting approach in fertility preservation. Preclinical studies have demonstrated the protective and regenerative properties of EVs in chemotherapy-induced ovarian and testicular damage in animal models. EVs provide a cell-free therapy that can potentially preserve ovarian function in females and spermatogenesis in males without the need for surgery or delay in cancer treatment. Additionally, using MSC-derived EVs offers advantages over traditional stem cell therapies, such as a reduced risk of immune rejection, targeted treatment, and avoidance of safety concerns associated with stem cell-based therapies. Future directions include enhancing the therapeutic potential of MSC-derived EVs through genetic engineering or cell priming techniques to target specific tissues and further optimize their utilization in fertility preservation. Given the potential of MSC-derived EVs to protect fertility in both females and males, this approach could revolutionize treatment in oncofertility. Further research, including clinical trials, is necessary to confirm the safety and efficacy of MSC-derived EVs, focusing on premature ovarian insufficiency. Looking ahead, MSC-derived EVs could revolutionize fertility preservation, offering hope for cancer patients and individuals exposed to various environmental risks affecting reproduction, including in space exploration, where protection from cosmic radiation is essential.</p>","PeriodicalId":13003,"journal":{"name":"Human reproduction","volume":" ","pages":""},"PeriodicalIF":6.1,"publicationDate":"2026-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146112899","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}
Sebastian J Leathersich, Susan R Davis, Sandra García Martínez, Christophe Blockeel, Francisca Martínez, Antonio Gosálvez, Peter Humaidan, Laura de la Fuente, Francesc Fàbregues, Anja Pinborg, Dominic Stoop, Nikolaos P Polyzos
<p><strong>Study question: </strong>Does transdermal testosterone treatment improve fertility-related quality of life (QOL) in women with diminished ovarian reserve (DOR)?</p><p><strong>Summary answer: </strong>Transdermal testosterone for 9 weeks at a dose of 5.5 mg per day did not result in improved fertility-related QOL compared with placebo in women with DOR.</p><p><strong>What is known already: </strong>Reduced QOL is prevalent in women with infertility, many of whom have DOR. Several studies have shown a correlation between DOR and lower testosterone levels, and testosterone is frequently prescribed to women with DOR undergoing fertility treatment. Some studies have reported that testosterone therapy may improve wellbeing in pre- and post-menopausal women, though others have found no benefit. There are no studies evaluating the effect of testosterone on QOL in women undergoing fertility treatment.</p><p><strong>Study design, size, duration: </strong>Pre-planned secondary analysis of a double-blind placebo-controlled randomized controlled trial that included 288 participants recruited between April 2015 and August 2022. Of these, 213 completed QOL surveys both before and after treatment and were eligible for inclusion in this analysis.</p><p><strong>Participants/materials, settings, methods: </strong>Participants were women aged 18-43 years with DOR according to the Bologna criteria and planning to undergo IVF treatment at one of eight fertility clinics in Spain, Belgium, and Denmark. Participants were randomized to 5.5 mg of transdermal testosterone per day as 1% gel (n = 106) or an identical placebo (n = 107), applied for a median of 60 days prior to commencing ovarian stimulation. QOL was assessed using the FertiQoL instrument prior to commencing the intervention, and at the completion of the intervention but prior to commencing ovarian stimulation. QOL scores were compared using a one-way ANCOVA adjusted for age, BMI, parity, history of IVF treatment, and baseline FertiQoL scores.</p><p><strong>Main results and the role of chance: </strong>There were no significant differences in baseline characteristics between the testosterone (n = 106) and placebo (n = 107) groups. After adjustment, testosterone showed no benefit over placebo for the Total FertiQoL score (F(1,204)=0.07, P = 0.79), the Core and Treatment scores, nor for any of the included FertiQoL subscales. Total testosterone levels were higher in the testosterone group than the placebo group at the end of the treatment (3.2 ± 2.7 nmol/l vs 0.6 ± 0.4 nmol/l, P < 0.001).</p><p><strong>Limitation, reasons for caution: </strong>QOL was a secondary outcome in this trial, and participants were not recruited based on a low QOL.</p><p><strong>Wider implications of the findings: </strong>Considering the available evidence, including the current study, premenopausal women are unlikely to benefit from testosterone treatment with regard to wellbeing and QOL. This study provides further evidence
{"title":"The impact of transdermal testosterone treatment on quality of life in women with diminished ovarian reserve: secondary analysis of a randomized controlled trial.","authors":"Sebastian J Leathersich, Susan R Davis, Sandra García Martínez, Christophe Blockeel, Francisca Martínez, Antonio Gosálvez, Peter Humaidan, Laura de la Fuente, Francesc Fàbregues, Anja Pinborg, Dominic Stoop, Nikolaos P Polyzos","doi":"10.1093/humrep/deaf233","DOIUrl":"10.1093/humrep/deaf233","url":null,"abstract":"<p><strong>Study question: </strong>Does transdermal testosterone treatment improve fertility-related quality of life (QOL) in women with diminished ovarian reserve (DOR)?</p><p><strong>Summary answer: </strong>Transdermal testosterone for 9 weeks at a dose of 5.5 mg per day did not result in improved fertility-related QOL compared with placebo in women with DOR.</p><p><strong>What is known already: </strong>Reduced QOL is prevalent in women with infertility, many of whom have DOR. Several studies have shown a correlation between DOR and lower testosterone levels, and testosterone is frequently prescribed to women with DOR undergoing fertility treatment. Some studies have reported that testosterone therapy may improve wellbeing in pre- and post-menopausal women, though others have found no benefit. There are no studies evaluating the effect of testosterone on QOL in women undergoing fertility treatment.</p><p><strong>Study design, size, duration: </strong>Pre-planned secondary analysis of a double-blind placebo-controlled randomized controlled trial that included 288 participants recruited between April 2015 and August 2022. Of these, 213 completed QOL surveys both before and after treatment and were eligible for inclusion in this analysis.</p><p><strong>Participants/materials, settings, methods: </strong>Participants were women aged 18-43 years with DOR according to the Bologna criteria and planning to undergo IVF treatment at one of eight fertility clinics in Spain, Belgium, and Denmark. Participants were randomized to 5.5 mg of transdermal testosterone per day as 1% gel (n = 106) or an identical placebo (n = 107), applied for a median of 60 days prior to commencing ovarian stimulation. QOL was assessed using the FertiQoL instrument prior to commencing the intervention, and at the completion of the intervention but prior to commencing ovarian stimulation. QOL scores were compared using a one-way ANCOVA adjusted for age, BMI, parity, history of IVF treatment, and baseline FertiQoL scores.</p><p><strong>Main results and the role of chance: </strong>There were no significant differences in baseline characteristics between the testosterone (n = 106) and placebo (n = 107) groups. After adjustment, testosterone showed no benefit over placebo for the Total FertiQoL score (F(1,204)=0.07, P = 0.79), the Core and Treatment scores, nor for any of the included FertiQoL subscales. Total testosterone levels were higher in the testosterone group than the placebo group at the end of the treatment (3.2 ± 2.7 nmol/l vs 0.6 ± 0.4 nmol/l, P < 0.001).</p><p><strong>Limitation, reasons for caution: </strong>QOL was a secondary outcome in this trial, and participants were not recruited based on a low QOL.</p><p><strong>Wider implications of the findings: </strong>Considering the available evidence, including the current study, premenopausal women are unlikely to benefit from testosterone treatment with regard to wellbeing and QOL. This study provides further evidence","PeriodicalId":13003,"journal":{"name":"Human reproduction","volume":" ","pages":"231-238"},"PeriodicalIF":6.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145855588","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}
Christopher L R Barratt, Kirstine Kirkegaard, Denny Sakkas, Lauren A Wise, Andrew C Williams
{"title":"40th anniversary of Human Reproduction: reflecting on four decades of scientific excellence.","authors":"Christopher L R Barratt, Kirstine Kirkegaard, Denny Sakkas, Lauren A Wise, Andrew C Williams","doi":"10.1093/humrep/deaf241","DOIUrl":"https://doi.org/10.1093/humrep/deaf241","url":null,"abstract":"","PeriodicalId":13003,"journal":{"name":"Human reproduction","volume":"41 2","pages":"137"},"PeriodicalIF":6.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146105265","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":"Development of technologies for the non-invasive assessment of single embryo metabolism and viability.","authors":"David K Gardner, Henry J Leese","doi":"10.1093/humrep/deaf242","DOIUrl":"https://doi.org/10.1093/humrep/deaf242","url":null,"abstract":"","PeriodicalId":13003,"journal":{"name":"Human reproduction","volume":"41 2","pages":"138-139"},"PeriodicalIF":6.1,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146105272","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}