Surrogacy is the assisted reproductive technology (ART) practice in which a person becomes pregnant, carries, and delivers a child on behalf of another couple/person, who are the intended parent(s). Surrogacy is an especially complex practice as the interests of the intended parents, the gestational carrier, and the future child may differ. This paper considers ethical questions related to different forms of surrogacy. It concludes that non-commercial surrogacy is an acceptable method of assisted reproduction for specific indications. When using surrogacy to form a family, it is essential that there are measures to protect all parties, to guarantee well-considered decision-making, and to minimize risks. The current paper formulates recommendations to promote these measures. This paper is an update to the ESHRE Task Force Ethics and Law Paper 10: Surrogacy and replaces this paper.
{"title":"Ethical considerations on surrogacy†.","authors":"Francoise Shenfield, Basil Tarlatzis, Guiliana Baccino, Theofano Bounartzi, Lucy Frith, Guido Pennings, Veerle Provoost, Nathalie Vermeulen, Heidi Mertes","doi":"10.1093/humrep/deaf006","DOIUrl":"https://doi.org/10.1093/humrep/deaf006","url":null,"abstract":"<p><p>Surrogacy is the assisted reproductive technology (ART) practice in which a person becomes pregnant, carries, and delivers a child on behalf of another couple/person, who are the intended parent(s). Surrogacy is an especially complex practice as the interests of the intended parents, the gestational carrier, and the future child may differ. This paper considers ethical questions related to different forms of surrogacy. It concludes that non-commercial surrogacy is an acceptable method of assisted reproduction for specific indications. When using surrogacy to form a family, it is essential that there are measures to protect all parties, to guarantee well-considered decision-making, and to minimize risks. The current paper formulates recommendations to promote these measures. This paper is an update to the ESHRE Task Force Ethics and Law Paper 10: Surrogacy and replaces this paper.</p>","PeriodicalId":13003,"journal":{"name":"Human reproduction","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143046632","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}
Juan J Fraire-Zamora, George Liperis, Munevver Serdarogullari, Omar F Ammar, Paul Pirtea, Paola Viganò, Laurentiu Craciunas, Micah J Hill, Kashish Sharma
{"title":"Recurrent implantation failure: science or fiction?","authors":"Juan J Fraire-Zamora, George Liperis, Munevver Serdarogullari, Omar F Ammar, Paul Pirtea, Paola Viganò, Laurentiu Craciunas, Micah J Hill, Kashish Sharma","doi":"10.1093/humrep/deaf007","DOIUrl":"https://doi.org/10.1093/humrep/deaf007","url":null,"abstract":"","PeriodicalId":13003,"journal":{"name":"Human reproduction","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143023194","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}
A M Klimczak, E Osman, M Esbert, R M Yildirim, C Whitehead, N S Herlihy, B M Hanson, L M Roberts, E Seli, R T Scott
STUDY QUESTION Does the use of slush nitrogen (SN) for embryo vitrification improve embryo transfer outcomes compared to liquid nitrogen (LN)? SUMMARY ANSWER SN is a safe method for embryo preservation and significantly improves post-warming survival rates during repeated vitrification–warming cycles; however, after a single freeze–thaw cycle, pregnancy outcomes are not improved when embryos are vitrified with SN compared to LN. WHAT IS KNOWN ALREADY SN is a combination of solid and LN, with a temperature lower than regular LN, and it is an alternative to conventional LN in achieving a faster cooling speed. Studies have shown that SN improves survival in non-human embryos and human oocytes. However, it is unknown whether the use of SN reduces blastocyst damage in humans during vitrification—as indicated by increased survival across multiple vitrification–warming cycles—or whether it enhances pregnancy outcomes in a single vitrification–warming cycle. STUDY DESIGN, SIZE, DURATION Following the pre-clinical trial assessing embryo survival after repeated freeze–thaw cycles using SN and LN on 50 donated embryos per group, a randomized controlled trial was performed, where 253 patients were enrolled between September 2020 and January 2022, and 245 underwent an IVF stimulation, which resulted in at least one blastocyst for cryopreservation. Of those, 121 were allocated to the SN (study), and 124 were allocated to the LN (control) group. Randomization occurred on the day of blastocyst biopsy using a computer-generated block schema. Groups were assigned via opaque envelopes, opened by the embryologist on vitrification day. The patient, physician, and clinical team were blinded to the intervention. PARTICIPANTS/MATERIALS, SETTING, METHODS All couples with female aged between 18 and 42 years old undergoing IVF stimulation at one university-affiliated infertility center, with plan for preimplantation genetic testing for aneuploidy and subsequent single, frozen embryo transfer (FET) were eligible for inclusion in this study. MAIN RESULTS AND THE ROLE OF CHANCE The pre-clinical trial demonstrated significant improvements in blastocyst survival, with the SN group achieving a mean of 7.5 survived vitrification–warming cycles (range: 3–22), significantly surpassing the mean of 3.0 cycles (range: 0–10) in the LN group (P < 0.0001). Following the pre-clinical trial, 223 patients randomized to SN or LN underwent single FET. Baseline characteristics were similar between groups, as were embryology outcomes, including the number of oocytes retrieved, mature oocytes, fertilization rate, and total blastocysts biopsied. No significant differences were observed between the two groups in pregnancy rate, clinical pregnancy rate, sustained implantation rate, or miscarriage rate (P = 0.16, 0.80, 0.49, and 0.74, respectively, using Student’s t-test). A futility analysis indicated no value in continuing recruitment and therefore the study was closed. LIMITATIONS, REASONS
{"title":"A randomized controlled trial comparing embryo vitrification with slush nitrogen to liquid nitrogen in women undergoing frozen embryo transfer: embryology and clinical outcomes","authors":"A M Klimczak, E Osman, M Esbert, R M Yildirim, C Whitehead, N S Herlihy, B M Hanson, L M Roberts, E Seli, R T Scott","doi":"10.1093/humrep/deaf003","DOIUrl":"https://doi.org/10.1093/humrep/deaf003","url":null,"abstract":"STUDY QUESTION Does the use of slush nitrogen (SN) for embryo vitrification improve embryo transfer outcomes compared to liquid nitrogen (LN)? SUMMARY ANSWER SN is a safe method for embryo preservation and significantly improves post-warming survival rates during repeated vitrification–warming cycles; however, after a single freeze–thaw cycle, pregnancy outcomes are not improved when embryos are vitrified with SN compared to LN. WHAT IS KNOWN ALREADY SN is a combination of solid and LN, with a temperature lower than regular LN, and it is an alternative to conventional LN in achieving a faster cooling speed. Studies have shown that SN improves survival in non-human embryos and human oocytes. However, it is unknown whether the use of SN reduces blastocyst damage in humans during vitrification—as indicated by increased survival across multiple vitrification–warming cycles—or whether it enhances pregnancy outcomes in a single vitrification–warming cycle. STUDY DESIGN, SIZE, DURATION Following the pre-clinical trial assessing embryo survival after repeated freeze–thaw cycles using SN and LN on 50 donated embryos per group, a randomized controlled trial was performed, where 253 patients were enrolled between September 2020 and January 2022, and 245 underwent an IVF stimulation, which resulted in at least one blastocyst for cryopreservation. Of those, 121 were allocated to the SN (study), and 124 were allocated to the LN (control) group. Randomization occurred on the day of blastocyst biopsy using a computer-generated block schema. Groups were assigned via opaque envelopes, opened by the embryologist on vitrification day. The patient, physician, and clinical team were blinded to the intervention. PARTICIPANTS/MATERIALS, SETTING, METHODS All couples with female aged between 18 and 42 years old undergoing IVF stimulation at one university-affiliated infertility center, with plan for preimplantation genetic testing for aneuploidy and subsequent single, frozen embryo transfer (FET) were eligible for inclusion in this study. MAIN RESULTS AND THE ROLE OF CHANCE The pre-clinical trial demonstrated significant improvements in blastocyst survival, with the SN group achieving a mean of 7.5 survived vitrification–warming cycles (range: 3–22), significantly surpassing the mean of 3.0 cycles (range: 0–10) in the LN group (P &lt; 0.0001). Following the pre-clinical trial, 223 patients randomized to SN or LN underwent single FET. Baseline characteristics were similar between groups, as were embryology outcomes, including the number of oocytes retrieved, mature oocytes, fertilization rate, and total blastocysts biopsied. No significant differences were observed between the two groups in pregnancy rate, clinical pregnancy rate, sustained implantation rate, or miscarriage rate (P = 0.16, 0.80, 0.49, and 0.74, respectively, using Student’s t-test). A futility analysis indicated no value in continuing recruitment and therefore the study was closed. LIMITATIONS, REASONS","PeriodicalId":13003,"journal":{"name":"Human reproduction","volume":"32 1","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-01-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142992172","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}
Families have been subject to enormous transformations with the emergence of artificial reproductive technology and the appearance of donor-conceived children. These new families are challenged to disclose origins with their children and parents feel concern that conception stories might have an emotional impact on their children. Fertility counsellors still feel ill-equipped on what to recommend to parents because developmental psychology has not designed systematic evidence-based guidelines to address a three-dimensional matter: 'what', 'when', and 'how' to discuss conception stories. The argument developed herein is that professionals working with families in fertility clinics, could benefit from understanding these new family conversational processes of origin storytelling from these three perspectives, not only on 'what' and 'when' but also on the less elaborated 'how' to talk about it. For this purpose, understanding elaborative reminiscing as a specific way of talking about the past that helps children to build autobiographical memories and develop their identity might be key.
{"title":"Beyond the disclosure debate in donor-conception: how do we help families to discuss origin stories with their children?","authors":"Javiera Navarro-Marshall","doi":"10.1093/humrep/deaf004","DOIUrl":"https://doi.org/10.1093/humrep/deaf004","url":null,"abstract":"Families have been subject to enormous transformations with the emergence of artificial reproductive technology and the appearance of donor-conceived children. These new families are challenged to disclose origins with their children and parents feel concern that conception stories might have an emotional impact on their children. Fertility counsellors still feel ill-equipped on what to recommend to parents because developmental psychology has not designed systematic evidence-based guidelines to address a three-dimensional matter: 'what', 'when', and 'how' to discuss conception stories. The argument developed herein is that professionals working with families in fertility clinics, could benefit from understanding these new family conversational processes of origin storytelling from these three perspectives, not only on 'what' and 'when' but also on the less elaborated 'how' to talk about it. For this purpose, understanding elaborative reminiscing as a specific way of talking about the past that helps children to build autobiographical memories and develop their identity might be key.","PeriodicalId":13003,"journal":{"name":"Human reproduction","volume":"6 1","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142991729","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: Unveiling early predictors of adverse birth outcomes: the potential and limits of embryonic growth metrics.","authors":"Jorine Roelants, Marijn J Vermeulen, Régine Steegers-Theunissen","doi":"10.1093/humrep/deae296","DOIUrl":"https://doi.org/10.1093/humrep/deae296","url":null,"abstract":"","PeriodicalId":13003,"journal":{"name":"Human reproduction","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142970639","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 De Corte, I Milhoranca, A S Oberg, T Kurth, S Mechsner, K Heinemann
STUDY QUESTION Does endometriosis affect the mental health of women using oral contraceptives? SUMMARY ANSWER Among oral contraceptive users, women with endometriosis have a higher risk of depression compared to those without endometriosis, although the absolute risk increase is small. WHAT IS KNOWN ALREADY Previous studies have suggested a potential link between endometriosis and mental health issues, but the impact of endometriosis on depression among oral contraceptive users remains unclear. STUDY DESIGN, SIZE, DURATION A secondary pooled cohort study utilizing data from two longitudinal patient-centric studies (INAS-VIPOS and PRO-E2) was conducted across 11 European countries, Colombia and Australia. The study included 93 541 women newly prescribed oral contraceptives, with or without endometriosis, and without a self-reported history of depression. PARTICIPANTS/MATERIALS, SETTING, METHODS Participant’s mental health was captured using self-administered questionnaires at baseline and every 6–12 months thereafter, asking about any newly occurred episodes of depression. Incidence rates (IRs) of self-reported depression were calculated per 10 000 woman-years. Absolute risk difference (ARD) and number needed to harm (NNH) were calculated with 95% CIs. The association between endometriosis and self-reported depression was estimated through crude and adjusted hazard ratios (HRs) with 95% CI, using stabilized inverse probability of treatment weighting (IPTW). MAIN RESULTS AND THE ROLE OF CHANCE Of the included 93 541 women, 21 090 had endometriosis (49 541 woman-years) and 72 451 had no endometriosis (137 137 woman-years.) Of those with endometriosis, 308 (1.5%) reported an episode of depression (IR: 62.2/10 000, 95% CI: 55.4–69.5) compared to 535 (0.7%) of women without endometriosis (IR 39.0/10 000, 95% CI: 35.8–42.5). The ARD and NNH were 23.2 per 10 000 (95% CI: 15.2–30.9) and 431 (95% CI: 323.7–657.0) respectively. The HR of depression in women with endometriosis was 1.85 (95% CI: 1.60–2.13) using stabilized IPTW to control for age, BMI, smoking, education, and age at menarche. Subgroup and sensitivity analyses showed similar results. LIMITATIONS, REASONS FOR CAUTION While efforts were made to control for confounding factors, residual confounding may still exist. Additionally, the results can only be generalized to users of oral contraceptives. WIDER IMPLICATIONS OF THE FINDINGS These results highlight the importance of considering the mental health implications of endometriosis among women using oral contraceptives. Further research is needed to explore additional contributing factors and potential interventions. STUDY FUNDING/COMPETING INTEREST(S) No funding was received for this study. No competing interests apply for this research. TRIAL REGISTRATION NUMBER N/A.
{"title":"Endometriosis and risk of depression among oral contraceptive users: a pooled analysis of cohort studies from 13 countries","authors":"P De Corte, I Milhoranca, A S Oberg, T Kurth, S Mechsner, K Heinemann","doi":"10.1093/humrep/deae299","DOIUrl":"https://doi.org/10.1093/humrep/deae299","url":null,"abstract":"STUDY QUESTION Does endometriosis affect the mental health of women using oral contraceptives? SUMMARY ANSWER Among oral contraceptive users, women with endometriosis have a higher risk of depression compared to those without endometriosis, although the absolute risk increase is small. WHAT IS KNOWN ALREADY Previous studies have suggested a potential link between endometriosis and mental health issues, but the impact of endometriosis on depression among oral contraceptive users remains unclear. STUDY DESIGN, SIZE, DURATION A secondary pooled cohort study utilizing data from two longitudinal patient-centric studies (INAS-VIPOS and PRO-E2) was conducted across 11 European countries, Colombia and Australia. The study included 93 541 women newly prescribed oral contraceptives, with or without endometriosis, and without a self-reported history of depression. PARTICIPANTS/MATERIALS, SETTING, METHODS Participant’s mental health was captured using self-administered questionnaires at baseline and every 6–12 months thereafter, asking about any newly occurred episodes of depression. Incidence rates (IRs) of self-reported depression were calculated per 10 000 woman-years. Absolute risk difference (ARD) and number needed to harm (NNH) were calculated with 95% CIs. The association between endometriosis and self-reported depression was estimated through crude and adjusted hazard ratios (HRs) with 95% CI, using stabilized inverse probability of treatment weighting (IPTW). MAIN RESULTS AND THE ROLE OF CHANCE Of the included 93 541 women, 21 090 had endometriosis (49 541 woman-years) and 72 451 had no endometriosis (137 137 woman-years.) Of those with endometriosis, 308 (1.5%) reported an episode of depression (IR: 62.2/10 000, 95% CI: 55.4–69.5) compared to 535 (0.7%) of women without endometriosis (IR 39.0/10 000, 95% CI: 35.8–42.5). The ARD and NNH were 23.2 per 10 000 (95% CI: 15.2–30.9) and 431 (95% CI: 323.7–657.0) respectively. The HR of depression in women with endometriosis was 1.85 (95% CI: 1.60–2.13) using stabilized IPTW to control for age, BMI, smoking, education, and age at menarche. Subgroup and sensitivity analyses showed similar results. LIMITATIONS, REASONS FOR CAUTION While efforts were made to control for confounding factors, residual confounding may still exist. Additionally, the results can only be generalized to users of oral contraceptives. WIDER IMPLICATIONS OF THE FINDINGS These results highlight the importance of considering the mental health implications of endometriosis among women using oral contraceptives. Further research is needed to explore additional contributing factors and potential interventions. STUDY FUNDING/COMPETING INTEREST(S) No funding was received for this study. No competing interests apply for this research. TRIAL REGISTRATION NUMBER N/A.","PeriodicalId":13003,"journal":{"name":"Human reproduction","volume":"82 1","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142968236","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":"Unveiling early predictors of adverse birth outcomes: the potential and limits of embryonic growth metrics.","authors":"Binglin Li, Yueqi Feng, Ruijuan Chen","doi":"10.1093/humrep/deae295","DOIUrl":"https://doi.org/10.1093/humrep/deae295","url":null,"abstract":"","PeriodicalId":13003,"journal":{"name":"Human reproduction","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142970642","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>What is the association between endometriosis and working life (lost), workforce participation, and productivity?</p><p><strong>Summary answer: </strong>Women with endometriosis experienced more working years lost due to disability pension and to a smaller degree sick leave, they were less frequently working or enrolled in education, had more sick days, were less productive, and had lower work ability.</p><p><strong>What is known already: </strong>Endometriosis is associated with negative consequences on working life; however, previous studies are based on self-reported data or smaller samples of women. To the best of our knowledge, no previous studies have quantified the average reduction in working hours during the entire span of working life using population-based registers.</p><p><strong>Study design, size, duration: </strong>This study included two Danish data sources. In the register-based cohort study (main analysis), a total of 2 650 554 women aged 18-65 years were followed for a total of 42.8 million person-years from 1992 to 2021. In the questionnaire-based cross-sectional study (Supplementary Analysis), 35 490 women aged 26-51 years were invited to participate and 7298 women completed the questionnaire.</p><p><strong>Participants/materials, setting, methods: </strong>For the main analysis, 42 741 (1.6%) were diagnosed with endometriosis. We estimated working years lost decomposed into disability pension, voluntary early retirement, or death for women with endometriosis and the general female population. For the supplementary analysis, 270 (4.0%) reported to have endometriosis. We analysed these recent questionnaire data on women's health to further investigate working life and productivity among women with and without endometriosis.</p><p><strong>Main results and the role of chance: </strong>Based on the main analysis, women with endometriosis lost on average an additional 0.26 years (95% CI: 0.17-0.37) of working life compared to the general female population. This was due to sick leave and especially disability pension. For the supplementary analysis, the participation rate was 20.6%. Women with endometriosis reported to be less frequently working or enrolled in education (74.1% (95% CI 68.4%-79.2%) with endometriosis, 82.7% (95% CI 81.8%-83.7%) without) and had more sick days (4-28 sick days last 4 weeks: 16.2% (95% CI 11.6%-21.8%) with endometriosis, 7.9% (95% CI 7.2%-8.7%) without). In addition, they reported lower productivity and work ability.</p><p><strong>Limitations, reasons for caution: </strong>Endometriosis is underdiagnosed in the register data as only hospital diagnoses are registered and diagnoses from private practicing gynaecologists and general practitioners are missing. In addition, sick leave might be underestimated as shorter periods of sick leave are not included in the registers. Questionnaire data were self-reported including endometriosis and participants might be a selected
研究问题：子宫内膜异位症与工作寿命（丧失）、工作参与率和生产力之间有什么联系？概要回答：患有子宫内膜异位症的女性由于残疾抚恤金而失去了更多的工作年限，并且在较小程度上病假，她们工作或上学的频率更低，请病假的次数更多，工作效率更低，工作能力更低。已知情况：子宫内膜异位症与工作生活的负面影响有关；然而，之前的研究是基于自我报告的数据或较小的女性样本。据我们所知，以前没有研究使用基于人口的登记来量化整个工作寿命期间工作时间的平均减少。研究设计、规模、持续时间：本研究包括两个丹麦数据源。在基于登记的队列研究（主要分析）中，从1992年到2021年，共有2650554名年龄在18-65岁之间的女性被随访，共计4280万人年。在以问卷为基础的横断面研究（补充分析）中，邀请35 490名26-51岁的女性参与，7298名女性完成了问卷。参与者/材料、环境、方法：主要分析42441例（1.6%）诊断为子宫内膜异位症。我们估计了子宫内膜异位症女性和一般女性人群中分解为残疾抚恤金、自愿提前退休或死亡的丧失工作年数。在补充分析中，270例（4.0%）报告患有子宫内膜异位症。我们分析了这些最近关于女性健康的问卷数据，以进一步调查有和没有子宫内膜异位症的女性的工作生活和生产力。主要结果和偶然性的作用：根据主要分析，与普通女性人群相比，患有子宫内膜异位症的女性平均减少了0.26年的工作寿命（95% CI: 0.17-0.37）。这是由于请病假，特别是残疾养恤金。在补充分析中，参与率为20.6%。据报道，患有子宫内膜异位症的妇女工作或接受教育的频率较低（74.1% （95% CI 68.4%-79.2%）患有子宫内膜异位症，82.7% （95% CI 81.8%-83.7%）没有），并且有更多的病假（4-28天持续4周：16.2% （95% CI 11.6%-21.8%）患有子宫内膜异位症，7.9% （95% CI 7.2%-8.7%）没有）。此外，他们的工作效率和工作能力也较低。局限性，谨慎的原因：子宫内膜异位症在登记数据中诊断不足，因为只有医院诊断被登记，而私人执业妇科医生和全科医生的诊断缺失。此外，病假可能被低估，因为较短的病假没有被列入登记册。问卷数据是自我报告的，包括子宫内膜异位症，参与者可能是一组选定的妇女。研究结果的更广泛意义：这项研究与之前关于子宫内膜异位症及其对工作寿命影响的研究一致。此外，据我们所知，之前没有研究量化了在整个工作生涯中平均减少的工作年限。然而，这些发现可能只适用于丹麦或北欧国家，因为这些国家的福利制度在失业、生病或工作能力下降期间提供了经济保障。研究资金/竞争利益：本研究由“使用机器学习发现子宫内膜异位症”项目（FEMaLe/101017562）资助，该项目已获得欧盟地平线2020研究和创新计划的资助。作者没有利益冲突。试验注册号：无。
{"title":"Association between endometriosis and working life among Danish women.","authors":"Eeva-Liisa Røssell, Oleguer Plana-Ripoll, Marie Josiasen, Karina Ejgaard Hansen, Bodil Hammer Bech, Dorte Rytter","doi":"10.1093/humrep/deae298","DOIUrl":"https://doi.org/10.1093/humrep/deae298","url":null,"abstract":"<p><strong>Study question: </strong>What is the association between endometriosis and working life (lost), workforce participation, and productivity?</p><p><strong>Summary answer: </strong>Women with endometriosis experienced more working years lost due to disability pension and to a smaller degree sick leave, they were less frequently working or enrolled in education, had more sick days, were less productive, and had lower work ability.</p><p><strong>What is known already: </strong>Endometriosis is associated with negative consequences on working life; however, previous studies are based on self-reported data or smaller samples of women. To the best of our knowledge, no previous studies have quantified the average reduction in working hours during the entire span of working life using population-based registers.</p><p><strong>Study design, size, duration: </strong>This study included two Danish data sources. In the register-based cohort study (main analysis), a total of 2 650 554 women aged 18-65 years were followed for a total of 42.8 million person-years from 1992 to 2021. In the questionnaire-based cross-sectional study (Supplementary Analysis), 35 490 women aged 26-51 years were invited to participate and 7298 women completed the questionnaire.</p><p><strong>Participants/materials, setting, methods: </strong>For the main analysis, 42 741 (1.6%) were diagnosed with endometriosis. We estimated working years lost decomposed into disability pension, voluntary early retirement, or death for women with endometriosis and the general female population. For the supplementary analysis, 270 (4.0%) reported to have endometriosis. We analysed these recent questionnaire data on women's health to further investigate working life and productivity among women with and without endometriosis.</p><p><strong>Main results and the role of chance: </strong>Based on the main analysis, women with endometriosis lost on average an additional 0.26 years (95% CI: 0.17-0.37) of working life compared to the general female population. This was due to sick leave and especially disability pension. For the supplementary analysis, the participation rate was 20.6%. Women with endometriosis reported to be less frequently working or enrolled in education (74.1% (95% CI 68.4%-79.2%) with endometriosis, 82.7% (95% CI 81.8%-83.7%) without) and had more sick days (4-28 sick days last 4 weeks: 16.2% (95% CI 11.6%-21.8%) with endometriosis, 7.9% (95% CI 7.2%-8.7%) without). In addition, they reported lower productivity and work ability.</p><p><strong>Limitations, reasons for caution: </strong>Endometriosis is underdiagnosed in the register data as only hospital diagnoses are registered and diagnoses from private practicing gynaecologists and general practitioners are missing. In addition, sick leave might be underestimated as shorter periods of sick leave are not included in the registers. Questionnaire data were self-reported including endometriosis and participants might be a selected","PeriodicalId":13003,"journal":{"name":"Human reproduction","volume":" ","pages":""},"PeriodicalIF":6.0,"publicationDate":"2025-01-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142970633","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}
Nicolas Gatimel, Guillaume Perez, Eloïse Bruno, David Sagnat, Corinne Rolland, Yan Tanguy-Le-Gac, Emeline Di Donato, Claire Racaud, Roger Léandri, Célia Bettiol, Céline Deraison, Jean-Paul Motta, Eric Huyghe, Nathalie Vergnolle
STUDY QUESTION Does a human fallopian tube (HFT) organoid model offer a favourable apical environment for human sperm survival and motility? SUMMARY ANSWER After differentiation, the apical compartment of a new HFT organoid model provides a favourable environment for sperm motility, which is better than commercial media. WHAT IS KNOWN ALREADY HFTs are the site of major events that are crucial for achieving an ongoing pregnancy, such as gamete survival and competence, fertilization steps, and preimplantation embryo development. In order to better understand the tubal physiology and tubal factors involved in these reproductive functions, and to improve still suboptimal in vitro conditions for gamete preparation and embryo culture during IVF, we sought to develop an HFT organoid model from isolated adult stem cells to allow spermatozoa co-culture in the apical compartment. STUDY DESIGN, SIZE, DURATION Over a 2-year period, fallopian tube tissues were collected for organoid culture purposes from 10 ‘donor’ patients undergoing bilateral salpingectomy by laparoscopy for definitive sterilization. After tissue digestion, isolated cells from the isthmus and ampulla regions were separately seeded in 3D Matrigel and cultured with conventional growth factors for organoid culture and specific factors for differentiation of the female genital tract. PARTICIPANTS/MATERIALS, SETTING, METHODS HFT organoids were characterized by light microscopy, scanning and transmission electron microscopy, immunofluorescence, and transcriptome analysis. Following simultaneous organoid culture on specific inserts, spermatozoa from five donors were placed either in control media or in the apical compartment of colon or HFT organoids (isthmus and ampulla separately) for 96 h. Vitality and motility and kinematic parameters were assessed at 0, 48, and 96 h on 200 spermatozoa in each condition and in duplicate and compared using the Wilcoxon test. MAIN RESULTS AND THE ROLE OF CHANCE Specific fallopian tube differentiation of our model was confirmed by immunofluorescence, transcriptome analysis, and electron microscopy observations that exhibited ciliated and secretory cells. We succeeded in releasing spermatozoa in the apical compartment of HFT organoids and in recovering them for sperm analysis. Sperm vitality values were similar in HFT organoids and in commercial sperm media. We demonstrated a superiority of the HFT organoid apical compartment for sperm motility compared with other controls (colon organoids, organoid culture media, and conventional commercial sperm fertilization media). At 48 h of incubation, progressive sperm motility was higher in the apical compartment of HFT organoids (ampulla 31% ± 17, isthmus 29% ± 15) than in commercial fertilization media (15% ± 15) (P < 0.05) and compared with all other conditions. At 96 h, progressive sperm motility was almost nil (<1%) in all conditions except for spermatozoa in HFT organoids (P < 0.05): 12% ± 15 and
{"title":"Human fallopian tube organoids provide a favourable environment for sperm motility","authors":"Nicolas Gatimel, Guillaume Perez, Eloïse Bruno, David Sagnat, Corinne Rolland, Yan Tanguy-Le-Gac, Emeline Di Donato, Claire Racaud, Roger Léandri, Célia Bettiol, Céline Deraison, Jean-Paul Motta, Eric Huyghe, Nathalie Vergnolle","doi":"10.1093/humrep/deae258","DOIUrl":"https://doi.org/10.1093/humrep/deae258","url":null,"abstract":"STUDY QUESTION Does a human fallopian tube (HFT) organoid model offer a favourable apical environment for human sperm survival and motility? SUMMARY ANSWER After differentiation, the apical compartment of a new HFT organoid model provides a favourable environment for sperm motility, which is better than commercial media. WHAT IS KNOWN ALREADY HFTs are the site of major events that are crucial for achieving an ongoing pregnancy, such as gamete survival and competence, fertilization steps, and preimplantation embryo development. In order to better understand the tubal physiology and tubal factors involved in these reproductive functions, and to improve still suboptimal in vitro conditions for gamete preparation and embryo culture during IVF, we sought to develop an HFT organoid model from isolated adult stem cells to allow spermatozoa co-culture in the apical compartment. STUDY DESIGN, SIZE, DURATION Over a 2-year period, fallopian tube tissues were collected for organoid culture purposes from 10 ‘donor’ patients undergoing bilateral salpingectomy by laparoscopy for definitive sterilization. After tissue digestion, isolated cells from the isthmus and ampulla regions were separately seeded in 3D Matrigel and cultured with conventional growth factors for organoid culture and specific factors for differentiation of the female genital tract. PARTICIPANTS/MATERIALS, SETTING, METHODS HFT organoids were characterized by light microscopy, scanning and transmission electron microscopy, immunofluorescence, and transcriptome analysis. Following simultaneous organoid culture on specific inserts, spermatozoa from five donors were placed either in control media or in the apical compartment of colon or HFT organoids (isthmus and ampulla separately) for 96 h. Vitality and motility and kinematic parameters were assessed at 0, 48, and 96 h on 200 spermatozoa in each condition and in duplicate and compared using the Wilcoxon test. MAIN RESULTS AND THE ROLE OF CHANCE Specific fallopian tube differentiation of our model was confirmed by immunofluorescence, transcriptome analysis, and electron microscopy observations that exhibited ciliated and secretory cells. We succeeded in releasing spermatozoa in the apical compartment of HFT organoids and in recovering them for sperm analysis. Sperm vitality values were similar in HFT organoids and in commercial sperm media. We demonstrated a superiority of the HFT organoid apical compartment for sperm motility compared with other controls (colon organoids, organoid culture media, and conventional commercial sperm fertilization media). At 48 h of incubation, progressive sperm motility was higher in the apical compartment of HFT organoids (ampulla 31% ± 17, isthmus 29% ± 15) than in commercial fertilization media (15% ± 15) (P &lt; 0.05) and compared with all other conditions. At 96 h, progressive sperm motility was almost nil (&lt;1%) in all conditions except for spermatozoa in HFT organoids (P &lt; 0.05): 12% ± 15 and","PeriodicalId":13003,"journal":{"name":"Human reproduction","volume":"129 1","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142961638","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}
S Lee, O Aasmets, R K Arffman, J Laru, H R Rossi, A Salumets, T T Piltonen, E Org
STUDY QUESTION Do polycystic ovary syndrome (PCOS), menstrual cycle phases, and ovulatory status affect reproductive tract (RT) microbiome profiles? SUMMARY ANSWER We identified microbial features associated with menstrual cycle phases in the upper and lower RT microbiome, but only two specific differences in the upper RT according to PCOS status. WHAT IS KNOWN ALREADY The vaginal and uterine microbiome profiles vary throughout the menstrual cycle. Studies have reported alterations in the vaginal microbiome among women diagnosed with PCOS. STUDY DESIGN, SIZE, DURATION This prospective case-control study included a cohort of 37 healthy control women and 52 women diagnosed with PCOS. Microbiome samples were collected from the vagina as vaginal swabs (VS) and from the uterus as endometrial flushing (EF) aspirate samples, and compared according to PCOS diagnosis, the menstrual cycle phases, and ovulatory status, at Oulu University Hospital (Oulu, Finland) from January 2017 to March 2020. PARTICIPANTS/MATERIALS, SETTING, METHODS A total of 83 VS samples and 80 EF samples were collected. Age and body mass index (BMI) were matched between women with and without PCOS. Clinical characteristics were assessed using blood samples collected between cycle days 2 and 8, and microbial DNA was sequenced on the Ion Torrent platform. Microbial alpha diversity (i.e. the observed number of unique genera and Shannon diversity index) was analysed across sample types, PCOS diagnosis and menstrual cycle phases. Linear mixed-effects models were utilised to identify microbial features in relation to PCOS and the menstrual cycle phases. Associations between the beta diversity of the RT microbiome and PCOS- and cycle-related clinical features were calculated using PERMANOVA. MAIN RESULTS AND THE ROLE OF CHANCE Microbial alpha diversity showed no difference with PCOS (VS: Pobserved feature = 0.836, Pshannon = 0.998; EF: Pobserved feature = 0.366, Pshannon = 0.185), but varied with menstrual cycle phases (VS: Pobserved feature = 0.001, Pshannon = 0.882; EF: Pobserved feature = 0.026, Pshannon = 0.048). No difference was observed in beta diversity based on either PCOS or the menstrual cycle phases (VS: PPCOS = 0.280, Pcycle = 0.115; EF: PPCOS = 0.234, Pcycle = 0.088). In the endometrial flushing samples, we identified two novel microbial features, characterised by the ratio of differential abundance of two genera, associated with PCOS (FDR ≤ 0.1) and 13 novel features associated with the menstrual cycle phases (FDR ≤ 0.1). LIMITATIONS, REASONS FOR CAUTION Although this was the first study to simultaneously analyse, the lower and upper RT microbiome in women with and without PCOS, the limited sample size of anovulatory cases may hinder the detection of differences related to PCOS and ovulatory status. WIDER IMPLICATIONS OF THE FINDINGS The main finding suggests that PCOS and the menstrual cycle phases are associated with specific microbial features in the upper RT, indicating th
{"title":"The reproductive tract microbiome in women with polycystic ovary syndrome and across different menstrual cycle phases","authors":"S Lee, O Aasmets, R K Arffman, J Laru, H R Rossi, A Salumets, T T Piltonen, E Org","doi":"10.1093/humrep/deae270","DOIUrl":"https://doi.org/10.1093/humrep/deae270","url":null,"abstract":"STUDY QUESTION Do polycystic ovary syndrome (PCOS), menstrual cycle phases, and ovulatory status affect reproductive tract (RT) microbiome profiles? SUMMARY ANSWER We identified microbial features associated with menstrual cycle phases in the upper and lower RT microbiome, but only two specific differences in the upper RT according to PCOS status. WHAT IS KNOWN ALREADY The vaginal and uterine microbiome profiles vary throughout the menstrual cycle. Studies have reported alterations in the vaginal microbiome among women diagnosed with PCOS. STUDY DESIGN, SIZE, DURATION This prospective case-control study included a cohort of 37 healthy control women and 52 women diagnosed with PCOS. Microbiome samples were collected from the vagina as vaginal swabs (VS) and from the uterus as endometrial flushing (EF) aspirate samples, and compared according to PCOS diagnosis, the menstrual cycle phases, and ovulatory status, at Oulu University Hospital (Oulu, Finland) from January 2017 to March 2020. PARTICIPANTS/MATERIALS, SETTING, METHODS A total of 83 VS samples and 80 EF samples were collected. Age and body mass index (BMI) were matched between women with and without PCOS. Clinical characteristics were assessed using blood samples collected between cycle days 2 and 8, and microbial DNA was sequenced on the Ion Torrent platform. Microbial alpha diversity (i.e. the observed number of unique genera and Shannon diversity index) was analysed across sample types, PCOS diagnosis and menstrual cycle phases. Linear mixed-effects models were utilised to identify microbial features in relation to PCOS and the menstrual cycle phases. Associations between the beta diversity of the RT microbiome and PCOS- and cycle-related clinical features were calculated using PERMANOVA. MAIN RESULTS AND THE ROLE OF CHANCE Microbial alpha diversity showed no difference with PCOS (VS: Pobserved feature = 0.836, Pshannon = 0.998; EF: Pobserved feature = 0.366, Pshannon = 0.185), but varied with menstrual cycle phases (VS: Pobserved feature = 0.001, Pshannon = 0.882; EF: Pobserved feature = 0.026, Pshannon = 0.048). No difference was observed in beta diversity based on either PCOS or the menstrual cycle phases (VS: PPCOS = 0.280, Pcycle = 0.115; EF: PPCOS = 0.234, Pcycle = 0.088). In the endometrial flushing samples, we identified two novel microbial features, characterised by the ratio of differential abundance of two genera, associated with PCOS (FDR ≤ 0.1) and 13 novel features associated with the menstrual cycle phases (FDR ≤ 0.1). LIMITATIONS, REASONS FOR CAUTION Although this was the first study to simultaneously analyse, the lower and upper RT microbiome in women with and without PCOS, the limited sample size of anovulatory cases may hinder the detection of differences related to PCOS and ovulatory status. WIDER IMPLICATIONS OF THE FINDINGS The main finding suggests that PCOS and the menstrual cycle phases are associated with specific microbial features in the upper RT, indicating th","PeriodicalId":13003,"journal":{"name":"Human reproduction","volume":"7 1","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142961644","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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