Carmen Shu Man Ng,Paul Yu Wing Tong,Evelyn Wong,Heidi Hiu Yee Cheng,Jennifer Ka Yee Ko,Raymond Hang Wun Li,Ernest Hung Yu Ng
STUDY QUESTIONDoes the use of virtual reality (VR) reduce pain levels experienced by women during transvaginal oocyte retrieval using paracervical block and conscious sedation?SUMMARY ANSWERThe use of VR did not reduce pain levels during oocyte retrieval using paracervical block and conscious sedation.WHAT IS KNOWN ALREADYConscious sedation is commonly used for pain relief during oocyte retrieval, and the concurrent use of more than one method of sedation and analgesia resulted in better pain relief than a single modality. Many studies have shown promising results in reducing anxiety and pain with the use of VR during medical procedures.STUDY DESIGN, SIZE, DURATIONThis is a randomized controlled trial of 160 infertile women undergoing transvaginal oocyte retrieval using paracervical block and conscious sedation between December 2022 and October 2023.PARTICIPANTS/MATERIALS, SETTING, METHODSThe study was conducted in a university-affiliated assisted reproduction unit. Recruited women were randomly assigned into the VR group (n = 80) and the standard care group (n = 80). Pain levels upon vaginal puncture and oocyte retrieval were recorded using a 100-point visual analogue scale.MAIN RESULTS AND THE ROLE OF CHANCEBoth groups were comparable in terms of demographic parameters, ovarian stimulation responses, and the anxiety trait and state scores. There was no significant difference in maximal pain level at vaginal puncture (50.8 ± 23.6 vs. 54.8 ± 25.4; 95% CI -11.7, 3.7; P = 0.30) and oocyte retrieval (56.4 ± 24.6 vs. 60.3 ± 26.8; 95% CI -12.0, 4.2; P = 0.34) between the VR group and standard care group. The satisfaction score was similar in both groups.LIMITATIONS, REASONS FOR CAUTIONThe small sample size of the study was a limitation. Blinding participants and researchers were not feasible due to the nature of the study. The degree of immersion was also affected when viewing the VR headset from a prone perspective, and the experience was also limited by the standardization of VR scenario and audio. The pain score recorded by the visual analogue scale was a subjective measurement.WIDER IMPLICATIONS OF THE FINDINGSAlthough the use of VR was otherwise well tolerated without major side effect, its routine use for pain relief during oocyte retrieval cannot be supported.STUDY FUNDING/COMPETING INTEREST(S)The study was supported by an internal grant (Professor P.C. Ho Research and Development Fund in Reproductive Medicine). None of the authors has conflicts of interest to declare.TRIAL REGISTRATION NUMBERClinicalTrials.gov with identifier NCT05218382.TRIAL REGISTRATION DATE18 December 2021.DATE OF FIRST PATIENT’S ENROLMENT1 December 2022.
研究问题：使用虚拟现实（VR）是否可以减少女性在经阴道取卵过程中使用宫颈旁阻滞和有意识镇静的疼痛程度？结论：在宫颈旁阻滞和清醒镇静下，VR的使用并没有减少卵母细胞回收过程中的疼痛程度。已知情况：在取卵过程中，意识镇静通常用于缓解疼痛，同时使用多种镇静和镇痛方法比单一方式更能缓解疼痛。许多研究表明，在医疗过程中使用虚拟现实技术可以减少焦虑和疼痛。研究设计、规模、持续时间：这是一项随机对照试验，在2022年12月至2023年10月期间，160名不育症妇女采用宫颈旁阻滞和清醒镇静经阴道取卵。参与者/材料、环境、方法本研究在一所大学附属辅助生殖机构进行。招募的女性被随机分配到VR组（n = 80）和标准治疗组（n = 80）。阴道穿刺和卵母细胞回收时的疼痛水平用100点视觉模拟量表记录。主要结果和机会的作用两组在人口学参数、卵巢刺激反应、焦虑特征和状态评分方面具有可比性。阴道穿刺时的最大疼痛水平（50.8±23.6比54.8±25.4;95% CI -11.7, 3.7; P = 0.30）和卵母细胞回收时的最大疼痛水平（56.4±24.6比60.3±26.8;95% CI -12.0, 4.2; P = 0.34）在VR组和标准护理组之间无显著差异。两组的满意度得分相似。局限性，注意原因本研究样本量小是一个局限性。由于研究的性质，对参与者和研究人员进行盲法是不可行的。俯卧视角观看VR头显也会影响沉浸感，VR场景和音频的标准化也会限制体验。视觉模拟量表记录的疼痛评分是一种主观测量。研究结果的更广泛意义尽管VR的使用在其他方面耐受良好且无主要副作用，但不能支持其在卵母细胞提取期间用于缓解疼痛的常规使用。研究经费/竞争利益(S)本研究获内部拨款（何炳平教授生殖医学研究及发展基金）资助。所有作者均无利益冲突需要申报。试验注册编号clinicaltrials .gov，标识符NCT05218382。试验注册日期为2021年12月18日。第一位患者入组日期：2022年12月1日。
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L W Voskamp, J J Koerts, R E Wiegel, K Verdonk, A H J Danser, R P M Steegers-Theunissen, M Rousian
STUDY QUESTION Is the number of corpora lutea (CL) associated with maternal circulatory adaptation to pregnancy, as assessed by blood pressure and uterine artery Doppler pulsatility and resistance indices? SUMMARY ANSWER Pregnancies without a corpus luteum have a higher mean arterial pressure throughout pregnancy and lower uterine artery pulsatility and resistance indices in the first and second trimesters, compared to pregnancies where one or more than one corpus luteum is present. WHAT IS KNOWN ALREADY Different modes of conception result in varying numbers of corpus luteum in early pregnancy. Previous research has demonstrated significant differences in hypertensive disorders of pregnancy and birthweight in women with 0, 1, and multiple CL, as well as altered maternal cardiovascular adaptation. Although direct causal evidence is limited, these differences are thought to reflect the presence or absence of corpus luteum-derived hormones, suboptimal decidualization in programmed cycles, or both. STUDY DESIGN, SIZE, DURATION This prospective study used data from the ongoing Rotterdam Periconception Cohort, including women with singleton pregnancies enrolled from 2010 to 2022 at the Erasmus MC, University Medical Center, a tertiary care facility. PARTICIPANTS/MATERIALS, SETTING, METHODS The study population for this research involved pregnancies in 1986 women: 1456 with one corpus luteum (1292 due to natural conception or insemination and 164 due to natural cycle frozen embryo transfer), 457 with more than one corpus luteum (due to fresh embryo transfer), and 73 with no corpus luteum (due to artificial cycle (AC)-FET). Linear mixed models were adjusted for maternal age, body mass index, nulliparity, smoking, pre-existing hypertension, and uterine artery Doppler outcomes, including mean arterial pressure. MAIN RESULTS AND THE ROLE OF CHANCE Adjusted mean arterial pressure during pregnancy was significantly higher in women with 0 vs 1 CL (β + 2.19 mmHg, 95% CI [0.43–3.95], P = 0.015), but was not different between those with >1 and 1 CL (β −0.35 mmHg [−1.22 to 0.53], P = 0.438). This was also true for diastolic but not for systolic blood pressure. Uterine artery Doppler indices were available for 624 women. Adjusted uterine artery pulsatility index (PI) and resistance index (RI) were significantly lower in women with 0 CL compared to 1 CL, both at 11 weeks (PI: 1.53, 95% CI [1.38–1.69] vs 1.72 [1.65–1.79], P = 0.026; RI: 0.69, [0.66–0.73] vs 0.73 [0.72–0.75], P = 0.034) and at 22 weeks gestational age (PI: 0.64 [0.57–0.72] vs 0.81 [0.78–0.85], P < 0.001; RI: 0.44 [0.41–0.46] vs 0.51 [0.50–0.53], P < 0.001). In pregnancies with >1 CL, uterine artery indices were comparable to the 1 CL group, except for a slightly higher RI at 22 weeks (0.54 [0.52–0.55], P = 0.011). Restricting the analyses to only pregnancies conceived using ARTs did not change the observed directions of the effects. LIMITATIONS, REASONS FOR CAUTION This st
研究问题：通过血压、子宫动脉多普勒脉搏和阻力指数评估，黄体（CL）的数量是否与母体对妊娠的循环适应有关？与存在一个或多个黄体的妊娠相比，没有黄体的妊娠在整个妊娠期间平均动脉压较高，在妊娠早期和中期子宫动脉搏动和阻力指数较低。不同的受孕方式导致妊娠早期黄体数量不同。先前的研究表明，妊娠期高血压疾病和出生体重在0、1和多重CL妇女中存在显著差异，以及母体心血管适应性的改变。虽然直接的因果证据有限，但这些差异被认为反映了黄体来源激素的存在或不存在，程序周期中的次优脱个体化，或两者兼而有之。研究设计、规模、持续时间这项前瞻性研究使用了正在进行的鹿特丹围孕期队列的数据，包括2010年至2022年在伊拉斯谟大学医学中心（三级医疗机构）登记的单胎妊娠妇女。参与者/材料、环境、方法本研究的研究人群涉及1986年怀孕的妇女：1456例有一个黄体（1292例由于自然受孕或人工授精，164例由于自然周期冷冻胚胎移植），457例有多个黄体（由于新鲜胚胎移植），73例没有黄体（由于人工周期(AC)-FET）。线性混合模型调整了产妇年龄、体重指数、未生育、吸烟、既往高血压和子宫动脉多普勒结果，包括平均动脉压。主要结果和CHANCE的作用妊娠期调整后平均动脉压在CL = 0和CL = 1的妇女中显著升高（β + 2.19 mmHg, 95% CI [0.43-3.95], P = 0.015），但在CL = 1的妇女中无差异；1和1 CL （β - 0.35 mmHg [- 1.22 ~ 0.53], P = 0.438）。舒张压也是如此，而收缩压则不然。子宫动脉多普勒指数624例。在11周（PI: 1.53, 95% CI [1.38-1.69] vs . 1.72 [1.65-1.79], P = 0.026; RI: 0.69, [0.66-0.73] vs . 0.73 [0.72-0.75], P = 0.034）和孕22周（PI: 0.64 [0.57-0.72] vs . 0.81 [0.78-0.85], P < 0.001; RI: 0.44 [0.41-0.46] vs . 0.51 [0.50-0.53], P < 0.001）时，0 CL妇女的调整子宫动脉搏动指数（PI）和阻力指数（RI）均显著低于1 CL。在怀孕&；gt；1 CL组子宫动脉指数与1 CL组相当，但22周时RI略高（0.54 [0.52-0.55],P = 0.011）。将分析限制在仅使用抗逆转录病毒治疗的妊娠中并没有改变观察到的影响方向。本研究是在三级医院环境中进行的，这可能限制了对其他人群的推广。黄体支持的细节不完整，黄体数量是根据受孕方式来推断的，这可能会引起适应症的混淆。这些结果与先前的文献一致，并提供了来自大队列的有力证据，调整了混杂因素。值得注意的是，根据观察到的平均动脉压差异，对子宫动脉模型进行了额外调整。然而，尽管进行了这种调整，子宫动脉指数在CL组之间的差异仍然存在，这表明这些差异不能用较高的平均动脉压来解释，并提示不同的血管机制参与其中。观察到的黄体数量多的孕妇对妊娠的循环适应差异可能是没有黄体的孕妇妊娠后高血压疾病发生率较高的原因。此外，这些见解进一步支持在可行的情况下优先使用某些抗逆转录病毒治疗，以优化孕产妇和新生儿结局。研究经费/竞争利益(S)本研究由荷兰鹿特丹大学医学中心Erasmus MC的妇产科和内科资助。作者声明没有利益冲突。本研究已在荷兰试验注册（NTR6854）上注册。
{"title":"Corpus luteum number and maternal circulatory adaptation from early pregnancy onwards: the Rotterdam Periconception Cohort (Predict Study)","authors":"L W Voskamp, J J Koerts, R E Wiegel, K Verdonk, A H J Danser, R P M Steegers-Theunissen, M Rousian","doi":"10.1093/humrep/deaf181","DOIUrl":"https://doi.org/10.1093/humrep/deaf181","url":null,"abstract":"STUDY QUESTION Is the number of corpora lutea (CL) associated with maternal circulatory adaptation to pregnancy, as assessed by blood pressure and uterine artery Doppler pulsatility and resistance indices? SUMMARY ANSWER Pregnancies without a corpus luteum have a higher mean arterial pressure throughout pregnancy and lower uterine artery pulsatility and resistance indices in the first and second trimesters, compared to pregnancies where one or more than one corpus luteum is present. WHAT IS KNOWN ALREADY Different modes of conception result in varying numbers of corpus luteum in early pregnancy. Previous research has demonstrated significant differences in hypertensive disorders of pregnancy and birthweight in women with 0, 1, and multiple CL, as well as altered maternal cardiovascular adaptation. Although direct causal evidence is limited, these differences are thought to reflect the presence or absence of corpus luteum-derived hormones, suboptimal decidualization in programmed cycles, or both. STUDY DESIGN, SIZE, DURATION This prospective study used data from the ongoing Rotterdam Periconception Cohort, including women with singleton pregnancies enrolled from 2010 to 2022 at the Erasmus MC, University Medical Center, a tertiary care facility. PARTICIPANTS/MATERIALS, SETTING, METHODS The study population for this research involved pregnancies in 1986 women: 1456 with one corpus luteum (1292 due to natural conception or insemination and 164 due to natural cycle frozen embryo transfer), 457 with more than one corpus luteum (due to fresh embryo transfer), and 73 with no corpus luteum (due to artificial cycle (AC)-FET). Linear mixed models were adjusted for maternal age, body mass index, nulliparity, smoking, pre-existing hypertension, and uterine artery Doppler outcomes, including mean arterial pressure. MAIN RESULTS AND THE ROLE OF CHANCE Adjusted mean arterial pressure during pregnancy was significantly higher in women with 0 vs 1 CL (β + 2.19 mmHg, 95% CI [0.43–3.95], P = 0.015), but was not different between those with &gt;1 and 1 CL (β −0.35 mmHg [−1.22 to 0.53], P = 0.438). This was also true for diastolic but not for systolic blood pressure. Uterine artery Doppler indices were available for 624 women. Adjusted uterine artery pulsatility index (PI) and resistance index (RI) were significantly lower in women with 0 CL compared to 1 CL, both at 11 weeks (PI: 1.53, 95% CI [1.38–1.69] vs 1.72 [1.65–1.79], P = 0.026; RI: 0.69, [0.66–0.73] vs 0.73 [0.72–0.75], P = 0.034) and at 22 weeks gestational age (PI: 0.64 [0.57–0.72] vs 0.81 [0.78–0.85], P &lt; 0.001; RI: 0.44 [0.41–0.46] vs 0.51 [0.50–0.53], P &lt; 0.001). In pregnancies with &gt;1 CL, uterine artery indices were comparable to the 1 CL group, except for a slightly higher RI at 22 weeks (0.54 [0.52–0.55], P = 0.011). Restricting the analyses to only pregnancies conceived using ARTs did not change the observed directions of the effects. LIMITATIONS, REASONS FOR CAUTION This st","PeriodicalId":13003,"journal":{"name":"Human reproduction","volume":"38 1","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145089727","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}
Rebecca L Kelley,Yee S L Lee,Franca Agresta,Nils-Gunnar Pehrsson,John M Stevens,Alice Huang,Joseph Sgroi,Genia Rozen,Alex Polyakov,Lyndon Hale,Raelia Lew,Catharyn Stern,Manuela Toledo,Fleur Cattrall,David K Gardner
STUDY QUESTIONDoes the addition of three antioxidants to culture media during gamete collection, insemination, and embryo culture increase the clinical pregnancy rate from fresh blastocyst transfers?SUMMARY ANSWERThe clinical pregnancy rate from fresh blastocyst transfers was not increased by the addition of antioxidants to IVF and embryo culture media.WHAT IS KNOWN ALREADYAddition of antioxidants to media is beneficial in mouse IVF, embryo culture, and cryopreservation. Prospective clinical trials of sibling human oocytes found an improvement in embryo quality and increased pregnancy rates from frozen blastocyst transfers in older patients.STUDY DESIGN, SIZE, DURATIONSingle-centre, prospective randomized controlled trial, superiority study comparing media with or without the addition of antioxidants from January 2019 to November 2021. A total of 1482 patients were randomized before egg collection. Patients and their doctors were blinded to the treatment group.PARTICIPANTS/MATERIALS, SETTING, METHODSPatients undergoing IVF/ICSI cycles and intending to undergo a fresh transfer of a single blastocyst were recruited. Exclusion criteria were previous participation in the study, use of cryopreserved oocytes/embryos, artificial oocyte activation, freeze-all cycle, or extraction of sperm from testicular biopsy. Seven hundred thirty-nine patients were randomized to control media and 743 patients to media containing the 'A3' antioxidant combination of acetyl-L-carnitine, α-lipoic acid, and N-acetyl-L-cysteine (treatment group).MAIN RESULTS AND THE ROLE OF CHANCEThe clinical pregnancy rate per randomized patient per cycle from fresh embryo transfer was not different between the control and antioxidant media (26.1% vs 22.9%; P > 0.05; RR 0.88 (95% CI 0.73-1.05)). In the Per Protocol population, which excludes patients with protocol violations or without a fresh transfer due to freeze-all or no embryo available, there was also no difference in between the control and antioxidant media in clinical pregnancy rate (36.7% vs 33.2%; P > 0.05; RR 0.90 (95% CI 0.76-1.07)) and live birth rate (32.4% vs 29.5%, P > 0.05). In the Intention-to-Treat population, antioxidant media produced a significant increase in the fertilization rate from 59.2 ± 26.3% to 64.5 ± 25.4% (P < 0.001) compared to control media. Blastocyst development rate per fertilized oocyte was not affected by antioxidant media, but the higher fertilization rate resulted in more fertilized oocytes per patient and therefore more blastocysts utilized per patient in the antioxidant group compared to the control (2.70 ± 2.59 vs 3.09 ± 2.96, P < 0.01). The increase in fertilization rate was observed in a subgroup analysis of ICSI cycles (57.9 ± 27.2% vs 68.3 ± 24.7%, P < 0.0001), and a decrease in the number of cycles with failed fertilization from 8.0 to 3.7% with antioxidant media (P < 0.01). In contrast, there was no effect of antioxidant media on fertilization rate in cycles with IVF insemination.LIMITATI
研究问题：在配子采集、授精和胚胎培养过程中向培养基中添加三种抗氧化剂是否能提高新鲜囊胚移植的临床妊娠率？结论：体外受精和胚胎培养基中添加抗氧化剂并不能提高新鲜囊胚移植的临床妊娠率。在培养基中添加抗氧化剂有利于小鼠体外受精、胚胎培养和低温保存。兄弟姐妹人类卵母细胞的前瞻性临床试验发现，在老年患者中，冷冻囊胚移植可以改善胚胎质量，提高妊娠率。研究设计、规模、持续时间2019年1月至2021年11月，单中心、前瞻性随机对照试验，比较添加或未添加抗氧化剂的培养基的优势研究。1482例患者在取卵前随机抽取。患者和他们的医生对治疗组不知情。参与者/材料，环境，方法：招募接受IVF/ICSI周期并打算进行单个囊胚新鲜移植的患者。排除标准为先前参与研究、使用冷冻保存的卵母细胞/胚胎、人工激活卵母细胞、冷冻全周期或从睾丸活检中提取精子。739例患者随机分到对照组，743例患者分到含有乙酰左旋肉碱、α-硫辛酸和n -乙酰-l -半胱氨酸的“A3”抗氧化剂组合培养基（治疗组）。对照组和抗氧化组每周期随机患者的临床妊娠率无差异（26.1% vs 22.9%; P < 0.05; RR = 0.88 (95% CI = 0.73-1.05)）。在Per方案人群中，不包括违反方案或因冷冻全部或无胚胎而没有新鲜移植的患者，对照组和抗氧化培养基在临床妊娠率（36.7% vs 33.2%; P > 0.05; RR 0.90 (95% CI 0.76-1.07)）和活产率（32.4% vs 29.5%, P > 0.05）方面也没有差异。在意向处理群体中，与对照培养基相比，抗氧化培养基使受精率从59.2±26.3%显著提高到64.5±25.4% （P < 0.001）。抗氧化培养基对每受精卵的囊胚发育率没有影响，但与对照组相比，受精卵率越高，每患者受精卵数越多，利用囊胚数越多（2.70±2.59 vs 3.09±2.96,P < 0.01）。在ICSI周期亚组分析中，受精率增加（57.9±27.2% vs 68.3±24.7%,P < 0.0001），受精失败周期从8.0减少到3.7% （P < 0.01）。相反，抗氧化培养基对体外受精周期受精率没有影响。局限性和注意原因：这是一项单中心研究，因此抗氧化介质在不同方案的诊所中的作用尚不清楚。患者的氧化应激可能受到炎症、饮食、吸烟状况、抗氧化剂补充剂消费和其他生活方式因素的影响，但未被考虑在内。在培养过程中对培养基中抗氧化剂进行更新的任何潜在影响未进行检查。研究结果的广泛意义在培养基中添加抗氧化剂并不影响新鲜单胚胎移植的受孕率。观察到受精率的增加，导致更多的囊胚可用于转移和冷冻保存。抗氧化剂对囊胚发育速率和囊胚等级没有影响。抗氧化剂对ICSI后受精率的影响有待进一步研究证实。研究经费/竞争利益(S) Vitrolife AB资助了文化媒体和一位独立统计学家。R.L.K获得了Vitrolife提供的旅行经费和演讲酬金。D.K.G.获得了墨尔本大学Vitrolife的研究资助。n.g.p.已经从Vitrolife公司获得了这项研究相关工作的咨询费。所有其他作者都没有什么要申报的。试验注册号为actrn12618001479291。试验注册日期为2018年9月4日。第一位患者入组日期2019年1月28日。
{"title":"A prospective randomized controlled trial of antioxidants in human IVF and embryo culture media.","authors":"Rebecca L Kelley,Yee S L Lee,Franca Agresta,Nils-Gunnar Pehrsson,John M Stevens,Alice Huang,Joseph Sgroi,Genia Rozen,Alex Polyakov,Lyndon Hale,Raelia Lew,Catharyn Stern,Manuela Toledo,Fleur Cattrall,David K Gardner","doi":"10.1093/humrep/deaf183","DOIUrl":"https://doi.org/10.1093/humrep/deaf183","url":null,"abstract":"STUDY QUESTIONDoes the addition of three antioxidants to culture media during gamete collection, insemination, and embryo culture increase the clinical pregnancy rate from fresh blastocyst transfers?SUMMARY ANSWERThe clinical pregnancy rate from fresh blastocyst transfers was not increased by the addition of antioxidants to IVF and embryo culture media.WHAT IS KNOWN ALREADYAddition of antioxidants to media is beneficial in mouse IVF, embryo culture, and cryopreservation. Prospective clinical trials of sibling human oocytes found an improvement in embryo quality and increased pregnancy rates from frozen blastocyst transfers in older patients.STUDY DESIGN, SIZE, DURATIONSingle-centre, prospective randomized controlled trial, superiority study comparing media with or without the addition of antioxidants from January 2019 to November 2021. A total of 1482 patients were randomized before egg collection. Patients and their doctors were blinded to the treatment group.PARTICIPANTS/MATERIALS, SETTING, METHODSPatients undergoing IVF/ICSI cycles and intending to undergo a fresh transfer of a single blastocyst were recruited. Exclusion criteria were previous participation in the study, use of cryopreserved oocytes/embryos, artificial oocyte activation, freeze-all cycle, or extraction of sperm from testicular biopsy. Seven hundred thirty-nine patients were randomized to control media and 743 patients to media containing the 'A3' antioxidant combination of acetyl-L-carnitine, α-lipoic acid, and N-acetyl-L-cysteine (treatment group).MAIN RESULTS AND THE ROLE OF CHANCEThe clinical pregnancy rate per randomized patient per cycle from fresh embryo transfer was not different between the control and antioxidant media (26.1% vs 22.9%; P > 0.05; RR 0.88 (95% CI 0.73-1.05)). In the Per Protocol population, which excludes patients with protocol violations or without a fresh transfer due to freeze-all or no embryo available, there was also no difference in between the control and antioxidant media in clinical pregnancy rate (36.7% vs 33.2%; P > 0.05; RR 0.90 (95% CI 0.76-1.07)) and live birth rate (32.4% vs 29.5%, P > 0.05). In the Intention-to-Treat population, antioxidant media produced a significant increase in the fertilization rate from 59.2 ± 26.3% to 64.5 ± 25.4% (P < 0.001) compared to control media. Blastocyst development rate per fertilized oocyte was not affected by antioxidant media, but the higher fertilization rate resulted in more fertilized oocytes per patient and therefore more blastocysts utilized per patient in the antioxidant group compared to the control (2.70 ± 2.59 vs 3.09 ± 2.96, P < 0.01). The increase in fertilization rate was observed in a subgroup analysis of ICSI cycles (57.9 ± 27.2% vs 68.3 ± 24.7%, P < 0.0001), and a decrease in the number of cycles with failed fertilization from 8.0 to 3.7% with antioxidant media (P < 0.01). In contrast, there was no effect of antioxidant media on fertilization rate in cycles with IVF insemination.LIMITATI","PeriodicalId":13003,"journal":{"name":"Human reproduction","volume":"16 1","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145089877","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}
E Wentz,B Hagberg,H Hagberg,H Bokström,M Brännström
STUDY QUESTIONWhat are the outcomes regarding cognition, development, physical, and psychiatric status of children born after uterus transplantation (UTx) up to 6 years after birth?SUMMARY ANSWERThe long-term and very long-term outcomes of children born after UTx indicate normal cognitive, neuropsychiatric, and physical development.WHAT IS KNOWN ALREADYPrevious cohort studies of children born after UTx and followed up to 2-3 years indicate normal neurodevelopment and occasional cases of minor malformations.STUDY DESIGN, SIZE, DURATIONA prospective cohort study was performed on 11 offspring after UTx. All children (7 boys, 4 girls) were examined at age 2.5 years and eight children (5 boys, 3 girls) were examined at age 6 years.PARTICIPANTS/MATERIALS, SETTING, METHODSThe cognitive evaluations, Bayley-III test and WPPSI-IV, were performed at age 2.5 years (n = 11) and age 6 years (n = 8), respectively. Parental questionnaires pertaining to neurodevelopmental and behavioural problems, including the Strengths and Difficulties questionnaire (SDQ) and the ESSENCE-Q, were administered. All children (age 2.5 years: n = 11; age: 6 years: n = 8) underwent physical examinations.MAIN RESULTS AND THE ROLE OF CHANCECognitive skills showed results within the normal range at both age 2.5 years and age 6 years. According to the SDQ, emotional problems were the most common symptoms, affecting two children at age 2.5 years and two children at age 6 years. Three children scored above the cut off on the ESSENCE-Q at age 2.5 years, and one child continued to score 'high' at age 6 years. At the first examination, three children had asthma, and speech problems were observed in five children. Among those who were also assessed at age 6 years, these problems had abated. At age 6 years, one child was considered hyperactive, and another child exhibited vocal tics. Developmental and behavioural deviations were observed almost exclusively in the boys.LIMITATIONS, REASONS FOR CAUTIONLimitations of the study include the small sample size, and the lack of a comparison group. The small sample does not offer enough statistical power, and no firm conclusions can therefore be drawn based on the reported deviances.WIDER IMPLICATIONS OF THE FINDINGSThe long-term and very long-term outcomes of children born after UTx indicated normal cognitive development. A minority had minor physical and developmental problems, including asthma and speech problems at age 2.5 years, but most of these symptoms subsided by age 6 years. Boys seemed to be over-represented regarding developmental and behavioural deviations. The small sample size limits the ability to generalize the findings to all children born after UTx.STUDY FUNDING/COMPETING INTEREST(S)The study was supported by The Swedish research council (Grant/Award Numbers: Dnr 2023-02035 (H.H.), 2024-03487 (M.B.)), the Swedish state under the agreement between the Swedish Government and the country councils, the ALF-agreement, grant/Award-Numbers:
{"title":"Uterus transplantation; first data on neurologic, neuropsychiatric, and physical examination follow-up of children up to 6 years of age.","authors":"E Wentz,B Hagberg,H Hagberg,H Bokström,M Brännström","doi":"10.1093/humrep/deaf178","DOIUrl":"https://doi.org/10.1093/humrep/deaf178","url":null,"abstract":"STUDY QUESTIONWhat are the outcomes regarding cognition, development, physical, and psychiatric status of children born after uterus transplantation (UTx) up to 6 years after birth?SUMMARY ANSWERThe long-term and very long-term outcomes of children born after UTx indicate normal cognitive, neuropsychiatric, and physical development.WHAT IS KNOWN ALREADYPrevious cohort studies of children born after UTx and followed up to 2-3 years indicate normal neurodevelopment and occasional cases of minor malformations.STUDY DESIGN, SIZE, DURATIONA prospective cohort study was performed on 11 offspring after UTx. All children (7 boys, 4 girls) were examined at age 2.5 years and eight children (5 boys, 3 girls) were examined at age 6 years.PARTICIPANTS/MATERIALS, SETTING, METHODSThe cognitive evaluations, Bayley-III test and WPPSI-IV, were performed at age 2.5 years (n = 11) and age 6 years (n = 8), respectively. Parental questionnaires pertaining to neurodevelopmental and behavioural problems, including the Strengths and Difficulties questionnaire (SDQ) and the ESSENCE-Q, were administered. All children (age 2.5 years: n = 11; age: 6 years: n = 8) underwent physical examinations.MAIN RESULTS AND THE ROLE OF CHANCECognitive skills showed results within the normal range at both age 2.5 years and age 6 years. According to the SDQ, emotional problems were the most common symptoms, affecting two children at age 2.5 years and two children at age 6 years. Three children scored above the cut off on the ESSENCE-Q at age 2.5 years, and one child continued to score 'high' at age 6 years. At the first examination, three children had asthma, and speech problems were observed in five children. Among those who were also assessed at age 6 years, these problems had abated. At age 6 years, one child was considered hyperactive, and another child exhibited vocal tics. Developmental and behavioural deviations were observed almost exclusively in the boys.LIMITATIONS, REASONS FOR CAUTIONLimitations of the study include the small sample size, and the lack of a comparison group. The small sample does not offer enough statistical power, and no firm conclusions can therefore be drawn based on the reported deviances.WIDER IMPLICATIONS OF THE FINDINGSThe long-term and very long-term outcomes of children born after UTx indicated normal cognitive development. A minority had minor physical and developmental problems, including asthma and speech problems at age 2.5 years, but most of these symptoms subsided by age 6 years. Boys seemed to be over-represented regarding developmental and behavioural deviations. The small sample size limits the ability to generalize the findings to all children born after UTx.STUDY FUNDING/COMPETING INTEREST(S)The study was supported by The Swedish research council (Grant/Award Numbers: Dnr 2023-02035 (H.H.), 2024-03487 (M.B.)), the Swedish state under the agreement between the Swedish Government and the country councils, the ALF-agreement, grant/Award-Numbers: ","PeriodicalId":13003,"journal":{"name":"Human reproduction","volume":"77 1","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-09-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145089873","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":"Correction to: A core outcome set for future male infertility research: development of an international consensus.","authors":"","doi":"10.1093/humrep/deaf175","DOIUrl":"https://doi.org/10.1093/humrep/deaf175","url":null,"abstract":"","PeriodicalId":13003,"journal":{"name":"Human reproduction","volume":"24 1","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145031838","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}
Faith E Carter,Brittany Y Jarrett,Noah D Lee,Nabiha Zaman,Alexandra M Reich,Keziah A Wilson,Alexis L Oldfield,Heidi Vanden Brink,Marla E Lujan
STUDY QUESTIONDoes weight loss from a hypocaloric dietary intervention improve antral follicle dynamics in women with PCOS?SUMMARY ANSWERDuring a 3-month hypocaloric dietary intervention, women with PCOS who experienced clinically meaningful weight loss showed more organized antral follicle development including fewer recruitment events, but no change in the overall frequency of selection, dominance, or ovulation.WHAT IS KNOWN ALREADYThere is a spectrum of disordered antral follicle development in women with PCOS including excessive follicle recruitment and turnover, decreased frequency of selection and dominance, and failure of ovulation. Lifestyle intervention aimed at weight loss is recommended to improve metabolic health in women with PCOS yet benefits on ovarian follicle development and ovulation are unclear.STUDY DESIGN, SIZE, DURATIONThis was a prospective, single-arm lifestyle intervention study conducted over 4 months including a 1-month baseline assessment period and 3-month hypocaloric dietary intervention. Twenty women were allocated to the intervention with 0% attrition.PARTICIPANTS/MATERIALS, SETTING, METHODSFemales, ages 18-38 years, with PCOS and obesity (BMI > 30 kg/m2) underwent every-other-day transvaginal ultrasonography and venipuncture at an academic clinical research unit for 4 months. The number and size of all follicles were evaluated at each study visit, with individual growth profiles plotted retrospectively for follicles that grew to at least 7 mm. Gonadotropin and ovarian steroid hormone concentrations were measured every-other-day. Reproductive, anthropometric, and metabolic status markers were assessed at baseline and at the end of the intervention.MAIN RESULTS AND THE ROLE OF CHANCEHypocaloric dietary intervention resulted in an average weight loss of 8 ± 3% with significant reductions in all anthropometric markers assessed including BMI, waist circumference, total percent fat, and trunk fat mass (all P < 0.05). Of the glucoregulatory and cardiovascular risk markers assessed, only diastolic blood pressure (P = 0.040) and 2-h insulin concentrations following a glucose challenge (P = 0.029) were decreased post-intervention. Antral follicle development appeared more cyclic following the intervention with the frequency of recruitment (P = 0.043), and number of follicles recruited per cohort (P < 0.0001), decreasing with weight loss. By contrast, the frequency of selection, dominance, and ovulation did not change with weight loss (all P < 0.05). When ovulation occurred during the intervention, the size at selection for ovulatory follicles decreased with weight loss (P < 0.0001), whereas maximum luteal progesterone levels increased with weight loss (P = 0.036). Participants (35%) who responded to the intervention with a shortened inter-menstrual interval had lower baseline trunk fat mass (P = 0.048), fasting insulin (P = 0.022), and homeostatic model assessment for insulin resistance (P = 0.017) compared to non-responder
{"title":"Changes in antral follicle dynamics following weight loss in women with polycystic ovary syndrome.","authors":"Faith E Carter,Brittany Y Jarrett,Noah D Lee,Nabiha Zaman,Alexandra M Reich,Keziah A Wilson,Alexis L Oldfield,Heidi Vanden Brink,Marla E Lujan","doi":"10.1093/humrep/deaf169","DOIUrl":"https://doi.org/10.1093/humrep/deaf169","url":null,"abstract":"STUDY QUESTIONDoes weight loss from a hypocaloric dietary intervention improve antral follicle dynamics in women with PCOS?SUMMARY ANSWERDuring a 3-month hypocaloric dietary intervention, women with PCOS who experienced clinically meaningful weight loss showed more organized antral follicle development including fewer recruitment events, but no change in the overall frequency of selection, dominance, or ovulation.WHAT IS KNOWN ALREADYThere is a spectrum of disordered antral follicle development in women with PCOS including excessive follicle recruitment and turnover, decreased frequency of selection and dominance, and failure of ovulation. Lifestyle intervention aimed at weight loss is recommended to improve metabolic health in women with PCOS yet benefits on ovarian follicle development and ovulation are unclear.STUDY DESIGN, SIZE, DURATIONThis was a prospective, single-arm lifestyle intervention study conducted over 4 months including a 1-month baseline assessment period and 3-month hypocaloric dietary intervention. Twenty women were allocated to the intervention with 0% attrition.PARTICIPANTS/MATERIALS, SETTING, METHODSFemales, ages 18-38 years, with PCOS and obesity (BMI > 30 kg/m2) underwent every-other-day transvaginal ultrasonography and venipuncture at an academic clinical research unit for 4 months. The number and size of all follicles were evaluated at each study visit, with individual growth profiles plotted retrospectively for follicles that grew to at least 7 mm. Gonadotropin and ovarian steroid hormone concentrations were measured every-other-day. Reproductive, anthropometric, and metabolic status markers were assessed at baseline and at the end of the intervention.MAIN RESULTS AND THE ROLE OF CHANCEHypocaloric dietary intervention resulted in an average weight loss of 8 ± 3% with significant reductions in all anthropometric markers assessed including BMI, waist circumference, total percent fat, and trunk fat mass (all P < 0.05). Of the glucoregulatory and cardiovascular risk markers assessed, only diastolic blood pressure (P = 0.040) and 2-h insulin concentrations following a glucose challenge (P = 0.029) were decreased post-intervention. Antral follicle development appeared more cyclic following the intervention with the frequency of recruitment (P = 0.043), and number of follicles recruited per cohort (P < 0.0001), decreasing with weight loss. By contrast, the frequency of selection, dominance, and ovulation did not change with weight loss (all P < 0.05). When ovulation occurred during the intervention, the size at selection for ovulatory follicles decreased with weight loss (P < 0.0001), whereas maximum luteal progesterone levels increased with weight loss (P = 0.036). Participants (35%) who responded to the intervention with a shortened inter-menstrual interval had lower baseline trunk fat mass (P = 0.048), fasting insulin (P = 0.022), and homeostatic model assessment for insulin resistance (P = 0.017) compared to non-responder","PeriodicalId":13003,"journal":{"name":"Human reproduction","volume":"33 1","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-09-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145031839","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}
STUDY QUESTIONWhat is the direct effect of mumps virus (MuV) replication within the human testis on the tissue innate immune responses and testicular cell functions?SUMMARY ANSWERMuV induces an early pro-inflammatory response in the human testis ex vivo and infects both Leydig cells and Sertoli cells, which drastically alters testosterone and inhibin B production.WHAT IS KNOWN ALREADYDespite widespread vaccination efforts, orchitis remains a significant complication of MuV infection, especially in young men, which potentially results in infertility in up to 87% of patients with bilateral orchitis. Our understanding of MuV pathogenesis in the human testis has been limited by the lack of relevant animal models, impairing the development of effective treatments.STUDY DESIGN, SIZE, DURATIONNormal testes were collected from seven uninfected post-mortem donors (median age of 55 years, range 29-79). Organotypic cultures of human testis explants exposed or not to MuV ex vivo were undertaken for 10 days. Utilizing this original ex vivo model, we investigated the replication kinetics of MuV, identified its target cells, characterized the innate immune responses of the testis to the virus, and assessed the impact of the infection on testicular cell functions.PARTICIPANTS/MATERIALS, SETTING, METHODSHuman testis explants were exposed overnight to MuV at a multiplicity of infection of 1 and cultured on polyethylene terephthalate inserts at the air/medium interface for 10 days. MuV replication in human testis explants was evidenced by measuring the release of infectious viral particles in plaque-forming assay and viral RNA in RT-qPCR, as well as by in situ detection of replicative viral RNA in testicular cells all along the 10-day culture period. Infected cells were characterized by microscopy using specific cell markers and a probe against viral RNA. The innate immune response was assessed using RT-qPCR, in situ hybridization, and LegendPlex. Testosterone and its precursors were measured in the supernatants of MuV and mock-infected explants by mass spectrometry, while inhibin B was measured by ELISA. The impact of MuV infection on testis tissue and cells was further explored by lactate dehydrogenase viability assay, RT-qPCR, immunohistochemistry, and western blot.MAIN RESULTS AND THE ROLE OF CHANCEMuV robustly replicated in human testicular explants all along the 10-day culture, progressing from the interstitial tissue, where it infected Leydig cells, macrophages, and peritubular cells, to the seminiferous tubules, where it targeted Sertoli cells. Unlike Zika virus, another testis-tropic virus, MuV triggered a pro-inflammatory response within 4 h in exposed human testis explants, characterized by transcriptional upregulation of interleukin 1 beta (IL1B) in sentinel cells. This was followed by the tissue release of inflammatory mediators (P = 0.02 for IL1B at 72 h and Day 7) and the dynamic regulation of interleukin 10 (IL10) upon viral replication. MuV replica
{"title":"Mumps virus infection triggers early pro-inflammatory responses and impairs Leydig and Sertoli cell function in an ex vivo human testis model.","authors":"Lina Franklin,Ohiniba-Nadège Kuassivi,Anne-Pascale Satie,Hervé Abiven,Romain Mathieu,Naoufel Miaadi,Ingrid Plotton,Anna Le Tortorec,Nathalie Dejucq-Rainsford","doi":"10.1093/humrep/deaf155","DOIUrl":"https://doi.org/10.1093/humrep/deaf155","url":null,"abstract":"STUDY QUESTIONWhat is the direct effect of mumps virus (MuV) replication within the human testis on the tissue innate immune responses and testicular cell functions?SUMMARY ANSWERMuV induces an early pro-inflammatory response in the human testis ex vivo and infects both Leydig cells and Sertoli cells, which drastically alters testosterone and inhibin B production.WHAT IS KNOWN ALREADYDespite widespread vaccination efforts, orchitis remains a significant complication of MuV infection, especially in young men, which potentially results in infertility in up to 87% of patients with bilateral orchitis. Our understanding of MuV pathogenesis in the human testis has been limited by the lack of relevant animal models, impairing the development of effective treatments.STUDY DESIGN, SIZE, DURATIONNormal testes were collected from seven uninfected post-mortem donors (median age of 55 years, range 29-79). Organotypic cultures of human testis explants exposed or not to MuV ex vivo were undertaken for 10 days. Utilizing this original ex vivo model, we investigated the replication kinetics of MuV, identified its target cells, characterized the innate immune responses of the testis to the virus, and assessed the impact of the infection on testicular cell functions.PARTICIPANTS/MATERIALS, SETTING, METHODSHuman testis explants were exposed overnight to MuV at a multiplicity of infection of 1 and cultured on polyethylene terephthalate inserts at the air/medium interface for 10 days. MuV replication in human testis explants was evidenced by measuring the release of infectious viral particles in plaque-forming assay and viral RNA in RT-qPCR, as well as by in situ detection of replicative viral RNA in testicular cells all along the 10-day culture period. Infected cells were characterized by microscopy using specific cell markers and a probe against viral RNA. The innate immune response was assessed using RT-qPCR, in situ hybridization, and LegendPlex. Testosterone and its precursors were measured in the supernatants of MuV and mock-infected explants by mass spectrometry, while inhibin B was measured by ELISA. The impact of MuV infection on testis tissue and cells was further explored by lactate dehydrogenase viability assay, RT-qPCR, immunohistochemistry, and western blot.MAIN RESULTS AND THE ROLE OF CHANCEMuV robustly replicated in human testicular explants all along the 10-day culture, progressing from the interstitial tissue, where it infected Leydig cells, macrophages, and peritubular cells, to the seminiferous tubules, where it targeted Sertoli cells. Unlike Zika virus, another testis-tropic virus, MuV triggered a pro-inflammatory response within 4 h in exposed human testis explants, characterized by transcriptional upregulation of interleukin 1 beta (IL1B) in sentinel cells. This was followed by the tissue release of inflammatory mediators (P = 0.02 for IL1B at 72 h and Day 7) and the dynamic regulation of interleukin 10 (IL10) upon viral replication. MuV replica","PeriodicalId":13003,"journal":{"name":"Human reproduction","volume":"15 1","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145025624","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}
Recent studies have shown a high prevalence of psychological distress among fertility patients and how it correlates with decreases in IVF treatment continuation rates. In addition, research has demonstrated the efficacy of psychological interventions, especially cognitive behavioral therapy and mind-body interventions, in reducing fertility patient distress and potentially increasing pregnancy rates. With the significant relationships between patient distress and dropout rates and between psychological interventions and decreased patient distress both established, the question that remains unaddressed is the impact of psychological interventions on IVF discontinuation rates. Specifically, if it is known that infertility patients are distressed, that the distress is associated with treatment termination, and that psychological interventions can lead to significant decreases in distress, can and do these interventions also increase treatment continuation rates? This mini-review examines the prevalence of negative psychological symptoms in individuals with infertility, why patients discontinue fertility treatment, the efficacy of psychological interventions on patient distress, and, ultimately, the efficacy of psychological interventions on fertility patient retention.
{"title":"Patient distress and its negative impact on treatment continuation: do psychological interventions have a significant impact?","authors":"Schuyler Awtrey,Alice D Domar","doi":"10.1093/humrep/deaf162","DOIUrl":"https://doi.org/10.1093/humrep/deaf162","url":null,"abstract":"Recent studies have shown a high prevalence of psychological distress among fertility patients and how it correlates with decreases in IVF treatment continuation rates. In addition, research has demonstrated the efficacy of psychological interventions, especially cognitive behavioral therapy and mind-body interventions, in reducing fertility patient distress and potentially increasing pregnancy rates. With the significant relationships between patient distress and dropout rates and between psychological interventions and decreased patient distress both established, the question that remains unaddressed is the impact of psychological interventions on IVF discontinuation rates. Specifically, if it is known that infertility patients are distressed, that the distress is associated with treatment termination, and that psychological interventions can lead to significant decreases in distress, can and do these interventions also increase treatment continuation rates? This mini-review examines the prevalence of negative psychological symptoms in individuals with infertility, why patients discontinue fertility treatment, the efficacy of psychological interventions on patient distress, and, ultimately, the efficacy of psychological interventions on fertility patient retention.","PeriodicalId":13003,"journal":{"name":"Human reproduction","volume":"34 1","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145018229","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
STUDY QUESTIONDoes a high proportion of immature oocytes impact embryo development and live birth rates in IVF-ICSI cycles?SUMMARY ANSWERWhile a high proportion of immature oocytes is associated with lower blastocyst formation and reduced preimplantation genetic testing for aneuploidy (PGT-A) utilization, live birth rates remain comparable when key confounders-such as age, BMI, gonadotropin dosage, and metaphase-II (MII) count-are balanced, but cycles with a very low MII proportion resulted in fewer embryo transfers, which is quantitatively limiting, even if embryo quality appears unaffected.WHAT IS KNOWN ALREADYPrevious studies have linked a lower proportion of mature oocytes (MII) to decreased fertilization rates, abnormal embryo development, and lower pregnancy and live birth rates. However, it remains unclear whether these outcomes are due to quantitative limitations (fewer mature oocytes available) or qualitative deficiencies (intrinsic oocyte quality issues). The impact of high proportions of immature oocytes on downstream IVF outcomes remains controversial.STUDY DESIGN, SIZE, DURATIONRetrospective cohort study at a single academically affiliated fertility clinic between December 2014 and December 2023.PARTICIPANTS/MATERIALS, SETTING, METHODS22 117 patients undergoing IVF-ICSI cycles were categorized into three groups based on the proportion of mature (MII) oocytes: very low MII proportion (≤0.25), low MII proportion (≤0.5), and 100% MII oocytes. Propensity score matching (PSM) was applied in two phases: first, adjusting for age, BMI, gonadotropin dosage, and anti-Müllerian hormone levels; second, adjusting for age, BMI, gonadotropin dosage, and MII count.MAIN RESULTS AND THE ROLE OF CHANCECycles with a very low MII proportion (≤0.25) had significantly lower blastocyst formation-mean 1.32 (SD 2.77; 95% CI: 1.03-1.61) versus 3.10 (SD 3.22; 95% CI: 2.77-3.43; P < 0.001)-and reduced PGT-A utilization-mean percent PGT-A normal 34% (95% CI: 30-38%) versus 40% (95% CI: 36-44%; P < 0.001). However, after PSM, live birth rates per an embryo transfer did not differ significantly between very low MII and perfect MII groups for both cryopreserved transfers (41.6% versus 30%, P = 0.68) and fresh embryo transfers (46.1% versus 38%, P = 0.69). The low MII proportion group (≤0.5) showed a trend toward lower cryopreserved transfer rates (44% versus 53%, P = 0.05), while fresh transfer rates remained comparable (30% versus 26.6%, P = 0.55).LIMITATIONS, REASONS FOR CAUTIONThis study is limited by its retrospective nature and reliance on electronic medical records. While PSM effectively reduced confounding, inherent oocyte quality markers (e.g. mitochondrial function) were not directly measured. Additionally, the non-uniform distribution of MII proportions across groups may have influenced statistical power.WIDER IMPLICATIONS OF THE FINDINGSThese results underscore the importance of personalized ovarian stimulation protocols to optimize mature oocyte (MII) yi
{"title":"A high proportion of immature oocytes in a cycle cohort does not compromise embryo development or live birth rates after ICSI.","authors":"Veda Sripada,Denny Sakkas,Denis Vaughan,Brittany Morse,Yuval Fouks","doi":"10.1093/humrep/deaf167","DOIUrl":"https://doi.org/10.1093/humrep/deaf167","url":null,"abstract":"STUDY QUESTIONDoes a high proportion of immature oocytes impact embryo development and live birth rates in IVF-ICSI cycles?SUMMARY ANSWERWhile a high proportion of immature oocytes is associated with lower blastocyst formation and reduced preimplantation genetic testing for aneuploidy (PGT-A) utilization, live birth rates remain comparable when key confounders-such as age, BMI, gonadotropin dosage, and metaphase-II (MII) count-are balanced, but cycles with a very low MII proportion resulted in fewer embryo transfers, which is quantitatively limiting, even if embryo quality appears unaffected.WHAT IS KNOWN ALREADYPrevious studies have linked a lower proportion of mature oocytes (MII) to decreased fertilization rates, abnormal embryo development, and lower pregnancy and live birth rates. However, it remains unclear whether these outcomes are due to quantitative limitations (fewer mature oocytes available) or qualitative deficiencies (intrinsic oocyte quality issues). The impact of high proportions of immature oocytes on downstream IVF outcomes remains controversial.STUDY DESIGN, SIZE, DURATIONRetrospective cohort study at a single academically affiliated fertility clinic between December 2014 and December 2023.PARTICIPANTS/MATERIALS, SETTING, METHODS22 117 patients undergoing IVF-ICSI cycles were categorized into three groups based on the proportion of mature (MII) oocytes: very low MII proportion (≤0.25), low MII proportion (≤0.5), and 100% MII oocytes. Propensity score matching (PSM) was applied in two phases: first, adjusting for age, BMI, gonadotropin dosage, and anti-Müllerian hormone levels; second, adjusting for age, BMI, gonadotropin dosage, and MII count.MAIN RESULTS AND THE ROLE OF CHANCECycles with a very low MII proportion (≤0.25) had significantly lower blastocyst formation-mean 1.32 (SD 2.77; 95% CI: 1.03-1.61) versus 3.10 (SD 3.22; 95% CI: 2.77-3.43; P < 0.001)-and reduced PGT-A utilization-mean percent PGT-A normal 34% (95% CI: 30-38%) versus 40% (95% CI: 36-44%; P < 0.001). However, after PSM, live birth rates per an embryo transfer did not differ significantly between very low MII and perfect MII groups for both cryopreserved transfers (41.6% versus 30%, P = 0.68) and fresh embryo transfers (46.1% versus 38%, P = 0.69). The low MII proportion group (≤0.5) showed a trend toward lower cryopreserved transfer rates (44% versus 53%, P = 0.05), while fresh transfer rates remained comparable (30% versus 26.6%, P = 0.55).LIMITATIONS, REASONS FOR CAUTIONThis study is limited by its retrospective nature and reliance on electronic medical records. While PSM effectively reduced confounding, inherent oocyte quality markers (e.g. mitochondrial function) were not directly measured. Additionally, the non-uniform distribution of MII proportions across groups may have influenced statistical power.WIDER IMPLICATIONS OF THE FINDINGSThese results underscore the importance of personalized ovarian stimulation protocols to optimize mature oocyte (MII) yi","PeriodicalId":13003,"journal":{"name":"Human reproduction","volume":"13 1","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145003195","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}
STUDY QUESTIONDo IVF laboratory workflows influence the mean blastulation rate per cohort of inseminated metaphase II oocytes (m-BR)?SUMMARY ANSWERNeither the total number of procedures nor the workload per operator affected m-BR; instead, each additional hour in the interval from ovulation trigger to oocyte denudation (range 36-44 h) was associated with a measurable decline, especially beyond the 40-h threshold.WHAT IS KNOWN ALREADYControl of laboratory conditions and standardized protocols are essential for optimizing m-BR in IVF. While advancements in technology and culture systems have improved ART outcomes, the effect of laboratory managerial decisions and procedural timing on embryological outcomes remains unclear. Previous studies have suggested that factors, such as prolonged oocyte handling, suboptimal culture conditions, and organizational inefficiencies, may affect in vitro embryo development, but available data are still limited.STUDY DESIGN, SIZE, DURATIONThis retrospective study analyzed 7986 ICSI cycles performed between 2015 and 2022 at a private IVF center. Data were automatically registered and then retrospectively extracted from an Electronic Witnessing System to evaluate workload distribution and procedural timings. The study aimed to assess whether variations in laboratory managerial decisions influence the m-BR.PARTICIPANTS/MATERIALS, SETTING, METHODSThe study included all patients undergoing ICSI with fresh own oocytes. Metrics under investigation included the number of daily procedures overall and per operator and procedural timings, such as the interval between ovulation trigger and oocyte denudation. Results were adjusted for confounders, including maternal age, male factor infertility, and culture conditions. Multivariate linear regression and generalized estimating equations were used to assess associations with m-BR, accounting for repeated measures in couples undergoing multiple retrievals.MAIN RESULTS AND THE ROLE OF CHANCEThe overall m-BR was 35.7 ± 28.1% with 79% of the cycles resulting in at least one blastocyst obtained. No significant association was found between daily workload and m-BR, indicating that the number of daily procedures did not impact laboratory performance. After adjusting for confounders (maternal age, sperm factor, incubation conditions, and culture medium type), only the timing between ovulation trigger and oocyte denudation emerged as critical. A consistent and significant decline in m-BR was observed with each additional hour of delay between 36- and 44-h post-trigger (unstandardized coefficient B: -1.6%, 95% CI: -2.1 to -1.1%). The time between oocyte retrieval and denudation (range: 2-6 h) showed a significant association with a lower chance to obtain at least one blastocyst in each ICSI cycle (adjusted OR: 0.91, 95% CI: 0.86-0.96, P < 0.001).LIMITATIONS, REASONS FOR CAUTIONThis was a retrospective single-center study. While the findings are robust and relevant for high-volume IVF laborat
{"title":"Optimizing IVF lab workflows through data-driven insights: associations between lab management, procedural timings, and workload with blastulation rates.","authors":"Federica Innocenti,Greta Chiara Cermisoni,Marilena Taggi,Valentina Casciani,Daria Maria Soscia,Lisa Dovere,Marta Stoppa,Laura Albricci,Alberto Vaiarelli,Giovanni Coticchio,Roberta Maggiulli,Laura Rienzi,Danilo Cimadomo","doi":"10.1093/humrep/deaf164","DOIUrl":"https://doi.org/10.1093/humrep/deaf164","url":null,"abstract":"STUDY QUESTIONDo IVF laboratory workflows influence the mean blastulation rate per cohort of inseminated metaphase II oocytes (m-BR)?SUMMARY ANSWERNeither the total number of procedures nor the workload per operator affected m-BR; instead, each additional hour in the interval from ovulation trigger to oocyte denudation (range 36-44 h) was associated with a measurable decline, especially beyond the 40-h threshold.WHAT IS KNOWN ALREADYControl of laboratory conditions and standardized protocols are essential for optimizing m-BR in IVF. While advancements in technology and culture systems have improved ART outcomes, the effect of laboratory managerial decisions and procedural timing on embryological outcomes remains unclear. Previous studies have suggested that factors, such as prolonged oocyte handling, suboptimal culture conditions, and organizational inefficiencies, may affect in vitro embryo development, but available data are still limited.STUDY DESIGN, SIZE, DURATIONThis retrospective study analyzed 7986 ICSI cycles performed between 2015 and 2022 at a private IVF center. Data were automatically registered and then retrospectively extracted from an Electronic Witnessing System to evaluate workload distribution and procedural timings. The study aimed to assess whether variations in laboratory managerial decisions influence the m-BR.PARTICIPANTS/MATERIALS, SETTING, METHODSThe study included all patients undergoing ICSI with fresh own oocytes. Metrics under investigation included the number of daily procedures overall and per operator and procedural timings, such as the interval between ovulation trigger and oocyte denudation. Results were adjusted for confounders, including maternal age, male factor infertility, and culture conditions. Multivariate linear regression and generalized estimating equations were used to assess associations with m-BR, accounting for repeated measures in couples undergoing multiple retrievals.MAIN RESULTS AND THE ROLE OF CHANCEThe overall m-BR was 35.7 ± 28.1% with 79% of the cycles resulting in at least one blastocyst obtained. No significant association was found between daily workload and m-BR, indicating that the number of daily procedures did not impact laboratory performance. After adjusting for confounders (maternal age, sperm factor, incubation conditions, and culture medium type), only the timing between ovulation trigger and oocyte denudation emerged as critical. A consistent and significant decline in m-BR was observed with each additional hour of delay between 36- and 44-h post-trigger (unstandardized coefficient B: -1.6%, 95% CI: -2.1 to -1.1%). The time between oocyte retrieval and denudation (range: 2-6 h) showed a significant association with a lower chance to obtain at least one blastocyst in each ICSI cycle (adjusted OR: 0.91, 95% CI: 0.86-0.96, P < 0.001).LIMITATIONS, REASONS FOR CAUTIONThis was a retrospective single-center study. While the findings are robust and relevant for high-volume IVF laborat","PeriodicalId":13003,"journal":{"name":"Human reproduction","volume":"16 1","pages":""},"PeriodicalIF":6.1,"publicationDate":"2025-09-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145003206","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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