STUDY QUESTIONIs the use of acetaminophen during pregnancy associated with external genital tract malformations in boys and girls?SUMMARY ANSWERThis meta-analysis found no evidence linking in utero acetaminophen exposure to external genital malformations in boys but further research focusing on girls and considering relevant confounding factors is needed.WHAT IS KNOWN ALREADYAcetaminophen is widely used by pregnant women, but findings are conflicting regarding a possible increased risk of genital malformations in the offspring of both sexes.STUDY DESIGN, SIZE, DURATIONIn this systematic review and meta-analysis, we searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, International Clinical Trials Registry Platform, ClinicalTrials.gov on 18 April 2024, and subsequently updated the search on 20 September 2025 for randomized controlled trials and observational studies. This meta-analysis included randomized controlled trials and observational studies focusing on the association between in utero exposure to acetaminophen, with no restriction on publication dates and languages.PARTICIPANTS/MATERIALS, SETTING, METHODSTwo reviewers independently screened studies, extracted data, and assessed risk of bias. The two primary outcomes were a composite endpoint including cryptorchidism, hypospadias, and penile hypoplasia in boys, and a composite outcome including clitoral enlargement, labial fusion, vulvar malformations, and rectovaginal fistula in girls. Secondary outcomes included individual genital malformations and differences in anogenital distance (AGD). GRADE was used to evaluate the level of certainty.MAIN RESULTS AND THE ROLE OF CHANCETen observational studies were included. Regarding boys, meta-analysis of the predefined primary outcome could not be performed as no studies reported penile hypoplasia. Another composite endpoint including cryptorchidism and/or hypospadias was reconstructed and no significant association was found with acetaminophen, pooled crude odds ratio (OR) 1.27 [95% CI (0.18, 8.94), studies = 2, participants = 155 362, I2=79%, phet=0.03, random-effects model (REM)]. No significant association was found for cryptorchidism or hypospadias separately based on adjusted estimates with pooled OR of 1.02 [95% CI (0.78, 1.35), studies = 3, participants = 155 852, I2=32%, phet=0.23, REM] and 1.02 [95% CI (0.89, 1.17), studies = 3, participants = 159 572, I2=40%, phet=0.19, REM], respectively. No significant difference was found for short AGD. No meta-analysis was possible for girls for any of the predefined outcomes due to lack of data. The level of certainty was low to very low.LIMITATIONS, REASONS FOR CAUTIONThe predefined primary outcomes in boys and girls could not be fully evaluated. Small study effects could not be assessed as the number of included studies was limited. There was significant heterogeneity in the reporting of results and information regarding maternal characteristics was lacking. Lastly, all inclu
{"title":"Association between in utero exposure to acetaminophen and external genital tract malformations in boys and girls: a systematic review and meta-analysis.","authors":"Lina Eletri,Kristen Joseph-Delaffon,Agnes Dechartres,Per Damkier,Jonathan Richardson,Elisabeth Elefant,Delphine Mitanchez,Benoit Marin","doi":"10.1093/humrep/deaf253","DOIUrl":"https://doi.org/10.1093/humrep/deaf253","url":null,"abstract":"STUDY QUESTIONIs the use of acetaminophen during pregnancy associated with external genital tract malformations in boys and girls?SUMMARY ANSWERThis meta-analysis found no evidence linking in utero acetaminophen exposure to external genital malformations in boys but further research focusing on girls and considering relevant confounding factors is needed.WHAT IS KNOWN ALREADYAcetaminophen is widely used by pregnant women, but findings are conflicting regarding a possible increased risk of genital malformations in the offspring of both sexes.STUDY DESIGN, SIZE, DURATIONIn this systematic review and meta-analysis, we searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, International Clinical Trials Registry Platform, ClinicalTrials.gov on 18 April 2024, and subsequently updated the search on 20 September 2025 for randomized controlled trials and observational studies. This meta-analysis included randomized controlled trials and observational studies focusing on the association between in utero exposure to acetaminophen, with no restriction on publication dates and languages.PARTICIPANTS/MATERIALS, SETTING, METHODSTwo reviewers independently screened studies, extracted data, and assessed risk of bias. The two primary outcomes were a composite endpoint including cryptorchidism, hypospadias, and penile hypoplasia in boys, and a composite outcome including clitoral enlargement, labial fusion, vulvar malformations, and rectovaginal fistula in girls. Secondary outcomes included individual genital malformations and differences in anogenital distance (AGD). GRADE was used to evaluate the level of certainty.MAIN RESULTS AND THE ROLE OF CHANCETen observational studies were included. Regarding boys, meta-analysis of the predefined primary outcome could not be performed as no studies reported penile hypoplasia. Another composite endpoint including cryptorchidism and/or hypospadias was reconstructed and no significant association was found with acetaminophen, pooled crude odds ratio (OR) 1.27 [95% CI (0.18, 8.94), studies = 2, participants = 155 362, I2=79%, phet=0.03, random-effects model (REM)]. No significant association was found for cryptorchidism or hypospadias separately based on adjusted estimates with pooled OR of 1.02 [95% CI (0.78, 1.35), studies = 3, participants = 155 852, I2=32%, phet=0.23, REM] and 1.02 [95% CI (0.89, 1.17), studies = 3, participants = 159 572, I2=40%, phet=0.19, REM], respectively. No significant difference was found for short AGD. No meta-analysis was possible for girls for any of the predefined outcomes due to lack of data. The level of certainty was low to very low.LIMITATIONS, REASONS FOR CAUTIONThe predefined primary outcomes in boys and girls could not be fully evaluated. Small study effects could not be assessed as the number of included studies was limited. There was significant heterogeneity in the reporting of results and information regarding maternal characteristics was lacking. Lastly, all inclu","PeriodicalId":13003,"journal":{"name":"Human reproduction","volume":"93 1","pages":""},"PeriodicalIF":6.1,"publicationDate":"2026-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146088921","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 S Rubin,M Kornfield,M Palmor,M B Luck,B Garg,D Wu,T O'Leary,S Krieg,P Amato
STUDY QUESTIONDo transgender and gender diverse patients with prior testosterone gender affirming hormone therapy (T-GAHT) have oocyte cryopreservation and IVF outcomes that differ from those without prior T-GAHT?SUMMARY ANSWERPrior T-GAHT was associated with a decrease in the total number of blastocysts after adjusting for age, but not with a difference in the number of mature oocytes.WHAT IS KNOWN ALREADYMany TGD people pursue oocyte cryopreservation or IVF after previously initiating T-GAHT for fertility preservation and/or a partner-carried pregnancy; however, data regarding embryo outcomes are scarce. Retrospective cohort studies suggest high mature oocyte yields in oocyte cryopreservation following T-GAHT, but it is unknown whether embryos from patients with prior T-GAHT have a normal capacity to fertilize, cleave, and form blastocysts.STUDY DESIGN, SIZE, DURATIONThis was a retrospective observational cohort study of 46 ovarian stimulation cycles initiated for TGD patients assigned female at birth with and without prior T-GAHT from January 2013 to March 2024.PARTICIPANTS/MATERIALS, SETTING, METHODSThis study included 36 TGD patients assigned female at birth, 25 undergoing IVF and 11 undergoing oocyte cryopreservation. Prior T-GAHT timing, duration, and discontinuation, as well as stimulation cycle characteristics and outcomes collected from the electronic health record retrospectively. Cycles outcomes of TGD people with prior T-GAHT were compared to those without prior T-GAHT. The first completed cycle was used for statistical analysis, with the first initiated cycle (intention to treat) and all cycles as sensitivity analyses. The primary outcome was the number of mature oocytes retrieved for all patients and the total number of blastocysts for patients undergoing IVF. Our secondary outcomes were maturity rate, number of top-quality blastocysts (AB or better), and cumulative live birth rate. A sub-analysis of subjects with prior T-GAHT was performed assessing discontinuation timing and IVF outcomes.MAIN RESULTS AND THE ROLE OF CHANCEOf the 36 TGD patients included, 14 subjects (20 cycles) had prior T-GAHT, 22 patients (26 cycles) had no prior T-GAHT. Accounting for multiple cycles in 10 subjects, a total of 17 IVF and 3 oocyte cryopreservation cycles were initiated in the prior T-GAHT cohort, and 18 IVF and 8 oocyte cryopreservation cycles in the no T-GAHT cohort. After adjusting for age, in the first cycle, prior T-GAHT was associated with a decrease in the total number of blastocysts (coefficient -0.62, 95% CI: -0.95, -0.30) and number of top-quality blastocysts (coefficient -1.09, 95% CI: -1.68, -0.51) but was not associated with a difference in the number of mature oocytes or maturity. Modeling using the first initiated cycle and including all 46 cycles demonstrated the same results. The first cycle cumulative live birth rate was 60% in the prior T-GAHT cohort and 87.5% in those without T-GAHT (P = 0.20). In patients with prior T-GAHT p
{"title":"In vitro fertilization outcomes in transgender individuals with prior testosterone therapy.","authors":"E S Rubin,M Kornfield,M Palmor,M B Luck,B Garg,D Wu,T O'Leary,S Krieg,P Amato","doi":"10.1093/humrep/deag003","DOIUrl":"https://doi.org/10.1093/humrep/deag003","url":null,"abstract":"STUDY QUESTIONDo transgender and gender diverse patients with prior testosterone gender affirming hormone therapy (T-GAHT) have oocyte cryopreservation and IVF outcomes that differ from those without prior T-GAHT?SUMMARY ANSWERPrior T-GAHT was associated with a decrease in the total number of blastocysts after adjusting for age, but not with a difference in the number of mature oocytes.WHAT IS KNOWN ALREADYMany TGD people pursue oocyte cryopreservation or IVF after previously initiating T-GAHT for fertility preservation and/or a partner-carried pregnancy; however, data regarding embryo outcomes are scarce. Retrospective cohort studies suggest high mature oocyte yields in oocyte cryopreservation following T-GAHT, but it is unknown whether embryos from patients with prior T-GAHT have a normal capacity to fertilize, cleave, and form blastocysts.STUDY DESIGN, SIZE, DURATIONThis was a retrospective observational cohort study of 46 ovarian stimulation cycles initiated for TGD patients assigned female at birth with and without prior T-GAHT from January 2013 to March 2024.PARTICIPANTS/MATERIALS, SETTING, METHODSThis study included 36 TGD patients assigned female at birth, 25 undergoing IVF and 11 undergoing oocyte cryopreservation. Prior T-GAHT timing, duration, and discontinuation, as well as stimulation cycle characteristics and outcomes collected from the electronic health record retrospectively. Cycles outcomes of TGD people with prior T-GAHT were compared to those without prior T-GAHT. The first completed cycle was used for statistical analysis, with the first initiated cycle (intention to treat) and all cycles as sensitivity analyses. The primary outcome was the number of mature oocytes retrieved for all patients and the total number of blastocysts for patients undergoing IVF. Our secondary outcomes were maturity rate, number of top-quality blastocysts (AB or better), and cumulative live birth rate. A sub-analysis of subjects with prior T-GAHT was performed assessing discontinuation timing and IVF outcomes.MAIN RESULTS AND THE ROLE OF CHANCEOf the 36 TGD patients included, 14 subjects (20 cycles) had prior T-GAHT, 22 patients (26 cycles) had no prior T-GAHT. Accounting for multiple cycles in 10 subjects, a total of 17 IVF and 3 oocyte cryopreservation cycles were initiated in the prior T-GAHT cohort, and 18 IVF and 8 oocyte cryopreservation cycles in the no T-GAHT cohort. After adjusting for age, in the first cycle, prior T-GAHT was associated with a decrease in the total number of blastocysts (coefficient -0.62, 95% CI: -0.95, -0.30) and number of top-quality blastocysts (coefficient -1.09, 95% CI: -1.68, -0.51) but was not associated with a difference in the number of mature oocytes or maturity. Modeling using the first initiated cycle and including all 46 cycles demonstrated the same results. The first cycle cumulative live birth rate was 60% in the prior T-GAHT cohort and 87.5% in those without T-GAHT (P = 0.20). In patients with prior T-GAHT p","PeriodicalId":13003,"journal":{"name":"Human reproduction","volume":"66 1","pages":""},"PeriodicalIF":6.1,"publicationDate":"2026-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146056523","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}
Preimplantation human embryos frequently exhibit aneuploidy and chromosomal mosaicism, yet emerging evidence suggests they may possess mechanisms for ploidy correction that can mitigate these abnormalities. Several potential pathways have been proposed, including selective apoptosis of abnormal cells, cellular exclusion of aneuploid blastomeres, compartmentalization of abnormal cells into extraembryonic tissues, and chromosomal rescue events (such as trisomic or monosomic rescue), while in some embryos, no correction occurs, leading to persistence of aneuploid cell lineages. Follow-up studies on mosaic embryo transfer outcomes indicate that some embryos can eliminate or segregate aneuploid cells, leading to successful live births. However, the extent to which self-correction occurs, and the precise biological mechanisms underlying these processes, remain poorly understood. The likelihood of successful correction depends on the proportion and distribution of aneuploid cells as current evidence shows that embryos with high-level mosaicism have reduced developmental potential. This mini-review integrates current biological insights into ploidy correction mechanisms with clinical outcome data from mosaic embryo transfers, highlighting both the potential and limitations of embryonic self-correction hypotheses. By examining the interplay between mechanism studies and clinical observations, it underscores the challenges in predicting embryo viability and the necessity for standardized approaches in ART. Future research could help in defining the molecular and developmental pathways governing ploidy correction to improve embryo selection strategies and refine ART guidelines.
{"title":"Embryonic ploidy correction: an update on mechanisms and insights from mosaic embryo transfer.","authors":"Anna Mantzouratou,Anastasia Mania","doi":"10.1093/humrep/deaf254","DOIUrl":"https://doi.org/10.1093/humrep/deaf254","url":null,"abstract":"Preimplantation human embryos frequently exhibit aneuploidy and chromosomal mosaicism, yet emerging evidence suggests they may possess mechanisms for ploidy correction that can mitigate these abnormalities. Several potential pathways have been proposed, including selective apoptosis of abnormal cells, cellular exclusion of aneuploid blastomeres, compartmentalization of abnormal cells into extraembryonic tissues, and chromosomal rescue events (such as trisomic or monosomic rescue), while in some embryos, no correction occurs, leading to persistence of aneuploid cell lineages. Follow-up studies on mosaic embryo transfer outcomes indicate that some embryos can eliminate or segregate aneuploid cells, leading to successful live births. However, the extent to which self-correction occurs, and the precise biological mechanisms underlying these processes, remain poorly understood. The likelihood of successful correction depends on the proportion and distribution of aneuploid cells as current evidence shows that embryos with high-level mosaicism have reduced developmental potential. This mini-review integrates current biological insights into ploidy correction mechanisms with clinical outcome data from mosaic embryo transfers, highlighting both the potential and limitations of embryonic self-correction hypotheses. By examining the interplay between mechanism studies and clinical observations, it underscores the challenges in predicting embryo viability and the necessity for standardized approaches in ART. Future research could help in defining the molecular and developmental pathways governing ploidy correction to improve embryo selection strategies and refine ART guidelines.","PeriodicalId":13003,"journal":{"name":"Human reproduction","volume":"15 1","pages":""},"PeriodicalIF":6.1,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145986214","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 are the outcomes for prepubertal and pubertal girls with Turner syndrome (TS) in terms of fertility counselling and preservation?SUMMARY ANSWERFertility counselling is crucial for prepubertal and pubertal girls with TS, as it can facilitate their pursuit of fertility preservation (FP), primarily through oocyte cryopreservation (OC) and is particularly relevant for patients with blood karyotype abnormality with good prognosis for future fertility.WHAT IS KNOWN ALREADYTS is a common genetic condition affecting ∼1 in 2500 live-born girls. One consequence of TS is premature ovarian insufficiency, significantly impacting the quality of life in adulthood. Therefore, appropriate counselling and effective FP or solutions are essential. When OC is proposed, the role of anti-Müllerian hormone (AMH) and FSH in predicting the outcomes of OC has been examined in the literature with controversial data.STUDY DESIGN, SIZE, DURATIONThis retrospective observational study was conducted at the Reproductive Biology Laboratory-CECOS of Rouen University Hospital, evaluating the follow-up of 40 prepubertal and pubertal girls with TS referred for fertility counselling. Clinical and biological data were collected from medical records between January 2008 and December 2022.PARTICIPANTS/MATERIALS, SETTING, METHODSPrepubertal and pubertal patients with TS attended a fertility counselling consultation, accompanied by their parents or legal guardian if they were under the age of 18 years. The impact of TS on future fertility and potential FP procedures, including OC, were explained. An assessment of ovarian reserve was conducted. Based on the results and depending on the patient's pubertal status, FP could be initiated immediately in TS patients with spontaneous menarche or follow-up could continue until spontaneous puberty and menarche occur.MAIN RESULTS AND THE ROLE OF CHANCEIn terms of FP, 25% (10/40) of the patients underwent OC. On average, 4.9 ± 3.8 oocytes per controlled ovarian hyperstimulation cycle were cryopreserved. No relationship was found between basal FSH or AMH serum level, karyotype abnormalities, and the number of mature oocytes retrieved. Conversely, a positive correlation was observed between the peak estradiol level at the time of triggering and the number of mature oocytes retrieved. In the multiple linear regression analysis with cross-validation, the peak estradiol level at triggering remained the only variable independently associated with mature oocyte yield. Most patients were aware of the impact of TS on future fertility but were uninformed about available parenthood alternatives.LIMITATIONS, REASONS FOR CAUTIONThe number of TS patients included in our study is a limitation, as well as the monocentric and retrospective nature of the study. Therefore, our data should be interpreted with caution.WIDER IMPLICATIONS OF THE FINDINGSFertility counselling and FP are essential for prepubertal and pubertal TS patients. Regular and systema
{"title":"Fertility preservation and counselling in prepubertal and pubertal girls with Turner syndrome.","authors":"Alix Sage,Nathalie Rives,Romane Levadé,Audrey Réal-Lhommet,Maria Letailleur,Fanny Jumeau,Agnès Liard,Géraldine Joly-Hélas,Ariane Cuny,Mireille Castanet,Aurélie Feraille","doi":"10.1093/humrep/deaf249","DOIUrl":"https://doi.org/10.1093/humrep/deaf249","url":null,"abstract":"STUDY QUESTIONWhat are the outcomes for prepubertal and pubertal girls with Turner syndrome (TS) in terms of fertility counselling and preservation?SUMMARY ANSWERFertility counselling is crucial for prepubertal and pubertal girls with TS, as it can facilitate their pursuit of fertility preservation (FP), primarily through oocyte cryopreservation (OC) and is particularly relevant for patients with blood karyotype abnormality with good prognosis for future fertility.WHAT IS KNOWN ALREADYTS is a common genetic condition affecting ∼1 in 2500 live-born girls. One consequence of TS is premature ovarian insufficiency, significantly impacting the quality of life in adulthood. Therefore, appropriate counselling and effective FP or solutions are essential. When OC is proposed, the role of anti-Müllerian hormone (AMH) and FSH in predicting the outcomes of OC has been examined in the literature with controversial data.STUDY DESIGN, SIZE, DURATIONThis retrospective observational study was conducted at the Reproductive Biology Laboratory-CECOS of Rouen University Hospital, evaluating the follow-up of 40 prepubertal and pubertal girls with TS referred for fertility counselling. Clinical and biological data were collected from medical records between January 2008 and December 2022.PARTICIPANTS/MATERIALS, SETTING, METHODSPrepubertal and pubertal patients with TS attended a fertility counselling consultation, accompanied by their parents or legal guardian if they were under the age of 18 years. The impact of TS on future fertility and potential FP procedures, including OC, were explained. An assessment of ovarian reserve was conducted. Based on the results and depending on the patient's pubertal status, FP could be initiated immediately in TS patients with spontaneous menarche or follow-up could continue until spontaneous puberty and menarche occur.MAIN RESULTS AND THE ROLE OF CHANCEIn terms of FP, 25% (10/40) of the patients underwent OC. On average, 4.9 ± 3.8 oocytes per controlled ovarian hyperstimulation cycle were cryopreserved. No relationship was found between basal FSH or AMH serum level, karyotype abnormalities, and the number of mature oocytes retrieved. Conversely, a positive correlation was observed between the peak estradiol level at the time of triggering and the number of mature oocytes retrieved. In the multiple linear regression analysis with cross-validation, the peak estradiol level at triggering remained the only variable independently associated with mature oocyte yield. Most patients were aware of the impact of TS on future fertility but were uninformed about available parenthood alternatives.LIMITATIONS, REASONS FOR CAUTIONThe number of TS patients included in our study is a limitation, as well as the monocentric and retrospective nature of the study. Therefore, our data should be interpreted with caution.WIDER IMPLICATIONS OF THE FINDINGSFertility counselling and FP are essential for prepubertal and pubertal TS patients. Regular and systema","PeriodicalId":13003,"journal":{"name":"Human reproduction","volume":"55 1","pages":""},"PeriodicalIF":6.1,"publicationDate":"2026-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145971875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
F Dreischor,E Dancet,E T M Laan,M Goddijn,J E den Hartog,M H A van Hooff,C B Lambalk,M van Wely,I M Custers
STUDY QUESTIONWhat is the prevalence of sexual dysfunction, and what are the determinants of sexual (dys)functioning in couples with newly diagnosed unexplained infertility?SUMMARY ANSWERAt least one in four couples are at risk of sexual dysfunction, and higher age, longer infertility duration, higher sperm quality, and poorer personal and relational well-being were associated with decreased sexual functioning.WHAT IS KNOWN ALREADYMany couples diagnosed with unexplained infertility have the ability to conceive naturally over time, but infertility is linked to reduced sexual functioning, which can hinder conception. Surprisingly, sexual functioning, its risk factors, and partner interdependence are still understudied in unexplained infertility, while knowing the risk factors for reduced sexual functioning would enable fertility specialists to timely diagnose, prevent, or treat sexual dysfunction, and in this way improve natural conception rates.STUDY DESIGN, SIZE, DURATIONA cross-sectional survey, which also serves as the baseline assessment of a randomized controlled trial (RCT, 2016-2021). A total of 700 heterosexual couples were addressed.PARTICIPANTS/MATERIALS, SETTING, METHODSDutch heterosexual couples (female age 18-38 years) who were able to have coitus and were recently diagnosed with unexplained infertility in secondary or tertiary clinics were eligible. The main outcome measures were sexual functioning as a continuous variable and female and erectile dysfunction based on cut-off scores of the Female Sexual Function Index and International Index of Erectile Function. Determinants included demographic, lifestyle, and diagnostic factors, as well as personal and relational well-being, which were assessed with the Hospital Anxiety and Depression Scale and the Revised Dyadic Adjustment Scale. Sexual (dys)functioning and determinants were subjected to dyadic analysis followed by linear regression.MAIN RESULTS AND THE ROLE OF CHANCEA total of 581 (83%) women and 478 (68%) men completed the questionnaires. Complete couple data were available for 451 (68.9%) couples. About 1 in 4 women (24.3%) and 1 in 14 men (7.3%) were at risk for, respectively, female sexual dysfunction and erectile dysfunction after a fertility work-up. Couples had a mean coital frequency of seven times per month (SD: 2.7). Higher female and male sexual desire (β: 0.04, P < 0.01 and β: 0.02, P < 0.02) and satisfaction (β: 0.03, P < 0.01 and β: 0.06, P < 0.01), but not orgasm, were significantly associated with increased coital frequency. Lower female sexual functioning (β) or dysfunction (OR) was associated with own age (β: -0.64, OR: 1.12), anxiety (β: -9.47, OR: 4.22), depression (β: -7.61, OR: 3.23), relationship distress (β: -8.97, OR: 2.04), and total motility sperm count (β: -4.88). Lower male sexual functioning was associated with anxiety (β: -5.03), depression (β: -3.65), relationship distress (β: -5.77), and partner's age (β: -0.46) and couple's duration of infertilit
研究问题：新近诊断为不明原因不孕症的夫妇中，性功能障碍的患病率是多少？性功能障碍的决定因素是什么？至少四分之一的夫妇有性功能障碍的风险，年龄越大、不孕持续时间越长、精子质量越高、个人和关系幸福感越差都与性功能下降有关。许多被诊断为不明原因不孕症的夫妇有能力随着时间的推移自然怀孕，但不孕症与性功能下降有关，这可能会阻碍受孕。令人惊讶的是，在不明原因的不孕症中，性功能、其风险因素和伴侣相互依赖的研究仍然不足，而了解性功能降低的风险因素将使生育专家能够及时诊断、预防或治疗性功能障碍，从而提高自然受孕率。研究设计、规模、持续时间一项横断面调查，也可作为随机对照试验的基线评估（RCT, 2016-2021）。共有700对异性恋夫妇接受了调查。参与者/材料、环境、方法荷兰异性恋夫妇（女性，年龄18-38岁）近期在二级或三级诊所被诊断为不明原因不孕症，符合条件。主要的结果测量是性功能作为一个连续变量，女性和勃起功能障碍基于女性性功能指数和国际勃起功能指数的分界点得分。决定因素包括人口统计、生活方式和诊断因素，以及个人和关系健康，这些因素通过医院焦虑和抑郁量表和修订的二元调整量表进行评估。性（日）功能和决定因素进行了二元分析，然后进行了线性回归。主要结果和机会的作用总共有581名女性（83%）和478名男性（68%）完成了问卷调查。451对（68.9%）夫妇有完整的夫妻资料。大约四分之一的女性（24.3%）和十四分之一的男性（7.3%）在生育检查后分别有女性性功能障碍和勃起功能障碍的风险。夫妻的平均性生活频率为每月7次（标准差：2.7）。男性和女性的性欲（β: 0.04, P < 0.01和β: 0.02, P < 0.02）和满意度（β: 0.03, P < 0.01和β: 0.06, P < 0.01）与性交频率增加有显著相关性，但与性高潮无显著相关性。较低的女性性功能（β）或功能障碍（or）与自身年龄（β: -0.64, or: 1.12）、焦虑（β: -9.47, or: 4.22）、抑郁（β: -7.61, or: 3.23）、关系困扰（β: -8.97, or: 2.04）和总活动精子数（β: -4.88）相关。男性性功能低下与焦虑（β: -5.03）、抑郁（β: -3.65）、关系困扰（β: -5.77）、伴侣年龄（β: -0.46）和夫妻不孕持续时间（β: -0.24, OR: 1.06）相关。局限性和谨慎的原因考虑到纳入了寻求医疗帮助并同意进行随机对照试验的夫妇，该研究容易出现选择偏差。由于数据缺失、病例数低或在“快乐与怀孕”（P&P）随机对照试验中未被评估等因素，并非所有先前确定的性功能决定因素都得到了研究。临床医生建议不明原因不孕的夫妇继续自然受孕，考虑到他们的预后良好，需要意识到至少四分之一的夫妇有性功能障碍的风险。临床医生应考虑性功能下降的风险因素，进行性记忆，并建议面对面或数字（例如通过网站或应用程序）性咨询和治疗。研究经费/竞争利益(S)这项工作得到了荷兰卫生研究与发展组织（ZonMW参考：843001605）、阿姆斯特丹大学和佛兰德斯研究基金会的支持。资助者在考虑研究设计、收集、分析和解释数据或撰写报告方面没有任何作用。直到1月1日，C.B.L.一直担任《人类生殖》杂志的主编，并获得了默克和奥根农的演讲酬金和旅行支持。试验注册号为NTR5709的P&P随机对照试验的基线评估。
{"title":"Sexual functioning and its determinants in individuals and their partners with unexplained infertility.","authors":"F Dreischor,E Dancet,E T M Laan,M Goddijn,J E den Hartog,M H A van Hooff,C B Lambalk,M van Wely,I M Custers","doi":"10.1093/humrep/deaf246","DOIUrl":"https://doi.org/10.1093/humrep/deaf246","url":null,"abstract":"STUDY QUESTIONWhat is the prevalence of sexual dysfunction, and what are the determinants of sexual (dys)functioning in couples with newly diagnosed unexplained infertility?SUMMARY ANSWERAt least one in four couples are at risk of sexual dysfunction, and higher age, longer infertility duration, higher sperm quality, and poorer personal and relational well-being were associated with decreased sexual functioning.WHAT IS KNOWN ALREADYMany couples diagnosed with unexplained infertility have the ability to conceive naturally over time, but infertility is linked to reduced sexual functioning, which can hinder conception. Surprisingly, sexual functioning, its risk factors, and partner interdependence are still understudied in unexplained infertility, while knowing the risk factors for reduced sexual functioning would enable fertility specialists to timely diagnose, prevent, or treat sexual dysfunction, and in this way improve natural conception rates.STUDY DESIGN, SIZE, DURATIONA cross-sectional survey, which also serves as the baseline assessment of a randomized controlled trial (RCT, 2016-2021). A total of 700 heterosexual couples were addressed.PARTICIPANTS/MATERIALS, SETTING, METHODSDutch heterosexual couples (female age 18-38 years) who were able to have coitus and were recently diagnosed with unexplained infertility in secondary or tertiary clinics were eligible. The main outcome measures were sexual functioning as a continuous variable and female and erectile dysfunction based on cut-off scores of the Female Sexual Function Index and International Index of Erectile Function. Determinants included demographic, lifestyle, and diagnostic factors, as well as personal and relational well-being, which were assessed with the Hospital Anxiety and Depression Scale and the Revised Dyadic Adjustment Scale. Sexual (dys)functioning and determinants were subjected to dyadic analysis followed by linear regression.MAIN RESULTS AND THE ROLE OF CHANCEA total of 581 (83%) women and 478 (68%) men completed the questionnaires. Complete couple data were available for 451 (68.9%) couples. About 1 in 4 women (24.3%) and 1 in 14 men (7.3%) were at risk for, respectively, female sexual dysfunction and erectile dysfunction after a fertility work-up. Couples had a mean coital frequency of seven times per month (SD: 2.7). Higher female and male sexual desire (β: 0.04, P < 0.01 and β: 0.02, P < 0.02) and satisfaction (β: 0.03, P < 0.01 and β: 0.06, P < 0.01), but not orgasm, were significantly associated with increased coital frequency. Lower female sexual functioning (β) or dysfunction (OR) was associated with own age (β: -0.64, OR: 1.12), anxiety (β: -9.47, OR: 4.22), depression (β: -7.61, OR: 3.23), relationship distress (β: -8.97, OR: 2.04), and total motility sperm count (β: -4.88). Lower male sexual functioning was associated with anxiety (β: -5.03), depression (β: -3.65), relationship distress (β: -5.77), and partner's age (β: -0.46) and couple's duration of infertilit","PeriodicalId":13003,"journal":{"name":"Human reproduction","volume":"51 1","pages":""},"PeriodicalIF":6.1,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145956089","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}
Over a number of years, there has been growing interest in the introduction of more invasive ARTs, such as nuclear transfer, otherwise referred to as mitochondrial donation, and mitochondrial supplementation/transfer into clinical medicine. They have been proposed to overcome repeated failed fertilization or developmental arrest or to prevent carriers of mitochondrial DNA disease from having affected children. These technologies require considerable manipulation of the oocyte, which can affect its epigenetic programming that was established as it grew and developed into a fertilizable oocyte. Consequently, when a nucleus is transferred into an enucleated oocyte or pronuclei are transferred into an enucleated zygote, the nucleus must adapt to its new cytoplasmic environment in readiness for the waves of DNA demethylation and methylation that take place during preimplantation development. As a result, some key developmental gene networks are affected. Additionally, these approaches also affect patterns of mitochondrial DNA inheritance, with some embryos and offspring possessing mitochondrial DNA carried over into the oocyte with the nucleus, as well as the mitochondrial DNA from the donor oocyte. Similar outcomes result from the addition of extra mitochondrial DNA into oocytes through mitochondrial supplementation. We provide a background as to how these technologies evolved and discuss recent outcomes associated with clinical work so far undertaken within these approaches and their consequences for the offspring. We conclude that these technologies are not simply replacing or replenishing defective ooplasms with new or extra mitochondria but rather induce a series of genomic and epigenomic events that we do not yet fully understand. To our minds, these issues should be first addressed before clinical trials are continued.
{"title":"The need to understand the underlying mechanisms associated with mitochondrial therapies in assisted reproduction before further clinical trials are performed.","authors":"Justin C St John,Raymond J Rodgers","doi":"10.1093/humrep/deaf247","DOIUrl":"https://doi.org/10.1093/humrep/deaf247","url":null,"abstract":"Over a number of years, there has been growing interest in the introduction of more invasive ARTs, such as nuclear transfer, otherwise referred to as mitochondrial donation, and mitochondrial supplementation/transfer into clinical medicine. They have been proposed to overcome repeated failed fertilization or developmental arrest or to prevent carriers of mitochondrial DNA disease from having affected children. These technologies require considerable manipulation of the oocyte, which can affect its epigenetic programming that was established as it grew and developed into a fertilizable oocyte. Consequently, when a nucleus is transferred into an enucleated oocyte or pronuclei are transferred into an enucleated zygote, the nucleus must adapt to its new cytoplasmic environment in readiness for the waves of DNA demethylation and methylation that take place during preimplantation development. As a result, some key developmental gene networks are affected. Additionally, these approaches also affect patterns of mitochondrial DNA inheritance, with some embryos and offspring possessing mitochondrial DNA carried over into the oocyte with the nucleus, as well as the mitochondrial DNA from the donor oocyte. Similar outcomes result from the addition of extra mitochondrial DNA into oocytes through mitochondrial supplementation. We provide a background as to how these technologies evolved and discuss recent outcomes associated with clinical work so far undertaken within these approaches and their consequences for the offspring. We conclude that these technologies are not simply replacing or replenishing defective ooplasms with new or extra mitochondria but rather induce a series of genomic and epigenomic events that we do not yet fully understand. To our minds, these issues should be first addressed before clinical trials are continued.","PeriodicalId":13003,"journal":{"name":"Human reproduction","volume":"81 1","pages":""},"PeriodicalIF":6.1,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145956088","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}
Sandro C Esteves, Christopher J De Jonge, Allan Pacey, Mónica H Vazquez-Levin
{"title":"The 2025 WHO infertility guideline: value in focusing on clinical varicocele and recognizing gaps in male diagnosis and treatment.","authors":"Sandro C Esteves, Christopher J De Jonge, Allan Pacey, Mónica H Vazquez-Levin","doi":"10.1093/humrep/deaf251","DOIUrl":"https://doi.org/10.1093/humrep/deaf251","url":null,"abstract":"","PeriodicalId":13003,"journal":{"name":"Human reproduction","volume":" ","pages":""},"PeriodicalIF":6.1,"publicationDate":"2026-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145933142","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 QUESTIONHow can educational resources be feasibly co-designed and used to support conversations between staff and patients about ending fertility treatment?SUMMARY ANSWERCo-design workshops allow for the development of educational resources that account for all stakeholders' perspectives and are considered sensitive, informative, and helpful to support end-of-treatment conversations, but staff and patients have different views about how these can be used within the treatment pathway.WHAT IS KNOWN ALREADYEnding treatment without children is a common outcome but seldom discussed with patients. Preventive end-of-treatment care aims to promote healthy transitions at the end of treatment by preparing and helping patients cope with this possible outcome. Nine in ten patients want to receive such care, but only 3 in 10 report receiving it. Knowledge of perceived barriers to implementing preventive end-of-treatment care at clinics and whether digital educational resources can be developed to support its provision is lacking.STUDY DESIGN, SIZE, DURATIONCo-design workshops with fertility staff (March 2022), patients, and patient advocates (March-December 2022) from Europe (Belgium, Finland, Germany, Italy, Portugal, Spain, and UK) and South America (Argentina, Brazil, and Chile). Staff were invited to participate through fertility professional and scientific associations, and patients and advocates via charities and social media. Eligibility criteria were being aged 18 or older and working in fertility care (for staff) or charity (for advocates) or being waiting to initiate, undergoing, or having undergone treatment within 6 months (for patients).PARTICIPANTS/MATERIALS, SETTING, METHODSA preliminary specification and initial prototypes of digital educational resources to support staff and patients, respectively, in having conversations about ending treatment were developed with relevant stakeholders. Co-design workshops with study participants were conducted. A semi-structured script, following Bowen et al.'s (2009)feasibility framework, was used to guide the workshops. Questions covered: (i) experiences, views, and preferences on the provision of preventive end-of-treatment care at clinics and iterative prototypes of the resources to support this provision (acceptability); (ii) perceived need and benefits (demand); and (iii) perceived barriers and facilitators to its implementation at clinics (practicalities). Workshops were recorded and transcribed verbatim, and data were analysed using Framework Analysis.MAIN RESULTS AND THE ROLE OF CHANCEFifteen fertility staff, 34 patients, and 7 advocates participated. Staff were mainly psychologists/counsellors (40.0%) or clinicians (26.7%) working in the field for around 23 years. Patients were mostly women (91.2%), on average aged 38 years. Most were childless (73.5%) and trying to conceive for around 3 years. Framework analysis of data collected during the co-design workshops generated four themes and one m
{"title":"A multi-country study to co-design and evaluate digital educational resources to support conversations about ending fertility treatment.","authors":"Mariana Sousa-Leite,Sofia Gameiro","doi":"10.1093/humrep/deaf248","DOIUrl":"https://doi.org/10.1093/humrep/deaf248","url":null,"abstract":"STUDY QUESTIONHow can educational resources be feasibly co-designed and used to support conversations between staff and patients about ending fertility treatment?SUMMARY ANSWERCo-design workshops allow for the development of educational resources that account for all stakeholders' perspectives and are considered sensitive, informative, and helpful to support end-of-treatment conversations, but staff and patients have different views about how these can be used within the treatment pathway.WHAT IS KNOWN ALREADYEnding treatment without children is a common outcome but seldom discussed with patients. Preventive end-of-treatment care aims to promote healthy transitions at the end of treatment by preparing and helping patients cope with this possible outcome. Nine in ten patients want to receive such care, but only 3 in 10 report receiving it. Knowledge of perceived barriers to implementing preventive end-of-treatment care at clinics and whether digital educational resources can be developed to support its provision is lacking.STUDY DESIGN, SIZE, DURATIONCo-design workshops with fertility staff (March 2022), patients, and patient advocates (March-December 2022) from Europe (Belgium, Finland, Germany, Italy, Portugal, Spain, and UK) and South America (Argentina, Brazil, and Chile). Staff were invited to participate through fertility professional and scientific associations, and patients and advocates via charities and social media. Eligibility criteria were being aged 18 or older and working in fertility care (for staff) or charity (for advocates) or being waiting to initiate, undergoing, or having undergone treatment within 6 months (for patients).PARTICIPANTS/MATERIALS, SETTING, METHODSA preliminary specification and initial prototypes of digital educational resources to support staff and patients, respectively, in having conversations about ending treatment were developed with relevant stakeholders. Co-design workshops with study participants were conducted. A semi-structured script, following Bowen et al.'s (2009)feasibility framework, was used to guide the workshops. Questions covered: (i) experiences, views, and preferences on the provision of preventive end-of-treatment care at clinics and iterative prototypes of the resources to support this provision (acceptability); (ii) perceived need and benefits (demand); and (iii) perceived barriers and facilitators to its implementation at clinics (practicalities). Workshops were recorded and transcribed verbatim, and data were analysed using Framework Analysis.MAIN RESULTS AND THE ROLE OF CHANCEFifteen fertility staff, 34 patients, and 7 advocates participated. Staff were mainly psychologists/counsellors (40.0%) or clinicians (26.7%) working in the field for around 23 years. Patients were mostly women (91.2%), on average aged 38 years. Most were childless (73.5%) and trying to conceive for around 3 years. Framework analysis of data collected during the co-design workshops generated four themes and one m","PeriodicalId":13003,"journal":{"name":"Human reproduction","volume":"76 1","pages":""},"PeriodicalIF":6.1,"publicationDate":"2026-01-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145907832","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>How does iron overload affect ovarian function in pediatric patients with transfusion-dependent beta-thalassemia major?</p><p><strong>Summary answer: </strong>Iron overload in pediatric patients with beta-thalassemia major is strongly associated with decreased ovarian reserve and mitochondrial damage.</p><p><strong>What is known already: </strong>Beta-thalassemia major is a severe blood disorder necessitating frequent blood transfusions, leading to iron overload. Excessive iron causes oxidative stress and damage in various organs, including the ovaries, but its impact on ovarian function in pediatric patients has not been fully explored.</p><p><strong>Study design, size, duration: </strong>This study analyzed data from 194 pediatric patients who were treated at The Sixth Affiliated Hospital of Sun Yat-Sen University between January 2021 and January 2024, among whom 138 had beta-thalassemia major. Meanwhile, we conducted experiments using human samples and mouse models of iron overload.</p><p><strong>Participants/materials, setting, methods: </strong>The study involved 194 pediatric patients. Clinical assessments measured serum ferritin and ovarian reserve indicators anti-Müllerian hormone (AMH) and antral follicle count. Ovarian tissue from pediatric patients was used for histopathological examination, immunohistochemical (IHC) staining, transmission electron microscopy (TEM), and transcriptome analysis, to investigate the effects of iron overload. For the animal experiments, we utilized 20 newborn female mice to establish an iron overload and control model. These animals underwent comprehensive evaluations, including histopathological examination, TEM, and IHC analyses, to systematically investigate the impact of iron overload on ovarian tissue.</p><p><strong>Main results and the role of chance: </strong>Pubertal pediatric patients with high iron overload had significantly lower AMH, indicating reduced ovarian reserve, accompanied by evident mitochondrial damage and fibrotic remodeling in ovarian tissues, collectively contributing to impaired ovarian function. Decreased AMH and impaired follicular development were also observed in iron-overloaded mice, along with mitochondrial damage and ovarian fibrosis.</p><p><strong>Large scale data: </strong>Transcriptome data are available at China National Center for Bioinformation, reference HRA004373 and HRA013348.</p><p><strong>Limitations, reasons for caution: </strong>The cross-sectional design limits causality assessment. The sample size for molecular analyses is relatively small, necessitating larger, longitudinal studies to confirm these findings and understand long-term effects.</p><p><strong>Wider implications of the findings: </strong>Effective iron management in pediatric patients with beta-thalassemia major is crucial to preserving ovarian function and preventing long-term reproductive issues. These findings can guide clinical practices and therapeutic strat
{"title":"Ovarian function compromise in pediatric beta-thalassemia major: a consequence of iron overload-induced mitochondrial and fibrotic damage.","authors":"Xiaoping Liu, Peigen Chen, Yongfang Li, Weie Zhao, Xiaoke Zheng, Peng Sun, Yingchun Guo, Cong Fang, Xiaoyan Liang, Jingjie Li","doi":"10.1093/humrep/deaf250","DOIUrl":"https://doi.org/10.1093/humrep/deaf250","url":null,"abstract":"<p><strong>Study question: </strong>How does iron overload affect ovarian function in pediatric patients with transfusion-dependent beta-thalassemia major?</p><p><strong>Summary answer: </strong>Iron overload in pediatric patients with beta-thalassemia major is strongly associated with decreased ovarian reserve and mitochondrial damage.</p><p><strong>What is known already: </strong>Beta-thalassemia major is a severe blood disorder necessitating frequent blood transfusions, leading to iron overload. Excessive iron causes oxidative stress and damage in various organs, including the ovaries, but its impact on ovarian function in pediatric patients has not been fully explored.</p><p><strong>Study design, size, duration: </strong>This study analyzed data from 194 pediatric patients who were treated at The Sixth Affiliated Hospital of Sun Yat-Sen University between January 2021 and January 2024, among whom 138 had beta-thalassemia major. Meanwhile, we conducted experiments using human samples and mouse models of iron overload.</p><p><strong>Participants/materials, setting, methods: </strong>The study involved 194 pediatric patients. Clinical assessments measured serum ferritin and ovarian reserve indicators anti-Müllerian hormone (AMH) and antral follicle count. Ovarian tissue from pediatric patients was used for histopathological examination, immunohistochemical (IHC) staining, transmission electron microscopy (TEM), and transcriptome analysis, to investigate the effects of iron overload. For the animal experiments, we utilized 20 newborn female mice to establish an iron overload and control model. These animals underwent comprehensive evaluations, including histopathological examination, TEM, and IHC analyses, to systematically investigate the impact of iron overload on ovarian tissue.</p><p><strong>Main results and the role of chance: </strong>Pubertal pediatric patients with high iron overload had significantly lower AMH, indicating reduced ovarian reserve, accompanied by evident mitochondrial damage and fibrotic remodeling in ovarian tissues, collectively contributing to impaired ovarian function. Decreased AMH and impaired follicular development were also observed in iron-overloaded mice, along with mitochondrial damage and ovarian fibrosis.</p><p><strong>Large scale data: </strong>Transcriptome data are available at China National Center for Bioinformation, reference HRA004373 and HRA013348.</p><p><strong>Limitations, reasons for caution: </strong>The cross-sectional design limits causality assessment. The sample size for molecular analyses is relatively small, necessitating larger, longitudinal studies to confirm these findings and understand long-term effects.</p><p><strong>Wider implications of the findings: </strong>Effective iron management in pediatric patients with beta-thalassemia major is crucial to preserving ovarian function and preventing long-term reproductive issues. These findings can guide clinical practices and therapeutic strat","PeriodicalId":13003,"journal":{"name":"Human reproduction","volume":" ","pages":""},"PeriodicalIF":6.1,"publicationDate":"2026-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145891883","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: Reply: Biosimilars versus the originator of follitropin alfa in ART: eyes wide shut?","authors":"","doi":"10.1093/humrep/deaf220","DOIUrl":"10.1093/humrep/deaf220","url":null,"abstract":"","PeriodicalId":13003,"journal":{"name":"Human reproduction","volume":" ","pages":"130"},"PeriodicalIF":6.1,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145556737","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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