Human Fertility最新文献

As demand for donor conception (DC) rises the landscape is becoming increasingly complex. DC-linking now occurs through various means, including direct-to-consumer DNA testing, which may reveal DC where this has not been disclosed and make those genetically related known to each other, including earlier than is possible through identity-release provisions in many jurisdictions. Early contact between donors and recipient parents, as well as same-donor siblings is becoming more common. Large sibling groups within and across jurisdictions are increasingly being identified and there is also growing reliance on imported gametes and online donor recruitment platforms. These developments can be associated with challenges for donor-conceived people (DCP), parents, donors and their families, and have led to calls for more accessible and responsive psycho-social support services. This paper maps the DC context in ten Western countries, including the availability of psychosocial support and counselling. Given the growing complexity of DC and its lifelong impact on all involved, we pay particular attention to post-donation counselling support related to disclosure, long-term psychosocial wellbeing, and DC-linking. We identify key challenges in existing DC provisions and support systems and propose improvements that support DCP, donors, parents, siblings, and their families in managing the longer-term implications of DC.

This article explores how connections brought about through practices of donor conception are changing in the context of mediatisation and, in particular, how digital technologies shape possibilities for donors and recipient families to know one another. We focus on the growing practice of 'informal' donor conception (IDC) in the UK - donor conceptions which are arranged outside of medical institutions and often facilitated via online platforms. Drawing on interviews with 30 (intended) parents via IDC and 19 informal sperm donors, we show how donors and recipients carefully manage, or attempt to manage, the ways in which they are known and knowable to one another, and to a potential donor-conceived person. We identify four ways of knowing, and being known, within participants' accounts: 1) selective sharing of identifying information; 2) (dis)embedding donation connections within wider communities; 3) communicative forms of knowing; and 4) via the creation and management of digital artefacts. Donors and recipients sought to use and limit these different modes of knowing in varied combinations, shaped by their knowledge of (clinical) assisted reproduction practices, changing digital cultures and the legal marginalisation of IDC practices.

Congenital cervical agenesis is a rare but important obstructive cause of primary amenorrhoea. Initial diagnosis is often delayed. With advances in reconstructive surgery, fertility restoration is now a realistic option for some women. We present a case of complete cervical and vaginal agenesis diagnosed in a 16-year-old girl who presented with cyclical pelvic pain and primary amenorrhoea. Following successful vaginoplasty and direct uterovaginal anastomosis, regular, pain-free menses, and later, uncomplicated sexual intercourse was achieved. Following a 10-year period of primary infertility and unsuccessful assisted reproduction treatment, natural pregnancy was achieved with the birth of a healthy male infant by caesarean section at term. This report aims to highlight the potential complexities of both natural and assisted conception following corrective uterine surgery. The importance of an individualised, multi-disciplinary approach to care is also highlighted.

In the forty years since the publication of the Warnock Report, the fertility field has changed dramatically-in part due to the growing influence of finance capital. This article examines how private equity (PE) and venture capital (VC) investments are reshaping the organisation, practice and future of assisted reproduction. While Warnock anticipated sufficient provision of IVF through the NHS, contemporary IVF has become one of the most privatised and financialised areas of medicine. PE-backed acquisitions introduce short-term return-on-investment logics centred on scaling up, cost-cutting and revenue expansion-all of which have implications for pricing, labour, clinical practice, research and training. Meanwhile, VC investments in fertility start-ups embed reproductive innovation within Silicon Valley's cultures of disruptive innovation and speculative futures. From AI-driven embryo selection and DIY fertility apps to stem-cell based innovations and automated embryology, the approximation between the tech and fertility industries increasingly frames reproduction as a process to be engineered, optimised and platformised. Together, the financial forces of PE and VC reshape power relations in assisted reproduction and reconfigure the future direction of reproductive medicine within their logics of valuation. Revisiting Warnock in this context highlights the need for regulatory frameworks that address not only the ethics of fertility treatments, but the consequences of the expanding financial infrastructures that now underpin the fertility sector.

Suppression of an LH surge is fundamental to successful oocyte retrieval after controlled ovarian stimulation. This study evaluates the efficacy and cost-effectiveness of progestin-primed ovarian stimulation (PPOS) using oral medroxyprogesterone acetate in fertility preservation cycles. The design is a retrospective single-centre study (January 2022-August 2023) comparing two ovarian stimulation protocols: PPOS and the gonadotrophin-releasing hormone antagonist (GnRHant) protocols. Cycles began at any time of the menstrual cycle. The primary outcome was the number of metaphase II oocytes retrieved. Secondary outcomes included total oocytes retrieved, maturity ratio, stimulation duration, incidence of premature LH rise/ovulation events, and the cost of medication used to prevent ovulation. The study included 125 fertility preservation cycles: 54 in the PPOS group and 71 in the GnRHant group. Median body mass index, antral follicle count, and anti-Mullerian hormone levels were comparable between the two groups. The median age was younger in the PPOS group; 28 years vs. 32 years, p = 0.03. Mature oocyte retrieval was similar; mean 9.33 [SD 5.87] vs. 8.97 [SD 5.44], p = 0.73. No premature LH rises occurred in either group. Secondary outcomes showed no significant differences, except for the cost of medication used to prevent ovulation. The PPOS protocol was considerably more cost-effective, by achieving a 98.06% cost reduction (medroxyprogesterone acetate, mean £4.38 [SD, £1.10] vs cetrorelix acetate £226.2 [SD £64.36], p= <0.0001. PPOS is a practical, cost-effective strategy for fertility preservation. Its appeal lies in its patient-centric focus, with a less invasive injection-based administration, while maintaining comparable effectiveness and significant cost reduction compared with the GnRH antagonist ovarian stimulation protocol.

Anti-Müllerian hormone (AMH) is a reliable biomarker for assessing ovarian reserve, offering insight into the quantity of a woman's remaining oocyte pool. As AMH levels naturally decline with age, establishing accurate reference values is crucial for fertility assessment and reproductive planning. While existing nomograms predominantly focus on infertile populations or small cohorts, the current study presents a comprehensive, population-based analysis of AMH levels in 5,230 women aged 25 to under 45 years. Serum samples were obtained through a central laboratory in a large tertiary hospital (Sheba Medical Center) which processes AMH tests collected primarily in the community. This unique setting provides a broadly representative sample of women from a community-based population. Utilizing these community-based serum samples measured using the Elecsys Cobas AMH assay; this cross-sectional study developed age-specific AMH percentiles and z-scores using the general additive model for location, scale and shape (GAMLSS). Participants were randomly split into a learning group (n = 4,000) and a validation group (n = 1,230), with similar median age (34.3 vs. 34.2 years, p = 0.499) and AMH (1.83 vs. 1.85 ng/mL, p = 0.584) levels. Median AMH values demonstrated a clear age-dependent decline, ranging from 3.03 ng/mL at age 25 to 0.31 ng/mL at age 44. The generated reference chart enables interpretation of AMH results in relation to age-matched peers, enhancing the clinical utility of AMH testing for counselling and decision-making in both individual and public health contexts. Importantly, this study addresses a gap in current literature by including a community-based population and avoiding the selection biases inherent in studies limited to women with infertility or polycystic ovary syndrome. The mean z-score in the validation group was approximately zero, confirming the model's robustness. These results reinforce the value of AMH as a tool for fertility assessment, while highlighting variability in AMH across populations and emphasising the need for standardised reference ranges. The newly established percentiles may support timely fertility preservation decisions and inform public health strategies aimed at fertility awareness in reproductive-aged women. As AMH testing becomes increasingly accessible, age-specific interpretation using robust population data will become essential in tailoring personalised reproductive care.

Elevated serum uric acid (SUA) has been linked to adverse outcomes in polycystic ovary syndrome, yet its broader role in female fertility is unclear. This retrospective cohort study of 16,223 women undergoing a first in vitro fertilisation (IVF)/intracytoplasmic sperm injection (ICSI) cycle investigated associations between pre-treatment SUA and reproductive parameters. Higher SUA levels were independently associated with elevated luteinizing hormone (LH), testosterone, and anti-Müllerian hormone (AMH), and with lower estradiol and follicle-stimulating hormone. Each 50 µmol/L SUA increase correlated with a 16-gram reduction in neonatal birth weight and a 0.06-week decrease in gestational age, with a threshold effect near 350 µmol/L. Bidirectional Mendelian randomisation analyses supported a causal effect of elevated SUA on increased LH and testosterone, while reverse analysis suggested lower AMH may elevate SUA. These findings identify SUA as a biomarker influencing ovarian reserve and neonatal outcomes through bidirectional mechanisms, including a potential SUA-AMH feedback loop. Routine SUA monitoring in fertility treatment is supported, and interventions for individuals with SUA ≥350 µmol/L warrant clinical investigation.

Period tracking applications (apps) are increasingly being used by people who menstruate to predict the timing of their next period, monitor symptoms, and avoid or plan pregnancy. Despite their growing popularity, there has been a lack of critical engagement regarding their development, usage, regulation, claimed benefits, and unintended harms. This study aimed to explore how popular international period trackers are promoted, including the quality of the information provided and the communication strategies used in the app descriptions and websites. 'Period tracker' and 'Menstrual cycle calculator' were searched in the Apple and Google app stores and results were combined with Statista's report on the most downloaded period trackers and women's health apps globally. The top ten recurring apps were selected and analysed using an inductive content analysis. The content extracted was categorised into four overarching themes: (1) function and abilities, (2) marketing language, (3) health claims made, and (4) any caveats described. Most apps (60%) featured empowerment language and claimed that users would gain knowledge and understanding of their bodies (60%), yet few (40%) disclosed that they should not replace professional medical advice, diagnosis or treatment. None of the apps included a caveat that their predictions may be inaccurate and should only be interpreted as a guide. By summarising the quality of information and questioning the use of non-evidence-based claims in the promotion of period tracking apps, our findings highlight the need for greater transparency and regulation. Improving information quality, disclosing how predictions are generated, and openly communicating limitations is vital in setting realistic user expectations, enhancing menstrual health literacy, and maximising the benefits of period tracking apps for women and people who menstruate overall.

Objective: To investigate the association between an abnormal hysterosalpingogram (HSG) and obstetrical and neonatal outcomes.

Design: A retrospective cohort study comparing outcomes between women with normal versus abnormal tubal patency and uterine cavity on HSG.

Results: Among 2181 women included in the study, 494 (22.6%) had an abnormal HSG. Of these, 207 (42%) presented with uterine abnormalities, 336 (68%) with tubal abnormalities and 49 (10%) with both. The study identified 232 clinical pregnancies in the abnormal HSG group and 814 pregnancies in controls. Women with abnormal HSG showed higher rates of preterm labour (PTL) compared to controls (13.6% vs. 7.7%, p < 0.05, n = 1687). Multivariate analysis revealed that any HSG abnormality was associated with an increased risk of PTL (aOR 2.39, 1.04-5.51). When analysing by type of abnormality, uterine abnormalities increased the risk of preeclampsia (aOR 2.86, 1.06-7.7) and low birthweight (aOR 2.31, 1.0-5.35), while tubal abnormalities were specifically associated with increased risk of PTL (aOR 3.87, 1.63-9.19).

Conclusion: An abnormal HSG study was associated with adverse obstetrical outcomes. Specifically, uterine abnormalities increased the risk of preeclampsia and birthweight below 10th percentile, while tubal abnormalities were associated with a heightened risk of PTL.

This article examines and evaluates the adequacy of current legislation regarding uterus transplants in light of the Warnock Committee's foundational work on reproductive ethics and technology. With increasing advancements in reproductive technology, the potential for uterus transplants to provide opportunities for cisgender women with absolute uterine factor infertility (AUFI) to gestate has garnered significant attention. However, existing legal frameworks often lag behind medical innovations, leading to disparities in access, regulation, and patient rights. Questions also arise regarding applying existing legislation to novel medical innovations, such as the potential to provide a uterus transplant to transgender women. As uterus transplantation emerges as a viable treatment option for cisgender women with absolute uterine factor infertility, the need for comprehensive legal frameworks becomes increasingly urgent and so this article assesses whether existing assisted reproduction laws are fit for purpose or whether reform is required given advances in reproductive medicine such as uterus transplantation.