Human Fertility最新文献

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.

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.

Recurrent implantation failure (RIF) is a major barrier to successful assisted reproduction, often linked to impaired endometrial receptivity. Gonadotropin-releasing hormone agonist (GnRHa) pretreatment may improve outcomes in frozen embryo transfer (FET) cycles, but evidence in unexplained RIF remains inconclusive. Ki67, a marker of cellular proliferation, has been proposed as being associated with receptivity. This retrospective study included 182 women with unexplained RIF who underwent FET at Nanjing Drum Tower Hospital between January 2020 and December 2023. Patients were divided into a GnRHa-HRT group (n = 121) and an HRT group (n = 61). Endometrial tissue was collected during the mid-secretory phase, and Ki67 expression was assessed by immunohistochemistry. Patients were stratified into high and low Ki67 groups according to integrated optical density (IOD fold). The GnRHa-HRT group achieved higher clinical pregnancy rates than the HRT group (68.6% vs. 52.5%, P = 0.033) and showed a trend toward higher live birth rates (57.9% vs. 42.6%, P = 0.052). Importantly, in patients with high Ki67 expression (IOD fold >1.5), GnRHa pretreatment significantly increased the clinical pregnancy rate (P = 0.004), whereas no significant differences were observed in patients with low Ki67 expression. These findings suggest that secretory phase Ki67 expression may serve as a predictive biomarker for tailoring GnRHa pretreatment in unexplained RIF, supporting more individualised strategies to optimise clinical outcomes.

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.

In New Zealand, embryo donors and recipients meet in a joint counselling session before donation where their needs and expectations for future contact are discussed. However, the extent and experience of contact - including that occurring before the mandated age of identity release at 18 - has received little international research attention and has not been explored in New Zealand. This study, based on interviews with nine participants who had donated or received embryos, examined donor and recipient expectations and experiences of early contact, including the nature of their relationships, how boundaries and expectations are managed and their role in each other's lives. Thematic analysis identified that contact was experienced as overwhelmingly positive, with many participants describing strong, meaningful connections between families. Relationships between children in both families were particularly valued, and extended family often became part of these networks. Contact arrangements were flexible, combining in-person and digital communication. Joint counselling was viewed as instrumental in establishing contact expectations and fostering positive relationships. Although participants were satisfied with the pre-donation counselling process, findings suggest the value of ongoing access to support for issues which may emerge after donation.

Male infertility is commonly diagnosed by semen analysis, but it often fails to distinguish fertile from infertile men unless abnormalities are marked. Sperm DNA fragmentation (SDF) testing is becoming a diagnostic aid. High SDF-defined as values higher than assay-specific cut-offs-predicts adverse reproductive outcomes in natural conception and after IUI, IVF, and ICSI, as shown in this systematic review and meta-analysis. From inception to March 2025, we searched MEDLINE, EMBASE, CINAHL, Google Scholar, Web of Science, and SCISEARCH for COMET, SCSA, TUNEL, or SCD studies that reported pregnancy or miscarriage. Assay cut-offs were used to extract data into 2x2 tables. Pooled sensitivity, specificity, likelihood ratios, and diagnostic odds ratios were evaluated using random-effects HSROC models following PRISMA and QUADAS-2 guidelines. In 52 trials with 19,930 subjects, all reported pregnancies and 41 reported miscarriages. High SDF had low sensitivity and higher specificity across natural and assisted conception, with modest likelihood and diagnostic odds ratios indicating limited discrimination. With significant heterogeneity, HSROC curves showed poor-to-moderate discrimination. High SDF had low sensitivity and high specificity for miscarriage, indicating poor prediction. Evaluating high SDF alone to predict pregnancy or miscarriage is limited. Its clinical value needs to be determined through well-designed trials.

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.