Human Fertility最新文献

Infertility is increasing globally, affecting one in six adults due to factors like delayed childbearing and lifestyle changes. Despite the recognition of the importance of increasing fertility awareness, levels remain low. This study evaluated the perceptions of 'FActs!', a serious game aimed at improving adolescents' fertility awareness. The narratives of adolescents, parents and teachers about the utility of this tool and its educational potential were also addressed using focus groups. The game (https://myfacts.eu/) comprises 12 questions (birth year, biological sex, country and nine questions addressing fertility topics (probability of conceiving, the definition of infertility, and fertility risk factors such as age, smoking, alcohol, drugs and physical exercise). These questions emerge from four scenarios: a school playground, a party, a gym and a sibling's house. Players receive immediate feedback about their answers and brief educational information to improve their knowledge. Players accumulate stars for correct answers as they progress through the scenarios and answer the questions. Findings revealed that 'FActs!' effectively engages adolescents and enhances their understanding of fertility. Adolescents, parents and teachers responded positively, appreciating its interactive nature and ability to facilitate discussions on reproductive health. However, limitations such as the need for more comprehensive information and high reading requirements were noted. The study highlights the importance of integrating comprehensive fertility education into health curricula using diverse, engaging methods. It also underscores the necessity of supporting parents and teachers to improve their comfort and capability in discussing fertility. "FActs!" is a valuable tool with the potential for broader educational contexts. Future research should quantitatively assess "FActs!" across various demographics and include interventions to boost fertility awareness among parents and teachers, thereby enhancing their support for adolescents' informed reproductive choices.

Infertility affects one in six individuals globally, with oxidative stress-modifiable through diet and lifestyle-being a key factor in female infertility. This study examines associations between dietary/lifestyle Oxidative Balance Scores (OBS) and infertility risk in reproductive-aged women. Using 2013-2018 NHANES data from 2,447 women aged 20-44, we calculated OBS (16 dietary and 4 lifestyle components) reflecting antioxidant vs. pro-oxidant exposure. Higher scores indicate antioxidant dominance. Weighted logistic regression models adjusted for sociodemographic and health covariates revealed an inverse linear relationship: each 1-unit OBS increase correlated with 4.7% lower infertility risk (95% CI: 0.929-0.977, p < 0.001). Women in the highest OBS tertile had 6.4% reduced odds versus lower tertiles (95% CI: 0.897-0.977, p = 0.003). Joint analyses showed higher lifestyle OBS mitigated infertility risk among women with low dietary OBS. Results remained consistent across subgroups and sensitivity analyses. These findings underscore the potential of antioxidant-rich diets and healthy lifestyles in reducing oxidative stress-related infertility, advocating for targeted interventions to improve reproductive health outcomes.

This study presents the findings from a UK-based survey exploring fertility treatment add-ons, treatment costs, and information transparency. The online survey, distributed via social media, targeted current and prospective IVF patients, yielding 304 eligible responses. Results indicate an increase in the use of fertility treatment add-ons compared to previous data. Respondents primarily relied on multiple sources for information about these add-ons, with search engines being the most frequently used, followed by fertility clinic websites, the HFEA website, and medical or scientific articles. These sources were also deemed the most reliable. In contrast, social media, online forums, and blogs were less frequently used and rated as less reliable. Respondents reported significant variation in the total cost per cycle of privately funded treatment, ranging from £5,000 to £13,000, with an average of £11,950. Although there was a slight upward trend in costs with rising household income, no strong correlation was observed. Fertility clinic websites were the primary source of cost-related information, with 99% of respondents emphasising the importance of clinics providing accurate and up-to-date information on their websites. The findings also reveal respondents' views on potential policy actions to improve transparency around information and costs in the fertility sector.

In vitro gametogenesis (IVG) is a biotechnological development which aims to replicate the process of gametogenesis outside the human body. If proven safe and effective, IVG could disrupt various social and biological norms, and create new reproductive possibilities and opportunities for those who experience infertility as a result of both social and biomedical factors. In this article we argue that the new reproductive possibilities provided by IVG, much like earlier discussions of assisted reproductive technologies (ARTs) dating back to the Warnock Report, highlight the importance of exploring the distinctions often made in policy terms between 'medical' and 'social' understandings of infertility, and that any access and funding decisions made on this basis require careful and critical attention.

Anonymous egg donation is prohibited in Australia, with all states allowing donor-conceived people (DCPs) to access their donor's identity at age 18 or 16, depending on the state. However, early contact, well before age 18, is becoming more common. A key driver of this trend is recipients' and donors' use of online platforms (OPs) like Facebook to find one another, enabling donor-recipient contact before donation and/or after the donor-conceived children are born. This study reports on interviews with 24 egg donors who met recipients via OPs and had early contact post-birth. Using reflexive thematic analysis, the study found that donors were primarily motivated by empathy and saw donation as a relational act. They selected recipients with shared values around early contact and negotiated post-birth relationships. Early contact often led to meaningful kinship connections, with relationships described using extended family terms. The donor-recipient relationship unfolded as a progressive relational model: motivations informed recipient choice and contact expectations, and early contact deepened relational bonds. However, some donors experienced relationship breakdowns with recipients, illustrating the emotional complexity of (early) contact, even when agreed to. Findings underscore the importance of psychosocial support to ensure donor conception practices promote the wellbeing of all parties involved.

Retained products of conception (RPOC) is a common complication following first-trimester pregnancy loss. However, there are no formal recommendations regarding the diagnosis of RPOC. This systematic review aimed to synthesise and critically appraise the existing evidence on the definition and diagnostic criteria for RPOC. We registered this systematic review prospectively with PROSPERO (CRD42023444456). A comprehensive literature search was conducted in October 2024 using the following databases: Embase (OVID), Medline (OVID), Global Health, CINAHL on EBSCOhost, Cochrane Central and Web of Science. Databases were searched using free-text keywords and subject headings for the key concepts of 'early', 'miscarriage' and 'retained'. Data were extracted and 2 by 2 tables populated. Risk of bias and quality assessments were performed using the QUADAS-2 tool. The literature search yielded 2,014 articles that were screened for eligibility, resulting in the inclusion of 17 studies in the final analysis. Ultrasound scan was the primary diagnostic tool, used in 16 of the 17 included studies. Ultrasound diagnostic markers included: endometrial thickness (ET), the presence of hyperechoic or echogenic material, and colour flow Doppler. One study used persistent bleeding for more than 14 days as the primary diagnostic marker. There was significant variation in the diagnostic thresholds used and no single ultrasound marker demonstrated consistent reliability in diagnosing RPOC. The findings of this review highlight the limitations of ultrasound as a standalone diagnostic tool for RPOC. Given the lack of clear diagnostic criteria, clinicians should integrate ultrasound findings with clinical symptoms to improve diagnostic accuracy. RPOC appears to be a distinct pathology within the spectrum of early pregnancy loss, characterised by the persistence of pregnancy tissue within the uterine cavity despite initial management which distinguishes it from incomplete miscarriage. This review provides a foundation for future research and calls for a Delphi consensus to refine the diagnosis and management of RPOC.

Over the past two decades, mitochondrial DNA (mtDNA) content has been studied as a potential biomarker for embryo viability and implantation success during in vitro fertilization (IVF) procedures. However, its reliability for embryo selection remains uncertain. Therefore, our study aimed to examine the relationship between blastocyst mtDNA content and blastocyst quality, timing of fully expanded blastocyst formation, and cleavage-stage embryo quality in blastocysts biopsied at the uniform expansion stage. We analyzed bioinformatics data from 125 day-5 and day-6 blastocysts from women aged 18 to 35 years. Each blastocyst was biopsied at expansion stage 4 and classified as euploid through preimplantation genetic testing for aneuploidy using next-generation sequencing. Blastocysts were categorized into four groups based on quality and the day of biopsy. Poor-quality day-6 blastocysts exhibited lower mtDNA levels compared to good-quality day-5 blastocysts (p = 0.006), poor-quality day-5 blastocysts (p = 0.008), and good-quality day-6 blastocysts (p = 0.003). Embryos with day-3 grades lower than 2.5 displayed lower blastocyst mtDNA levels compared to those graded 1 (p < 0.001), 1.5 (p < 0.001), and 2 (p < 0.001). These findings suggest further insights into the interplay between blastocyst mtDNA content and preimplantation embryo morphology. Nonetheless, mtDNA remains an unreliable biomarker for assessing embryo viability, warranting further investigation to determine its clinical relevance.

To evaluate whether oocyte cryopreservation affects obstetric and perinatal outcomes, 350 donor oocyte recipients with live-born singletons were divided into three groups: frozen embryo transfer (FET) with fresh oocytes (n = 101), fresh embryo transfer (ET) with frozen oocytes (n = 190), FET with frozen oocytes (n = 59). Gestational age differed significantly (P = 0.025), with the FET with frozen oocytes group showing longer gestational age than FET with fresh oocytes group (276 days vs. 272 days, P = 0.04). Other outcomes were comparable among groups. Subgroup analysis of FET pregnancies revealed no significant differences between frozen and fresh oocyte groups in gestational age (B 1.38, P = 0.749), birth weight (B -0.11, P = 0.530), premature birth rates (6.8% vs. 11.9%, P = 0.746), low birth weight (LBW) (5.1% vs. 12.9%, P = 0.865), macrosomia (5.1% vs. 4.0%, P = 0.976), small for gestational age (SGA) (6.8% vs. 11.9%, P = 0.599), large for gestational age (LGA) (22.0% vs. 18.8%, P = 0.943), gestational diabetes mellitus (GDM) (10.2% vs. 11.9%, P = 0.343), hypertensive disorders of pregnancy (HDP) (8.5% vs. 17.8%, P = 0.143) or placental abnormalities (8.5% vs. 19.8%, P = 0.133). The study confirmed oocyte cryopreservation did not affect birth weight or obstetrical complications in donor oocyte recipients.

This British Fertility Society (BFS) Policy and Practice guideline aims to support clinicians in preventing ovarian hyperstimulation syndrome (OHSS) in patients undergoing gonadotropin ovarian stimulation. A systematic literature search of the medical databases was performed. The Guideline Development Group (GDG) identified the risk factors of OHSS before and during ovarian stimulation. The relation of different pre-treatment measures and different ovarian stimulation protocols with OHSS was evaluated. The optimal monitoring during treatment was assessed. The current evidence on preventive strategies during and after ovarian stimulation and the available adjuvant preventive agents were examined. Based on this, the GDG developed evidence-based, graded recommendations for clinical practice. The evidence was evaluated within context, considering the effectiveness, cost and practical problems of assisted reproductive technology for patients and healthcare providers. Early identification and application of preventive measures identified in this guideline may reduce the incidence of OHSS or reduce its severity. Suggestions for future research on OHSS prevention are provided.