Reproductive biomedicine online最新文献

英文中文

Adenomyosis: the missed disease b子宫腺肌症：错过的疾病

IF 3.7 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Reproductive biomedicine online

Pub Date : 2025-04-01 DOI: 10.1016/j.rbmo.2025.104837

Pietro Santulli , Silvia Vannuccini , Mathilde Bourdon , Charles Chapron , Felice Petraglia

Adenomyosis, a menstruation-related uterine disorder, refers to the presence of endometrial stroma and glands within the myometrium and is typically observed in reproductive-age women. The pathogenesis explaining the migration, persistence, proliferation and differentiation of ectopic endometrial cells includes a genetic and epigenetic background, an oestrogen/progesterone receptor imbalance and an inflammatory reaction driven by local immune dysfunction, along with fibrosis and neuroangiogenesis within the myometrium. In the past, it was thought that adenomyosis almost exclusively affected multiparous women after 40 years of age and the diagnosis was generally confirmed upon hysterectomy. Nowadays, using imaging techniques such as transvaginal ultrasonography and magnetic resonance imaging, adenomyosis is increasingly identified in young women with dysmenorrhoea, dyspareunia, abnormal uterine bleeding and heavy menstrual bleeding, and also in infertile patients. Furthermore, adenomyosis often coexists with other gynaecological conditions, such as endometriosis and uterine fibroids. Despite the improvement of non-invasive diagnostic tools, the awareness of the condition is still poor and the diagnosis is often missed, due also to a heterogeneity in clinical presentation and imaging criteria. In addition, medical and surgical management do not follow shared recommendations, even though adenomyosis requires a lifelong management plan, including pain and bleeding control, fertility preservation and pregnancy complications.

子宫腺肌症是一种与月经有关的子宫疾病，是指子宫内膜间质和腺体在子宫肌层内的存在，通常见于育龄妇女。解释异位子宫内膜细胞迁移、持续、增殖和分化的发病机制包括遗传和表观遗传背景、雌激素/孕激素受体失衡和局部免疫功能障碍驱动的炎症反应，以及肌层内的纤维化和神经血管生成。过去，人们认为子宫腺肌症几乎只影响40岁以上的多胎妇女，通常在子宫切除术后确诊。目前，利用经阴道超声和磁共振成像等成像技术，越来越多的发现子宫腺肌症出现在有痛经、性交困难、子宫异常出血和月经大出血的年轻女性以及不孕症患者中。此外，子宫腺肌症常与其他妇科疾病共存，如子宫内膜异位症和子宫肌瘤。尽管非侵入性诊断工具有所改进，但由于临床表现和影像学标准的异质性，对该病的认识仍然很差，诊断经常被遗漏。此外，尽管子宫腺肌症需要终身管理计划，包括疼痛和出血控制、保留生育能力和妊娠并发症，但医疗和手术管理并不遵循共同的建议。

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引用次数: 0

Is planned oocyte cryopreservation delivering? 计划的卵母细胞冷冻保存是否有效？

IF 3.7 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Reproductive biomedicine online

Pub Date : 2025-04-01 DOI: 10.1016/j.rbmo.2025.104794

Ana Cobo , Sarah Druckenmiller Cascante , Juan García-Velasco , James A. Grifo

The objective of this review is to determine whether planned oocyte cryopreservation is successfully providing women with reproductive autonomy and the opportunity to shape their families. Planned oocyte cryopreservation is an established means to expand the reproductive function of oocytes and is not associated with an increased risk of congenital anomalies or short-term health risks to the offspring. There is sufficient clinical evidence to support the success of planned oocyte cryopreservation; however, this technology does not guarantee live birth, and outcomes greatly depend on both the age at cryopreservation and the total number of cryopreserved oocytes. While reproducibility between centres must be improved, the results from the authors two large, experienced centres are consistent and provide useful data for patient counselling. Planned oocyte cryopreservation provides the highest cumulative live birth rates (>75%) when it is performed below the age of 35 years and 15–20 or more mature oocytes are cryopreserved. Live birth rates from planned oocyte cryopreservation at an ideal age are higher than live birth rates from women who delay childbearing past their reproductive prime and then attempt natural conception followed by IVF if they are unsuccessful.

本综述的目的是确定计划的卵母细胞冷冻保存是否成功地为妇女提供生殖自主权和塑造家庭的机会。有计划的卵母细胞冷冻保存是扩大卵母细胞生殖功能的一种既定手段，与先天性异常风险增加或后代短期健康风险无关。有足够的临床证据支持计划卵母细胞冷冻保存的成功；然而，这项技术并不能保证活产，其结果在很大程度上取决于冷冻保存的年龄和冷冻保存的卵母细胞总数。虽然中心之间的可重复性必须改进，但作者的两个大型、有经验的中心的结果是一致的，并为患者咨询提供了有用的数据。计划卵母细胞冷冻保存在35岁以下，冷冻保存15-20个或更多成熟卵母细胞时，可提供最高的累计活产率（75%）。在理想年龄进行计划卵母细胞冷冻保存的活产率高于生育年龄后推迟生育，然后尝试自然受孕，如果失败再进行体外受精的妇女的活产率。

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引用次数: 0

Artificial intelligence in assisted reproductive technology: separating the dream from reality 辅助生殖技术中的人工智能：将梦想与现实分离

IF 3.7 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Reproductive biomedicine online

Pub Date : 2025-04-01 DOI: 10.1016/j.rbmo.2025.104855

Jacques Cohen , Giuseppe Silvestri , Omar Paredes , Hector E. Martin-Alcala , Alejandro Chavez-Badiola , Mina Alikani , Giles A. Palmer

This paper critically reviews the role of artificial intelligence (AI) in assisted reproductive technology (ART), a nascent field that has emerged over the last decade. While AI holds immense promise for enhancing IVF efficiency, standardization, and outcomes, its current trajectory reveals significant challenges. Much of the recent literature presents variations on established methodologies rather than groundbreaking advancements, with many studies lacking clear clinical applications or outcome-driven validations. Moreover, the growing enthusiasm for AI in ART is often accompanied by undue hype that obscures its realistic potential and fosters inflated expectations. Despite these limitations, AI-driven innovations such as advanced image analysis, personalized protocols, and automation of embryology workflows are beginning to show value. Machine learning algorithms and robotics may help address inefficiencies, alleviate staff shortages, and improve decision-making in the IVF laboratory. However, progress is tempered by drawbacks including ethical concerns, limited transparency in AI systems, and regulatory impediments. Data-sharing barriers in our field hinder AI tool development significantly. Energy-intensive computational processes and expanding data centers also raise sustainability concerns, underscoring the need for environmentally responsible development. As the field evolves, it must emphasize rigorous validation, collaborative data frameworks, and alignment with the needs of ART practitioners and patients.

本文批判性地回顾了人工智能（AI）在辅助生殖技术（ART）中的作用，这是过去十年出现的一个新兴领域。虽然人工智能在提高试管婴儿效率、标准化和结果方面有着巨大的希望，但其目前的发展轨迹显示出重大挑战。最近的许多文献呈现的是对既定方法的变化，而不是突破性的进展，许多研究缺乏明确的临床应用或结果驱动的验证。此外，对人工智能在ART领域日益增长的热情往往伴随着不适当的炒作，掩盖了其现实潜力，并助长了过高的期望。尽管存在这些限制，人工智能驱动的创新，如先进的图像分析、个性化协议和胚胎学工作流程的自动化，已经开始显示出价值。机器学习算法和机器人技术可以帮助解决试管婴儿实验室的效率低下，缓解人员短缺，并改善决策。然而，人工智能技术的进步受到伦理问题、人工智能系统透明度有限以及监管障碍等问题的制约。我们领域的数据共享障碍严重阻碍了人工智能工具的发展。能源密集型计算过程和不断扩大的数据中心也引起了对可持续性的关注，强调了对环境负责任的发展的必要性。随着该领域的发展，它必须强调严格的验证、协作数据框架以及与抗逆转录病毒治疗从业者和患者的需求保持一致。

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引用次数: 0

Front Matter - Continued TOC 正面物质-继续TOC

IF 3.7 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Reproductive biomedicine online

Pub Date : 2025-04-01 DOI: 10.1016/S1472-6483(25)00117-8

引用次数: 0

Sir Robert Edwards: Founder of RBMO 罗伯特-爱德华兹爵士RBMO 创始人

IF 3.7 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Reproductive biomedicine online

Pub Date : 2025-04-01 DOI: 10.1016/j.rbmo.2025.104881

引用次数: 0

25 years of advancing the frontiers of reproductive medicine 推动生殖医学前沿发展 25 年

IF 3.7 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Reproductive biomedicine online

Pub Date : 2025-04-01 DOI: 10.1016/j.rbmo.2025.104863

Nick Macklon, Juan Garcia-Velasco

引用次数: 0

The road from Duck End Farm: the formative years of RBMOnline 鸭尾农场之路：RBMOnline 的成长岁月

IF 3.7 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Reproductive biomedicine online

Pub Date : 2025-04-01 DOI: 10.1016/j.rbmo.2025.104853

Kamal K. Ahuja , Simon Brown

Reproductive BioMedicine Online has now reached its 25th year and in marking the anniversary this article looks back to its earliest years and the practicalities faced by its founder, Sir Robert Edwards, in establishing a new journal based on internet publication. The narrative follows the first years of production, with a full-time staff of just two, and how the journal quickly set a forward-looking tone of innovation in reproductive medicine. Despite its name, and despite its originating principle of internet production, since 2010 RBMO has been produced – online and in print – in collaboration with a commercial publisher, which greatly streamlined the management of manuscripts and their rapid publication. While Bob Edwards has remained the inspiration for the journal's progress, each of the editors who succeeded him – Jacques Cohen, Bart Fauser, Juan Garcia-Velasco and Nick Macklon – each gave renewed identity to the title, expanded its reach and nurtured its growth.

《生殖生物医学在线》现在已经创刊25年了，为了纪念这一周年，这篇文章回顾了创刊的最初几年，以及创刊者罗伯特·爱德华兹爵士在创建一份基于互联网出版的新期刊时所面临的实际情况。这本书讲述了《生殖医学》创刊的头几年，当时只有两名全职员工，以及该杂志如何迅速确立了生殖医学创新的前瞻性基调。尽管它的名字和最初的原则是互联网制作，但自2010年以来，RBMO已经与一家商业出版商合作制作了在线和印刷，这大大简化了手稿的管理和快速出版。鲍勃·爱德华兹一直是《华尔街日报》发展的灵感来源，而他的每一位继任者——雅克·科恩、巴特·福泽、胡安·加西亚·贝拉斯科和尼克·麦克隆——每一位都赋予了《华尔街日报》新的身份，扩大了它的影响范围，促进了它的发展。

引用次数: 0

Do we still need embryologists? 我们还需要胚胎学家吗？

IF 3.7 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Reproductive biomedicine online

Pub Date : 2025-04-01 DOI: 10.1016/j.rbmo.2024.104790

Giovanni Coticchio , Danilo Cimadomo , Laura Rienzi

IVF has given scientists a unique role, one probably unparalleled in other medical disciplines. This role has become increasingly more impactful due to the introduction of breakthrough laboratory interventions, such as intracytoplasmic sperm injection and cryopreservation. More recently, incessant advances in automation, information technology and artificial intelligence have started to transform diverse biomedical disciplines. In IVF, relevant examples are novel equipment that can automatically perform embryo assessment, patient/sample identification, vitrification and sperm manipulation/selection/analysis. This has questioned the role of the embryologist. However, the introduction of novel technology is not straightforward; it generates numerous challenges. Which manual interventions should be automated and why? Do machines perform better than humans? Does automation involve higher treatment costs? At the same time, certain highly intellectual activities, such as the integration of novel categories of data and their interpretation, formulation of novel key performance indicators, generation of novel educational and training contents and enhancement and collaborative research, remain human prerogatives. Therefore, while it is to be expected that direct human intervention will be partly replaced by automated devices, we can envisage that the embryologist's role will not become extinct, but will evolve in new forms. Ideally, this change should be guided by principles safeguarding the ethics of medicine and human activity.

试管婴儿给了科学家一个独特的角色，一个在其他医学学科中可能无与伦比的角色。由于引入突破性的实验室干预措施，如胞浆内单精子注射和冷冻保存，这一角色变得越来越有影响力。最近，自动化、信息技术和人工智能的不断进步已经开始改变各种生物医学学科。在体外受精中，相关的例子是可以自动进行胚胎评估、患者/样本鉴定、玻璃化和精子操作/选择/分析的新型设备。这对胚胎学家的作用提出了质疑。然而，引进新技术并不简单；它带来了许多挑战。哪些人工干预应该自动化，为什么？机器的表现比人类好吗？自动化是否涉及更高的治疗费用？与此同时，某些高度智力的活动，例如整合新的数据类别及其解释、拟订新的关键绩效指标、产生新的教育和培训内容以及加强和合作研究，仍然是人类的特权。因此，虽然可以预期直接的人类干预将部分被自动化设备所取代，但我们可以设想胚胎学家的角色不会消失，而是会以新的形式发展。理想情况下，这种改变应该以维护医学伦理和人类活动的原则为指导。

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引用次数: 0

IVF – through the looking glass 试管受精——通过镜子

IF 3.7 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Reproductive biomedicine online

Pub Date : 2025-04-01 DOI: 10.1016/j.rbmo.2025.104835

David K. Gardner

‘Through the looking-glass’ is a metaphor often used to infer an unfamiliar or anomalous situation, an altered reality. This is perhaps a fitting representation of what human oocytes, spermatozoa and embryos experience when isolated and maintained in the artificial world that comprises an IVF laboratory. Rather than the dynamic and dark reproductive tract in vivo, the laboratory represents a strikingly foreign landscape to gametes and embryos, characterized by a polystyrene substrate, aqueous media and exposure to light. Furthermore, all culture systems employed over the past five decades have been static, in striking contrast to the continual movement experienced by gametes and embryos within the female tract. Recent developments in microfabrication, biomimetics and artificial intelligence, are, however, paving the way to replicate aspects of in-vivo physiology and anatomy that may enhance gamete preparation and selection, creating healthier embryos. Combined with potential improvements in culture conditions afforded by microperfusion, developments in new microscopies and in AI could also provide new ways both to visualize embryos and to acquire important data on their metabolic state to facilitate improved diagnosis of viability and aneuploidy. Such advancements will contribute to higher pregnancy rates, reducing time to pregnancy and reducing pregnancy loss, culminating in improved clinical outcomes.

“Through the looking-glass”是一个比喻，通常用来推断一个不熟悉或反常的情况，一个改变的现实。这也许是人类卵母细胞、精子和胚胎在体外受精实验室的人工世界中分离和维持时所经历的一种恰当的表现。与体内动态和黑暗的生殖道不同，实验室代表了配子和胚胎的一个引人注目的异国景观，其特点是聚苯乙烯衬底、水介质和暴露在光线下。此外，在过去的50年里，所有的培养系统都是静态的，这与配子和胚胎在雌性生殖道内的持续运动形成了鲜明的对比。然而，最近在微加工、仿生学和人工智能方面的发展，正在为复制体内生理和解剖学方面铺平道路，这些方面可能会增强配子的准备和选择，创造更健康的胚胎。结合微灌注对培养条件的潜在改善，新型显微镜和人工智能的发展也可以为胚胎可视化和获取其代谢状态的重要数据提供新的方法，以促进改善生存能力和非整倍体的诊断。这些进步将有助于提高妊娠率，缩短妊娠时间，减少妊娠损失，最终改善临床结果。

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引用次数: 0

Renewing ovarian stimulation 更新卵巢刺激

IF 3.7 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Reproductive biomedicine online

Pub Date : 2025-04-01 DOI: 10.1016/j.rbmo.2024.104788

Baris Ata

Conventional ovarian stimulation protocols were designed for fresh embryo transfer. They start in the early follicular phase, i.e. the infamous day 2-3, gonadotrophin-releasing hormone analogues are used to prevent premature ovulation, and the stimulation is harnessed due to the fear of ovarian hyperstimulation syndrome and the decreasing chance of a live birth following a fresh transfer. The advent of vitrification allows a confident cancellation of fresh transfers and effective oocyte/embryo freezing for future use. Today, many stimulation cycles are not intended to involve a fresh embryo transfer. Ovarian stimulation for freeze-all cycles can be vastly different from conventional stimulation. The quantitative and qualitative oocyte yield seems independent of the starting day, and the early or late follicular or luteal phase may have distinct advantages for different needs. A variety of pituitary suppression protocols including oral progestins or not using exogenous suppression at all can be employed without compromising oocyte quantity and quality. Stimulation can cautiously aim for the patient's maximal potential since the agonist trigger without a fresh transfer curbs the risk of ovarian hyperstimulation syndrome. Patients can be even stimulated multiple times in a menstrual cycle when deemed beneficial. Ovarian stimulation is more patient and physician friendly than ever.

传统的卵巢刺激方案是为新鲜胚胎移植而设计的。由于担心卵巢过度刺激综合征和新鲜胚胎移植后活产的几率降低，因此这些方案都是在卵泡早期阶段，即臭名昭著的第 2-3 天开始，使用促性腺激素释放激素类似物来防止过早排卵，并对刺激进行控制。玻璃化技术的出现使人们可以放心地取消新鲜移植，并有效地冷冻卵母细胞/胚胎以备将来使用。如今，许多促排卵周期都不打算进行新鲜胚胎移植。冻存周期的卵巢刺激与传统刺激有很大不同。卵母细胞产量的定量和定性似乎与起始日无关，卵泡期或黄体期的早期或晚期对于不同的需求可能有不同的优势。可以采用各种垂体抑制方案，包括口服孕激素或完全不使用外源性抑制，而不会影响卵母细胞的数量和质量。刺激可以谨慎地瞄准患者的最大潜能，因为激动剂触发而不进行新的移植可以降低卵巢过度刺激综合征的风险。在认为有益的情况下，患者甚至可以在一个月经周期内接受多次刺激。卵巢刺激疗法比以往任何时候都更适合患者和医生。

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