Does the long-acting stimulation protocol with corifollitropin alfa (CFA) followed by daily low-dose recombinant FSH (r-FSH) reduce the risk of premature progesterone elevation (PPE) in women with low ovarian reserve compared with daily high-dose r-FSH?
Design
This randomized controlled trial, conducted from February 2022 to May 2024, enrolled 110 patients who met the Bologna criteria for poor ovarian responders. Participants were randomized into two groups: the intervention group received long-acting CFA followed by daily 150 IU r-FSH from day 8; and the control group received daily 300 IU r-FSH. The primary outcome was the proportion of patients with progesterone ≥1.1 ng/ml on the day of human chorionic gonadotrophin trigger. Secondary outcomes included number of retrieved oocytes, fertilization rate, fresh embryo transfer rate, and pregnancy rate.
Results
A significantly lower rate of PPE was observed in the CFA group compared with the control group [2/56 (3.6%) versus 12/54 (22.2%), respectively]. CFA stimulation was associated with an 89% reduction in the odds of PPE (OR 0.11, 95% CI 0.02–0.55; P = 0.007). Fresh embryo transfer was achieved in 34/52 (65%) patients in the CFA group versus 21/48 (44%) patients in the control group (P = 0.04).
Conclusions
Ovarian stimulation with long-acting CFA plus daily 150 IU r-FSH significantly reduced the risk of PPE and increased the feasibility of fresh embryo transfer in patients with low ovarian reserve. This strategy may offer a better approach for managing PPE, and may improve overall IVF success for this specific patient population.
研究问题：与每日高剂量的r-FSH相比，口服促孕激素（CFA）和每日低剂量重组FSH （r-FSH）的长效刺激方案是否能降低卵巢储备能力低的女性早孕激素升高（PPE）的风险？设计：该随机对照试验于2022年2月至2024年5月进行，纳入了110名符合Bologna标准的卵巢不良反应患者。参与者被随机分为两组：干预组从第8天开始接受长效CFA，随后每日150 IU r-FSH；对照组每天给予300 IU的r-FSH。主要终点是人绒毛膜促性腺激素触发当天孕激素≥1.1 ng/ml的患者比例。次要结果包括卵母细胞数量、受精率、新鲜胚胎移植率和妊娠率。结果：CFA组PPE发生率明显低于对照组[2/56 (3.6%)vs . 12/54(22.2%)]。CFA刺激与PPE发生率降低89%相关（OR 0.11, 95% CI 0.02-0.55; P = 0.007）。CFA组34/52例（65%）患者实现了新鲜胚胎移植，对照组21/48例（44%）患者实现了新鲜胚胎移植（P = 0.04）。结论：卵巢刺激长效CFA加每日150 IU r-FSH可显著降低卵巢储备不足患者发生PPE的风险，提高新鲜胚胎移植的可行性。这种策略可能为管理PPE提供更好的方法，并可能提高这一特定患者群体的整体试管婴儿成功率。
{"title":"Risk of progesterone elevation in patients with low ovarian reserve using long-acting FSH IVF protocol: a randomized controlled trial","authors":"Enrico Papaleo , Antonio Quartucci , Mara Zanirato , Daria Marzanati , Valeria Stella Vanni , Edoardo Delfanti , Giulia Bertapelle , Massimo Candiani","doi":"10.1016/j.rbmo.2025.105270","DOIUrl":"10.1016/j.rbmo.2025.105270","url":null,"abstract":"<div><h3>Research question</h3><div>Does the long-acting stimulation protocol with corifollitropin alfa (CFA) followed by daily low-dose recombinant FSH (r-FSH) reduce the risk of premature progesterone elevation (PPE) in women with low ovarian reserve compared with daily high-dose r-FSH?</div></div><div><h3>Design</h3><div>This randomized controlled trial, conducted from February 2022 to May 2024, enrolled 110 patients who met the Bologna criteria for poor ovarian responders. Participants were randomized into two groups: the intervention group received long-acting CFA followed by daily 150 IU r-FSH from day 8; and the control group received daily 300 IU r-FSH. The primary outcome was the proportion of patients with progesterone ≥1.1 ng/ml on the day of human chorionic gonadotrophin trigger. Secondary outcomes included number of retrieved oocytes, fertilization rate, fresh embryo transfer rate, and pregnancy rate.</div></div><div><h3>Results</h3><div>A significantly lower rate of PPE was observed in the CFA group compared with the control group [2/56 (3.6%) versus 12/54 (22.2%), respectively]. CFA stimulation was associated with an 89% reduction in the odds of PPE (OR 0.11, 95% CI 0.02–0.55; <em>P</em> = 0.007). Fresh embryo transfer was achieved in 34/52 (65%) patients in the CFA group versus 21/48 (44%) patients in the control group (<em>P</em> = 0.04).</div></div><div><h3>Conclusions</h3><div>Ovarian stimulation with long-acting CFA plus daily 150 IU r-FSH significantly reduced the risk of PPE and increased the feasibility of fresh embryo transfer in patients with low ovarian reserve. This strategy may offer a better approach for managing PPE, and may improve overall IVF success for this specific patient population.</div></div>","PeriodicalId":21134,"journal":{"name":"Reproductive biomedicine online","volume":"52 3","pages":"Article 105270"},"PeriodicalIF":3.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146119918","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2025-05-30DOI: 10.1016/j.rbmo.2025.105073
Sania Latif , Shaheer U Saeed , Yipeng Hu , Lucrezia De Braud , Ephia Yasmin , Ertan Saridogan , Dimitrios Mavrelos
Research question
Do women with adenomyosis have altered uterine peristalsis, and can an objective and reproducible tool be developed to quantify uterine peristalsis on transvaginal sonography (TVS)?
Design
Prospective observational cohort study in women with moderate to severe adenomyosis (n = 26) or a normal uterus (n = 40) undergoing TVS during assisted conception. TVS recordings (n = 143) were conducted at baseline, day 6–10 of ovarian stimulation and day of embryo transfer by operator A, and then repeated by operator A, B or C. Image data were stored offline for optical flow analysis. Pixel-level displacements for points at the endometrial–-myometrial junction were used to compute peristalsis frequency and amplitude by fitting to the two-dimensional wave equation. Fit error was taken as a measure of wave coordination. Inter-class correlation coefficient (ICC) was calculated to assess inter- and intra-observer agreement.
Results
Women with adenomyosis had a significantly higher fit error at all time points during the IVF cycle (baseline: + 0.725, P < 0.001; ovarian stimulation: + 0.612, P = 0.004; embryo transfer: + 0.627, P < 0.001), indicating lower uterine peristalsis coordination compared with women with a normal uterus. Inter- and intra-observer agreement for each wave feature (frequency, amplitude and coordination of uterine peristalsis and myometrial contractility) was found to be moderate to good (intra-observer ICC: 0.62–0.75, inter-observer ICC: 0.58–0.79).
Conclusion
An objective and reproducible measuring tool is proposed to quantify uterine peristalsis using TVS, with potential for wide application across assisted conception and gynaecology settings.
{"title":"Quantitative analysis of uterine peristalsis in women with adenomyosis using optical flow for motion quantification","authors":"Sania Latif , Shaheer U Saeed , Yipeng Hu , Lucrezia De Braud , Ephia Yasmin , Ertan Saridogan , Dimitrios Mavrelos","doi":"10.1016/j.rbmo.2025.105073","DOIUrl":"10.1016/j.rbmo.2025.105073","url":null,"abstract":"<div><h3>Research question</h3><div>Do women with adenomyosis have altered uterine peristalsis, and can an objective and reproducible tool be developed to quantify uterine peristalsis on transvaginal sonography (TVS)?</div></div><div><h3>Design</h3><div>Prospective observational cohort study in women with moderate to severe adenomyosis (<em>n</em> = 26) or a normal uterus (<em>n</em> = 40) undergoing TVS during assisted conception. TVS recordings (<em>n</em> = 143) were conducted at baseline, day 6–10 of ovarian stimulation and day of embryo transfer by operator A, and then repeated by operator A, B or C. Image data were stored offline for optical flow analysis. Pixel-level displacements for points at the endometrial–-myometrial junction were used to compute peristalsis frequency and amplitude by fitting to the two-dimensional wave equation. Fit error was taken as a measure of wave coordination. Inter-class correlation coefficient (ICC) was calculated to assess inter- and intra-observer agreement.</div></div><div><h3>Results</h3><div>Women with adenomyosis had a significantly higher fit error at all time points during the IVF cycle (baseline: + 0.725, <em>P</em> < 0.001; ovarian stimulation: + 0.612, <em>P</em> = 0.004; embryo transfer: + 0.627, <em>P</em> < 0.001), indicating lower uterine peristalsis coordination compared with women with a normal uterus. Inter- and intra-observer agreement for each wave feature (frequency, amplitude and coordination of uterine peristalsis and myometrial contractility) was found to be moderate to good (intra-observer ICC: 0.62–0.75, inter-observer ICC: 0.58–0.79).</div></div><div><h3>Conclusion</h3><div>An objective and reproducible measuring tool is proposed to quantify uterine peristalsis using TVS, with potential for wide application across assisted conception and gynaecology settings.</div></div>","PeriodicalId":21134,"journal":{"name":"Reproductive biomedicine online","volume":"52 3","pages":"Article 105073"},"PeriodicalIF":3.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146228314","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Uterine contractility has emerged as a potential key element in the orchestration of female reproductive functions, with specific motility patterns seemingly aligning with hormonal fluctuations throughout the menstrual cycle. These dynamic contractility profiles appear to facilitate various stages of conception, underscoring the importance of maintaining physiological uterine kinetics for fertility. Altered uterine contractility might thus contribute to cases of unexplained infertility. By offering a comprehensive reappraisal of uterine contractility across both physiological and pathological contexts, this review has been undertaken to challenge conventional fertility paradigms. The review outlines uterine anatomy and details the genesis and regulation of uterine contractions, emphasizing the electrophysiological role of uterine pacemaker cells, namely interstitial Cajal-like cells. It also provides a thorough overview of current methodologies for assessing uterine contractility, focusing on non-invasive ultrasound-based approaches, and discussing both innovative applications of established techniques and entirely novel diagnostic methods. The review then evaluates the various physiological uterine contractility patterns observed across the menstrual cycle, and finally presents evidence supporting potential causal links between impaired uterine contractility and fertility-threatening uterine pathologies. Since the directionality of this association remains uncertain, longitudinal studies are needed to determine whether alterations in uterine contractility precede or are a consequence of uterine disease. This is a distinction with critical implications for both treatment and prevention strategies in reproductive medicine.
{"title":"Decoding uterine contractility: from physiology to pathology, through emerging technologies","authors":"Pierpaolo Nicolì , Paola Viganò , Dominique de Ziegler , Gabriele Saccone , Stefania Saponara , Salvatore Giovanni Vitale , Edoardo Di Naro , Ettore Cicinelli , Vincenzo Pinto , Amerigo Vitagliano","doi":"10.1016/j.rbmo.2025.105355","DOIUrl":"10.1016/j.rbmo.2025.105355","url":null,"abstract":"<div><div>Uterine contractility has emerged as a potential key element in the orchestration of female reproductive functions, with specific motility patterns seemingly aligning with hormonal fluctuations throughout the menstrual cycle. These dynamic contractility profiles appear to facilitate various stages of conception, underscoring the importance of maintaining physiological uterine kinetics for fertility. Altered uterine contractility might thus contribute to cases of unexplained infertility. By offering a comprehensive reappraisal of uterine contractility across both physiological and pathological contexts, this review has been undertaken to challenge conventional fertility paradigms. The review outlines uterine anatomy and details the genesis and regulation of uterine contractions, emphasizing the electrophysiological role of uterine pacemaker cells, namely interstitial Cajal-like cells. It also provides a thorough overview of current methodologies for assessing uterine contractility, focusing on non-invasive ultrasound-based approaches, and discussing both innovative applications of established techniques and entirely novel diagnostic methods. The review then evaluates the various physiological uterine contractility patterns observed across the menstrual cycle, and finally presents evidence supporting potential causal links between impaired uterine contractility and fertility-threatening uterine pathologies. Since the directionality of this association remains uncertain, longitudinal studies are needed to determine whether alterations in uterine contractility precede or are a consequence of uterine disease. This is a distinction with critical implications for both treatment and prevention strategies in reproductive medicine.</div></div>","PeriodicalId":21134,"journal":{"name":"Reproductive biomedicine online","volume":"52 3","pages":"Article 105355"},"PeriodicalIF":3.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146195588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2025-08-20DOI: 10.1016/j.rbmo.2025.105231
Keri Bergin , Ashna Mehra , Rick Slifkin , Morgan Baird , Dmitry Gounko , Carlos Hernandez-Nieto , Joseph Lee , Chelsea Canon , Alan B. Copperman , Lucky Sekhon
Research question
Are there any differences in the warming, fertilization and embryo development outcomes of late mature cryopreserved oocytes versus immediately mature cryopreserved oocytes?
Design
This retrospective cohort study analysed autologous oocyte cryopreservation cycles with warming from January 2016 to September 2024. Group 1 comprised oocytes that were mature [metaphase II (MII)] at retrieval (assessed within 1 h of retrieval), and Group 2 comprised late mature oocytes, which included day 0 and day 1 late mature oocytes, which reached MII on re-assessment after short term (4–6 h) and next-day (18–28 h) rescue in-vitro maturation, respectively. Comparative statistics and univariate analysis were performed using Wilcoxon rank sum test and chi-squared test. Logistic regression fitted with a generalized estimating equation, adjusted for oocyte age, anti-Müllerian hormone, body mass index, year of oocyte cryopreservation and year of oocyte warming, was performed for warming survival, fertilization, blastulation and ploidy rates.
Results
Among 565 patients (699 cryopreservation and 629 warming cycles), Group 1 included 6899 oocytes that were mature at retrieval and Group 2 included 956 late mature oocytes. The warming survival rate was comparable between the groups (79.4% versus 78.0% for Groups 1 and 2, respectively; P = 0.33). The fertilization rate was significantly higher in Group 1 (75.3%) than Group 2 (59.8%) (adjusted OR 0.52, 95% CI 0.42–0.63; P < 0.001). Group 1 had significantly higher blastulation (37.7% versus 26.1%; P ≤ 0.001) and euploidy (54.5% versus 39.3%; P = 0.0023) rates compared with Group 2, and this was confirmed on adjusted analysis. A subanalysis showed no difference between day 0 and day 1 late mature oocytes.
Conclusions
Late mature cryopreserved oocytes show lower reproductive potential than oocytes that are mature at retrieval. This could be attributed to dysynchronous cytoplasmic and nuclear maturation. Despite suboptimal development, late mature oocytes can create high-quality blastocysts, offering additional opportunities for future family-building.
研究问题：晚成熟的冷冻保存卵母细胞与立即成熟的冷冻保存卵母细胞在升温、受精和胚胎发育结果上有什么不同？设计：本回顾性队列研究分析了2016年1月至2024年9月的自体卵母细胞低温保存周期。第1组为检索时成熟的卵母细胞[中期II (MII)]（检索后1小时内评估），第2组为晚期成熟卵母细胞，包括第0天和第1天的晚期成熟卵母细胞，分别在短期（4-6小时）和第二天（18-28小时）体外抢救成熟后重新评估达到MII。采用Wilcoxon秩和检验和卡方检验进行比较统计和单因素分析。对卵母细胞年龄、抗勒氏激素、体重指数、卵母细胞冷冻保存年份和卵母细胞加热年份进行校正，拟合了广义估计方程的Logistic回归，对加热存活率、受精率、囊胚率和倍性率进行了校正。结果：565例患者（699例冷冻保存，629例升温循环）中，1组有6899例取卵时成熟的卵母细胞，2组有956例晚成熟卵母细胞。各组间的升温存活率具有可比性（第一组为79.4%，第二组为78.0%;P = 0.33）。1组受精率（75.3%）显著高于2组（59.8%）（校正OR 0.52, 95% CI 0.42 ~ 0.63; P < 0.001）。组1的囊胚率（37.7% vs . 26.1%, P≤0.001）和整倍体率（54.5% vs . 39.3%, P = 0.0023）显著高于组2，经校正分析证实。亚分析显示第0天和第1天晚成熟卵母细胞之间没有差异。结论：较晚成熟的冷冻保存卵母细胞的生殖潜能低于在取出时成熟的卵母细胞。这可能归因于细胞质和核成熟不同步。尽管发育不理想，但成熟较晚的卵母细胞可以产生高质量的囊胚，为未来的家庭建设提供了额外的机会。
{"title":"Assessing the reproductive potential of late mature cryopreserved oocytes","authors":"Keri Bergin , Ashna Mehra , Rick Slifkin , Morgan Baird , Dmitry Gounko , Carlos Hernandez-Nieto , Joseph Lee , Chelsea Canon , Alan B. Copperman , Lucky Sekhon","doi":"10.1016/j.rbmo.2025.105231","DOIUrl":"10.1016/j.rbmo.2025.105231","url":null,"abstract":"<div><h3>Research question</h3><div>Are there any differences in the warming, fertilization and embryo development outcomes of late mature cryopreserved oocytes versus immediately mature cryopreserved oocytes?</div></div><div><h3>Design</h3><div>This retrospective cohort study analysed autologous oocyte cryopreservation cycles with warming from January 2016 to September 2024. Group 1 comprised oocytes that were mature [metaphase II (MII)] at retrieval (assessed within 1 h of retrieval), and Group 2 comprised late mature oocytes, which included day 0 and day 1 late mature oocytes, which reached MII on re-assessment after short term (4–6 h) and next-day (18–28 h) rescue in-vitro maturation, respectively. Comparative statistics and univariate analysis were performed using Wilcoxon rank sum test and chi-squared test. Logistic regression fitted with a generalized estimating equation, adjusted for oocyte age, anti-Müllerian hormone, body mass index, year of oocyte cryopreservation and year of oocyte warming, was performed for warming survival, fertilization, blastulation and ploidy rates.</div></div><div><h3>Results</h3><div>Among 565 patients (699 cryopreservation and 629 warming cycles), Group 1 included 6899 oocytes that were mature at retrieval and Group 2 included 956 late mature oocytes. The warming survival rate was comparable between the groups (79.4% versus 78.0% for Groups 1 and 2, respectively; <em>P</em> = 0.33). The fertilization rate was significantly higher in Group 1 (75.3%) than Group 2 (59.8%) (adjusted OR 0.52, 95% CI 0.42–0.63; <em>P</em> < 0.001). Group 1 had significantly higher blastulation (37.7% versus 26.1%; <em>P</em> ≤ 0.001) and euploidy (54.5% versus 39.3%; <em>P</em> = 0.0023) rates compared with Group 2, and this was confirmed on adjusted analysis. A subanalysis showed no difference between day 0 and day 1 late mature oocytes.</div></div><div><h3>Conclusions</h3><div>Late mature cryopreserved oocytes show lower reproductive potential than oocytes that are mature at retrieval. This could be attributed to dysynchronous cytoplasmic and nuclear maturation. Despite suboptimal development, late mature oocytes can create high-quality blastocysts, offering additional opportunities for future family-building.</div></div>","PeriodicalId":21134,"journal":{"name":"Reproductive biomedicine online","volume":"52 3","pages":"Article 105231"},"PeriodicalIF":3.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146197870","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2025-10-10DOI: 10.1016/j.rbmo.2025.105342
Sára á Lakjuni , Lone Schmidt , Søren Ziebe , Randi Sylvest , Ditte Vassard , Gritt Marie Hviid Malling
Fertility rates are decreasing globally, and the Nordic countries currently have fertility rates of 1.3-1.5 per woman. The objectives of this scoping review, covering the Nordic welfare states since 1970, were to explore women’s and men’s parenthood intentions, their assessment of important circumstances for family building and their fertility knowledge. Overall, 24 quantitative studies and 6 qualitative studies were included. Across studies, the majority of both women and men expressed a desire to have children, while 0–14% did not wish to do so. Among those having parenthood intentions approximately 85% wanted to have two or three children. Parenthood intentions did not decline during the 50-year period of the empirical studies. Hence, as fertility rates are substantially decreasing, the gap between parenthood intentions and actual birth rates is widening. Since 2006, 12 of the included studies explored study participants’ fertility knowledge. All studies except one reported uncertain fertility knowledge, either overestimating or underestimating the probability of spontaneous pregnancy, or overestimating the success rate after IVF treatment. There is an urgent need for cross-disciplinary and structural efforts to bridge the increasing gap between desired and actualized parenthood.
{"title":"Parenthood intentions and fertility knowledge in the Nordic population 1970 to 2021 – a scoping review","authors":"Sára á Lakjuni , Lone Schmidt , Søren Ziebe , Randi Sylvest , Ditte Vassard , Gritt Marie Hviid Malling","doi":"10.1016/j.rbmo.2025.105342","DOIUrl":"10.1016/j.rbmo.2025.105342","url":null,"abstract":"<div><div>Fertility rates are decreasing globally, and the Nordic countries currently have fertility rates of 1.3-1.5 per woman. The objectives of this scoping review, covering the Nordic welfare states since 1970, were to explore women’s and men’s parenthood intentions, their assessment of important circumstances for family building and their fertility knowledge. Overall, 24 quantitative studies and 6 qualitative studies were included. Across studies, the majority of both women and men expressed a desire to have children, while 0–14% did not wish to do so. Among those having parenthood intentions approximately 85% wanted to have two or three children. Parenthood intentions did not decline during the 50-year period of the empirical studies. Hence, as fertility rates are substantially decreasing, the gap between parenthood intentions and actual birth rates is widening. Since 2006, 12 of the included studies explored study participants’ fertility knowledge. All studies except one reported uncertain fertility knowledge, either overestimating or underestimating the probability of spontaneous pregnancy, or overestimating the success rate after IVF treatment. There is an urgent need for cross-disciplinary and structural efforts to bridge the increasing gap between desired and actualized parenthood.</div></div>","PeriodicalId":21134,"journal":{"name":"Reproductive biomedicine online","volume":"52 3","pages":"Article 105342"},"PeriodicalIF":3.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146213683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2025-08-29DOI: 10.1016/j.rbmo.2025.105234
Semra Kahraman, Ipek Duzguner, Yucel Sahin
Research question
Does the presence of endometriosis and/or adenomyosis, adversely affect oocyte morphology?
Design
Retrospective, single-centre study evaluating 29,130 ART cycles between August 2011 and March 2023. Patients diagnosed with endometriosis and/or adenomyosis, were included (n = 4602 cycles; 27,204 oocytes). Two pre-defined subgroups were evaluated: adenomyosis with or without endometriosis (n = 497 patients; n = 3377 oocytes); and endometriosis-only patients (endometriosis without adenomyosis) (n = 3355 patients; n = 24,320 oocytes). The control group included all patients without endometriosis or adenomyosis. Oocyte morphology, cycle characteristics, fresh and frozen embryo transfer outcomes were compared between the study and control groups. Oocyte morphology results were reported using effect sizes owing to the large number of oocytes analysed.
Results
Phi effect size indicated only negligible differences in oocyte morphology between endometriosis and control groups. In endometriosis cases, a significantly lower number of aspirated, mature and fertilized oocytes were found compared with the control group (P < 0.001, all). Cliff’s delta effect size indicated only negligible differences in oocyte morphology between adenomyosis and endometriosis only groups. No significant difference was found between embryo transfer outcomes. Adenomyosis with or without endometriosis patients had lower pregnancy and live birth rates (P < 0.001, both) and higher biochemical and clinical pregnancy loss rates (P = 0.009 and P = 0.01 respectively) compared with patients with endometriosis only.
Conclusions
Endometriosis and adenomyosis did not affect oocyte morphology. Clinical pregnancy and live birth rates were unaffected by endometriosis. Adenomyosis increased the risk of pregnancy loss and decreased live birth rates.
{"title":"Effect of endometriosis and adenomyosis on oocyte quality: an evaluation of 205,978 oocytes","authors":"Semra Kahraman, Ipek Duzguner, Yucel Sahin","doi":"10.1016/j.rbmo.2025.105234","DOIUrl":"10.1016/j.rbmo.2025.105234","url":null,"abstract":"<div><h3>Research question</h3><div>Does the presence of endometriosis and/or adenomyosis, adversely affect oocyte morphology?</div></div><div><h3>Design</h3><div>Retrospective, single-centre study evaluating 29,130 ART cycles between August 2011 and March 2023. Patients diagnosed with endometriosis and/or adenomyosis, were included (<em>n</em> = 4602 cycles; 27,204 oocytes). Two pre-defined subgroups were evaluated: adenomyosis with or without endometriosis (<em>n</em> = 497 patients; <em>n</em> = 3377 oocytes); and endometriosis-only patients (endometriosis without adenomyosis) (<em>n</em> = 3355 patients; <em>n</em> = 24,320 oocytes). The control group included all patients without endometriosis or adenomyosis. Oocyte morphology, cycle characteristics, fresh and frozen embryo transfer outcomes were compared between the study and control groups. Oocyte morphology results were reported using effect sizes owing to the large number of oocytes analysed.</div></div><div><h3>Results</h3><div>Phi effect size indicated only negligible differences in oocyte morphology between endometriosis and control groups. In endometriosis cases, a significantly lower number of aspirated, mature and fertilized oocytes were found compared with the control group (<em>P</em> < 0.001, all). Cliff’s delta effect size indicated only negligible differences in oocyte morphology between adenomyosis and endometriosis only groups. No significant difference was found between embryo transfer outcomes. Adenomyosis with or without endometriosis patients had lower pregnancy and live birth rates (<em>P</em> < 0.001, both) and higher biochemical and clinical pregnancy loss rates (<em>P</em> = 0.009 and <em>P</em> = 0.01 respectively) compared with patients with endometriosis only.</div></div><div><h3>Conclusions</h3><div>Endometriosis and adenomyosis did not affect oocyte morphology. Clinical pregnancy and live birth rates were unaffected by endometriosis. Adenomyosis increased the risk of pregnancy loss and decreased live birth rates.</div></div>","PeriodicalId":21134,"journal":{"name":"Reproductive biomedicine online","volume":"52 3","pages":"Article 105234"},"PeriodicalIF":3.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146038316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Micro- and nanoplastics (MNP) are pervasive pollutants, detected in every ecosystem. Human exposure is extensive, and their capacity to cross biological barriers and accumulate in tissues raises growing concerns about reproductive health and pregnancy outcomes. Research has shown the presence of MNP in human placenta, fetal meconium and amniotic fluid, confirming their ability to reach the fetal compartment, potentially increasing risks for fetal development. In women, MNP have also been detected in follicular fluid, although their specific effects remain to be determined. In-vitro studies have reported MNP-induced placental vascular damage, whereas murine models suggest impaired ovarian function, reduced oocyte quality and decreased pregnancy rates after MNP exposure. In men, MNP have been identified in testicular tissue and semen. Animal studies report decreased sperm count and quality, likely because of oxidative stress, hormonal disruption and inflammation. Various techniques are available for detecting MNP in biological tissues. Mass and Raman spectroscopy are among the most widely used, each offering specific advantages and limitations. Interpreting experimental data also requires caution, as many in-vitro and in-vivo models use unrealistically high doses of pristine polymers lacking environmental additives, potentially limiting the relevance of their findings to real-world exposures.
{"title":"Plastic pollution in human reproduction: should we worry?","authors":"Martina Broggiato , Stefania Pezzana , Chiara Scaccabarozzi , Francesca Parisi , Claudia Vanetti , Chiara Katerina Guinea Montalvo , Valeria M Savasi , Claudio Fenizia","doi":"10.1016/j.rbmo.2025.105343","DOIUrl":"10.1016/j.rbmo.2025.105343","url":null,"abstract":"<div><div>Micro- and nanoplastics (MNP) are pervasive pollutants, detected in every ecosystem. Human exposure is extensive, and their capacity to cross biological barriers and accumulate in tissues raises growing concerns about reproductive health and pregnancy outcomes. Research has shown the presence of MNP in human placenta, fetal meconium and amniotic fluid, confirming their ability to reach the fetal compartment, potentially increasing risks for fetal development. In women, MNP have also been detected in follicular fluid, although their specific effects remain to be determined. In-vitro studies have reported MNP-induced placental vascular damage, whereas murine models suggest impaired ovarian function, reduced oocyte quality and decreased pregnancy rates after MNP exposure. In men, MNP have been identified in testicular tissue and semen. Animal studies report decreased sperm count and quality, likely because of oxidative stress, hormonal disruption and inflammation. Various techniques are available for detecting MNP in biological tissues. Mass and Raman spectroscopy are among the most widely used, each offering specific advantages and limitations. Interpreting experimental data also requires caution, as many in-vitro and in-vivo models use unrealistically high doses of pristine polymers lacking environmental additives, potentially limiting the relevance of their findings to real-world exposures.</div></div>","PeriodicalId":21134,"journal":{"name":"Reproductive biomedicine online","volume":"52 3","pages":"Article 105343"},"PeriodicalIF":3.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146137718","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2025-10-09DOI: 10.1016/j.rbmo.2025.105288
Ibrahim Elkhatib , Aşina Bayram , Andrea Abdala , Noreen Hourani , Virginia Ferracuti , Samyra Siqueira , Erkan Kalafat , Human M. Fatemi , Daniela Nogueira
Research question
Does refreshment of single-step culture medium on Day 3 impact blastocyst formation and ploidy rates in embryos cultured in benchtop dry incubators?
Design
This randomized sibling oocyte study was performed between July 2021 and October 2023 including 177 patients who underwent preimplantation genetic testing for aneuploidy (PGT-A). Following intracytoplasmic sperm injection, 3016 metaphase II (MII) oocytes were randomized equally to two culture conditions: (a) medium refreshment on Day 3 (R-D3) or (b) medium refreshment on Day 5 (R-D5). All embryos were cultured in single-step medium in a benchtop dry incubator. No embryo assessments were performed between fertilization check and Day 5. Post-insemination outcomes and ploidy rates were compared between the groups.
Results
Fertilization rates were similar between R-D3 and R-D5 (OR 0.89, 95% CI 0.75–1.07; P = 0.212). No significant differences in total usable blastocysts (OR 0.88, 95% CI 0.75–1.02; P = 0.091), euploid blastocysts (OR 0.95, 95% CI 0.80–1.13; P = 0.561) or mosaic blastocysts (OR 1.06, 95% CI 0.72–1.56; P = 0.771) per inseminated MII oocyte were observed. Similar results were observed per two pronuclei (2PN) embryo. However, R-D5 was associated with lower odds of Day 5 blastulation (OR 0.80, 95% CI 0.66–0.98; P = 0.032) and high-quality blastulation per inseminated MII oocyte (OR 0.82, 95% CI 0.68–0.98; P = 0.027), although this was not significant when analysed per 2PN embryo. Sensitivity analyses did not identify interactions between treatment group and cycle characteristics.
Conclusion
Omitting the refreshment of single-step medium on Day 3 does not compromise the viability of euploid embryos to blastocyst stage, but does lead to a slight reduction in the number of morphologically high-quality blastocysts.
研究问题：在第3天更新单步培养基是否会影响在台式干式培养箱中培养的胚胎的囊胚形成和倍性率？设计：这项随机同胞卵母细胞研究于2021年7月至2023年10月进行，包括177名接受非整倍体植入前基因检测（PGT-A）的患者。在卵浆内单精子注射后，3016个中期II （MII）卵母细胞被随机分为两种培养条件：(a)第3天培养基（R-D3）或(b)第5天培养基（R-D5）。所有胚胎均在台式干燥培养箱的单步培养基中培养。在受精检查和第5天之间没有进行胚胎评估。比较两组之间的受精后结果和倍性率。结果：R-D3和R-D5的受精率相似（OR 0.89, 95% CI 0.75 ~ 1.07; P = 0.212）。每个受精卵的可用囊胚总数（OR 0.88, 95% CI 0.75-1.02; P = 0.091）、整倍体囊胚（OR 0.95, 95% CI 0.80-1.13; P = 0.561）或花叶囊胚（OR 1.06, 95% CI 0.72-1.56; P = 0.771）均无显著差异。在两个原核（2PN）胚胎中观察到类似的结果。然而，R-D5与第5天囊胚形成的几率较低（OR 0.80, 95% CI 0.66-0.98; P = 0.032）和每个受精卵的高质量囊胚形成相关（OR 0.82, 95% CI 0.68-0.98; P = 0.027），尽管当分析每2PN胚胎时这并不显著。敏感性分析没有确定治疗组和周期特征之间的相互作用。结论：第3天不补充单步培养基不会影响整倍体胚胎到囊胚期的生存能力，但会导致形态学上高质量囊胚的数量略有减少。
{"title":"Day 3 versus Day 5 refreshment of single-step medium for embryos cultured in a benchtop dry incubator: a randomized sibling oocyte study","authors":"Ibrahim Elkhatib , Aşina Bayram , Andrea Abdala , Noreen Hourani , Virginia Ferracuti , Samyra Siqueira , Erkan Kalafat , Human M. Fatemi , Daniela Nogueira","doi":"10.1016/j.rbmo.2025.105288","DOIUrl":"10.1016/j.rbmo.2025.105288","url":null,"abstract":"<div><h3>Research question</h3><div>Does refreshment of single-step culture medium on Day 3 impact blastocyst formation and ploidy rates in embryos cultured in benchtop dry incubators?</div></div><div><h3>Design</h3><div>This randomized sibling oocyte study was performed between July 2021 and October 2023 including 177 patients who underwent preimplantation genetic testing for aneuploidy (PGT-A). Following intracytoplasmic sperm injection, 3016 metaphase II (MII) oocytes were randomized equally to two culture conditions: (a) medium refreshment on Day 3 (R-D3) or (b) medium refreshment on Day 5 (R-D5). All embryos were cultured in single-step medium in a benchtop dry incubator. No embryo assessments were performed between fertilization check and Day 5. Post-insemination outcomes and ploidy rates were compared between the groups.</div></div><div><h3>Results</h3><div>Fertilization rates were similar between R-D3 and R-D5 (OR 0.89, 95% CI 0.75–1.07; <em>P</em> = 0.212). No significant differences in total usable blastocysts (OR 0.88, 95% CI 0.75–1.02; <em>P</em> = 0.091), euploid blastocysts (OR 0.95, 95% CI 0.80–1.13; <em>P</em> = 0.561) or mosaic blastocysts (OR 1.06, 95% CI 0.72–1.56; <em>P</em> = 0.771) per inseminated MII oocyte were observed. Similar results were observed per two pronuclei (2PN) embryo. However, R-D5 was associated with lower odds of Day 5 blastulation (OR 0.80, 95% CI 0.66–0.98; <em>P</em> = 0.032) and high-quality blastulation per inseminated MII oocyte (OR 0.82, 95% CI 0.68–0.98; <em>P</em> = 0.027), although this was not significant when analysed per 2PN embryo. Sensitivity analyses did not identify interactions between treatment group and cycle characteristics.</div></div><div><h3>Conclusion</h3><div>Omitting the refreshment of single-step medium on Day 3 does not compromise the viability of euploid embryos to blastocyst stage, but does lead to a slight reduction in the number of morphologically high-quality blastocysts.</div></div>","PeriodicalId":21134,"journal":{"name":"Reproductive biomedicine online","volume":"52 3","pages":"Article 105288"},"PeriodicalIF":3.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146213702","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2026-02-04DOI: 10.1016/j.rbmo.2025.105431
Giles Anthony Palmer, Begum Aydogan Mathyk, Jeffrey Jones, Blair T Stocks, Paul Root Wolpe, Virginia Wotring, Christopher E Mason, Jacques Cohen, Fathi Karouia
As the era of commercial and frequent spaceflight advances, the question of human fertility in space is no longer theoretical but urgently practical. Despite over 65 years of human spaceflight activities, little is known of the impact of the space environment on the human reproductive systems during long-duration missions. Extended time in space poses potential hazards to the reproductive function of female and male astronauts, including exposure to cosmic radiation, altered gravity, psychological and physical stress, and disruption to circadian rhythm. This review encapsulates current understanding of the effects of spaceflight on reproductive physiology, incorporating findings from animal studies, a recent experiment on sperm motility, and omics-based insights from astronaut physiology. Female reproductive systems appear to be especially vulnerable, with implications for oogenesis and embryonic development in microgravity. Male reproductive function reveals compromised DNA integrity, even when motility appears to be preserved. This review examines the limited embryogenesis studies in space, which show frequent abnormal cell division and impaired development in rodents. Alongside physiological findings, this review explores ethical issues of space work, particularly with increasing spaceflights involving non-professional astronauts and individuals of all ages. This convergence of space medicine, reproductive biology and bioethics represents a novel and critical intersection that warrants attention. Drawing from multidisciplinary fields, a collaborative framework is proposed for future research, aiming to catalyse cross-disciplinary dialogue and guide the next generation of reproductive biomedical research in space.
{"title":"Reproductive biomedicine in space: implications for gametogenesis, fertility and ethical considerations in the era of commercial spaceflight.","authors":"Giles Anthony Palmer, Begum Aydogan Mathyk, Jeffrey Jones, Blair T Stocks, Paul Root Wolpe, Virginia Wotring, Christopher E Mason, Jacques Cohen, Fathi Karouia","doi":"10.1016/j.rbmo.2025.105431","DOIUrl":"10.1016/j.rbmo.2025.105431","url":null,"abstract":"<p><p>As the era of commercial and frequent spaceflight advances, the question of human fertility in space is no longer theoretical but urgently practical. Despite over 65 years of human spaceflight activities, little is known of the impact of the space environment on the human reproductive systems during long-duration missions. Extended time in space poses potential hazards to the reproductive function of female and male astronauts, including exposure to cosmic radiation, altered gravity, psychological and physical stress, and disruption to circadian rhythm. This review encapsulates current understanding of the effects of spaceflight on reproductive physiology, incorporating findings from animal studies, a recent experiment on sperm motility, and omics-based insights from astronaut physiology. Female reproductive systems appear to be especially vulnerable, with implications for oogenesis and embryonic development in microgravity. Male reproductive function reveals compromised DNA integrity, even when motility appears to be preserved. This review examines the limited embryogenesis studies in space, which show frequent abnormal cell division and impaired development in rodents. Alongside physiological findings, this review explores ethical issues of space work, particularly with increasing spaceflights involving non-professional astronauts and individuals of all ages. This convergence of space medicine, reproductive biology and bioethics represents a novel and critical intersection that warrants attention. Drawing from multidisciplinary fields, a collaborative framework is proposed for future research, aiming to catalyse cross-disciplinary dialogue and guide the next generation of reproductive biomedical research in space.</p>","PeriodicalId":21134,"journal":{"name":"Reproductive biomedicine online","volume":" ","pages":"105431"},"PeriodicalIF":3.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146119875","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-03-01Epub Date: 2025-09-26DOI: 10.1016/j.rbmo.2025.105277
Paul Pirtea , Baris Ata
The commonly used 7 mm threshold for endometrial thickness in assisted reproductive technology lacks strong evidence and stems from outdated data. Recent studies show that live birth outcomes are comparable even with linings of less than 7 mm, particularly when using euploid embryos. Measurement variability, confounding factors and differing clinical practices limit the reliability of endometrial thickness as a standalone predictor. While extremely thin linings may warrant further evaluation, rigid cut-off values are unjustified. Endometrial thickness should be integrated into a broader, individualized assessment rather than drive clinical decisions in isolation.
{"title":"The endometrium: is thickness all that counts?","authors":"Paul Pirtea , Baris Ata","doi":"10.1016/j.rbmo.2025.105277","DOIUrl":"10.1016/j.rbmo.2025.105277","url":null,"abstract":"<div><div>The commonly used 7 mm threshold for endometrial thickness in assisted reproductive technology lacks strong evidence and stems from outdated data. Recent studies show that live birth outcomes are comparable even with linings of less than 7 mm, particularly when using euploid embryos. Measurement variability, confounding factors and differing clinical practices limit the reliability of endometrial thickness as a standalone predictor. While extremely thin linings may warrant further evaluation, rigid cut-off values are unjustified. Endometrial thickness should be integrated into a broader, individualized assessment rather than drive clinical decisions in isolation.</div></div>","PeriodicalId":21134,"journal":{"name":"Reproductive biomedicine online","volume":"52 3","pages":"Article 105277"},"PeriodicalIF":3.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146038315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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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