Reproductive biomedicine online最新文献_第2页

Exposure to endocrine-disrupting chemicals in follicular fluid: implications for assisted reproductive technology outcomes 暴露于卵泡液中干扰内分泌的化学物质：对辅助生殖技术结果的影响

IF 3.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Reproductive biomedicine online

Pub Date : 2026-03-01 Epub Date: 2025-10-13 DOI: 10.1016/j.rbmo.2025.105341

Yuxin Jiang , Xiaoyu Long , Yongxiu Hao , Lixue Chen , Tian Tian , Yue Zhao

Research question

Are endocrine-disrupting chemicals (EDC) in follicular fluid associated with assisted reproductive technology (ART) outcomes among women undergoing ART treatment?

Design

This prospective cohort study involved 176 women who underwent ART treatment in China. The concentrations of 76 EDC, across five categories, in follicular fluid were quantified. Generalized linear models (with and without restricted cubic splines to account for non-linear relationships) and Bayesian kernel machine regression (BKMR) models were utilized.

Results

Fifteen EDC exhibited significant negative associations with at least one conventional IVF/intracytoplasmic sperm injection (ICSI) outcome. Notably, mono (2-ethyl-5-carboxypentyl) phthalate (MECPP) was consistently associated with reductions in all conventional IVF/ICSI outcomes, including the numbers of retrieved oocytes, mature oocytes, two pronuclear zygotes, blastocysts and high-quality embryos. Similarly, 3,5-di-tert-butyl-4-hydroxybenzoic acid (BHT-COOH) was negatively associated with all conventional IVF/ICSI outcomes except the number of blastocysts. No significant negative associations were observed between individual EDC and pregnancy outcomes, including the live birth rate. BKMR model analyses revealed that combinations of EDC were significantly associated with reductions in the numbers of retrieved oocytes and mature oocytes, and the probability of biochemical pregnancy. Among EDC combinations, phthalates (PAE) and bisphenol S (BPS) were identified as dominant contributors to adverse conventional IVF/ICSI outcomes and the biochemical pregnancy rate, respectively. Stratified and interaction analyses further indicated that stronger associations with conventional IVF/ICSI outcomes were observed among women aged ≤33 years.

Conclusions

Elevated concentrations of EDC in follicular fluid were associated with adverse ART outcomes, both as individual compounds and in combination. MECPP, BHT-COOH, PAE and BPS were identified as key EDC. Moreover, the associations were modified by age, with stronger adverse effects observed in younger women.

研究问题：在接受辅助生殖技术（ART）治疗的妇女中，卵泡液中的内分泌干扰化学物质（EDC）是否与辅助生殖技术（ART）的结果相关？设计：这项前瞻性队列研究涉及176名在中国接受抗逆转录病毒治疗的妇女。对卵泡液中5类76种EDC的浓度进行了定量分析。使用广义线性模型（有或没有限制三次样条来解释非线性关系）和贝叶斯核机回归（BKMR）模型。结果：15例EDC与至少一项常规IVF/胞浆内单精子注射（ICSI）结果呈显著负相关。值得注意的是，单（2-乙基-5-羧戊基）邻苯二甲酸酯（MECPP）始终与所有常规IVF/ICSI结果的降低相关，包括获得的卵母细胞、成熟卵母细胞、两个原核受精卵、囊胚和高质量胚胎的数量。同样，3,5-二叔丁基-4-羟基苯甲酸（BHT-COOH）与除囊胚数量外的所有常规IVF/ICSI结果呈负相关。未观察到个体EDC与妊娠结局（包括活产率）之间存在显著负相关。BKMR模型分析显示，EDC组合与取出的卵母细胞数量和成熟卵母细胞数量的减少以及生化妊娠的概率显著相关。在EDC联合用药中，邻苯二甲酸酯（PAE）和双酚S （BPS）分别被认为是导致常规IVF/ICSI不良结局和生化妊娠率的主要因素。分层和相互作用分析进一步表明，在年龄≤33岁的女性中，观察到与常规IVF/ICSI结果有更强的关联。结论：卵泡液中EDC浓度升高与抗逆转录病毒治疗的不良结果相关，无论是单独的化合物还是联合使用。MECPP、BHT-COOH、PAE和BPS被确定为关键EDC。此外，这种关联随着年龄的变化而改变，在年轻女性中观察到更强的不良反应。

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引用次数: 0

Assessing the performance of generative AI chatbots in preimplantation genetic testing: a comparative study of expert evaluations 评估人工智能聊天机器人在植入前基因检测中的表现：专家评估的比较研究。

IF 3.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Reproductive biomedicine online

Pub Date : 2026-03-01 Epub Date: 2025-09-22 DOI: 10.1016/j.rbmo.2025.105275

Belén Lledo , Paola Carbone , Jose A. Ortiz , Ruth Morales , Adoración Rodríguez-Arnedo , Leyre Herrero , Elisa Alvarez , Jorge Ten , Lydia Luque , Juan C. Castillo , Jordi Suñol , Anna Lissa Racca , Andrea Bernabeu

Research question

How reliable are generative artificial intelligence (AI) chatbots in responding to patient-relevant questions about preimplantation genetic testing (PGT), as evaluated by reproductive medicine specialists?

Design

A prospective evaluation was conducted comparing three publicly available generative AI models: ChatGPT-3.5, Gemini-1.5 and Llama-2. Twelve reproductive medicine specialists from different clinics assessed the chatbot-generated responses to 13 PGT-related questions, divided into simple and controversial categories. Each response was scored from 0 to 5 using predefined criteria. Assuming all answers were excellent, the maximum score was 25 points for simple questions and 40 points for controversial questions.

Results

In total, 156 evaluations were completed for each chatbot. Among the simple questions, ‘What are the types and techniques used for PGT?’ scored lowest (mean ± SD 2.83 ± 0.94). For the controversial questions, ‘What is the percentage of aneuploidy that allows an embryo to be defined as mosaic?’ scored lowest (mean ± SD 2.67 ± 1.22). ChatGPT performed best across both categories (simple 16.83 ± 1.80; controversial 27.75 ± 4.49), followed by Gemini (simple 14.92 ± 2.02; controversial 26.08 ± 3.99) and Llama (simple 13.58 ± 3.60; controversial 16.92 ± 4.96). Significant differences were observed, particularly between ChatGPT and Llama for both simple and controversial questions (P = 0.027 for simple, P < 0.001 for controversial), and between Gemini and Llama for controversial questions (P < 0.001). No significant performance differences were noted between participating specialists.

Conclusions

Generative AI shows moderate reliability in addressing PGT-related enquiries, with ChatGPT and Gemini outperforming Llama. While performance was higher for simple questions than for controversial questions, the variability underscores the need for clinical oversight. Further refinement and validation are essential before widespread integration of AI tools in reproductive medicine.

研究问题：根据生殖医学专家的评估，生殖人工智能（AI）聊天机器人在回答与植入前基因检测（PGT）相关的患者问题方面有多可靠？设计：对三种公开可用的生成式人工智能模型：ChatGPT-3.5、Gemini-1.5和Llama-2进行了前瞻性评估。来自不同诊所的12位生殖医学专家评估了聊天机器人对13个pgt相关问题的回答，这些问题被分为简单和有争议的几类。使用预定义的标准对每个回答进行0到5分的评分。假设所有的答案都是优秀的，那么简单题的最高分是25分，争议题的最高分是40分。结果：每个聊天机器人总共完成了156次评估。在一些简单的问题中，“PGT的类型和技术是什么？”评分最低（平均±SD 2.83±0.94）。对于有争议的问题，“非整倍性的百分比是多少，使得胚胎被定义为镶嵌？”得分最低（平均±标准差2.67±1.22）。ChatGPT在两个类别中均表现最佳（简单的16.83±1.80；有争议的27.75±4.49），其次是Gemini（简单的14.92±2.02；有争议的26.08±3.99）和Llama（简单的13.58±3.60；有争议的16.92±4.96）。观察到显著差异，特别是ChatGPT和Llama在简单和有争议问题上的差异（P = 0.027,P < 0.001）， Gemini和Llama在有争议问题上的差异（P < 0.001）。参与的专家之间没有明显的表现差异。结论：生成式人工智能在解决与pgt相关的查询方面表现出中等的可靠性，ChatGPT和Gemini的表现优于Llama。虽然简单的问题比有争议的问题表现得更好，但这种可变性强调了临床监督的必要性。在将人工智能工具广泛整合到生殖医学之前，必须进一步完善和验证。

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引用次数: 0

Prenatal occupational exposure to endocrine-disrupting chemicals during pregnancy and adult male reproductive hormones 产前职业暴露于怀孕期间的内分泌干扰化学物质和成年男性生殖激素

IF 3.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Reproductive biomedicine online

Pub Date : 2026-03-01 Epub Date: 2025-08-30 DOI: 10.1016/j.rbmo.2025.105236

Pauline Blanc-Petitjean , Rita Rahban , Brigitte Dananché , Alfred Senn , Fanny Zufferey , Eric Stettler , Luc Multigner , Serge Nef , Ronan Garlantézec

Research question: Does maternal occupational exposure to endocrine-disrupting chemicals (EDC) during pregnancy affect reproductive hormone concentrations in adult sons?

Design: Data from a cross-sectional study of 2326 Swiss conscripts collected between 2005 and 2017 were analysed. On inclusion, the conscripts’ mothers completed a detailed questionnaire about their pregnancy. A job-exposure matrix was used to assess exposure to 10 categories of potential EDC. Reproductive hormones – FSH, LH, total and free testosterone, oestradiol and sex hormone-binding globulin (SHBG) – were determined in serum samples from all conscripts whose mothers were exposed to EDC during pregnancy (n = 138) and a random sample of non-exposed conscripts (n = 276). Multiple linear regression analyses were adjusted for potential confounders.

Results: Prenatal exposure to phthalates or alkyl phenolic compounds was significantly associated with higher FSH concentrations (aβ = 0.26, 95% CI 0.03–0.49, and aβ = 0.22, 95% CI 0.02–0.42, respectively) and prenatal exposure to pesticides was significantly associated with higher SHBG concentrations (aβ = 0.22, 95% CI 0.05–0.38). No statistically significant associations were found between other EDC categories and reproductive hormones.

Conclusions: Maternal occupational exposure to certain types of EDC during pregnancy was associated with the concentrations of reproductive hormones in adult sons. These findings require replication in larger, prospective population studies.

研究问题：母亲在怀孕期间接触内分泌干扰化学物质（EDC）是否会影响成年儿子的生殖激素浓度？设计：对2005年至2017年间收集的2326名瑞士应征入伍者的横断面研究数据进行分析。入伍后，应征入伍者的母亲完成了一份详细的怀孕问卷。工作暴露矩阵用于评估10类潜在EDC的暴露。生殖激素——卵泡刺激素、黄体生成素、总睾酮和游离睾酮、雌二醇和性激素结合球蛋白（SHBG）——测定了母亲在怀孕期间暴露于EDC的所有应征士兵（ = 138）和随机抽样的未暴露的应征士兵（ = 276）的血清样本。多重线性回归分析对潜在混杂因素进行调整。结果：产前暴露于邻苯二甲酸酯或烷基酚类化合物与较高的FSH浓度显著相关（aβ = 0.26,95% CI 0.03-0.49，和aβ = 0.22,95% CI 0.02-0.42），产前暴露于农药与较高的SHBG浓度显著相关（aβ = 0.22,95% CI 0.05-0.38）。其他EDC类别与生殖激素之间无统计学意义的关联。结论：母亲在怀孕期间职业性暴露于某些类型的EDC与成年儿子的生殖激素浓度有关。这些发现需要在更大规模的前瞻性人群研究中得到验证。

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引用次数: 0

Low risk of endometrioma infection after oocyte retrieval 取卵后子宫内膜瘤感染风险低。

IF 3.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Reproductive biomedicine online

Pub Date : 2026-03-01 Epub Date: 2025-10-22 DOI: 10.1016/j.rbmo.2025.105344

Guillaume Parpex , Mathilde Bourdon , Louis Marcellin , Manon Sorel , Chloé Maignien , Corinne Bordonné , Caroline Charlier , Catherine Patrat , Pietro Santulli , Charles Chapron

Research Question

What is the incidence of endometrioma infections requiring surgical drainage following oocyte retrieval in women with ovarian endometrioma?

Design

This retrospective observational cohort study included women aged 18–43 years with a confirmed radiological diagnosis of ovarian endometrioma who underwent ovarian stimulation and oocyte retrieval for IVF/intracytoplasmic sperm injection (ICSI) or fertility preservation between January 2018 and December 2023 at a single tertiary academic centre. All procedures were performed under standardized aseptic conditions with antibiotic prophylaxis. Transcystic puncture was performed when deemed necessary. The primary outcome was the incidence of endometrioma infections requiring surgical drainage within 30 days after oocyte retrieval.

Results

Oocyte retrievals were performed in 1102 out of 1668 cycles (66.1%) for IVF/ICSI and in 566 cycles (33.9%) for fertility preservation. Bilateral endometriomas were present in 322 of 880 patients (36.6%), with a mean cyst (SD) diameter of 31.5 ± 22.7 mm. Endometriomas larger than 30 mm accounted for 295 of 649 cases (45.5%). Intentional transcystic puncture was performed in 76 of 1148 applicable procedures (6.6%), and endometrioma drainage during oocyte retrieval occurred in 52 cases (4.5%). Endometrioma infections requiring surgical drainage occurred in 6 of 1668 procedures (0.36%). Only one infection was reported following transcystic puncture (1.3%). No cases of sepsis or septic shock occurred. Five infections were managed with ultrasound-guided transvaginal drainage; one required laparoscopic surgery.

Conclusions

The incidence of endometrioma infection requiring surgical intervention after oocyte retrieval, including after transcystic puncture, is low. These findings support the safety of assisted reproductive techniques in women with endometriomas.

研究问题：卵巢子宫内膜异位瘤患者取卵后需要手术引流的子宫内膜异位瘤感染的发生率是多少？设计：本回顾性观察队列研究纳入了2018年1月至2023年12月在单一三级学术中心接受卵巢刺激和卵母细胞提取以进行体外受精/胞浆内单精子注射（ICSI）或保留生育能力的18-43岁放射学诊断为卵巢子宫内膜异位瘤的女性。所有操作均在标准化无菌条件下进行，并采用抗生素预防。必要时进行经囊穿刺。主要结果是子宫内膜瘤感染的发生率，需要在卵母细胞取出后30天内进行手术引流。结果：在IVF/ICSI的1668个周期中，有1102个周期（66.1%）进行了卵母细胞提取，566个周期（33.9%）进行了生育保存。880例患者中有322例（36.6%）存在双侧子宫内膜瘤，平均囊肿（SD）直径为31.5±22.7 mm。649例中大于30mm的子宫内膜瘤占295例（45.5%）。1148例手术中有76例（6.6%）进行了有意的经囊穿刺，52例（4.5%）在取卵过程中发生子宫内膜瘤引流。1668例手术中有6例（0.36%）发生子宫内膜瘤感染，需要手术引流。经囊穿刺后仅1例感染（1.3%）。无脓毒症或感染性休克病例发生。5例患者行超声引导下阴道引流术；其中一个需要腹腔镜手术。结论：卵母细胞取出后（包括经囊穿刺后）子宫内膜瘤感染需要手术干预的发生率较低。这些发现支持子宫内膜异位瘤妇女辅助生殖技术的安全性。

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引用次数: 0

Serum magnesium is linked with sperm concentration, motile sperm count and serum anti-Müllerian hormone in infertile men 在不育男性中，血清镁与精子浓度、活动精子数量和血清抗<s:1>勒氏激素有关。

IF 3.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Reproductive biomedicine online

Pub Date : 2026-03-01 Epub Date: 2025-08-23 DOI: 10.1016/j.rbmo.2025.105232

Sam Kafai Yahyavi , Benedicte Probst-Drejer , Nadia Nicholine Poulsen , Mads Joon Jorsal , Anders Juul , Niels Jørgensen , Martin Blomberg Jensen

Research question

What is the relationship between serum magnesium, semen quality and reproductive hormones in infertile men?

Design

This study was a secondary analysis of data from a randomized controlled trial involving 330 infertile men treated with cholecalciferol + calcium or placebo for 150 days. Each participant underwent a physical examination and had blood and semen parameters assessed. Thirty-one men were excluded due to missing serum magnesium, leaving 299 men stratified by serum magnesium tertile.

Results

Sperm concentration and total sperm count were higher in men in the highest serum magnesium tertile compared with men in the lowest serum magnesium tertile (20.9 million/ml versus 8.6 million/ml, P = 0.007; 72 million versus 37 million, P = 0.009, respectively). Total numbers of motile and progressively motile spermatozoa were also higher in men in the highest serum magnesium tertile (34 million versus 23 million, P = 0.023; 23 million versus 11 million, P = 0.033, respectively). Serum anti-Müllerian hormone (AMH) was higher in the highest serum magnesium tertile compared with the lowest serum magnesium tertile (40 pmol/l versus 28 pmol/l, P = 0.002), while FSH, LH and inhibin B showed no difference between serum magnesium tertiles. Vitamin D supplementation did not influence serum magnesium.

Conclusions

Serum magnesium is positively associated with serum AMH, and total numbers of motile and progressively motile spermatozoa. This study suggests that magnesium, along with other minerals, may influence male fertility. More evidence is needed for full validation of these findings.

研究问题：不育男性血清镁、精液质量和生殖激素之间的关系是什么？设计：本研究是对一项随机对照试验数据的二次分析，该试验涉及330名不育男性，接受胆钙化醇 + 钙或安慰剂治疗150天。每位参与者都接受了身体检查，并评估了血液和精液参数。31名男性因血清镁缺失而被排除，剩下299名男性按血清镁含量分层。结果：血清镁含量最高的男性精子浓度和总精子数高于血清镁含量最低的男性（2090万/ml比860万/ml， P = 0.007；7200万比3700万，P = 0.009）。血清镁含量最高的男性的活动精子和渐进式活动精子总数也更高（分别为3400万对2300万，P = 0.023；2300万对1100万，P = 0.033）。血清抗勒氏激素（AMH）在镁含量高的各组高于镁含量低的各组（40 pmol/l vs 28 pmol/l, P = 0.002），而FSH、LH和抑制素B在镁含量高的各组间无显著差异。补充维生素D对血清镁没有影响。结论：血清镁与血清AMH、活动精子总数和渐进式活动精子数量呈正相关。这项研究表明，镁和其他矿物质可能会影响男性的生育能力。需要更多的证据来充分证实这些发现。

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引用次数: 0

Never a lost cause: can artificial intelligence help embryologists when only poor-quality embryos are available? 永远不会失败：当只有劣质胚胎可用时，人工智能能帮助胚胎学家吗？

IF 3.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Reproductive biomedicine online

Pub Date : 2026-03-01 Epub Date: 2025-12-20 DOI: 10.1016/j.rbmo.2025.105439

Nina Gidel-Dissler , Guillaume Canat , Pierre Boyer , Daniela Nogueira , Alexandra Boussommier-Calleja

Research question

Can EMBRYOLY, an objectively trained artificial intelligence (AI) system, assist embryologists in embryo assessment when only poor-quality embryos are available for transfer?

Design

Data from 15,767 embryos were collected via EMBRYOLY from 3214 egg retrievals (2019–2024) across 15 clinics (four countries) using three time-lapse systems, including data from seven independent clinics (not used in the original training of the algorithm). EMBRYOLY was used to automatically detect poor-quality embryos. Subsequently, EMBRYOLY’s transformer-based model was applied on poor-quality embryos to evaluate agreement with embryologists, ranking performances against clinical pregnancy and live birth outcomes, effect on time to pregnancy and first cycle pregnancy rate. Finally, clinical pregnancy rate was compared between poor versus non-poor embryos recommended for transfer by EMBRYOLY’s hybrid model.

Results

For 29% of embryo cohorts, embryologists were faced with only poor-quality embryos available for transfer. EMBRYOLY’s first choice of poor-quality embryo was concordant with the embryologists’ first choice in 66% of embryo cohorts. EMBRYOLY’s score was significantly associated (P < 0.001) with clinical pregnancies and live births on poor-quality embryos. For multiple transfers of poor-quality embryos, the adjunct use of EMBRYOLY could have reduced cycles to pregnancy by 19% and increased first cycle pregnancy rate by 65%. When EMBRYOLY recommended a poor-quality embryo for transfer, it had comparable chances of leading to a clinical pregnancy compared with higher quality embryos.

Conclusions

Objectively trained AI can help embryologists to select poor-quality embryos that can lead to pregnancy, which is crucial when good or fair embryos are unavailable.

研究问题：当只有低质量的胚胎可供移植时，EMBRYOLY这个经过客观训练的人工智能（AI）系统能否协助胚胎学家进行胚胎评估？设计：使用三种延时系统，通过EMBRYOLY从15个诊所（四个国家）的3214个卵子检索（2019-2024）中收集了15,767个胚胎的数据，其中包括来自7个独立诊所的数据（未用于算法的原始训练）。胚胎学用于自动检测低质量胚胎。随后，将EMBRYOLY基于变压器的模型应用于质量差的胚胎，以评估与胚胎学家的一致性，根据临床妊娠和活产结局，对妊娠时间和第一周期妊娠率的影响进行排名。最后，通过EMBRYOLY杂交模型比较推荐移植的不良和非不良胚胎的临床妊娠率。结果：在29%的胚胎队列中，胚胎学家只面临可用于移植的低质量胚胎。在66%的胚胎队列中，EMBRYOLY对劣质胚胎的首选与胚胎学家的首选一致。EMBRYOLY评分与临床妊娠和低质量胚胎的活产显著相关（P < 0.001）。对于多次移植质量差的胚胎，辅助使用EMBRYOLY可以减少19%的妊娠周期，并将第一周期妊娠率提高65%。当EMBRYOLY推荐劣质胚胎进行移植时，与优质胚胎相比，它导致临床妊娠的机会相当。结论：经过客观训练的人工智能可以帮助胚胎学家选择可能导致怀孕的劣质胚胎，这在无法获得优质或公平胚胎的情况下至关重要。

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引用次数: 0

Patient motivations and barriers in the donation of surplus embryos: a systematic review 捐赠剩余胚胎的患者动机和障碍：系统综述

IF 3.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Reproductive biomedicine online

Pub Date : 2026-03-01 Epub Date: 2025-08-14 DOI: 10.1016/j.rbmo.2025.105218

Pilar Jiménez Fernández , Adrian Villalba , Gabriela Llanos , Salvador Mut , Leda Pedelini

Cryopreservation of surplus embryos in assisted reproductive technology has led to their substantial accumulation in fertility clinics worldwide, raising ethical, legal and logistical challenges. This systematic review examines the factors influencing patients’ decisions regarding surplus embryo disposition, including donation, continued storage or disposal. Following PRISMA guidelines, 24 studies from 15 countries were analysed, incorporating qualitative, quantitative and mixed-methods research. Findings reveal that patients’ choices are shaped by the moral status attributed to embryos (e.g. ‘cell cluster’ versus ‘potential child’), religious beliefs, educational level, gamete origin and storage duration. While many patients prefer donating embryos to research or other couples, emotional attachment and ethical concerns often lead to indecision or prolonged storage. Additionally, inadequate counselling and legal restrictions further complicate decision making, with many patients reporting insufficient information and support. The review highlights the need for improved patient-centred counselling, culturally sensitive policies and standardized ethical guidelines to address embryo accumulation while respecting patient autonomy. Future research should explore cross-cultural perspectives and develop interventions to facilitate informed, ethically sound decisions.

辅助生殖技术中多余胚胎的冷冻保存导致其在世界各地的生育诊所大量积累，引发了伦理、法律和后勤方面的挑战。本系统综述探讨了影响患者关于剩余胚胎处置决定的因素，包括捐赠、继续储存或处置。根据PRISMA的指导方针，分析了来自15个国家的24项研究，包括定性、定量和混合方法研究。研究结果显示，患者的选择受到胚胎的道德地位（例如“细胞群”与“潜在的孩子”）、宗教信仰、教育水平、配子来源和储存时间的影响。虽然许多患者更愿意将胚胎捐赠给研究或其他夫妇，但情感依恋和伦理问题往往导致优柔寡断或长期储存。此外，咨询不足和法律限制使决策进一步复杂化，许多患者报告信息和支持不足。该审查强调需要改进以患者为中心的咨询、具有文化敏感性的政策和标准化的伦理准则，以解决胚胎积累问题，同时尊重患者的自主权。未来的研究应探索跨文化视角，并制定干预措施，以促进知情的、合乎伦理的决策。

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引用次数: 0

Reproductive medicine and human embryo research: rethinking risk through the lens of Aristotle’s phronesis 生殖医学和人类胚胎研究：通过亚里士多德的phronesis透镜重新思考风险。

IF 3.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Reproductive biomedicine online

Pub Date : 2026-03-01 Epub Date: 2025-10-03 DOI: 10.1016/j.rbmo.2025.105287

Maxime Chaillot , Maxence Gaillard , Laurent David , Thomas Freour

In the field of assisted reproductive technology (ART) and human embryo research, clinicians and scientists regularly face decisions that blend scientific uncertainty with profound ethical complexity. As innovation accelerates in these fast-moving fields, ethical navigation can be challenging. Guidelines, regulations and protocols generally provide structure, yet often fall short of offering sufficient moral clarity. In this complex and evolving landscape, we propose that Aristotle’s famous concept of phronesis – practical wisdom, i.e. the ability to make morally sound decisions in complex, real-life situations by balancing knowledge, experience and ethical judgement – can offer an essential tool for navigating choices in ART and/or human embryo research where evidence, ethics and lived human experiences intersect.

在辅助生殖技术（ART）和人类胚胎研究领域，临床医生和科学家经常面临混合科学不确定性和深刻的伦理复杂性的决定。随着这些快速发展领域的创新加速，道德导航可能具有挑战性。指导方针、规章和协议通常提供结构，但往往不能提供足够的道德清晰度。在这种复杂和不断发展的环境中，我们提出亚里士多德著名的实践智慧概念，即在复杂的现实生活中通过平衡知识、经验和道德判断做出道德合理决策的能力，可以为在ART和/或人类胚胎研究中导航选择提供重要工具，在这些研究中，证据、伦理和人类生活经验交叉。

引用次数: 0

Synergistic effect of transfer of blastocyst and embryo vitrification on birth weight: a retrospective cohort study 囊胚移植和胚胎玻璃化对出生体重的协同作用：一项回顾性队列研究。

IF 3.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Reproductive biomedicine online

Pub Date : 2026-03-01 Epub Date: 2025-10-09 DOI: 10.1016/j.rbmo.2025.105340

Ming Li , Qingqing Tao , Zhengyang Zhao , Jin Huang , Ying Lian , Ping Liu , Qin Li , Rong Li , Jie Qiao

Research question

Does the synergistic interaction between blastocyst-stage embryo transfer and vitrification in assisted reproductive technology increase the risk of adverse neonatal outcomes, specifically elevated birth weight z-scores and a higher incidence of clinically concerning large for gestational age (LGA) or macrosomia in offspring?

Design

In this cohort study, multivariable regression analyses were conducted to examine the association between embryo transfer strategies (fresh versus frozen; cleavage versus blastocyst stage) and the birth weight z-score of singletons, as well as the incidence of LGA and macrosomia among 42,190 singleton live births from the Center for Reproductive Medicine at Peking University Third Hospital between 2012 and 2022.

Results

Compared with cleavage-stage embryo transfer, newborns resulting from blastocyst-stage transfers had significantly higher birth weight z-scores (P < 0.001), LGA (P < 0.001) and macrosomia (P = 0.013). Frozen embryo transfer (only vitrified–warmed) was associated with increased birth weight z-scores (P = 0.001), LGA (P = 0.004) and macrosomia (P = 0.007), compared with fresh embryo transfers. A significant synergetic effect of blastocyst transfer and vitrified–warmed transfer concerning the LGA was found (relative excess risks due to interaction = 0.24; 95% CI 0.06 to 0.42; P = 0.022 for multiplicative interaction term) on the additive and multiplicative scales.

Conclusions

Blastocyst stage and embryo vitrification were associated with elevated birth weight z-scores and an increased likelihood of LGA, with evidence of a synergistic effect. These findings support the importance of personalized clinical decision-making in the use of vitrified–warmed cleavage-stage transfer, particularly in the absence of clear medical indications.

研究问题：辅助生殖技术中囊胚期胚胎移植和玻璃化之间的协同相互作用是否会增加新生儿不良结局的风险，特别是出生体重z-评分升高和后代临床有关大胎龄（LGA）或巨大儿的更高发生率？设计：本队列研究采用多变量回归分析，探讨2012 - 2022年北京大学第三医院生殖医学中心42,190例单胎活产婴儿中，胚胎移植策略（新鲜与冷冻、卵裂与囊胚期）与单胎出生体重z-score、LGA和巨大儿发生率之间的关系。结果：与卵裂期胚胎移植相比，囊胚期移植的新生儿出生体重z-score （P < 0.001）、LGA （P < 0.001）和巨大儿（P = 0.013）显著高于卵裂期胚胎移植。与新鲜胚胎移植相比，冷冻胚胎移植（仅玻璃化加热）与出生体重z-score (P = 0.001),LGA （P = 0.004）和巨大儿（P = 0.007）增加相关。发现囊胚移植和玻璃化热移植对LGA有显著的协同效应（相互作用的相对超额风险 = 0.24;95% CI 0.06 ~ 0.42；乘法相互作用项P = 0.022）。结论：囊胚期和胚胎玻璃化与出生体重z分数升高和LGA可能性增加有关，有证据表明存在协同效应。这些发现支持在使用玻璃化加热的卵裂期移植时个性化临床决策的重要性，特别是在没有明确医学指征的情况下。

{"title":"Synergistic effect of transfer of blastocyst and embryo vitrification on birth weight: a retrospective cohort study","authors":"Ming Li , Qingqing Tao , Zhengyang Zhao , Jin Huang , Ying Lian , Ping Liu , Qin Li , Rong Li , Jie Qiao","doi":"10.1016/j.rbmo.2025.105340","DOIUrl":"10.1016/j.rbmo.2025.105340","url":null,"abstract":"<div><h3>Research question</h3><div>Does the synergistic interaction between blastocyst-stage embryo transfer and vitrification in assisted reproductive technology increase the risk of adverse neonatal outcomes, specifically elevated birth weight z-scores and a higher incidence of clinically concerning large for gestational age (LGA) or macrosomia in offspring?</div></div><div><h3>Design</h3><div>In this cohort study, multivariable regression analyses were conducted to examine the association between embryo transfer strategies (fresh versus frozen; cleavage versus blastocyst stage) and the birth weight z-score of singletons, as well as the incidence of LGA and macrosomia among 42,190 singleton live births from the Center for Reproductive Medicine at Peking University Third Hospital between 2012 and 2022.</div></div><div><h3>Results</h3><div>Compared with cleavage-stage embryo transfer, newborns resulting from blastocyst-stage transfers had significantly higher birth weight z-scores (<em>P</em> < 0.001), LGA (<em>P</em> < 0.001) and macrosomia (<em>P</em> = 0.013). Frozen embryo transfer (only vitrified–warmed) was associated with increased birth weight z-scores (<em>P</em> = 0.001), LGA (<em>P</em> = 0.004) and macrosomia (<em>P</em> = 0.007), compared with fresh embryo transfers. A significant synergetic effect of blastocyst transfer and vitrified–warmed transfer concerning the LGA was found (relative excess risks due to interaction = 0.24; 95% CI 0.06 to 0.42; <em>P</em> = 0.022 for multiplicative interaction term) on the additive and multiplicative scales.</div></div><div><h3>Conclusions</h3><div>Blastocyst stage and embryo vitrification were associated with elevated birth weight z-scores and an increased likelihood of LGA, with evidence of a synergistic effect. These findings support the importance of personalized clinical decision-making in the use of vitrified–warmed cleavage-stage transfer, particularly in the absence of clear medical indications.</div></div>","PeriodicalId":21134,"journal":{"name":"Reproductive biomedicine online","volume":"52 3","pages":"Article 105340"},"PeriodicalIF":3.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146143392","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}

引用次数: 0

Single motherhood by choice in Sweden: survey of unanticipated support needs and financial challenges 瑞典选择单身母亲：意外支持需求和财务挑战的调查。

IF 3.5 2区医学 Q1 OBSTETRICS & GYNECOLOGY

Reproductive biomedicine online

Pub Date : 2026-03-01 Epub Date: 2025-09-05 DOI: 10.1016/j.rbmo.2025.105241

Ylva Af Sandeberg , Claudia Lampic , Agneta Skoog Svanberg , Camilla Stenfelt , Anna-Karin Lind , Gunilla Sydsjö , Evangelia Elenis

Research question

What are the backgrounds, treatment motives, experiences of mandatory psychosocial evaluation, support needs, post-birth financial circumstances, and reflections on motherhood among single mothers by choice who received publicly or privately funded treatment in Sweden?

Design

A cross-sectional, anonymous, web-based survey was conducted in 2022 and completed by 256 single mothers by choice with children under five years conceived through assisted reproduction with donated gametes. Outcomes were analyzed by funding source.

Results

Participants were aged 28–48 years; 53.9% had received publicly funded treatment. Most (87.1%) held a university, master's, or PhD degree, with a median salary of €3,600. At treatment, 47.7% had been single for more than four years, and 25.4% chose single motherhood for reasons beyond partner absence, such as a desire for sole custody. Obstetric complications were reported by 48.8%. Substantial proportions were dissatisfied with practical support from family or friends (23% and 42%, respectively). After childbirth, 35.5% reduced employment, and 22.7% reported worse-than-expected finances due to unforeseen expenses or instability. Despite these challenges, 98.8% expressed no regret, and 45.3% planned additional children. Findings were largely similar across funding groups. Exceptions included privately funded women, who were older and more likely to report plans to remain voluntarily single, express dissatisfaction with workplace and healthcare support and question the psychosocial evaluation.

Conclusions

Single mothers by choice in Sweden are generally well educated and financially stable at treatment initiation but often face greater-than-expected challenges after childbirth, including medical complications, reduced income, and limited support. Nevertheless, most remain confident in their decision, reflecting long-term planning and strong reproductive agency. Funding source had minimal impact on post-birth financial hardship.

研究问题：在瑞典，选择接受公共或私人资助治疗的单身母亲的背景、治疗动机、强制性心理社会评估的经历、支持需求、产后经济状况和对母性的反思是什么？设计：一项横断面、匿名、基于网络的调查于2022年进行，由256位单身母亲自愿完成，她们通过捐赠的配子辅助生殖怀上了5岁以下的孩子。按资金来源对结果进行分析。结果：参与者年龄28-48岁；53.9%接受公费治疗。大多数（87.1%）拥有大学、硕士或博士学位，工资中位数为3600欧元。在接受治疗时，47.7%的人单身超过四年，25.4%的人选择单身母亲的原因不仅仅是伴侣不在，比如想要单独监护。产科并发症占48.8%。相当比例的人不满意来自家人或朋友的实际支持（分别为23%和42%）。分娩后，35.5%的人减少了就业，22.7%的人表示由于不可预见的费用或不稳定，财务状况比预期差。尽管面临这些挑战，98.8%的人表示不后悔，45.3%的人计划再要孩子。各资助团体的调查结果基本相似。例外情况包括私人资助的妇女，她们年龄较大，更有可能报告自愿保持单身的计划，对工作场所和医疗保健支持表示不满，并对心理社会评估提出质疑。结论：瑞典的单身母亲通常在治疗开始时受过良好的教育，经济稳定，但分娩后往往面临比预期更大的挑战，包括医疗并发症、收入减少和有限的支持。然而，大多数人仍然对自己的决定充满信心，这反映了长期规划和强大的生育能力。资金来源对产后经济困难的影响微乎其微。

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引用次数: 0