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used 7 mm threshold for endometrial thickness in assisted reproductive technology lacks strong evidence and stems from outdated data.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used 7 mm threshold for endometrial thickness in assisted reproductive technology lacks strong evidence and stems from outdated data.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}
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.
{"title":"Exposure to endocrine-disrupting chemicals in follicular fluid: implications for assisted reproductive technology outcomes","authors":"Yuxin Jiang , Xiaoyu Long , Yongxiu Hao , Lixue Chen , Tian Tian , Yue Zhao","doi":"10.1016/j.rbmo.2025.105341","DOIUrl":"10.1016/j.rbmo.2025.105341","url":null,"abstract":"<div><h3>Research question</h3><div>Are endocrine-disrupting chemicals (EDC) in follicular fluid associated with assisted reproductive technology (ART) outcomes among women undergoing ART treatment?</div></div><div><h3>Design</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":21134,"journal":{"name":"Reproductive biomedicine online","volume":"52 3","pages":"Article 105341"},"PeriodicalIF":3.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146150472","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: 2025-09-22DOI: 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.
{"title":"Assessing the performance of generative AI chatbots in preimplantation genetic testing: a comparative study of expert evaluations","authors":"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","doi":"10.1016/j.rbmo.2025.105275","DOIUrl":"10.1016/j.rbmo.2025.105275","url":null,"abstract":"<div><h3>Research question</h3><div>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?</div></div><div><h3>Design</h3><div>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.</div></div><div><h3>Results</h3><div>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 (<em>P</em> = 0.027 for simple, <em>P</em> < 0.001 for controversial), and between Gemini and Llama for controversial questions (<em>P</em> < 0.001). No significant performance differences were noted between participating specialists.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":21134,"journal":{"name":"Reproductive biomedicine online","volume":"52 3","pages":"Article 105275"},"PeriodicalIF":3.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146197916","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: 2025-10-22DOI: 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.
{"title":"Low risk of endometrioma infection after oocyte retrieval","authors":"Guillaume Parpex , Mathilde Bourdon , Louis Marcellin , Manon Sorel , Chloé Maignien , Corinne Bordonné , Caroline Charlier , Catherine Patrat , Pietro Santulli , Charles Chapron","doi":"10.1016/j.rbmo.2025.105344","DOIUrl":"10.1016/j.rbmo.2025.105344","url":null,"abstract":"<div><h3>Research Question</h3><div>What is the incidence of endometrioma infections requiring surgical drainage following oocyte retrieval in women with ovarian endometrioma?</div></div><div><h3>Design</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":21134,"journal":{"name":"Reproductive biomedicine online","volume":"52 3","pages":"Article 105344"},"PeriodicalIF":3.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146126171","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: 2025-08-23DOI: 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。
{"title":"Serum magnesium is linked with sperm concentration, motile sperm count and serum anti-Müllerian hormone in infertile men","authors":"Sam Kafai Yahyavi , Benedicte Probst-Drejer , Nadia Nicholine Poulsen , Mads Joon Jorsal , Anders Juul , Niels Jørgensen , Martin Blomberg Jensen","doi":"10.1016/j.rbmo.2025.105232","DOIUrl":"10.1016/j.rbmo.2025.105232","url":null,"abstract":"<div><h3>Research question</h3><div>What is the relationship between serum magnesium, semen quality and reproductive hormones in infertile men?</div></div><div><h3>Design</h3><div>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.</div></div><div><h3>Results</h3><div>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, <em>P</em> = 0.007; 72 million versus 37 million, <em>P</em> = 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, <em>P</em> = 0.023; 23 million versus 11 million, <em>P</em> = 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, <em>P</em> = 0.002), while FSH, LH and inhibin B showed no difference between serum magnesium tertiles. Vitamin D supplementation did not influence serum magnesium.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":21134,"journal":{"name":"Reproductive biomedicine online","volume":"52 3","pages":"Article 105232"},"PeriodicalIF":3.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146137756","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: 2025-12-20DOI: 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.
{"title":"Never a lost cause: can artificial intelligence help embryologists when only poor-quality embryos are available?","authors":"Nina Gidel-Dissler , Guillaume Canat , Pierre Boyer , Daniela Nogueira , Alexandra Boussommier-Calleja","doi":"10.1016/j.rbmo.2025.105439","DOIUrl":"10.1016/j.rbmo.2025.105439","url":null,"abstract":"<div><h3>Research question</h3><div>Can EMBRYOLY, an objectively trained artificial intelligence (AI) system, assist embryologists in embryo assessment when only poor-quality embryos are available for transfer?</div></div><div><h3>Design</h3><div>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.</div></div><div><h3>Results</h3><div>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 (<em>P</em> < 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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":21134,"journal":{"name":"Reproductive biomedicine online","volume":"52 3","pages":"Article 105439"},"PeriodicalIF":3.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146182042","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: 2025-08-14DOI: 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.
{"title":"Patient motivations and barriers in the donation of surplus embryos: a systematic review","authors":"Pilar Jiménez Fernández , Adrian Villalba , Gabriela Llanos , Salvador Mut , Leda Pedelini","doi":"10.1016/j.rbmo.2025.105218","DOIUrl":"10.1016/j.rbmo.2025.105218","url":null,"abstract":"<div><div>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.</div></div>","PeriodicalId":21134,"journal":{"name":"Reproductive biomedicine online","volume":"52 3","pages":"Article 105218"},"PeriodicalIF":3.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145980845","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: 2025-10-03DOI: 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.
{"title":"Reproductive medicine and human embryo research: rethinking risk through the lens of Aristotle’s phronesis","authors":"Maxime Chaillot , Maxence Gaillard , Laurent David , Thomas Freour","doi":"10.1016/j.rbmo.2025.105287","DOIUrl":"10.1016/j.rbmo.2025.105287","url":null,"abstract":"<div><div>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 <em>phronesis</em> – 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.</div></div>","PeriodicalId":21134,"journal":{"name":"Reproductive biomedicine online","volume":"52 3","pages":"Article 105287"},"PeriodicalIF":3.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145967001","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.2025.105340
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.
{"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}
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.
{"title":"Single motherhood by choice in Sweden: survey of unanticipated support needs and financial challenges","authors":"Ylva Af Sandeberg , Claudia Lampic , Agneta Skoog Svanberg , Camilla Stenfelt , Anna-Karin Lind , Gunilla Sydsjö , Evangelia Elenis","doi":"10.1016/j.rbmo.2025.105241","DOIUrl":"10.1016/j.rbmo.2025.105241","url":null,"abstract":"<div><h3>Research question</h3><div>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?</div></div><div><h3>Design</h3><div>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.</div></div><div><h3>Results</h3><div>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.</div></div><div><h3>Conclusions</h3><div>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.</div></div>","PeriodicalId":21134,"journal":{"name":"Reproductive biomedicine online","volume":"52 3","pages":"Article 105241"},"PeriodicalIF":3.5,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146158378","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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