Pub Date : 2025-11-02DOI: 10.1016/j.rbmo.2025.105379
Mizuki Ohashi, Jun Matsubayashi, Kana Sugeta, Yuichiro Yano, Kaori Kitaoka, Takashi Murakami, Shunichiro Tsuji
Research question: Considering the progressively delayed age of pregnancy, what is the current epidemiology of endometriosis in Japan, including its prevalence, incidence and medication patterns, as revealed by a large-scale, real-world dataset?
Design: A descriptive analysis of a health insurance dataset from January 2005 to July 2023. The study included adolescent girls and women aged 15 years or older with available data and at least 2 years of follow-up data. The main outcome measures were the prevalence of endometriosis, the age-specific incidence and the hypothetical cumulative incidences.
Results: Initially, 4,917,037 adolescent girls and women with at least 2 years of follow-up data were identified as potential participants, 285,309 of whom were diagnosed with endometriosis at 15-50 years of age. The prevalence of endometriosis increased consistently from 2006 to 2022, reaching 3.62% in 2022. The highest incidence was observed at 26 years of age. In older groups, the incidence of adenomyosis was higher than that of endometrioma. The hypothetical cumulative incidences were 37.34% for overall endometriosis and 20.08% for endometriosis treated with medications, with increasing trends observed for both conditions.
Conclusions: The hypothetical lifetime incidence of endometriosis by age 50 years was approximately one-third among women, and one-fifth required medication for its treatment, highlighting the need for increased awareness and improved management in clinical settings.
{"title":"Epidemiology of endometriosis based on real-world data in Japan.","authors":"Mizuki Ohashi, Jun Matsubayashi, Kana Sugeta, Yuichiro Yano, Kaori Kitaoka, Takashi Murakami, Shunichiro Tsuji","doi":"10.1016/j.rbmo.2025.105379","DOIUrl":"https://doi.org/10.1016/j.rbmo.2025.105379","url":null,"abstract":"<p><strong>Research question: </strong>Considering the progressively delayed age of pregnancy, what is the current epidemiology of endometriosis in Japan, including its prevalence, incidence and medication patterns, as revealed by a large-scale, real-world dataset?</p><p><strong>Design: </strong>A descriptive analysis of a health insurance dataset from January 2005 to July 2023. The study included adolescent girls and women aged 15 years or older with available data and at least 2 years of follow-up data. The main outcome measures were the prevalence of endometriosis, the age-specific incidence and the hypothetical cumulative incidences.</p><p><strong>Results: </strong>Initially, 4,917,037 adolescent girls and women with at least 2 years of follow-up data were identified as potential participants, 285,309 of whom were diagnosed with endometriosis at 15-50 years of age. The prevalence of endometriosis increased consistently from 2006 to 2022, reaching 3.62% in 2022. The highest incidence was observed at 26 years of age. In older groups, the incidence of adenomyosis was higher than that of endometrioma. The hypothetical cumulative incidences were 37.34% for overall endometriosis and 20.08% for endometriosis treated with medications, with increasing trends observed for both conditions.</p><p><strong>Conclusions: </strong>The hypothetical lifetime incidence of endometriosis by age 50 years was approximately one-third among women, and one-fifth required medication for its treatment, highlighting the need for increased awareness and improved management in clinical settings.</p>","PeriodicalId":21134,"journal":{"name":"Reproductive biomedicine online","volume":" ","pages":"105379"},"PeriodicalIF":3.5,"publicationDate":"2025-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146202594","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}
Unicornuate uterus is a rare Müllerian anomaly associated with infertility and adverse obstetric outcomes. The coexistence of advanced maternal age and diminished ovarian reserve further complicates reproductive management. Herein, we present the case of a 41-year-old woman with diminished ovarian reserve and unicornuate uterus who achieved a live birth following modified induction protocols and assisted reproductive techniques.
CASE PRESENTATION
A 41-year-old woman presented to our clinic in 2023 with primary infertility. Baseline ovarian reserve parameters were as follows: AMH 0.66 ng/mL, FSH 7.9 IU/L, and LH 5.6 IU/L. Semen analysis was within normal limits. The first stimulation cycle was cancelled due to lack of follicular response. In subsequent cycles, the induction protocol was modified, and different medication combinations were used.
During a stimulation in February 2024, an endometrial polyp was identified. In March 2024, hysteroscopic polypectomy was performed. At that time, hysterosalpingography suggested a unilateral fallopian tube, whereas hysteroscopic evaluation confirmed bilateral tubal patency. In May 2024, stimulation resulted in embryo cryopreservation. In January 2025, a single blastocyst transfer led to clinical pregnancy. During follow-up, gestational diabetes was diagnosed and successfully managed with dietary modification. At 36+6 weeks of gestation, an elective cesarean section was performed, delivering a healthy male infant weighing 2120 g.
CONCLUSION
This case demonstrates that in patients with diminished ovarian reserve and uterine anomalies such as unicornuate uterus, modified induction protocols combined with assisted reproductive techniques may lead to successful pregnancy outcomes. Moreover, the discrepancy between hysterosalpingography and hysteroscopic findings highlights the importance of a multidisciplinary approach in infertility evaluation.
{"title":"Live Birth After Assisted Reproductive Techniques in a Patient with Unicornuate Uterus and Diminished Ovarian Reserve: A Case Report","authors":"Esra Oncu , Shamama Behzad , Sinziana Petruta Mihai , Zeynep Ece Utkan Korun , Erkut Attar","doi":"10.1016/j.rbmo.2025.105336","DOIUrl":"10.1016/j.rbmo.2025.105336","url":null,"abstract":"<div><h3>INTRODUCTION</h3><div>Unicornuate uterus is a rare Müllerian anomaly associated with infertility and adverse obstetric outcomes. The coexistence of advanced maternal age and diminished ovarian reserve further complicates reproductive management. Herein, we present the case of a 41-year-old woman with diminished ovarian reserve and unicornuate uterus who achieved a live birth following modified induction protocols and assisted reproductive techniques.</div></div><div><h3>CASE PRESENTATION</h3><div>A 41-year-old woman presented to our clinic in 2023 with primary infertility. Baseline ovarian reserve parameters were as follows: AMH 0.66 ng/mL, FSH 7.9 IU/L, and LH 5.6 IU/L. Semen analysis was within normal limits. The first stimulation cycle was cancelled due to lack of follicular response. In subsequent cycles, the induction protocol was modified, and different medication combinations were used.</div><div>During a stimulation in February 2024, an endometrial polyp was identified. In March 2024, hysteroscopic polypectomy was performed. At that time, hysterosalpingography suggested a unilateral fallopian tube, whereas hysteroscopic evaluation confirmed bilateral tubal patency. In May 2024, stimulation resulted in embryo cryopreservation. In January 2025, a single blastocyst transfer led to clinical pregnancy. During follow-up, gestational diabetes was diagnosed and successfully managed with dietary modification. At 36+6 weeks of gestation, an elective cesarean section was performed, delivering a healthy male infant weighing 2120 g.</div></div><div><h3>CONCLUSION</h3><div>This case demonstrates that in patients with diminished ovarian reserve and uterine anomalies such as unicornuate uterus, modified induction protocols combined with assisted reproductive techniques may lead to successful pregnancy outcomes. Moreover, the discrepancy between hysterosalpingography and hysteroscopic findings highlights the importance of a multidisciplinary approach in infertility evaluation.</div></div>","PeriodicalId":21134,"journal":{"name":"Reproductive biomedicine online","volume":"51 ","pages":"Article 105336"},"PeriodicalIF":3.5,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145532397","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}
To assess the association of sexual dysfunction and IUI success in unexplained infertile women
MATERIALS AND METHODS
The sexual functions of 265 patients presenting to our clinic with unexplained infertility were evaluated using Female Sexual Functioning Index (FSFI), and the association of the results and IUI success was assessed. 15 patients declined to complete the test. 13 patients were excluded from the evaluation because they partially answered the questions. FSFI scores were divided into two groups: <26.5 and >26.5, and IUI success in these groups was evaluated.
RESULTS
Of the 237 patients who completed the FSFI test, 143 (0.60) had a FSFI score <26.5. Of these patients, 23 (16%) were BHCG positive and 20 (13%) had a live birth. The remaining 94 patients had a FSFI score >26.5. Of these patients, 15 (15.9%) were BHCG positive and 13 (13.8%) had a live birth.
CONCLUSIONS
As a result, no difference was found in terms of IUI results (BHCG positivity, live birth, etc.) between patients with sexual dysfunction (FSFI <26.5) and patients with normal sexual function (FSFI>26.5).
IMPACT STATEMENT
The fact that recent studies have generally focused on how the IUI process affects the sexual functions of patients or what changes occur during the IUI process, and the lack of clear information in the literature about the association of sexual function on IUI success, makes our study effective.
{"title":"Is the Presence of Sexual Dysfunction Associated with IUI Success in Patients with Unexplained Infertility?","authors":"Emine Acar , Abdullah Acar , Serap Mutlu Ozcelik Otcu , Cigdem Kilinc","doi":"10.1016/j.rbmo.2025.105330","DOIUrl":"10.1016/j.rbmo.2025.105330","url":null,"abstract":"<div><h3>OBJECTIVE</h3><div>To assess the association of sexual dysfunction and IUI success in unexplained infertile women</div></div><div><h3>MATERIALS AND METHODS</h3><div>The sexual functions of 265 patients presenting to our clinic with unexplained infertility were evaluated using Female Sexual Functioning Index (FSFI), and the association of the results and IUI success was assessed. 15 patients declined to complete the test. 13 patients were excluded from the evaluation because they partially answered the questions. FSFI scores were divided into two groups: <26.5 and >26.5, and IUI success in these groups was evaluated.</div></div><div><h3>RESULTS</h3><div>Of the 237 patients who completed the FSFI test, 143 (0.60) had a FSFI score <26.5. Of these patients, 23 (16%) were BHCG positive and 20 (13%) had a live birth. The remaining 94 patients had a FSFI score >26.5. Of these patients, 15 (15.9%) were BHCG positive and 13 (13.8%) had a live birth.</div></div><div><h3>CONCLUSIONS</h3><div>As a result, no difference was found in terms of IUI results (BHCG positivity, live birth, etc.) between patients with sexual dysfunction (FSFI <26.5) and patients with normal sexual function (FSFI>26.5).</div></div><div><h3>IMPACT STATEMENT</h3><div>The fact that recent studies have generally focused on how the IUI process affects the sexual functions of patients or what changes occur during the IUI process, and the lack of clear information in the literature about the association of sexual function on IUI success, makes our study effective.</div></div>","PeriodicalId":21134,"journal":{"name":"Reproductive biomedicine online","volume":"51 ","pages":"Article 105330"},"PeriodicalIF":3.5,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145532551","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}
This study aimed to investigate the association between the Systemic Immune-Inflammation Index (SII) and ovarian response parameters in women undergoing IVF who exhibit unexpected poor ovarian response (POR).
MATERIALS AND METHODS
A retrospective analysis was conducted on women aged 20–40 years undergoing IVF treatment at Ankara Etlik City Hospital between May 2024 and June 2025. Participants with normal ovarian reserve (AFC ≥5 and AMH ≥1.2 ng/mL) were grouped according to their ovarian response: unexpected poor responders (n=26) and normal responders (n=53). SII was calculated using peripheral blood neutrophil, lymphocyte, and platelet counts. Ovarian response was evaluated by Follicular Output Rate (FORT), Follicle-Oocyte Index (FOI), and Ovarian Sensitivity Index (OSI). Correlations between SII and ovarian response parameters were analyzed, and logistic regression was used to identify predictors of unexpected POR.
RESULTS
There was no significant difference in SII levels between women with low and normal AMH (624.75 ± 536.80 vs. 808.05 ± 973.28, p=0.103). However, women with unexpected poor ovarian response had significantly lower SII levels compared to normal responders (376.19 ± 180.57 vs. 1010.99 ± 1148.57, p=0.008). No significant correlations were found between SII and individual ovarian response parameters such as FORT, FOI, and OSI. Multivariate logistic regression showed that lower SII values were independently associated with a unexpected poor ovarian response, with each unit decrease in SII linked to a 52.7% increase in the odds of being a poor responder (OR = 0.473; 95% CI: 0.313–0.723; p < 0.001).
CONCLUSIONS
Lower systemic immune-inflammation levels are linked to unexpected poor ovarian response in women with normal ovarian reserve. Assessing SII may help personalize IVF treatments by identifying patients at risk of suboptimal response. Further studies are needed to confirm these findings.
IMPACT STATEMENT
Contrary to the expectation that higher systemic inflammation impairs ovarian response, our findings reveal that lower SII levels are linked to suboptimal ovarian responsiveness in women with normal ovarian reserve. This may suggest that a balanced level of systemic immune activation is essential for effective folliculogenesis and optimal oocyte yield. These results underscore the importance of a finely tuned immune-inflammatory environment in ovarian function and highlight systemic inflammation as a potential contributor to unexpected poor ovarian response.
目的：本研究旨在探讨体外受精（IVF）中出现意外卵巢反应差（POR）的女性的全身免疫炎症指数（SII）与卵巢反应参数之间的关系。材料与方法回顾性分析2024年5月至2025年6月在安卡拉Etlik市医院接受体外受精治疗的20-40岁女性。卵巢储备正常（AFC≥5和AMH≥1.2 ng/mL）的参与者根据卵巢反应分为意外不良反应者（n=26）和正常反应者（n=53）。通过外周血中性粒细胞、淋巴细胞和血小板计数计算SII。通过卵泡输出率（FORT）、卵泡-卵母细胞指数（FOI）和卵巢敏感性指数（OSI）评估卵巢反应。分析SII与卵巢反应参数之间的相关性，并使用逻辑回归来确定意外POR的预测因素。结果低AMH组与正常AMH组SII水平差异无统计学意义（624.75±536.80∶808.05±973.28,p=0.103）。然而，与正常应答者相比，卵巢反应意外不良的女性SII水平显著降低（376.19±180.57比1010.99±1148.57,p=0.008）。SII与个体卵巢反应参数（如FORT、FOI和OSI）之间无显著相关性。多因素logistic回归显示，较低的SII值与意料之外的卵巢不良反应独立相关，SII每降低一个单位，不良反应的几率增加52.7% （OR = 0.473;95% CI: 0.313-0.723; p < 0.001）。结论在卵巢储备正常的女性中，较慢的全身免疫炎症水平与意料之外的较差的卵巢反应有关。评估SII可以通过识别有次优反应风险的患者来帮助个性化试管婴儿治疗。需要进一步的研究来证实这些发现。影响声明：与预期较高的全身性炎症会损害卵巢反应相反，我们的研究结果显示，在卵巢储备正常的女性中，较低的SII水平与卵巢反应不佳有关。这可能表明，平衡水平的全身免疫激活对于有效的卵泡生成和最佳的卵母细胞产量至关重要。这些结果强调了精细调节免疫炎症环境对卵巢功能的重要性，并强调了全身性炎症是卵巢意外不良反应的潜在因素。
{"title":"Unexpected Poor Ovarian Response in IVF: Does Systemic Inflammation Matter?","authors":"Caner Kose , Busra Korpe , Dicle Mutel Gurer , Inci Kahyaoglu , Caganay Soysal","doi":"10.1016/j.rbmo.2025.105328","DOIUrl":"10.1016/j.rbmo.2025.105328","url":null,"abstract":"<div><h3>OBJECTIVE</h3><div>This study aimed to investigate the association between the Systemic Immune-Inflammation Index (SII) and ovarian response parameters in women undergoing IVF who exhibit unexpected poor ovarian response (POR).</div></div><div><h3>MATERIALS AND METHODS</h3><div>A retrospective analysis was conducted on women aged 20–40 years undergoing IVF treatment at Ankara Etlik City Hospital between May 2024 and June 2025. Participants with normal ovarian reserve (AFC ≥5 and AMH ≥1.2 ng/mL) were grouped according to their ovarian response: unexpected poor responders (n=26) and normal responders (n=53). SII was calculated using peripheral blood neutrophil, lymphocyte, and platelet counts. Ovarian response was evaluated by Follicular Output Rate (FORT), Follicle-Oocyte Index (FOI), and Ovarian Sensitivity Index (OSI). Correlations between SII and ovarian response parameters were analyzed, and logistic regression was used to identify predictors of unexpected POR.</div></div><div><h3>RESULTS</h3><div>There was no significant difference in SII levels between women with low and normal AMH (624.75 ± 536.80 vs. 808.05 ± 973.28, p=0.103). However, women with unexpected poor ovarian response had significantly lower SII levels compared to normal responders (376.19 ± 180.57 vs. 1010.99 ± 1148.57, p=0.008). No significant correlations were found between SII and individual ovarian response parameters such as FORT, FOI, and OSI. Multivariate logistic regression showed that lower SII values were independently associated with a unexpected poor ovarian response, with each unit decrease in SII linked to a 52.7% increase in the odds of being a poor responder (OR = 0.473; 95% CI: 0.313–0.723; p < 0.001).</div></div><div><h3>CONCLUSIONS</h3><div>Lower systemic immune-inflammation levels are linked to unexpected poor ovarian response in women with normal ovarian reserve. Assessing SII may help personalize IVF treatments by identifying patients at risk of suboptimal response. Further studies are needed to confirm these findings.</div></div><div><h3>IMPACT STATEMENT</h3><div>Contrary to the expectation that higher systemic inflammation impairs ovarian response, our findings reveal that lower SII levels are linked to suboptimal ovarian responsiveness in women with normal ovarian reserve. This may suggest that a balanced level of systemic immune activation is essential for effective folliculogenesis and optimal oocyte yield. These results underscore the importance of a finely tuned immune-inflammatory environment in ovarian function and highlight systemic inflammation as a potential contributor to unexpected poor ovarian response.</div></div>","PeriodicalId":21134,"journal":{"name":"Reproductive biomedicine online","volume":"51 ","pages":"Article 105328"},"PeriodicalIF":3.5,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145532569","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}
In this study, it was aimed to determine the effects of the addition of cumulus cell extracellular matrix (CCEMC) to the culture medium used during conventional sperm preparation techniques used in assisted reproductive treatment approaches on routine sperm parameters, fertilisation capacity and sperm DNA fragmentation and to perform comparative analyses of protocols used in sperm separation techniques.
MATERIALS AND METHODS
Ejaculate samples from 30 normozoospermic male patients and oocytes collected on the same day from their spouses were used in the study. The semen sample from each patient was divided into 5 equal volumes, and 5 different groups were formed as control, density gradient (DG), density gradient + cumulus cell extracellular matrix (DG+K), swim-up (SU), and swim-up + cumulus cell extracellular matrix (SU+K).
RESULTS
According to the results obtained, sperm concentration was significantly lower in all experimental groups compared to the control group, and there was a statistically significant difference, especially in the swim-up group. Motility rate was highest in the (SU+K) group, and it was also significantly increased in the (DG+K) and SU groups. TPMSS value decreased significantly in the SU and (SU+K) groups. There was no significant difference between the groups in terms of morphology. It was observed that the viability rate was significantly increased in the groups to which CCECM was added, and this significant increase continued in all experimental groups compared to the control group. ARIC scores indicating acrosomal reaction capacity were also significantly higher in the (DG+K) and (SU+K) groups. In addition, DFI values reflecting DNA damage were significantly lower in these two groups, indicating that CCECM contribution may protect DNA integrity.
CONCLUSIONS
As a result, it was determined that the addition of CCECM to the culture medium used during different sperm washing techniques, especially when used in combination with the swim-up method, had an effect on sperm quality and efficiency. We think that the applied method will be an applicable technique for male infertility treatment in the assisted reproductive treatment approach.
IMPACT STATEMENT
This study provides a novel sperm preparation approach using cumulus cell extracellular matrix, which may enhance fertilization potential and reduce sperm DNA damage in assisted reproductive technologies.
{"title":"Effects of Sperm Preparation Protocols Using Cumulus Cell Extracellular Matrix on Semen Parameters","authors":"Sabina Aghayeva , Duygu Gok-Yurtseven , Cihan Cakir , Isil Kasapoglu","doi":"10.1016/j.rbmo.2025.105301","DOIUrl":"10.1016/j.rbmo.2025.105301","url":null,"abstract":"<div><h3>OBJECTIVE</h3><div>In this study, it was aimed to determine the effects of the addition of cumulus cell extracellular matrix (CCEMC) to the culture medium used during conventional sperm preparation techniques used in assisted reproductive treatment approaches on routine sperm parameters, fertilisation capacity and sperm DNA fragmentation and to perform comparative analyses of protocols used in sperm separation techniques.</div></div><div><h3>MATERIALS AND METHODS</h3><div>Ejaculate samples from 30 normozoospermic male patients and oocytes collected on the same day from their spouses were used in the study. The semen sample from each patient was divided into 5 equal volumes, and 5 different groups were formed as control, density gradient (DG), density gradient + cumulus cell extracellular matrix (DG+K), swim-up (SU), and swim-up + cumulus cell extracellular matrix (SU+K).</div></div><div><h3>RESULTS</h3><div>According to the results obtained, sperm concentration was significantly lower in all experimental groups compared to the control group, and there was a statistically significant difference, especially in the swim-up group. Motility rate was highest in the (SU+K) group, and it was also significantly increased in the (DG+K) and SU groups. TPMSS value decreased significantly in the SU and (SU+K) groups. There was no significant difference between the groups in terms of morphology. It was observed that the viability rate was significantly increased in the groups to which CCECM was added, and this significant increase continued in all experimental groups compared to the control group. ARIC scores indicating acrosomal reaction capacity were also significantly higher in the (DG+K) and (SU+K) groups. In addition, DFI values reflecting DNA damage were significantly lower in these two groups, indicating that CCECM contribution may protect DNA integrity.</div></div><div><h3>CONCLUSIONS</h3><div>As a result, it was determined that the addition of CCECM to the culture medium used during different sperm washing techniques, especially when used in combination with the swim-up method, had an effect on sperm quality and efficiency. We think that the applied method will be an applicable technique for male infertility treatment in the assisted reproductive treatment approach.</div></div><div><h3>IMPACT STATEMENT</h3><div>This study provides a novel sperm preparation approach using cumulus cell extracellular matrix, which may enhance fertilization potential and reduce sperm DNA damage in assisted reproductive technologies.</div></div>","PeriodicalId":21134,"journal":{"name":"Reproductive biomedicine online","volume":"51 ","pages":"Article 105301"},"PeriodicalIF":3.5,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145532939","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}
Hyperinsulinemia as a result of IR is seen in 50-75% of patients with PCOS and is among the main etiologic mechanisms of ovulatory dysfunction and hyperandrogenism. Adipokines are polypeptide biological molecules involved in energy metabolism, fertilization, inflammatory processes and endocrine regulation. It is known that changes in adipokine secretion affect oocyte quality, ovulation, hormonal balance and general metabolic processes and are closely related to infertility. The aim of this study was to evaluate whether the presence of IR in women with PCOS is associated with adipokine imbalance and increased apoptosis in the follicular microenvironment and to investigate the possible effects of these biological changes on embryo quality and clinical outcomes.
MATERIALS AND METHODS
A total of 60 female patients were included in the study and the patients were divided into 3 groups as Control group (n=20), group with PCOS and IR (PCOS+IR, n=20) and group without PCOS and IR (PCOS-IR, n=20). Adipokine (CTRP3, adiponectin, leptin, visfatin) amounts, fasting insulin, fasting glucose levels, HOMA-IR values, FSHR/LHR (follicle stimulating hormone/ luteinizing hormone) ratios in serum, follicular fluid and cumulus cell samples obtained from the patients, caspase-3, IL-6 (interleukin-6), IGF-1 (insulin-like growth factor) values were statistically analyzed by ELISA and the results were evaluated in relation to embryology parameters and clinical outcomes
RESULTS
In the PCOS+IR group, CTRP3, adiponectin, IGF-1, FSHR, and LHR levels decreased, while leptin, visfatin, IL-6, and Caspase-3 increased. These alterations negatively affected embryo development, leading to reduced MII oocyte, fertilization, cleavage, and blastocyst rates, and significantly impaired blastocyst quality scores.
CONCLUSIONS
In conclusion, in PCOS women with IR (PCOS+IR) and PCOS women without IR (PCOS-IR), significant differences were found in adipokine levels in follicular fluid, serum and cumulus cells compared to the control group. It has also been scientifically shown that increased apoptotic activation negatively affects embryologic parameters and clinical outcomes.
IMPACT STATEMENT
Data demonstrate that IR is a direct determinant not only of metabolic but also of reproductive outcomes, highlighting the importance of considering the presence of IR in personalized treatment approaches. It is thought that controlling IR may improve fertility outcomes in women with PCOS.
{"title":"Insulin Resistance in PCOS: Impact on Follicular Microenvironment, Adipokines, Embryo Development & Clinical Outcomes","authors":"Selahattin Emiroğlu , Cihan Cakir , Isil Kasapoglu , Kiper Aslan , Gurkan Uncu","doi":"10.1016/j.rbmo.2025.105303","DOIUrl":"10.1016/j.rbmo.2025.105303","url":null,"abstract":"<div><h3>OBJECTIVE</h3><div>Hyperinsulinemia as a result of IR is seen in 50-75% of patients with PCOS and is among the main etiologic mechanisms of ovulatory dysfunction and hyperandrogenism. Adipokines are polypeptide biological molecules involved in energy metabolism, fertilization, inflammatory processes and endocrine regulation. It is known that changes in adipokine secretion affect oocyte quality, ovulation, hormonal balance and general metabolic processes and are closely related to infertility. The aim of this study was to evaluate whether the presence of IR in women with PCOS is associated with adipokine imbalance and increased apoptosis in the follicular microenvironment and to investigate the possible effects of these biological changes on embryo quality and clinical outcomes.</div></div><div><h3>MATERIALS AND METHODS</h3><div>A total of 60 female patients were included in the study and the patients were divided into 3 groups as Control group (n=20), group with PCOS and IR (PCOS+IR, n=20) and group without PCOS and IR (PCOS-IR, n=20). Adipokine (CTRP3, adiponectin, leptin, visfatin) amounts, fasting insulin, fasting glucose levels, HOMA-IR values, FSHR/LHR (follicle stimulating hormone/ luteinizing hormone) ratios in serum, follicular fluid and cumulus cell samples obtained from the patients, caspase-3, IL-6 (interleukin-6), IGF-1 (insulin-like growth factor) values were statistically analyzed by ELISA and the results were evaluated in relation to embryology parameters and clinical outcomes</div></div><div><h3>RESULTS</h3><div>In the PCOS+IR group, CTRP3, adiponectin, IGF-1, FSHR, and LHR levels decreased, while leptin, visfatin, IL-6, and Caspase-3 increased. These alterations negatively affected embryo development, leading to reduced MII oocyte, fertilization, cleavage, and blastocyst rates, and significantly impaired blastocyst quality scores.</div></div><div><h3>CONCLUSIONS</h3><div>In conclusion, in PCOS women with IR (PCOS+IR) and PCOS women without IR (PCOS-IR), significant differences were found in adipokine levels in follicular fluid, serum and cumulus cells compared to the control group. It has also been scientifically shown that increased apoptotic activation negatively affects embryologic parameters and clinical outcomes.</div></div><div><h3>IMPACT STATEMENT</h3><div>Data demonstrate that IR is a direct determinant not only of metabolic but also of reproductive outcomes, highlighting the importance of considering the presence of IR in personalized treatment approaches. It is thought that controlling IR may improve fertility outcomes in women with PCOS.</div></div>","PeriodicalId":21134,"journal":{"name":"Reproductive biomedicine online","volume":"51 ","pages":"Article 105303"},"PeriodicalIF":3.5,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145532941","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 : 2025-11-01DOI: 10.1016/j.rbmo.2025.105307
Gonca Ozten Dere , Onur Ince , Ali Can Gunes , Lale Karakoc Sokmensuer , Neslihan Coskun Akcay , Isil Damla Dinc , Fatma Caner Cabukoglu , Sezcan Mumusoglu
OBJECTIVE
To determine whether serum estradiol (E2) measured before, progesterone (P) initiation influences ongoing pregnancy rate (OPR) in hormone-replacement frozen-blastocyst transfer (HRT-FET) cycles.
MATERIALS AND METHODS
Retrospective cohort of the first HRT-FET cycles performed between January 2022 and March 2025 at a single IVF center. Women received oral estradiol valerate 6 mg/day for 9–18 days; serum E2 was sampled before P initiation. Embryo transfer (ET) was scheduled for day 6 of P exposure. PGT cycles were excluded. OPR was defined as the presence of fetal cardiac activity. Pregnancy loss was defined as β-hCG >5 IU/L without ongoing pregnancy. Logistic regression estimated adjusted odds ratios (aORs) for OPR, controlling for age, body mass index (BMI), parity, number and grade of blastocysts transferred, and serum P4 measured on or one day prior to ET. Continuous E2 effects were modelled per 100 pg/mL increment.
RESULTS
A total of 209 women were included (median female age 32 years; median BMI 24.74 kg/m²). Serum E2 levels were divided into quartiles (Table 1). Crude OPR numerically increased across ascending quartiles but did not reach statistical significance (Table 1). After adjusting for confounders, the highest versus lowest E2 quartile remained non-significant (aOR 1.93 [0.78–4.74]; p = 0.153). Multivariate continuous modeling demonstrated a borderline significant positive association between serum E2 and OPR (aOR 1.33 [1.00–1.75]; p = 0.047). In contrast, higher serum E2 tended to be associated with a lower risk of pregnancy loss, although this association was not statistically significant (aOR 0.69 [0.45–1.07]; p = 0.094). Higher ET-day serum P4 (aOR 1.06 per +10 ng/mL; p = 0.002) and poor blastocyst grade (aOR 0.19 [0.06–0.55] compared to excellent grade) were independently associated with OPR, whereas female age, BMI, parity, and number of embryos transferred were not.
CONCLUSIONS
In HRT-FET cycles, serum E2 measured immediately before P initiation does not appear to be a robust determinant of ongoing pregnancy when analysed categorically and demonstrates only a borderline linear association after full adjustment. These findings suggest that moderate fluctuations in E2 levels before P initiation may have limited clinical relevance when luteal P administration and embryo quality are optimized.
IMPACT STATEMENT
Routine measurement of E2 immediately before P initiation appears to provide limited benefit in HRT-FET cycles, and its omission is unlikely to substantially impact reproductive outcomes.
目的探讨激素替代冷冻囊胚移植（HRT-FET）周期中，起始孕酮(P)前血清雌二醇（E2）测定对持续妊娠率（OPR）的影响。材料和方法回顾性队列研究在2022年1月至2025年3月在单个IVF中心进行的第一次HRT-FET周期。女性口服戊酸雌二醇6毫克/天，持续9-18天；P起始前抽取血清E2。胚胎移植（ET）定于P暴露后第6天进行。排除PGT周期。OPR定义为胎儿心脏活动的存在。妊娠损失定义为未持续妊娠的β-hCG >；5 IU/L。Logistic回归估计了OPR的校正优势比（aORs），控制了年龄、体重指数（BMI）、胎次、转移囊胚数量和分级，以及在ET前一天或一天测量的血清P4。每增加100 pg/mL，模拟了E2的持续效应。结果共纳入209例女性，中位年龄32岁，中位BMI为24.74 kg/m²。血清E2水平分为四分位数（表1）。粗OPR在上升的四分位数上增加，但没有达到统计学意义（表1）。在调整混杂因素后，最高和最低E2四分位数仍然不显著（aOR 1.93 [0.78-4.74]; p = 0.153）。多变量连续模型显示血清E2与OPR呈正相关（aOR为1.33 [1.00-1.75];p = 0.047）。相比之下，较高的血清E2往往与较低的流产风险相关，尽管这种关联没有统计学意义（aOR 0.69 [0.45-1.07]; p = 0.094）。较高的ET-day血清P4 （aOR 1.06 / +10 ng/mL; p = 0.002）和较差的囊胚分级（aOR 0.19[0.06-0.55]与优良分级相比）与OPR独立相关，而女性年龄、BMI、胎次和移植胚胎数量与OPR无关。结论：在HRT-FET周期中，在P启动前立即测量的血清E2在分类分析时似乎不是持续妊娠的强大决定因素，并且在完全调整后仅显示出边缘线性关联。这些发现表明，当黄体P给药和胚胎质量优化时，P起始前E2水平的适度波动可能具有有限的临床相关性。影响声明：在启动P前立即常规测量E2似乎对HRT-FET周期的益处有限，其省略不太可能对生殖结果产生实质性影响。
{"title":"Effect of Serum Estradiol Levels Before Progesterone Initiation on Reproductive Outcomes in HRT-FET Cycles","authors":"Gonca Ozten Dere , Onur Ince , Ali Can Gunes , Lale Karakoc Sokmensuer , Neslihan Coskun Akcay , Isil Damla Dinc , Fatma Caner Cabukoglu , Sezcan Mumusoglu","doi":"10.1016/j.rbmo.2025.105307","DOIUrl":"10.1016/j.rbmo.2025.105307","url":null,"abstract":"<div><h3>OBJECTIVE</h3><div>To determine whether serum estradiol (E2) measured before, progesterone (P) initiation influences ongoing pregnancy rate (OPR) in hormone-replacement frozen-blastocyst transfer (HRT-FET) cycles.</div></div><div><h3>MATERIALS AND METHODS</h3><div>Retrospective cohort of the first HRT-FET cycles performed between January 2022 and March 2025 at a single IVF center. Women received oral estradiol valerate 6 mg/day for 9–18 days; serum E2 was sampled before P initiation. Embryo transfer (ET) was scheduled for day 6 of P exposure. PGT cycles were excluded. OPR was defined as the presence of fetal cardiac activity. Pregnancy loss was defined as β-hCG >5 IU/L without ongoing pregnancy. Logistic regression estimated adjusted odds ratios (aORs) for OPR, controlling for age, body mass index (BMI), parity, number and grade of blastocysts transferred, and serum P4 measured on or one day prior to ET. Continuous E2 effects were modelled per 100 pg/mL increment.</div></div><div><h3>RESULTS</h3><div>A total of 209 women were included (median female age 32 years; median BMI 24.74 kg/m²). Serum E2 levels were divided into quartiles (Table 1). Crude OPR numerically increased across ascending quartiles but did not reach statistical significance (Table 1). After adjusting for confounders, the highest versus lowest E2 quartile remained non-significant (aOR 1.93 [0.78–4.74]; p = 0.153). Multivariate continuous modeling demonstrated a borderline significant positive association between serum E2 and OPR (aOR 1.33 [1.00–1.75]; p = 0.047). In contrast, higher serum E2 tended to be associated with a lower risk of pregnancy loss, although this association was not statistically significant (aOR 0.69 [0.45–1.07]; p = 0.094). Higher ET-day serum P4 (aOR 1.06 per +10 ng/mL; p = 0.002) and poor blastocyst grade (aOR 0.19 [0.06–0.55] compared to excellent grade) were independently associated with OPR, whereas female age, BMI, parity, and number of embryos transferred were not.</div></div><div><h3>CONCLUSIONS</h3><div>In HRT-FET cycles, serum E2 measured immediately before P initiation does not appear to be a robust determinant of ongoing pregnancy when analysed categorically and demonstrates only a borderline linear association after full adjustment. These findings suggest that moderate fluctuations in E2 levels before P initiation may have limited clinical relevance when luteal P administration and embryo quality are optimized.</div></div><div><h3>IMPACT STATEMENT</h3><div>Routine measurement of E2 immediately before P initiation appears to provide limited benefit in HRT-FET cycles, and its omission is unlikely to substantially impact reproductive outcomes.</div></div>","PeriodicalId":21134,"journal":{"name":"Reproductive biomedicine online","volume":"51 ","pages":"Article 105307"},"PeriodicalIF":3.5,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145532953","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}
To assess the effectiveness of luteal phase support in primary and secondary infertile women undergoing IUI.
MATERIALS AND METHODS
This retrospective cohort study included 258 IUI cycles performed with CC for unexplained infertility between April 2021 and December 2024. Of these patients, 141 were primary infertile and 116 were secondary infertile. Of the primary infertile group, 69 received luteal phase support, while 72 did not. Of the secondary infertile group, 59 received luteal phase support, while 57 did not. In our clinic, we use 400 mg of natural micronized progesterone vaginally as a luteal phase support protocol.
RESULTS
In the primary infertile patient group, the live birth rate was significantly higher in the luteal phase support group compared to the control group (14.08% vs. 8.4%). The clinical pregnancy rate (20% vs. 8.4%) and the ongoing pregnancy rate (17.14% vs. 8.4%) were also significantly higher in the luteal phase support group. In the secondary infertile patient group, the live birth rate was significantly higher in the no luteal phase support group compared to the luteal phase support group (23.7% vs. 15.7%). The clinical pregnancy rate (28.07% vs. 16.9%) and the ongoing pregnancy rate (26.3% vs. 16.9%) were also significantly higher in the no luteal phase support group. In within-group comparisons, there were no significant differences in gestational age, mode of delivery, ectopic pregnancy rate, or abortion rate. Additionally, there were no significant differences in birth weight or birth length between the two groups.
CONCLUSIONS
When patients were divided into primary and secondary infertility groups in IUI cycles performed with clomiphene citrate, luteal support with vaginal progesterone significantly improved the live birth rate but did not affect neonatal outcomes. In the secondary infertility group, luteal phase support had no effect, and the live birth rate was significantly higher in the group without luteal phase support.
IMPACT STATEMENT
We have demonstrated with this retrospective cohort experience that further studies are needed regarding the homogeneous distribution of primary and secondary infertile patient groups in studies of luteal phase support in patients undergoing IUI due to unexplained infertility in the literature.
目的评价黄体期支持在原发性和继发性不孕妇女人工授精中的效果。材料和方法本回顾性队列研究纳入了2021年4月至2024年12月期间因不明原因不孕症使用CC进行的258次IUI周期。其中141例为原发性不孕症，116例为继发性不孕症。在原发性不孕症组中，69人接受了黄体期支持，72人没有。继发性不孕组59例接受黄体期支持，57例未接受黄体期支持。在我们的诊所，我们使用400mg天然微孕酮阴道作为黄体期支持方案。结果原发性不孕症患者组黄体期支持组活产率明显高于对照组（14.08% vs. 8.4%）。黄体期支持组的临床妊娠率（20% vs. 8.4%）和持续妊娠率（17.14% vs. 8.4%）也显著高于黄体期支持组。在继发性不孕症患者组中，无黄体期支持组的活产率明显高于黄体期支持组（23.7% vs. 15.7%）。无黄体期支持组的临床妊娠率（28.07% vs. 16.9%）和持续妊娠率（26.3% vs. 16.9%）也显著高于无黄体期支持组。在组内比较中，在胎龄、分娩方式、异位妊娠率或流产率方面没有显著差异。此外，两组婴儿的出生体重和出生长度没有显著差异。结论应用枸橼酸克罗米芬进行IUI周期，将患者分为原发性和继发不孕症组，阴道孕酮支持黄体可显著提高活产率，但不影响新生儿结局。继发性不孕症组黄体期支持无效，无黄体期支持组活产率明显高于无黄体期支持组。影响声明：我们通过回顾性队列研究表明，在文献中不明原因不孕的IUI患者的黄体期支持研究中，需要进一步研究原发性和继发性不孕患者组的均匀分布。
{"title":"Is There a Difference in the Success of Luteal Phase Support in Patients with Primary and Secondary Infertility?","authors":"Emine Acar , Abdullah Acar , Serap Mutlu Ozcelik Otcu , Cigdem Kilinc","doi":"10.1016/j.rbmo.2025.105308","DOIUrl":"10.1016/j.rbmo.2025.105308","url":null,"abstract":"<div><h3>OBJECTIVE</h3><div>To assess the effectiveness of luteal phase support in primary and secondary infertile women undergoing IUI.</div></div><div><h3>MATERIALS AND METHODS</h3><div>This retrospective cohort study included 258 IUI cycles performed with CC for unexplained infertility between April 2021 and December 2024. Of these patients, 141 were primary infertile and 116 were secondary infertile. Of the primary infertile group, 69 received luteal phase support, while 72 did not. Of the secondary infertile group, 59 received luteal phase support, while 57 did not. In our clinic, we use 400 mg of natural micronized progesterone vaginally as a luteal phase support protocol.</div></div><div><h3>RESULTS</h3><div>In the primary infertile patient group, the live birth rate was significantly higher in the luteal phase support group compared to the control group (14.08% vs. 8.4%). The clinical pregnancy rate (20% vs. 8.4%) and the ongoing pregnancy rate (17.14% vs. 8.4%) were also significantly higher in the luteal phase support group. In the secondary infertile patient group, the live birth rate was significantly higher in the no luteal phase support group compared to the luteal phase support group (23.7% vs. 15.7%). The clinical pregnancy rate (28.07% vs. 16.9%) and the ongoing pregnancy rate (26.3% vs. 16.9%) were also significantly higher in the no luteal phase support group. In within-group comparisons, there were no significant differences in gestational age, mode of delivery, ectopic pregnancy rate, or abortion rate. Additionally, there were no significant differences in birth weight or birth length between the two groups.</div></div><div><h3>CONCLUSIONS</h3><div>When patients were divided into primary and secondary infertility groups in IUI cycles performed with clomiphene citrate, luteal support with vaginal progesterone significantly improved the live birth rate but did not affect neonatal outcomes. In the secondary infertility group, luteal phase support had no effect, and the live birth rate was significantly higher in the group without luteal phase support.</div></div><div><h3>IMPACT STATEMENT</h3><div>We have demonstrated with this retrospective cohort experience that further studies are needed regarding the homogeneous distribution of primary and secondary infertile patient groups in studies of luteal phase support in patients undergoing IUI due to unexplained infertility in the literature.</div></div>","PeriodicalId":21134,"journal":{"name":"Reproductive biomedicine online","volume":"51 ","pages":"Article 105308"},"PeriodicalIF":3.5,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145532954","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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