Reproductive biomedicine online最新文献

{"title":"Does Oocyte Morphology Differ in Polycystic Ovary Syndrome Patients During IVF Cycles?: A Preliminary Study","authors":"Sebnem Alanya Tosun ,&nbsp;Sedanur Yilmaz Dogan ,&nbsp;Ayse Firuze Biyik ,&nbsp;Emine Aksoy ,&nbsp;Tugba Zengin ,&nbsp;Recep Erin ,&nbsp;Omur Erden ,&nbsp;Kubra Baki Erin","doi":"10.1016/j.rbmo.2025.105310","DOIUrl":"10.1016/j.rbmo.2025.105310","url":null,"abstract":"<div><h3>OBJECTIVE</h3><div>The purpose of this study was to determine the impact of polycystic ovary syndrome on oocyte morphology and fertility outcome in invitro fertilisation (IVF) cycles undergoing ovarian stimulation with a gonadotropin antagonist protocol.</div></div><div><h3>MATERIALS AND METHODS</h3><div>This retrospective study was conducted between June-2024 and June-2025 in a tertiary university hospital's IVF clinic with totally 67 IVF cycles of infertile women aged between 20 and 38 years who were applied antagonist gonadotropin stimulation procedure due to the unexplained infertility or polycystic ovary syndrome. All oocytes were individually classified and checked blindly by two different experienced senior embryologists. The oocyte morphology were recorded with the use of inverted microscope at 3200 magnification (Nikon Tokyo, Japan) and oocytes classified for morphological features as follows: empty zona, elliptical shape, vacuole, flat polar body, fragmented polar body, perivitelline septa, perivitelline debris, central granulation, dense central granulation, inclusion body, thick zona pellucida, smooth endoplasmic reticulum, resistance by oolemma. Fertilization was defined in oocytes when two pronuclei and two polar bodies were observed. The ratio of oocytes with specific morphological abnormalities was calculated and compared between groups.</div></div><div><h3>RESULTS</h3><div>Groups with and without polycystic ovary syndrome had similar baseline demographic and clinical characteristics including age, number of previous cycles, thyroid stimulating hormone, prolactin and follicle stimulating hormone tests (p &gt;.05, Table 1). Although, average duration of ovarian stimulation day was slightly higher in PCOS group, mean total gonadotropin dose used was similar between groups (Table 1). Peak estradiol level on the day of trigger, mean numbers of total and mature oocytes (MII) were significantly higher in the PCOS group (p &lt;.05, Table 1). Majority of specific oocyte morphological abnormalities were significantly higher in PCOS group (Table 1).</div></div><div><h3>CONCLUSIONS</h3><div>In conclusion, although PCOS patients had higher numbers of MII oocytes, PCOS was associated with a higher rate of abnormal oocytes morphologies.</div></div><div><h3>IMPACT STATEMENT</h3><div>Future studies using further oocyte quality assessment methods and prospective observational studies including live-birth rate should be designed.</div></div>","PeriodicalId":21134,"journal":{"name":"Reproductive biomedicine online","volume":"51 ","pages":"Article 105310"},"PeriodicalIF":3.5,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145532855","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}

{"title":"Comparative Molecular Profiling of Exosomes from First-Trimester Human Placental Organoids and Explants","authors":"Kerem Dalgic ,&nbsp;Melike Ucak ,&nbsp;Arda Inanc ,&nbsp;Gizem Melis Kargin ,&nbsp;Mert Turgal ,&nbsp;Ozgur Oktem ,&nbsp;Bora Akgun ,&nbsp;Ciler Celik-Ozenci","doi":"10.1016/j.rbmo.2025.105294","DOIUrl":"10.1016/j.rbmo.2025.105294","url":null,"abstract":"<div><h3>OBJECTIVE</h3><div>Exosomes are extracellular vesicles critical for intercellular communication, particularly in maternal–fetal signaling. This study aimed to isolate and characterize exosomes from human placenta organoids (HPOs) and compare their molecular profiles to those of exosomes from first-trimester placental explants.</div></div><div><h3>MATERIALS AND METHODS</h3><div>First-trimester placenta tissues (6–9 weeks; n = 9) were collected with informed consent (Ethics No:2025.107.IRB2.052). Villous explants were cultured at 24/48h in DMEM/F12+10% exosome-free FBS+1% penicillin-streptomycin, while HPOs were formed via cytotrophoblast cells embedded in Matrigel and maintained in trophoblast organoid medium (TOM). Explants were immunostained for CK7, Ki67, β-hCG, and vimentin; HPOs were evaluated via immunofluorescence (CK7, TP63, β-hCG, Ki67, E-cadherin), and β-hCG secretion was measured by ELISA. Conditioned media from explants and HPOs (day 3/8) were collected for exosome isolation by ultracentrifugation (100,000 × g, 2h, 4°C). Exosomes were analyzed by NTA, TEM, Western blot [CD63 (general), PLAP (placenta-specific), β-actin (negative) exosome markers], and RT-qPCR (miR-517a-3p, miR-519d-3p). PLAP expression in exosomes from term explants served as a positive control. Molecular fingerprints were assessed by surface-enhanced Raman spectroscopy (SERS). Statistical analysis included Mann-Whitney U test with Bonferroni correction for SERS data (p&lt; 0.001) and Kruskal-Wallis test for non-parametric NTA results (p&lt; 0.05).</div></div><div><h3>RESULTS</h3><div>Exosomes from both groups displayed characteristic morphology, marker expression, and size range (30–150 nm). Explant-derived exosomes had significantly higher particle concentrations (9.33 × 10¹⁰±8.71 × 10⁹ at 24h; 9.04 × 10¹⁰±6.72 × 10⁹ at 48h) than HPO-derived exosomes (3.19 × 10¹⁰±1.60 × 10⁹ at day 3; 3.71 × 10¹⁰±2.64 × 10⁹ at day 8) (p&lt; 0.05). CD63 was detected in exosomes for both groups; PLAP and β-actin were absent. TEM confirmed typical exosome morphology. Placenta-specific miRNAs were expressed in both groups. SERS revealed significant spectral differences (p&lt; 0.001) at 1080, 1445, and 1508 cm⁻¹, indicating differences in lipid and protein composition.</div></div><div><h3>CONCLUSIONS</h3><div>HPO-derived exosomes share key features with exosomes from matched first-trimester placenta explants, supporting the utility of HPOs as a relevant in vitro model to study placental extracellular vesicles.</div></div><div><h3>IMPACT STATEMENT</h3><div>This study introduces HPOs as a scalable source for placenta exosome research, enabling investigation of maternal–fetal signaling and pregnancy-related disorders.</div></div>","PeriodicalId":21134,"journal":{"name":"Reproductive biomedicine online","volume":"51 ","pages":"Article 105294"},"PeriodicalIF":3.5,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145532863","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}

{"title":"The Predictive Role of AMH In Letrozole Resistance Among PCOS Patients Undergoing Ovulation Induction","authors":"Elif Aylin Taskin ,&nbsp;Batuhan Aslan ,&nbsp;Yaprak Engin-Ustun","doi":"10.1016/j.rbmo.2025.105306","DOIUrl":"10.1016/j.rbmo.2025.105306","url":null,"abstract":"<div><h3>OBJECTIVE</h3><div>To investigate the predictive value of Anti-Müllerian Hormone (AMH) levels and define a threshold for the resistance to ovulation induction (OI) with Letrozole 5 mg/mL 5-day regimen in Polycystic Ovary Syndrome (PCOS) patients.</div></div><div><h3>MATERIALS AND METHODS</h3><div>A total of 195 PCOS patients undergoing 365 cycles of OI with Letrozole followed by IUI were enrolled to this retrospective cohort study. Patients with AMH levels lower than predefined age specific cut-offs were also excluded to increase diagnostic accuracy for PCOS and overcome interobserver bias for PCOM. OI with Letrozole (5 mg/day for 5 days) was initiated in all cycles, with dose escalation to 7.5 mg/day in resistant cases. Resistance to Letrozole, defined as failure to develop at least one pre-ovulatory follicle is the main outcome. Secondary outcomes include potential factors for resistance, predictive performance of AMH and clinical pregnancy rate (CPR).</div></div><div><h3>RESULTS</h3><div>Out of 195 patients 172 (88.2%) developed at least 1 dominant follicle in response to 5 mg/day letrozole for 5 days in at least one cycle constituting the Letrozole responsive group and 23 patients (11.8%) did not, constituting the letrozole resistant group. BMI, AMH, basal LH and LH/FSH ratio were higher in the resistant group (P˂0.05). Resistant group was characterized with a significantly high AMH when compared to responsive group (medians 8.5 vs 6.8 ng/mL, respectively, P=0.03) and probability of response was declining with increasing percentile of AMH, especially after the 75th percentile. In uni- and multivariant regression analyses, AMH and BMI are significant and independent predictors of resistance.</div><div>The ROC curve for prediction of resistance based on the serum AMH levels indicated moderate discrimination with AUC 0.64. Age-adjusted AMH thresholds for resistance are searched and above age of 30, AMH threshold of 6.5 ng/mL had 100% sensitivity and 86,4% specificity to predict resistance. CPR per cycle was 16.1% In responsive group and 9% in resistant group.</div></div><div><h3>CONCLUSIONS</h3><div>Our study demonstrates that high AMH levels and BMI are independent risk factors for letrozole resistance in PCOS patients. We propose an AMH threshold of 6.5 ng/mL as a sensitive and specific predictor of resistance in PCOS patients over 30 years of age.</div></div><div><h3>IMPACT STATEMENT</h3><div>High number of cycles with the same stimulation protocol in a large cohort with reliable diagnosis of PCOS enabled analysis of a very uniform data. We proposed an AMH threshold level to predict resistance to Letrozole in PCOS patients above 30.</div></div>","PeriodicalId":21134,"journal":{"name":"Reproductive biomedicine online","volume":"51 ","pages":"Article 105306"},"PeriodicalIF":3.5,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145532952","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}

{"title":"Fertility knowledge as a tool for informed reproductive decision-making","authors":"Shalini Singh","doi":"10.1016/j.rbmo.2025.105126","DOIUrl":"10.1016/j.rbmo.2025.105126","url":null,"abstract":"","PeriodicalId":21134,"journal":{"name":"Reproductive biomedicine online","volume":"51 5","pages":"Article 105126"},"PeriodicalIF":3.5,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145076145","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}

{"title":"Minimizing waste in medically assisted reproduction: a study on sustainability initiatives for oocyte retrieval and embryo transfer","authors":"Roos A. Sluimer,&nbsp;Theodora C. van Tilborg,&nbsp;Ralph J.A. Oude Ophuis,&nbsp;Willem M.J. Verpoest,&nbsp;Taghride Dahhan","doi":"10.1016/j.rbmo.2025.105081","DOIUrl":"10.1016/j.rbmo.2025.105081","url":null,"abstract":"<div><h3>Research question</h3><div>How can waste be reduced during medically assisted reproduction (MAR) procedures, including oocyte retrieval and embryo transfer, through sustainable interventions without compromising safety?</div></div><div><h3>Design</h3><div>A quality management initiative was conducted over 12 months (October 2023 to October 2024). Through a multidisciplinary approach, sustainability initiatives were developed aimed at reducing material and medication waste generated during oocyte retrieval and embryo transfer procedures. Sustainability interventions were implemented during a 3-month pilot phase. Waste generation was measured before and after implementation of these interventions. Infection rates were evaluated at baseline and after completing the pilot.</div></div><div><h3>Results</h3><div>During the study, 234 oocyte retrievals and 291 embryo transfers were carried out. The proposed interventions resulted in a material waste reduction of about 60% for oocyte retrieval and 8% for embryo transfer, with no clinical or laboratory infections recorded.</div></div><div><h3>Conclusions</h3><div>This study revealed the possibility for significant waste reduction in MAR procedures through targeted sustainability interventions. These findings underscore the feasibility of integrating sustainability practices in MAR procedures.</div></div>","PeriodicalId":21134,"journal":{"name":"Reproductive biomedicine online","volume":"51 5","pages":"Article 105081"},"PeriodicalIF":3.5,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145244894","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}

{"title":"Retraction notice to .ÇÿEffect of N-acetyl-cysteine after ovarian drilling in clomiphene citrate-resistant PCOS women: a pilot study.ÇÖ","authors":"A. Nasr","doi":"10.1016/j.rbmo.2025.105286","DOIUrl":"10.1016/j.rbmo.2025.105286","url":null,"abstract":"","PeriodicalId":21134,"journal":{"name":"Reproductive biomedicine online","volume":"51 5","pages":"Article 105286"},"PeriodicalIF":3.5,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145465394","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}

{"title":"Accuracy of Non-Invasive Preimplantation Genetic Testing For Aneuploidy (NiPGT-A) In Confirmed Aneuploid Embryos","authors":"Engin Turkgeldi ,&nbsp;Gozde Akcaoglu ,&nbsp;Arife Kunt ,&nbsp;Hasan Gursoy ,&nbsp;Aylin Mutlu ,&nbsp;Ali Osman Koyuncuoglu","doi":"10.1016/j.rbmo.2025.105293","DOIUrl":"10.1016/j.rbmo.2025.105293","url":null,"abstract":"<div><h3>OBJECTIVE</h3><div>To assess the diagnostic concordance between non-invasive preimplantation genetic testing for aneuploidy (niPGT-A) and standard PGT-A with trophectoderm biopsy in embryos previously diagnosed as aneuploid.</div></div><div><h3>MATERIALS AND METHODS</h3><div>Nineteen embryos from four patients previously diagnosed as aneuploid via PGT-A were re-evaluated using niPGT-A upon patient request. Embryos were thawed using the Ultrafast-Kitazato method and incubated in an Esco MIRI incubator. Laboratory preparation included particle reduction, disinfection, and use of DNA/RNA-free single-use materials. Embryologists wore sterile attire. Embryos were washed in four 30 μL drops and transferred to 12 μL culture dishes. Each dish contained three embryo-specific drops and one negative control drop. Incubation was 24 hours for D5 and 8 hours for D6/D7 embryos. Post-incubation, embryos were re-cryopreserved. Eight microliters of medium were collected per embryo into separate PCR tubes. Negative controls were similarly processed. Samples were stored at −20°C and sent to Igenomix TR via cold chain for analysis. Statistical analysis was conducted with a 2 × 2 contingency table.</div></div><div><h3>RESULTS</h3><div>Of the 19 embryos diagnosed as aneuploid by PGT-A, 18 were also found aneuploid by niPGT-A, 13 with perfect chromosomal match and 5 with minor differences. One embryo was classified as euploid by niPGT-A. This yielded an accuracy of 94.7% (95% CI: 73.9%–99.8%), specificity of 94.7% (95% CI: 73.9%–99.8%), and NPV of 100% (95% CI: 81.5%–100%) for euploidy. Sensitivity, PPV, Cohen’s Kappa, and McNemar’s test could not be calculated due to the absence of PGT-confirmed euploid embryos.</div></div><div><h3>CONCLUSIONS</h3><div>Our results show that NiPGT-A has very high NPV and specificity compared to the gold standard, PGT-A in aneuploid embryos. However, the small sample size and lack of euploid embryos by PGT limit the generalizability of findings. The euploid outcome may be associated of cumulus cell (CC) contamination, as morphological evaluation of the embryo revealed a greater abundance of CC compared to the others. Notably, 68.4% of embryos showed perfect qualitative agreement between methods. Although minor discrepancies were observed in 26.3% of embryos, all were still reported as aneuploid, suggesting limited clinical impact. Still, further validation with a larger, balanced dataset is necessary to establish the clinical reliability of the NiPGT-A.</div></div><div><h3>IMPACT STATEMENT</h3><div>niPGT-A offers high specificity and NPV relative to PGT-A in aneuploid embryos, supporting its potential as a non-invasive alternative.</div></div>","PeriodicalId":21134,"journal":{"name":"Reproductive biomedicine online","volume":"51 ","pages":"Article 105293"},"PeriodicalIF":3.5,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145532857","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}

{"title":"Single-Cell RNA-Seq Profiling Reveals PCOS-Associated Alterations in Oocytes from Small Antral Follicles for IVM Optimization","authors":"Nazli Akin ,&nbsp;Laura Saucedo Cuevas ,&nbsp;Antonio Galvao ,&nbsp;Berta Cava Cami ,&nbsp;Heidi Van Ranst ,&nbsp;Michel De Vos ,&nbsp;Gavin Kelsey ,&nbsp;Ellen Anckaert","doi":"10.1016/j.rbmo.2025.105305","DOIUrl":"10.1016/j.rbmo.2025.105305","url":null,"abstract":"<div><h3>OBJECTIVE</h3><div>Recommended by international guidelines, in vitro maturation (IVM) is a low treatment burden alternative for subfertile patients with polycystic ovary syndrome (PCOS) due to abolished risk of ovarian hyperstimulation syndrome. While IVM systems have been greatly optimized, lower cumulative live birth rates compared to IVF warrants further optimization. IVM targets maturation of GV oocytes collected from 2-9 mm antral follicles (AF) collected with minimal stimulation. Yet, previous studies that characterized PCOS oocyte molecular alterations focused on MII oocytes collected after conventional ovarian stimulation. Here, we provide a comprehensive molecular comparison of GV oocytes from PCOS and non-PCOS women to uncover targets for future IVM optimization.</div></div><div><h3>MATERIALS AND METHODS</h3><div>11 PCOS (phenotype A) and 7 non-PCOS (normo-ovulatory) donors were recruited for this study. Single-cell libraries were prepared with 81 GV oocytes (52 PCOS, 29 non-PCOS), aspirated from small-AF &lt;10 mm, following minimal HP-hMG priming (PCOS 600 IU, non-PCOS 450 IU). RNA-seq reads were aligned to GRCh38 with HISAT2 (v2.0.5) and quantified via SeqMonk. Differential gene expression was analyzed in R using DESeq2 (FDR &lt;0.05, |log2FC|&gt;0.58), followed by gene ontology term enrichment.</div></div><div><h3>RESULTS</h3><div>267 differentially expressed genes (114 down-, 153 up-regulated) were identified between PCOS vs non-PCOS oocytes. Three main biological processes being affected included (i) energy metabolism (e.g. respiration, lipid metabolism), (ii) cytoskeletal dynamics (e.g. microtubules) and (iii) intracellular signalling pathways. These alterations occur in key cellular compartments such as mitochondria, cytoskeleton, and ribosomes and affect molecular functions like structural support, enzyme regulation, and ion transport.</div></div><div><h3>CONCLUSIONS</h3><div>This is the first study analyzing transcriptomic differences between PCOS and non-PCOS oocytes collected from small AF after minimal hormonal stimulation and to be cultured using IVM. Our data indicate that PCOS leads to distinct changes in processes essential for cellular energy balance, structural dynamics, and intracellular communication. Utilizing mitochondrial and cytoskeletal modulators, or targeted growth factor supplementation may boost IVM outcomes to potentially match the clinical efficacy observed in conventional IVF.</div></div><div><h3>IMPACT STATEMENT</h3><div>This pioneer study identifies the alterations associated with PCOS pathology in the GV oocytes from small antral follicles and provides insights for future IVM optimization studies.</div></div>","PeriodicalId":21134,"journal":{"name":"Reproductive biomedicine online","volume":"51 ","pages":"Article 105305"},"PeriodicalIF":3.5,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145532951","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}

{"title":"Sibling Monozygotic Couples with Divergent Female Fertility: A Case Report Highlighting the Impact of BPA Exposure on OR","authors":"Hande Nalan Tore ,&nbsp;Hasan Bulut ,&nbsp;Rovshan Jabbarov ,&nbsp;Murat Berkkanoglu ,&nbsp;Kevin Coetzee ,&nbsp;Kemal Ozgur ,&nbsp;Muhittin Serdar","doi":"10.1016/j.rbmo.2025.105311","DOIUrl":"10.1016/j.rbmo.2025.105311","url":null,"abstract":"<div><h3>OBJECTIVE</h3><div>To present a rare case of monozygotic twin sisters with discordant ovarian reserve and fertility outcomes, highlighting the significant role of environmental exposure—particularly to bisphenol A (BPA)—and lifestyle factors in influencing reproductive health, despite identical genetic backgrounds. This case aims to underscore the necessity of incorporating environmental and epigenetic assessments in fertility evaluations.</div></div><div><h3>MATERIALS AND METHODS</h3><div>Sister B demonstrated normal ovarian reserve (AFC: 18; AMH: 2.4 ng/mL) and a reproductive history of two term pregnancies with live births. In contrast, Sister A had a seven-year history of infertility, with diminished ovarian reserve (AFC: 8; AMH: 0.8 ng/mL). Further evaluation revealed that Sister A had poor dietary habits—frequent fast-food consumption and minimal water intake, replaced by carbonated beverages. Occupational exposure to epoxy resins in a marble processing plant and pesticides in an agricultural setting was also noted. Semen analyses of both sisters' husbands were within normal parameters.</div></div><div><h3>RESULTS</h3><div>Toxicological screening revealed Sister A had a significantly elevated urinary BPA level (629.1 µg/L), over 50 times higher than her sister and their husbands (normal: 0–15.9 µg/L). After a diagnosis of diminished ovarian reserve, she adopted a healthier lifestyle to reduce environmental risks. Controlled ovarian stimulation yielded eight oocytes (three mature), resulting in three blastocysts. Two were transferred via ICSI and FET, leading to the term birth of a healthy 2750 g male infant. BPA levels normalized by 33 weeks of gestation.</div></div><div><h3>CONCLUSIONS</h3><div>This rare case demonstrates how even genetically identical individuals, living in the same environment, may exhibit striking differences in ovarian function, driven by differential exposure to environmental toxins such as BPA. This case report underscores the importance of investigating genetic (including epigenetics) as well as modifiable factors such as lifestyle habits, diet, and occupation in fertility workups and when encountering DOR and infertility.</div></div><div><h3>IMPACT STATEMENT</h3><div>This is the first reported case of significantly discordant ovarian reserve in monozygotic twins linked to differential BPA exposure. It underscores the critical impact of modifiable environmental and lifestyle factors on fertility and highlights the need to incorporate environmental and epigenetic assessments into routine reproductive evaluations. These findings offer novel insights with clinical and public health relevance.</div></div>","PeriodicalId":21134,"journal":{"name":"Reproductive biomedicine online","volume":"51 ","pages":"Article 105311"},"PeriodicalIF":3.5,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145532382","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}

{"title":"The Effect of Antagonist Initiation Day on IVF Outcomes in Patients with Unexplained Infertility: A Retrospective Analysis","authors":"Dogukan Halis Ozkan ,&nbsp;Merve Ayas Ozkan ,&nbsp;Yaprak Engin Ustun","doi":"10.1016/j.rbmo.2025.105331","DOIUrl":"10.1016/j.rbmo.2025.105331","url":null,"abstract":"<div><h3>OBJECTIVE</h3><div>This study aimed to investigate the effect of antagonist treatment initiation day on IVF outcomes in women with unexplained infertility undergoing controlled ovarian stimulation.</div></div><div><h3>MATERIALS AND METHODS</h3><div>This retrospective observational study included a total of 14 patients who were diagnosed with unexplained infertility and underwent antagonist protocol at our clinic between July 2024 and July 2025. Patients were divided into two groups based on the day antagonist treatment was initiated: fixed protocol group (Day 5, n=7) and flexible initiation group (≥Day 6, n=7).The groups were comparable in terms of age, body mass index (BMI), gravida, parity, and duration of infertility. The primary outcomes were the total number of oocytes retrieved, the number of mature oocytes, endometrial thickness on embryo transfer (ET) day, β-hCG positivity, and clinical pregnancy rate. Numerical data were analyzed using the Mann-Whitney U test, and categorical data were analyzed using Fisher's exact test.</div></div><div><h3>RESULTS</h3><div>The total number of oocytes was 11.57±2.37 in the fixed group and 8.71±3.64 in the flexible group (p=0.140). The number of mature oocytes was 8.71±2.56 and 7.29±3.77, respectively (p=0.561). Endometrial thickness on ET day was similar (10.53±3.15 vs. 10.74±2.97, p=0.798). β-hCG positivity was 57.1% in both groups (4/7 patients, p=1.000). The clinical pregnancy rate was 42.9% (3/7) in group 1 and 57.1% (4/7) in group 2 (p=1.000).</div></div><div><h3>CONCLUSIONS</h3><div>Starting the antagonist protocol later may allow for longer support of follicular development, thereby affecting oocyte response. Although clinical pregnancy rates were numerically higher in the later-starting group, statistical significance was not achieved. This may be related to the small sample size.Initiating the antagonist protocol on or after day 6 in patients with unexplained infertility may result in a clinically significant increase in oocyte response. This parameter, which influences IVF success, should be considered in individualized treatment planning. Further prospective studies with larger sample sizes are needed to validate these findings.</div></div><div><h3>IMPACT STATEMENT</h3><div>This study suggests that delaying antagonist initiation in IVF cycles for women with unexplained infertility may improve oocyte response and clinical pregnancy trends. These findings support individualized stimulation timing and warrant further validation in larger, prospective studies.</div></div>","PeriodicalId":21134,"journal":{"name":"Reproductive biomedicine online","volume":"51 ","pages":"Article 105331"},"PeriodicalIF":3.5,"publicationDate":"2025-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145532333","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}