Reproductive biomedicine online最新文献

Research question: What effect does the use of a rapid warming method of vitrified embryos have on survival and pregnancy?

Design: A comparison of two different warming embryos protocols: long protocol (group 1, n = 486) and a new fast protocol (group 2, n = 413) for blastocyst and cleavage stage frozen embryo transfers at two IVF centres: Assisted Reproductive Technology Centre, Careggi University Hospital Firenze and IVF Unit, 'Cervesi' Hospital Cattolica. Total pregnancy rate was considered primary outcome, and embryo survival rate, clinical pregnancy rate, miscarriage rate, ongoing pregnancy rate and mean time required for warming procedure were considered secondary outcomes.

Results: The same embryo survival rate was observed in the two groups. Total and clinical pregnancy rates seemed to be higher, but not statistically different, in group 2 compared with group 1 (29.5% versus 26.7% and 27.6% versus 22.6%, respectively). Conversely, a statistically significant reduction in miscarriage rate was found in group 2 compared with group 1 (18.0% versus 32.3%, P = 0.009). Similarly, a significant increase in pregnancy rate at 26 gestational weeks or over was observed in group 2 compared with group 1 (66.9% versus 80.3%, P = 0.016). Finally, a difference in time required for warming procedures was found in favour of group 2.

Conclusions: The use of the fast warming protocol is a valid alternative to the classic warming protocol, and allows a reduction in the time needed to carry out the procedure and the workload of embryologists in an IVF laboratory.

Research question: What are the experiences, needs and preferences of women with a history of sexual trauma undergoing fertility treatment?

Design: Women survivors of sexual violence who were previously referred for, underwent or were undergoing fertility treatment were invited to participate in an online survey. Respondents were asked about which screening tool they preferred to gather information about the history of sexual violence, and to rate the significance of specific triggers related to fertility treatment.

Results: A total of 155 women responded to the survey. The preferred screening tool for a history of sexual violence was an intake form (76 women [63%]) followed by direct questioning (20 women [16.5%]). Only 11 women (9%) preferred not to be screened for a history of sexual violence. The triggers with the highest intensity were arm and leg fixation during egg retrieval (66.2% and 66.8% of women respectively graded the trigger as 5/5). Past pregnancy was associated with a reduction in the intensity of triggers, but this was of small magnitude (5.8%). Although 65 women (59%) preferred a female physician to carry out fertility-related procedures, most women accepted the treating physician regardless of gender as long as the physician was trained in trauma-informed care.

Conclusion: Not all triggers related to infertility treatment can be completely avoided; however, a discussion with patients about what may pose a trigger and how to decrease the severity of that trigger is important.

Digital twins - the term for virtual representations of biological systems - are emerging as promising tools in reproductive medicine. They offer personalized simulations for optimizing fertility, assisted reproductive technology (ART) and pregnancy outcomes. However, their use remains limited and fragmented across diverse applications. A systematic search was conducted in PubMed, EMBASE, Scopus and IEEE Xplore up to July 2025 for this review of the current evidence on digital twins in fertility, ART and pregnancy, identifying applications, outcomes, challenges and future prospects. Original studies that applied digital twins to fertility, ART or pregnancy in human or in-silico models were included in this review. Eight original studies were included, complemented by nine mechanistic or conceptual works. Applications encompassed embryo selection, IVF procedure modelling, placental physiology, pregnancy pharmacokinetics, and intrapartum monitoring. Most studies were predictive or descriptive in nature, static or batch-coupled, and at early stages of validation. Risk of bias ranged from moderate to high due to study design and external validity concerns. Only two studies fulfilled strict digital twin criteria, and the exclusion of borderline studies did not change the overall conclusions. Digital twins hold substantial promise for personalized reproductive care. However, their clinical utility remains largely theoretical. Future work must improve modelling accuracy, data integration and ethical implementation to unlock their full potential.

Research question: Does the long-acting stimulation protocol with corifollitropin alfa (CFA) followed by daily low-dose recombinant FSH (r-FSH) reduce the risk of premature progesterone elevation (PPE) in women with low ovarian reserve compared with daily high-dose r-FSH?

Design: This randomized controlled trial, conducted from February 2022 to May 2024, enrolled 110 patients who met the Bologna criteria for poor ovarian responders. Participants were randomized into two groups: the intervention group received long-acting CFA followed by daily 150 IU r-FSH from day 8; and the control group received daily 300 IU r-FSH. The primary outcome was the proportion of patients with progesterone ≥1.1 ng/ml on the day of human chorionic gonadotrophin trigger. Secondary outcomes included number of retrieved oocytes, fertilization rate, fresh embryo transfer rate, and pregnancy rate.

Results: A significantly lower rate of PPE was observed in the CFA group compared with the control group [2/56 (3.6%) versus 12/54 (22.2%), respectively]. CFA stimulation was associated with an 89% reduction in the odds of PPE (OR 0.11, 95% CI 0.02-0.55; P = 0.007). Fresh embryo transfer was achieved in 34/52 (65%) patients in the CFA group versus 21/48 (44%) patients in the control group (P = 0.04).

Conclusions: Ovarian stimulation with long-acting CFA plus daily 150 IU r-FSH significantly reduced the risk of PPE and increased the feasibility of fresh embryo transfer in patients with low ovarian reserve. This strategy may offer a better approach for managing PPE, and may improve overall IVF success for this specific patient population.