Seminars in reproductive medicine最新文献

Endometriosis is a debilitating condition characterized by the growth of endometrial-like tissue outside the uterus, leading to chronic pain and inflammation. While its etiology remains complex, emerging evidence implicates environmental contaminants as potential contributors. This review explores the roles of endocrine-disrupting chemicals such as phthalates, bisphenol A (BPA), and benzophenone-like ultraviolet (UV) filters in the development and progression of endometriosis. These chemicals, commonly found in everyday products such as plastics, personal care items, and sunscreen, can mimic or interfere with hormonal functions, disrupting the hormonal balance essential for reproductive health. This review included 18 peer-reviewed studies on phthalates, BPA, and UV filters from 2003 to 2023. Evidence for UV filters was inconclusive, with only two studies available. BPA was positively associated with endometriosis in four out of seven studies. Phthalates were associated with a greater odds of endometriosis in five studies, and with a reduced odds in one study, while three studies found no association with endometriosis. This underscores the need for further research with improved timing of exposure measurement. Understanding the role of phthalates, BPA, and UV filters on endometriosis is crucial for developing effective prevention strategies, potentially reducing the burden of endometriosis.

Female reproductive aging often affects women's emotional, physical, and physiological well-being. Ovarian aging is characterized by fluctuations in reproductive hormones and determines the age at which menopause occurs. Understanding potentially modifiable factors that influence this process is essential for addressing health disparities, improving quality of life, and informing relevant public health strategies. This review synthesizes in vivo, in vitro, and epidemiological findings about the effects of endocrine-disrupting chemicals (EDCs), specifically heavy metals and perfluoroalkyl and polyfluoroalkyl substances (PFAS) on female reproductive aging. Most in vivo and in vitro studies have demonstrated that heavy metals alter ovarian morphology, folliculogenesis, and steroidogenesis. Evidence regarding the effects of PFAS is limited and inconsistent. Epidemiological studies have consistently shown that heavy metals are associated with a higher risk of diminished ovarian reserve (indicated by decreased anti-Müllerian hormone) and earlier menopause, with limited findings regarding reproductive hormone changes. PFAS exposure has been associated with decreased estradiol and earlier menopause but not significantly with ovarian reserve. Gaps in the literature require more comprehensive epidemiological research on the effects of EDCs on female reproductive aging, including ovarian reserve, age at menopause, and vasomotor symptoms, to inform future interventions to reduce hazardous exposures and improve women's health.

Environmental pollutants, including endocrine-disrupting chemicals (EDCs), air pollution, and climate change, are increasingly recognized for their potential impact on pregnancy outcomes. EDCs, found in pesticides, industrial chemicals, and personal care products, are associated with preterm birth and fetal growth restriction, primarily through hormonal interference. Air pollution, notably PM_2.5, NO₂, and O₃, has been linked to increased rates of preterm birth, low birth weight, and stillbirth. Climate factors, such as extreme heat, elevate risks of pregnancy loss and preterm birth, with significant impacts on vulnerable populations across diverse socioeconomic and geographic regions. These exposures contribute to adverse pregnancy outcomes through mechanisms involving oxidative stress, inflammation, and endocrine disruption. The interplay among these environmental factors underscores the need for integrated, longitudinal studies to understand their combined effects on pregnancy outcomes better. Future research should focus on region-specific impacts, cumulative exposure, and policy-driven interventions to mitigate these environmental risks, especially in vulnerable populations disproportionately affected by these hazards. This scoping review synthesizes recent findings from 2019 to 2024 to highlight these associations and identify research gaps.

Polycystic ovary syndrome (PCOS) is the most common heterogeneous endocrine disorder in women of reproductive age, affecting around 5 to 10% of women and up to 21% depending on the applied diagnostic criteria and study population. People with PCOS may experience oligomenorrhea, androgen excess, and polycystic ovary morphology. The etiology of the disease is not completely understood, with genetics, epigenetics, endocrine, metabolic, lifestyle, and environmental factors contributing to its development and severity. Environmental exposures are an important, burgeoning field in menstrual research, as they potentially link to menstrual cycle disruption and the risk of reproductive disorders such as PCOS. This review examines the recent research investigating environmental exposures-air pollution, micro- and nanoplastics, heavy metals, and endocrine-disrupting chemicals-and PCOS in human and animal models, concluding with potential mechanisms, limitations, and considerations for future work. Overall, research on environmental exposures and PCOS is limited and yields heterogeneous results across studies. Specifically, exposures such as air pollutants, micro- and nanoplastics, persistent organic pollutants, and parabens have noticeably limited research. Future research can help fill the gap in understanding how environmental exposures, particularly across gestational, childhood, and reproductive adult life stages, may impact PCOS.

Antiphospholipid syndrome (APS) is a disease characterized by the presence of antiphospholipid (aPL) antibodies, thrombosis, and obstetric complications. While patients with APS can have successful pregnancies, many important considerations exist. APS can also cooccur with other systemic autoimmune diseases which can affect pregnancy, particularly systemic lupus erythematosus. This article reviews specific considerations for pregnancy and reproductive health in patients with APS. Similar to other autoimmune diseases, stable or quiescent disease and planning with a rheumatologist and obstetrician prior to conception are vital components of a successful pregnancy. Pregnancy management for patients with aPL antibodies or diagnosis of APS with aspirin and/or anticoagulation depending on disease profile is discussed, as well as the effects of physiologic changes during pregnancy in maternal and fetal outcomes for this population. Given the reproductive span lasts beyond conception through delivery, we include discussions on safe contraception options, the use of assistive reproductive technology, pregnancy termination, menopause, and male fertility. While APS is a relatively rare condition, the effects this disease can have on maternal and fetal outcomes even with available therapies demonstrates the need for more high-quality, evidence-based research.

Hashimoto thyroiditis and Graves' disease are autoimmune thyroid disorders that are common in women of reproductive age and have a complex relationship with female fertility and health of the maternal-fetal dyad. Both hyperthyroidism and hypothyroidism, whether subclinical or overt in severity, directly or indirectly affect nearly every level of the hypothalamic-pituitary-ovary axis, uterine and ovarian function, as well as fetal development from implantation through delivery. Autoimmunity itself also appears to negatively impact both spontaneous and assisted fertility, as well as miscarriage risk, although the mechanism remains unclear, and the presence and magnitude of risk is variable in published literature. While treatment of overt hyperthyroidism and hypothyroidism is unequivocally recommended by professional societies, the impact of treatment on fertility outcomes, and the role of treatment in subclinical thyroid disease is more controversial. Unfortunately, levothyroxine has not been shown to abrogate the risk of subfertility and miscarriage observed in euthyroid thyroid autoantibody positive women.

Many individuals with systemic lupus erythematosus (SLE) face significant challenges manifesting their family planning goals due to numerous factors, including disease-related complications, treatment-induced effects, immunological factors, self-imposed limitations, and the socioeconomic impacts of having a chronic disease. Instances of unexplained infertility are also prevalent. Encouragingly, advancements in treatment modalities, risk factor management, specialized training within the medical community, and enhanced patient/provider education have contributed to an increase in successful pregnancies among SLE patients, fostering a safer, more promising reproductive landscape. However, despite advances, individuals with SLE continue to struggle with the complexities of family building. This review explores infertility and pregnancy outcomes in SLE, fertility preservation, the role of assisted reproductive technology, and considerations for tailoring these approaches to SLE patients.