Frontiers in reproductive health最新文献

Introduction: Lack of access to effective contraception methods can lead to an increased prevalence of unintended pregnancies, as well as possible deleterious health consequences. Community pharmacies represent the most accessible gateway for population medicines' and healthcare needs. Regarding contraceptives, they have also been identified as a platform for the provision of additional services, such as complementary counselling. This study aimed at assessing the knowledge, attitudes, and practices of community pharmacy staff towards contraception.

Methods: A cross-sectional study was undertaken in the Federal Capital Territory, Nigeria. Data were collected from 315 community pharmacy staff using self-administered questionnaires. The participants' knowledge and attitude scores were categorised using Bloom's cut-off point. Analyses were undertaken using Statistical Package for Social Sciences. The data were analysed using frequency distribution, chi-square, and linear regression at a 5% level of significance.

Results: Male participants in the study (165/315, 52.4%) were slightly higher than the female respondents (150/315, 47.6%), and about two-thirds of the study cohort were pharmacists (200/315, 63.5%). The majority of the participants (183/315, 58.1%) had poor knowledge of contraceptive use. A quarter of them (81/315, 25.7%) reported moderate attitudes. Almost all the participants (279/298, 93.6%) indicated recommending contraceptives for married adults, and a significant proportion of them (136/292, 45.5%) were opposed to recommending contraceptives for unmarried adolescents. Study respondents' professional role was also identified as a significant influence on their knowledge of contraceptives and contraception (p < 0.001).

Conclusion: Findings from this study revealed poor knowledge and negative attitudes of community pharmacy staff towards contraception. Government and relevant stakeholders can build on these novel findings to reform pertinent contextual policies and practices. This can significantly improve access to contraceptives amongst the populace, and consequently reduce unintended pregnancies alongside possible health and societal implications.

Artificial Intelligence (AI) has emerged as a transformative force in healthcare, with its integration into assisted reproduction technologies representing a notable milestone. The utilization of AI in assisted reproduction is rooted in the persistent challenge of optimizing outcomes. Despite years of progress, success rates in assisted reproductive techniques remain a concern. The current landscape of AI applications demonstrates significant potential to revolutionize various facets of assisted reproduction, including stimulation protocol optimization, embryo formation prediction, oocyte and sperm selection, and live birth prediction from embryos. AI's capacity for precise image-based analysis, leveraging convolutional neural networks, stands out as a promising avenue. Personalized treatment plans and enhanced diagnostic accuracy are central themes explored in this review. AI-driven healthcare products demonstrate the potential for real-time, adaptive health programs, fostering improved communication between patients and healthcare teams. Continuous learning systems to address challenges associated with biased training data and the time required for accurate decision-making capabilities to develop is imperative. Challenges and ethical considerations in AI-assisted conception as evident when taking into consideration issues such as the lack of legislation regulating AI in healthcare, a fact that emphasizes the need for transparency and equity in the development and implementation of AI technologies. The regulatory framework, both in the UK and globally, is making efforts to balance innovation with patient safety. This paper delves into the revolutionary impact of Artificial Intelligence (AI) in the realm of assisted reproduction technologies (ART). As AI continues to evolve, its application in the field of reproductive medicine holds great promise for improving success rates, personalized treatments, and overall efficiency. This comprehensive review explores the current state of AI in assisted reproduction, its potential benefits, challenges, and ethical considerations.

Background: Late initiation of antenatal care (ANC) continues to be a significant public health issue in sub-Saharan African countries, including Ethiopia. However, despite the high prevalence of late ANC initiation in Ethiopia, only a few studies have been conducted, particularly in developing regions, such as Bebishangul-Gumez. Therefore, this study aims to assess the prevalence of late initiation of the first ANC and associated factors among pregnant women in Western Ethiopia, 2023.

Methods: A facility-based cross-sectional study was conducted in Western Ethiopia from March 28, 2023 to April 30, 2023. We employed a systematic random sampling technique to select 427 participants. Data were collected using an electronic capture technique with open data kit (ODK), then, transported to XLS and exported to Stata version 17 software for analyses. Bivariate analysis was performed at significance level of p-value < 0.25 to select candidate variables for multivariable analysis. In the final model, factors with a p-value ≤ 0.05 were considered significantly associated with late initiation of ANC.

Results: A total of 414 pregnant women participated, yielding a response rate of 96.9%. The prevalence of late first ANC booking in this study was 56.8% (95% CI: 51.9, 61.5). Multivariable analysis revealed that being a housewives (AOR = 2.09, 95% CI 1.09, 4.01), having education status below secondary school (AOR = 3.5, 95% CI: 1.9, 6.1), having an unplanned pregnancy (AOR = 3.01, 95% CI 1.31, 6.90), lack of advise on when to start ANC (AOR = 1.74, 95% CI (1.09, 2.79), and attending ANC at hospital reduce the odds of late initiation of ANC (AOR = 0.41, 95% CI, 0.23, 0.72) were factors significantly associated with the late initiation of ANC.

Conclusion: The prevalence of late initiation of ANC was found to be high in the study area. Educational status below secondary school, unplanned pregnancy, lack of advice on when to start ANC, housewives and attending ANC at hospital were factors found to be significantly associated with the late initiation of ANC. Therefore, policies should be developed to increase support for female education, maintain women's empowerment initiatives through economic changes, expand family planning programs to decrease unplanned pregnancies, and increase awareness in the early initiation of ANC.

Introduction: Recently, issues related to climate change and endocrine-disrupting chemicals have come to the forefront. In particular, the pursuit of convenience has led to increased exposure to endocrine-disrupting chemicals in daily life, posing threats to reproductive health, including infertility and cancer. Therefore, this study aims to develop a questionnaire to assess the reproductive health behaviors of Koreans for reducing exposure to endocrine-disrupting chemicals, and to verify its reliability and validity.

Materials and method: This methodological study involved 288 adult men and women in South Korea and conducted item analysis, exploratory factor analysis, and confirmatory factor analysis.

Results: The developed survey questionnaire consists of four factors and 19 detailed items related to reproductive health behaviors and reproductive health promotion behaviors through the main exposure routes of endocrine-disrupting chemicals: food, respiratory pathways, and skin absorption.

Conclusion: Based on the results of this study, it is hoped that research on reproductive health behaviors aimed at reducing EDC exposure will expand, considering various environments such as national and ethnic differences.

[This corrects the article DOI: 10.3389/frph.2022.1052231.].

Purpose: This study aimed to investigate the influencing factors of three pronuclei (3PN) zygote incidence and their impact on pregnancy outcomes in women with good prognosis undergoing conventional in vitro fertilization with donor sperm (C-IVFD).

Methods: This retrospective study included women aged 35 years or younger who underwent the long/ultra-long follicular phase agonist protocol between January 2014 and January 2021. C-IVFD cycles were divided into the 3PN = 0% group (no 3PN zygotes) and the 3PN > 0% group (with 3PN zygotes). Multivariate logistic regression analysis was performed to identify factors influencing 3PN zygote incidence. The primary outcomes were clinical pregnancy, ongoing pregnancy, abortion and live birth rates. The secondary outcomes were cleavage, high-quality embryo, available embryo, implantation and ectopic pregnancy rates.

Results: 1,250 embryo transfer cycles were included in this study. The peak estradiol (E₂) level on the day of human chorionic gonadotrophin (hCG) administration (OR: 1.16, 95% CI 1.12-1.19, p < 0.001) and the number of retrieved oocytes (OR: 1.08, 95% CI 1.05-1.11, p < 0.001) were independently associated with 3PN incidence. Compared to the 3PN > 0% group, the 3PN = 0% group exhibited significantly higher ongoing pregnancy rates (p = 0.033) and live birth rates (p = 0.009), as well as lower abortion rate (p = 0.026). No significant differences were found between the 3PN = 0% and 3PN > 0% groups in cleavage, high-quality embryo, available embryo, implantation and ectopic pregnancy rates (p > 0.05).

Conclusions: The peak E₂ level on hCG administration day and the number of retrieved oocytes were independently associated with 3PN incidence. The incidence of 3PN zygotes has a negative impact on pregnancy outcomes in women with good prognosis undergoing C-IVFD.

Objective: To report a case of a patient who, after experiencing recurrent failed implantations, underwent a novel technological intervention-using the Q300 device-which successfully led to a pregnancy and delivery of a healthy baby.

Design: Case report.

Setting: Barzilai University Medical Center.

Patient s: A 33-year-old woman with primary infertility experienced recurrent implantation failure (RIF), while her 32-year-old male partner was diagnosed with severe oligo-astheno-teratozoospermia (OTA) syndrome.

Intervention: Using Q300 device for selection of the morphologically compliant sperm cells for intracytoplasmic sperm injection (ICSI).

Main outcome measures: Successful pregnancy and delivery.

Results: A unique case of clinical pregnancy and delivery involving a couple facing RIF and severe OTA. In this case, a new technology for sperm selection was used. The semen sample was examined using the Q300 device to choose WHO2021-morphologically compliant sperm cells for micro-injection. The resulting embryos were developed and then frozen. Later, a frozen-thawed embryo transfer was performed during the following natural menstrual cycle, leading to successful pregnancy and delivery.

Conclusion: The utilization of this new 3D imaging technology underscores the evolving landscape of reproductive medicine and the potential it holds for transforming outcomes in challenging cases. By documenting such cases, we contribute to the ongoing dialogue to refine assisted reproductive technology (ART) protocols and improve reproductive outcomes for individuals facing similar challenges.

Trial registration: NCT06232720 https://clinicaltrials.gov/study/NCT06232720. Date of registration: 15 Feb 2023. Date of enrollment of the first subject: 20 August 2023.

Despite increased availability of safe abortion following legal reform in Ethiopia, one-half of public sector abortion services are treatment of postabortion complications, indicating challenges meeting women's needs. Self-managed abortion (SMA)-the ability of pregnant people to manage their unwanted pregnancies with or without the support of a health care provider-is a safe, feasible, and acceptable option for women at gestational ages up to 12 weeks. Seeing the potential of SMA to vastly expand access to safe abortion and reduce postabortion complications, a pilot initiative targeting private pharmacies was implemented by the Ethiopian Ministry of Health, the Oromia Regional Health Bureau, and a non-profit organization. From December 2021 to March 2023, implementers trained and supported 41 pharmacies to provide SMA counseling and medical abortion drugs, with and without prescriptions, which was considered to contradict the legal framework at the time. Pharmacy clients' SMA experiences were documented in logbooks and via 21-day follow-up phone surveys. Thirty-two pharmacies (78%) supported 1,457 self-managed abortions during the pilot. Among clients with complete follow-up surveys (n = 1,233), 98.3% had a complete abortion without needing additional treatment. Only four clients (0.3%) reported a complication. The pilot demonstrated high demand for and feasibility of increasing access to quality SMA through private pharmacies in Ethiopia, but challenges remain due to the lack of a legal framework. We recommend providing multi-sector support on SMA to private pharmacies so they can in turn improve safe abortion accessibility by bringing safe, acceptable services closer to the people that need them.

Introduction: There is an increasing tendency to seek health information online rather than through medical professionals. However, the easy accessibility of information online allows for an increased risk of encountering medical misinformation.

Methods: We compared descriptions of symptomatology of bacterial vaginosis (BV) on four social media platforms: Instagram, Facebook, YouTube and X (Twitter). We then compared the frequency of discussion of symptoms with patients' report of symptoms in clinically diagnosed BV, vulvovaginal candidiasis and vulvodynia.

Results: Social media was more likely to report burning (45% of posts), itching (45%) or pain (23%) as symptoms of BV than patients (moderate-severe itching 30%, burning 21% or pain 21%). Although pain was reported more often by people with vulvodynia, other symptoms were not different across diagnoses.

Discussion: Social media overemphasizes the ability of symptoms to allow self-diagnosis of vaginitis, which can lead to delayed treatment, highlighting the need to promote accurate health information online.

Worldwide, infertility is a rising problem. A couple's lifestyle, age and environmental exposures can interfere with reproductive health. The scientific field tries to understand the various processes how male and female factors may affect fertility, but translation to the clinic is limited. I here emphasize potential reasons for failure in optimal treatment planning and especially why current prediction modelling falls short. First, Assisted Reproductive Technology (ART) has become a mainstream solution for couples experiencing infertility, while potential causes of infertility remain unexplored or undetermined. For instance, the role of men is generally left out of preconceptional testing and care. Second, regularly used statistical or computational methods to estimate pregnancy outcomes miss important biological and environmental factors, including features from the male side (e.g., age, smoking, obesity status, alcohol use and occupation), as well as genetic and epigenetic characteristics. I suggest using an integrated approach of biostatistics and machine learning methods to improve diagnostics and prediction modelling in the fertility clinic. The novelty of this concept includes the use of empirically collected information on the sperm epigenome combined with readily available data from medical records from both partners and lifestyle factors. As the reproductive field needs well-designed models at different levels, derivatives are needed. The objectives of patients, clinicians, and embryologists differ slightly, and mathematical models need to be adapted accordingly. A multidisciplinary approach where patients are seen by both, clinicians and biomedically skilled counsellors, could help provide evidence-based assistance to improve pregnancy success. Next, when it concerns factors that may change the ability to produce optimal embryos in ART, the embryologist would benefit from a personalized prediction model, including medical history of the patient as well as genetic and epigenetic data from easily accessible germ cells, such as sperm.