Frontiers in reproductive health最新文献

Objective: To investigate the correlation between vitamin D levels and clinical pregnancy rates in infertile women undergoing in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) procedures and to assess the utility of vitamin D levels in developing a predictive model for assisted reproductive technology (ART) outcomes.

Methods: A total of 188 infertile patients receiving their initial IVF or ICSI treatment at our reproductive center between June 2020 and July 2021 were selected for data collection. Vitamin D levels and other relevant ART-related factors were used to construct a predictive model.

Result: The multivariate regression analysis revealed that several independent variables significantly impacted ART pregnancy outcomes, including infertility age, vitamin D level, reproductive anti-Müllerian hormone, antral follicle count, Gn dose, daily endometrial thickness after human chorionic gonadotropin (HCG) administration, and number of retrieved eggs. The area under the receiver operating characteristic curve for this comprehensive model was 75.34%, with a standard error of 0.045 and p-value of 0.003 (95% confidence interval 0.712-0965). Furthermore, the multivariate regression analysis identified specific independent variables that might influence vitamin D levels, such as the number of embryos obtained, daily endometrial thickness after HCG administration, and clinical pregnancy.

Conclusion: The developed predictive model integrating serum 25-Hydroxyvitamin D level and ART-related factors holds significant clinical value in forecasting pregnancy outcomes.

Background: In vitro fertilization (IVF) is an increasingly common method of assisted reproduction given the high rates of infertility in the United States (U.S.). However, despite growing utilization of IVF technologies, there is little known about the experiences of those accessing or undergoing IVF, particularly among adults in the U.S. The aims of this review are to (1) explore how economic, emotional and physical health, and interpersonal relationships impact and are impacted by accessing or undergoing IVF, and (2) understand the role of healthcare providers and the healthcare system.

Methods: A narrative review was conducted to summarize the current literature and provide insight into potential channels for care improvement. Eligible studies were published in English from 2013 to 2024 which qualitatively evaluated experiences of individuals and couples accessing or undergoing IVF. Peer-reviewed publications were identified from three electronic bibliographic databases. Methodologic rigor was assessed by two reviewers who also abstracted data on the study's characteristics as they pertained to four domains: health systems, economic, interpersonal, and physical and emotional health. Among the 32 papers retrieved for review, 22 met inclusion criteria and were retained for analysis.

Results: The available literature suggests accessing and undergoing IVF can be positively and negatively influenced by health systems, economic, interpersonal, and physical and emotional health factors. Often an individual or couple experiences multiple factors that compound to create a complex situation. Health systems-related factors included physician interaction and challenges with information volume and processing. Economic challenges primarily pertained to financing IVF and navigating insurance coverage. Interpersonal factors related to changes in relationships with partners, family members, and friends due to IVF. Physical health concerns (e.g., pain) and emotional health concerns (e.g., sadness, stress) were also noted by all included papers.

Conclusions: Efforts to improve care experiences of adults accessing or undergoing IVF are urgently needed. The evidence base points to a need for provider sensitivity trainings, clinic-based intervention, and community education in both physical and virtual spaces.

Background: Male infertility is a significant global public health issue, with modifiable lifestyle factors such as smoking, obesity, and psychological stress contributing to impaired semen quality and hormonal dysregulation. This study investigates the relationships between modifiable lifestyle factors, reproductive hormones, and semen quality in Ghanaian males attending an IVF clinic.

Methods: A cross-sectional study was conducted with 212 male participants recruited from a fertility clinic in Ghana. Lifestyle factors were assessed using standardized questionnaires, and semen samples were analyzed following WHO guidelines. Hormonal profiles (LH, FSH, testosterone, estradiol) were measured using the enzyme-linked fluorescent assay (ELFA). Statistical analyses included Pearson's product-moment correlation and Bonferroni correction.

Results: Smoking and psychological stress were significantly associated with reduced sperm motility, viability, and concentration (p < 0.05). Elevated BMI correlated negatively with sperm concentration and testosterone levels (p < 0.05). Alcoholic bitters was linked to decreased semen quality, while caffeine consumption showed a positive association with progressive sperm motility.

Conclusion: Modifiable lifestyle factors, such as smoking, psychological stress, and increased body mass index (BMI), play a crucial role in male reproductive health by adversely affecting semen parameters and hormonal balance. These findings emphasize the need for public health interventions targeting modifiable behaviors to improve fertility outcomes.

Introduction: The trend of older pregnant women and infertile women in South Korea, who are influencing the low birth rate, is on the rise. Older infertile women earnestly hoped for pregnancy and persisted in undergoing assisted reproductive technology multiple times. However, contrary to their wishes, they experienced failure to conceive.

Materials and method: This study is qualitative research aimed at exploring the essential meaning of the experiences of women over 35 who have faced pregnancy failure after assisted reproductive technology.

Results: The average age of the participants in this study was 41.8 years, and they underwent an average of 5.7 assisted reproductive treatments after their infertility diagnosis. Through in-depth interviews with the participants, 120 meaningful statements were derived, which were classified into 23 themes, 9 theme clusters, and 4 categories. The four categories were "struggles and trials regarding assisted reproductive technology", "the challenging treatment journey", "the journey of overcoming sadness", and "the value and happiness gained from experience".

Conclusion: The results of this study showed that infertile women over 35, despite failing to conceive after assisted reproductive technology, were able to overcome their sadness and move towards personal growth. Therefore, various methods should be sought to support the psychological growth of women undergoing assisted reproductive technology.

Background: Understanding population dynamics is essential since the number of children ever born (CEB) affects the growth, composition, and structure of a nation's population. The number of CEB has increased significantly, contributing to the world's rapid population growth. The spatial distribution of CEB in Ethiopia lacks recent information. Therefore, this study aimed to assess spatial distribution, and associated factors of CEB among reproductive age women in Ethiopia.

Method: Mini Ethiopian Demographic and Health Survey (MEDHS) 2019 data were used in this study. The study comprised 5527 (weighted) women's between the ages of 15 and 49. STATA and Aeronautical Reconnaissance Coverage Geographic Information System (ArcGIS) 10.8 software was used. The primary outcome, CEB, was categorized as "low" if fewer than five children were born and "high" if five or more children were born. Global and local Moran's Index methods were used to assess the extent of clustering. Multi-level (two-level) logistic regression analysis was used and variables with a P value less than 0.05 were considered statistical significance. Adjusted odds ratio AOR) with a 95% confidence interval (CI) was used to show the strength and direction of the association respectively.

Results: High number of CEB in Ethiopia was 37.46%, 95% CI (0.39-0.56) and it was spatially clustered (Moran's index = 0.59 P value <0.0001). Significant hotspots of high CEB were found in the Eastern Somali, Hadiya, Sidama, and Welayta zones. From individual-Level variables: women who were married [AOR = 3.23, 95% CI (1.48, 6.62)] were positively associated with high number of CEB. Whereas, women who were primary educated [AOR = 0.18, 95% CI (0.12, 0.27)], women who were secondary educated [AOR = 0.0.05, 95% CI (0.02, 0.13)], women's whose age at first birth after 20 year [AOR = 0.38, 95% CI (0.27, 0.51)] and women's who were using contraceptive [AOR = 0.59, 95% CI (0.44-0.78) were negatively associated with high number of CEB. From community level variables: a community with high proportion of contraceptive non user [AOR = 1.38, 95% CI (1.94-2.04)] were positively associated with high number of CEB.

Conclusion: Both individual and community-level factors were significantly linked to a high number of children born. The government is advised to prioritize interventions that promote women's education, delay first births, and provide access to a range of contraceptive options, ensuring informed, voluntary choices. Empowering women to exercise reproductive autonomy, free from coercion, is key to influencing fertility outcomes effectively.

Background: Innovative strategies are essential to meet the World Health Organization's 90/70/90 cervical cancer elimination targets, aiming for 90% access to precancer treatment globally by 2030. In low-and middle-income countries (LMICs) where most cervical cancer cases occur, access to precancer treatment is severely limited. Scalable solutions like self-administered topical therapies can help close this gap. In a recent Phase I trial (ClinicalTrials.gov NCT05362955), we demonstrated safety and adherence to self-administered intravaginal 5% 5-Fluorouracil (5FU) cream as an adjuvant therapy for cervical precancer among women living with HIV (WLWH) in rural Kenya. To understand women's experiences with self-administered 5FU, we evaluated the acceptability of this intervention among trial participants.

Methods: All 12 participants from the Phase I trial completed a structured questionnaire and in-depth semi-structured interviews in their preferred language, focusing on their experiences with 5FU self-administration, challenges faced, and overall acceptability of the intervention, including whether they would use it again or recommend it to someone who needed it. Quantitative data were analyzed using descriptive statistics. In the qualitative study, acceptability was defined as "the perception that a given treatment is agreeable, palatable, or satisfactory." A thematic analysis was conducted using five dimensions of acceptability: content, complexity, comfort, delivery, and credibility.

Results: The mean age was 43.9 years (SD 4.4), and seven (58%) had primary education or less. While some participants reported feelings of uncertainty when they started using 5FU, at the end of the study, all 12 participants strongly agreed that the cream was safe and were confident they used it correctly. Most participants (91.7%) experienced no discomfort with the vaginal applicator, and most reported using tampons overnight after 5FU use, as recommended. Qualitative findings revealed that favorable perceptions of self-administered 5FU were driven by its ease of use, the discrete nature of the treatment, and the comfort of home application. The main challenges included correctly measuring the study drug, finding a private place at home to self-administer, and the need to use condoms during treatment. Compared to their previous ablation or excision treatments, participants found 5FU to be less painful, and all would prefer a self-administered treatment instead of a procedure if it were an option.

Conclusion: Self-administered intravaginal 5FU as an adjuvant treatment for cervical precancer among women living with HIV in Kenya was highly acceptable. Randomized studies of 5FU and other topical therapies in LMICs are needed to evaluate their use in closing the current precancer treatment gaps in these settings.

Introduction: Recent interest in sperm epigenetics has stemmed from its implication in sperm DNA quality, sperm fertility, environmental toxicity, and transgenerational inheritance. Sperm epigenetic data may be significantly affected by somatic DNA contamination, resulting in misleading conclusions. However, detecting and dealing with somatic DNA contamination in semen samples can be a challenging task.

Methods: In the present study, we worked out a detailed and robust plan to deal with somatic cell DNA contamination in sperm epigenetic studies in order to draw error-free scientific conclusions. Apart from incorporating simple quality checks, such as microscopic examination and somatic cell lysis buffer (SCLB) treatment, we compared the Infinium Human Methylation 450K BeadChip data for sperm and blood samples to identify the CpG sites that were highly methylated in blood samples in comparison to sperm, but were unrelated to infertility.

Results and discussion: The comparison of Infinium Human Methylation 450K BeadChip data for sperm and blood samples identified 9564 CpG sites that can be used as markers for analyzing somatic DNA contamination. We have put together a comprehensive plan including evaluation under a microscope, SCLB treatment, inclusion of CpG biomarkers for sample quality evaluation, and applying a 15% cut off at the time of data analysis to completely eliminate the influence of somatic DNA contamination in sperm epigenetic studies. We conclude that if this comprehensive plan is followed, the influence of somatic DNA contamination in sperm epigenetic studies can be completely eliminated.

Background: Unmet need for family planning (FP) refers to the proportion of women who are fecund, sexually active, and wish to delay or limit childbearing but are not using any effective contraceptive method. Unmet need for FP remains a significant public health concern, particularly among young women aged 15-24 years. This study explores the determinants of unmet need for FP among young women.

Method and material: This study used data from the 2022 Kenyan Demography and Health Survey to investigate the relationship between various factors and a binary outcome variable of unmet need for family planning among adolescent young age group. A multilevel binary logistic regression model was used to analyze the data, accounting for the clustering effects of the survey data. The statistical significance of the relationships was assessed using adjusted odds ratios with 95% confidence intervals. The model with the lowest deviance was considered the best fit for the data.

Result: Magnitude of unmet need family planning among adolescent young age in Kenya is 25% (95% CI: 24.5%-26%). Determinants of Unmet need for family planning are age 15-19 (AOR: 3.4, 95%CI (1.3-11), undecided desire number of children (AOR: 2.3, 95%CI: 1.4-2.1), age at first sex 15-29 (AOR: 2.7, 95%CI: 1.2-6.2), rural residency (AOR: 3.9, 95%CI: 1.1-14), high community level poverty (AOR: 2.1, 95%CI: 1.1-4.5).

Conclusion: The study finds that 25% of young women in Kenya lack access to family planning. Factors like age, desired family size, early sex, rural life, and poverty contribute to this. These factors create barriers that hinder women's ability to plan their pregnancies and access necessary resources. Younger women, those in rural areas, and those living in poverty are particularly affected. Addressing this issue requires a comprehensive approach that considers the specific circumstances of these vulnerable populations.

Objectives: There is a growing body of evidence that in the absence of Chlamydia trachomatis and/or Neisseria gonorrhoeae, Mycoplasma genitalium and bacterial vaginosis (BV) are associated with cervicitis. We aimed to describe infections detected among cervicitis cases over a decade and establish how commonly M. genitalium and BV were detected among non-chlamydial/non-gonococcal cases to inform testing and treatment practices.

Methods: We conducted a retrospective case-series to determine the number of cervicitis cases diagnosed with genital infections (C. trachomatis, N. gonorrhoeae, M. genitalium and BV) among women attending the largest public sexual health service in Australia from 2011 to 2021. We determined the proportion of cervicitis cases with one or more genital infections detected, and trends in testing and detection of each infection over time.

Results: Over a decade 813 cervicitis cases were diagnosed; 421 (52%, 95%CI: 48%-55%) had no infection detected; 226/729 (31%, 95%CI: 28%-35%) had BV, 163/809 (20%, 95%CI: 17%-23%) C. trachomatis, 48/747 (6%, 95%CI: 5%-8%) M. genitalium, and 13/793 (2%, 95%CI: 1%-3%) N. gonorrhoeae. Of the 665 (82%) cases tested for all four infections, 268 (40%) had one infection and 73 (11%) had >1 infection detected. Of the 517/665 (78%) non-chlamydial/non-gonococcal cases, 164 (32%) had BV and 16 (3%) had M. genitalium as the sole infections detected; a further 13 cases (3%) were co-infected with BV and M. genitalium. The proportion of cases tested for BV (90%) did not change overtime, but detection increased from 32% to 45% (P_trend < 0.001). The proportion of cases tested for M. genitalium increased from 84% in 2011 to 96% in 2019 (P_trend = 0.006), with M. genitalium-detection in cervicitis increasing from 3% to 7% (P_trend = 0.046).

Conclusions: In our study population, chlamydia or gonorrhoea were not detected in ∼75% of cervicitis cases; 1 in 3 of these cases had BV and/or M. genitalium, and both increased in prevalence over time. These data highlight the need for clinicians to consider BV and M. genitalium when assessing and managing cervicitis.