Frontiers in reproductive health最新文献

Purpose: To evaluate the effectiveness and safety of the novel protocol-progestin-primed ovarian stimulation (PPOS) protocol during controlled ovarian hyperstimulation (COH), in patients undergoing in vitro fertilization/intracytopalsmic sperm injection and embryo transfer (IVF/ICSI-ET).

Methods: By reviewing and analyzing published studies since PPOS protocol was firstly reported in 2015, we compared differences in ovarian stimulation characteristics, embryological features, pregnancy rates, and neonatal outcomes between PPOS protocol and conventional regimens employed in assisted reproductive technology (ART), and discussed the advantages and limitations of PPOS protocol.

Main finding: By adding exogenous progestin (P) during early follicular phase, PPOS scheme provide robust control over preovulatory luteinizing hormone (LH) surge and spontaneous ovulation, which promote oocyte maturation and recovery. Compared to various traditional protocols, PPOS achieved promising clinical pregnancy results, and equivalent rates of birth defect and congenital malformation. Moreover, it possessed significantly lower risk of ovarian hyperstimlation syndrome (OHSS).

Conclusion: Not inferior or comparable outcomes indicated that PPOS protocol is a competent alternative for ART with no obviously detrimental impact on oocyte development and embryo quality.

Introduction: Although advanced paternal age (APA) is increasingly scrutinized in reproductive medicine, its independent impact on embryo development and clinical outcomes remains contentious, particularly when controlling for maternal age and embryo ploidy.

Methods: This retrospective cohort study analyzed 357 preimplantation genetic testing for aneuploidy (PGT-A) cycles from couples with non-advanced maternal age (≤35 years). Cycles were stratified by paternal age into three groups: <35, 35-39, and ≥40 years. We compared sperm DNA fragmentation index (DFI), embryo development metrics, and clinical outcomes across these groups.

Results: Men aged ≥40 years exhibited significantly higher levels of sperm DFI compared to both younger groups (both P < 0.05). While no significant differences were observed in normal fertilization, high-quality embryo rates, or euploid blastocyst rates across paternal age groups, blastocyst development was notably impaired in the APA group. Specifically, the ≥40-year group demonstrated significantly reduced blastocyst formation rates (57.3% vs. 68.6% and 67.2%) and high-quality blastocyst formation rates (33.2% vs. 41.3% and 40.2%) compared to the <35 and 35-39 groups, respectively. Crucially, multivariate regression analysis identified DFI as an independent factor, with higher DFI significantly associated with a reduced likelihood of forming high-quality blastocysts (OR = 0.987, P = 0.046) and achieving a clinical pregnancy (OR = 0.961, P = 0.036). The sensitivity analysis demonstrates that even when examining a population of very young women (≤32 years) where the influence of maternal age on oocyte quality is expected to be minimal and uniform, the negative association between sperm DFI and embryo development potential persists (aOR = 0.980, P = 0.009).

Conclusion: Our findings indicate that APA itself does not directly affect blastocyst ploidy status but is associated with significantly elevated sperm DNA fragmentation. Despite the lack of direct evidence, the detrimental effects of APA on high-quality blastocyst formation and clinical pregnancy rates are probably associated with this increase in DFI. This study underscores the critical role of sperm DNA integrity in reproductive success and suggests that DFI assessment should be considered in the clinical evaluation of older men undergoing infertility treatments.

Background: Infertility is a real public health problem today with clinical and psychological aspects.

Objective: To improve the care and monitoring of women with primary infertility at the Angré University Hospital Center.

Materials and method: This was a cross-sectional and descriptive study over a period from January 1, 2021 to December 31, 2023. It concerned all women who came to consult for an inability to procreate dating back more than one year without using a contraceptive method, having regular and complete intercourse and having never become pregnant.

Results: Out of 7,348 gynecological consultations during the study period, 595 or 8% were related to infertility. The average age of the patients was 34.46 years (±5.9). Women with a higher education level were 56.3%. They were obese in 29.3% of cases. Genital infection (53.3%) was the main medical history in 53.3% of cases while the surgical history was dominated by myomectomy (44.7%) and appendectomy (38.3%). Among the causes of infertility, there was tubal obstruction (36.5%) followed by cycle irregularity and fibroids at 29% each. The main psychological disorders observed were anxiety (81.9%), sexual disturbances (56.3%) and stress (71.9%).

Conclusion: Primary infertility is becoming increasingly common in our context and affects increasingly younger women. It would be wise to now include its medical and psychological management in an inclusive health program for all through universal health coverage.

Background: Endocrine-disrupting chemicals (EDCs) disrupt hormonal regulation and pose health risks. Phthalates, common in personal care products, contribute to disparate chemical exposures among different demographic groups, notably impacting critical life stages like pregnancy and postpartum.

Objective: Using an environmental health literacy framework, we designed an educational intervention for pregnant Women of Color to highlight the health risks of phthalates in hair care products. The intervention aimed to measure behavioral changes toward phthalate-free products through self-reporting and urinary phthalate metabolite levels and explore factors influencing hair care practices during pregnancy.

Methods: In collaboration with multidisciplinary academicians, environmental health, and breast cancer advocates, we developed a virtual educational intervention during the COVID-19 pandemic. Components included a facilitated presentation, an educational video, and a semi-structured interview guide that was refined through feedback. Data collection involved baseline and follow-up sessions, sociodemographic data, hair product usage, behavior related to phthalate-containing products, and urine sample collection. To provide proof of methodological principle, we examined individual change over time from questionnaire data and targeted exposomics analysis of urinary phthalate compounds among women with baseline and follow-up data.

Results: Educational materials were developed in English and Spanish. Enrollment occurred from March 2021 to June 2022, involving participants in the second or third trimester of pregnancy. Women enrolled before 31 weeks gestation, completed a baseline assessment and at least one follow-up assessment, while those at ≥31 weeks gestation completed a baseline assessment and one postpartum follow-up assessment. Forty-six participants enrolled, with 31 completing the intervention, and 42 urine samples collected. Women who completed the educational intervention were slightly older than those women who did not attend an intervention session [mean age (SD) 31.0 (5.8) vs. 27.5 (5.4)], respectively. Product and brand use decreased over time, and portions of participants exhibited reductions in six different low molecular weight phthalate metabolites (27%-73% reductions).

Significance: This intervention was shaped by a collaborative effort that ensured its cultural relevance, linguistic inclusivity, and alignment with community needs, amplifying its potential impact on reducing the unequal burden of environmental exposures in marginalized communities.

Clinical trial registration: NCT04493892.

Menopause represents a pivotal transition in women's health, characterized by loss of ovarian hormone production and substantially increased cardiovascular disease (CVD) risk. Hormone replacement therapy (HRT), once widely prescribed for both symptom management and cardiovascular protection, faced significant scrutiny following the Women's Health Initiative (WHI) trial, which associated conventional regimens with elevated risks of stroke, thromboembolism, and breast cancer. Contemporary evidence demonstrates that cardiovascular outcomes vary considerably based on formulation, route of administration, timing of initiation, and patient-specific factors. Modern strategies emphasize individualized patient selection, lower-dose regimens, and transdermal delivery methods. The "timing hypothesis" proposes that HRT initiated within 10 years of menopause onset or before age 60 may confer cardiovascular benefit, whereas later initiation may increase cardiovascular risk. This narrative review synthesizes historical and contemporary evidence on HRT and CVD, examines mechanistic pathways including vascular, metabolic, and immunomodulatory effects, and evaluates evolving clinical guidelines. Despite substantial progress, significant uncertainties persist due to trial heterogeneity, underrepresentation of diverse populations, and inconsistent long-term outcomes. Future research priorities include personalized therapeutic approaches, mechanistic investigations, and rigorous evaluation of cardiovascular endpoints to definitively establish HRT's role in preventive cardiology. This review provides updated evidence for clinicians navigating complex decisions regarding HRT use in postmenopausal women, with emphasis on cardiovascular risk stratification and individualized treatment planning.

Background: Early-onset hypogonadism is an emerging cardiometabolic risk marker in young men, yet current care pathways remain fragmented and insufficiently tailored to patients' multidimensional needs. Digital health technologies offer an opportunity to support early risk stratification, promote self-management, and facilitate long-term prevention. This study presents a methodological framework combining Blueprint Persona modeling and multidisciplinary co-design to support the development of tailored digital health interventions.

Objective: To apply a persona-based, co-design methodology to develop a patient-centered, mHealth-enabled care model for young men with hypogonadism.

Methods: We screened 800 males aged 15-35 years; 55 were diagnosed with hypogonadism. Using the European Commission "Blueprint Persona" methodology, we constructed a representative persona ("Luigi") and validated it through a multidisciplinary Focus Group (11 experts). Unmet needs were identified and translated into key functional requirements for an mHealth-supported chronic care pathway.

Results: The hypogonadal cohort demonstrated a higher metabolic burden compared to eugonadal peers and reported priorities centred on sexual health, mood and musculoskeletal well-being, and prevention of premature cardiovascular risk. Despite significant psychosocial vulnerabilities, digital readiness was high. The co-design process generated a structured, mHealth-enabled intervention concept integrating teleconsultations, guided diagnostic/therapeutic steps, behavioral monitoring, and adherence-support features.

Conclusions: The Blueprint Persona methodology enabled the systematic translation of clinical, psychosocial, and behavioral insights into a digitally supported care model tailored to young men with hypogonadism. This Methods Article describes the development framework underlying the proposed intervention. A prospective evaluation will assess feasibility, adherence, and impact on cardiometabolic risk and quality of life.

Background: The psychological health issues and bone mass reduction observed in patients with human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) have attracted increasing public attention. This study aimed to assess anxiety status in male HIV/AIDS patients, develop a risk prediction model for bone mass reduction, identify major contributing factors, and evaluate the predictive performance of the model.

Methods: This cross-sectional study included 243 male HIV/AIDS inpatients who underwent dual-energy x-ray absorptiometry (DXA) at the Chengdu Public Health Clinical Medical Center, China, between March 2023 and December 2024. Clinical and laboratory data were retrospectively extracted from the hospital electronic medical record system, whereas anxiety information was prospectively assessed during hospitalization using the 14-item Hamilton Anxiety Rating Scale (HAM-A). Univariate and multivariate logistic regression analyses were performed to identify independent predictors of bone mass reduction, and a nomogram model was constructed and validated using the area under the curve (AUC), concordance index (C-index), Hosmer-Lemeshow test, and decision curve analysis (DCA).

Results: 1. HAM-A assessment of the 243 patients showed that 135 (55.56%) were likely to have anxiety, 73 (30.04%) were confirmed to have anxiety, 29 (11.93%) had marked anxiety, and 6 (2.47%) were likely to have severe anxiety. 2. Univariate analysis revealed that six variables-age, body mass index (BMI), antiretroviral therapy (ART), tenofovir disoproxil fumarate (TDF) exposure, hepatitis B surface antigen (HBsAg) positivity, and hepatitis C virus antibody (Anti-HCV) positivity-were significantly associated with bone mass reduction (P < 0.05). 3. Multivariate logistic regression analysis further confirmed these six variables as independent risk factors for bone mass reduction (P < 0.05). The AUC was 0.835 (95% CI: 0.775-0.894, P < 0.01), indicating good predictive performance. The bootstrap-validated C-index was 0.835, and the Hosmer-Lemeshow test (P = 0.483) demonstrated good calibration of the model. DCA showed that the model achieved favorable accuracy and net benefit across a wide range of threshold probabilities (0.04-0.90).

Conclusion: Bone mass reduction in male HIV/AIDS patients is closely associated with multiple clinical factors, particularly the duration of ART and TDF exposure, age, BMI, and viral markers. In addition, the high prevalence of anxiety symptoms among these patients warrants clinical attention. The developed risk prediction model for bone mass reduction demonstrated good discrimination and calibration, providing an effective tool for clinical practice to identify high-risk patients and facilitate early intervention.

Objective: To systematically evaluate the therapeutic efficacy and safety of Zishen Yutai Pill (ZYP) as an adjunctive treatment for women with polycystic ovary syndrome (PCOS) through systematic review and meta-analysis of randomized controlled trials.

Materials and methods: A systematic review and meta-analysis were conducted in accordance with PRISMA guidelines. Seven major databases, including PubMed, Embase, Web of Science, Cochrane Library, CNKI, VIP, and Wan Fang Database, were searched from inception through March 1, 2025. Randomized controlled trials comparing ZYP combined with Western medicines vs. Western medicines alone were included.

Results: Eighteen randomized controlled trials encompassing 1,751 participants with PCOS met the inclusion criteria. Meta-analysis demonstrated that ZYP, when combined with Western medicines, produced statistically significant improvements compared with Western medicines alone. Combination therapy significantly enhanced pregnancy rates [relative risk [RR] = 1.52, 95% confidence interval [CI] = 1.35-1.76, P < 0.00001] and ovulation rates (RR = 1.20, 95% CI = 1.12-1.30, P < 0.00001). ZYP combination therapy significantly increased endometrial thickness [mean difference (MD) = 1.34, 95% CI = 1.03-1.65, P < 0.00001]. Hormonal analysis revealed significant reductions in testosterone levels [standard mean difference (SMD) = -1.90, 95% CI = -2.94 to -0.86, P = 0.0003] and luteinizing hormone levels (SMD = -0.77, 95% CI = -1.21 to -0.33, P = 0.0006). Combination therapy significantly reduced miscarriage rates (RR = 0.54, 95% CI = 0.40-0.72, P < 0.0001).

Conclusion: This systematic review and meta-analysis suggests that adjunctive ZYP combined with Western medicines may improve reproductive outcomes in women with PCOS. However, the certainty of evidence for most outcomes was low or very low, and many trials had high or unclear risk of bias. Accordingly, these findings should be interpreted as hypothesis-supporting rather than practice-changing, and well-designed, independently funded multicenter randomized controlled trials with standardized outcome definitions are required before routine clinical use or guideline integration can be considered.

Systematic review registration: PROSPERO CRD42024522660.

Objective: This meta-analysis and systematic review aimed to evaluate the recurrence rate and clinical efficacy of aminolevulinic acid photodynamic therapy (ALA-PDT) in the treatment of perianal and intra-anal genital warts.

Methods: We systematically searched the China National Knowledge Infrastructure (CNKI), Wanfang Data, VIP, Chinese Biomedicine (CBM), PubMed, and Cochrane Library databases from their inception to April 1, 2024, for randomized controlled trials (RCTs) investigating ALA-PDT for perianal and intra-anal genital warts. Study quality was assessed using the Cochrane Collaboration's risk of bias tool, and statistical analysis was performed using RevMan 5.3 software.

Results: After rigorous screening, 32 RCTs involving 2,538 patients were included. The recurrence rate of perianal and intra-anal genital warts treated with ALA-PDT was significantly lower than that in conventional treatment groups (OR = 0.17, 95% CI [0.13, 0.22], P < 0.00001). While ALA-PDT monotherapy demonstrated lower efficacy compared to conventional treatments (OR = 0.49, 95% CI [0.29, 0.85], P = 0.01), ALA-PDT combined with other therapeutic modalities showed superior clinical outcomes (OR = 4.72, 95% CI [3.53, 6.32], P < 0.00001).

Conclusion: ALA-PDT effectively reduces recurrence rates of perianal and intra-anal genital warts and enhances treatment efficacy when used in combination with conventional therapies. As all included studies were conducted in China, further multinational RCTs are warranted to validate these findings across diverse populations.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42024501535.

Background: Financial barriers are a critical impediment to achieving Universal Health Coverage (UHC), particularly in sub-Saharan Africa. In East Africa, high out-of-pocket health expenditures persist, potentially exacerbating inequities in healthcare access, especially for vulnerable groups like women of reproductive age. This study aimed to assess the prevalence and socioeconomic inequalities of financial barriers to healthcare access among women in eight East African countries.

Methods: We conducted a cross-sectional analysis of nationally representative Demographic and Health Surveys (DHS) from Burundi, Ethiopia, Kenya, Rwanda, Somalia, Somaliland, Tanzania, and Uganda (2016-2022), comprising a weighted sample of 108,175 women. The outcome variable was a self-reported big problem with "money needed for treatment." We performed descriptive statistics, calculated concentration indices to measure economic inequality, and used a multivariable multilevel binary logistic regression to identify associated factors.

Results: Nearly half (49.7%) of the women reported financial barriers, with significant cross-country variation, ranging from 64.8% in Somalia to 36.2% in Tanzania. Financial hardship was disproportionately concentrated among poorer economic groups, as evidenced by negative concentration indices across all countries (e.g., Rwanda: -0.0825; Ethiopia: -0.0737). Multilevel analysis revealed that lower wealth quintile (AOR=0.21 for richest vs. poorest), no formal education (AOR=0.41 for higher vs. no education), and lack of a bank account (AOR=0.69) were strongly associated with higher odds of financial barriers. A key finding was the reversal of the rural-urban disparity upon adjusting for socioeconomic confounders, suggesting that poverty, not rurality itself, is the primary factor associated with financial access problems.

Conclusion: Financial barriers are the most prevalent and inequitable obstacle to healthcare access for women in East Africa, disproportionately affecting the poor, less educated, and financially excluded. Accelerating progress toward UHC requires health financing reforms that reduce out-of-pocket payments, alongside multi-sectoral policies that address underlying socioeconomic disadvantages through pro-poor interventions and financial inclusion. This focus is justified given their heightened need for maternal, sexual, and reproductive healthcare, and their heightened vulnerability to financial exclusion and catastrophic health expenditures.