Frontiers in reproductive health最新文献

Background: Understanding patients' needs is mandatory to optimize medical support. Previous research has identified differences in male and female coping strategies. As embryo implantation failure poses a burden for both partners and as an intact partnership is beneficial to overcome infertility, support models should adjust to the needs of both partners. Psychosocial reactions to recurrent failure of fertility treatments were identified as one of the important but under-researched topics in reproductive medicine, and especially knowledge on gender-specific reactions to recurrent implantation failure (RIF) is sparse. We therefore explored male and female emotional/ psychosocial reactions and coping strategies in RIF.

Methods: Women and men from heterosexual couples, where embryo transfers failed to result in pregnancy at least three consecutive times, participated in qualitative semi-structured interviews. Qualitative content analysis was conducted according to the content structuring model of Kuckartz and Rädiker.

Results: Dyadic influence in conversation was apparent, with women being more verbally inclined with a vivid narrative style. Men showed a lower intensity and variety of emotional and psychosocial reactions with disappointment being dominant. Greater optimism, little negative impact on quality of life, and sexuality were key male findings. Feelings of guilt were significantly more common among women. Unexpectedly, gender differences in coping strategies were less pronounced, and shared strategies emerged.

Discussion/conclusions: Experiences with RIF of affected women cannot be directly applied to male partners as men's emotional and psychosocial consequences differ in extent and quality. This gender gap should be considered to improve clinical practice.

Introduction: Assisted reproductive technologies (ART) are widely used to address infertility; however, they are costly, associated with medical risks, and often yield suboptimal clinical outcomes. Natural Procreative Technology, also known as NaProTechnology (NPT), provides a systematic and integrative approach to infertility by thoroughly identifying and treating underlying medical conditions to restore the couple's natural fertility potential. Despite its promise, real-world data on NPT effectiveness remain limited. The objective of this study is to evaluate the take-home baby rate in a large population of infertile couples treated with NPT and to synthesize findings from previously published studies.

Methods: A retrospective cohort study was conducted involving 1,310 infertile couples treated at a specialized fertility clinic in Spain over a 5-year period. Participants presented with primary or secondary infertility or recurrent pregnancy loss. Clinical data, diagnoses, and outcomes were analyzed, including surgical interventions and treatment duration.

Results: The mean age of women and men was 35.0 (SD 4.4) and 36.9 (SD 5.3) years, respectively. Primary infertility was the most common subtype (73.5%), the median infertility duration was 24 months, and prior ART attempts were recorded in 27.5% of couples. Mean number of diagnoses per couple was 2.5 (SD 1.3). The crude take-home baby rate was 35.3% (N = 463). Independent predictors of successful take-home baby included female age, recurrent pregnancy loss as the reason for consultation, duration of infertility, and the presence of endometriosis, hormonal dysfunction, male factor, and endometrial disorders as diagnoses. Considering a median duration of NPT of 10.9 months (range 8.1-17.0), the adjusted cumulative take-home baby rate was 62.1%. Rates varied significantly by female age, with higher success observed in younger women: 83.7% at 18-30 years, 53.3% at 36-40 years, and 24.4% over 40 years. A sensitivity analysis was performed to assess the impact of dropout assumptions on cumulative pregnancy rates. Nearly one-third of patients underwent surgery, most commonly hysteroscopy and/or laparoscopy.

Conclusion: In this cohort, NPT was associated with a notably high take-home baby rate in an infertile population with unfavorable prognostic factors, including advanced maternal age, prolonged duration of infertility, or previous failed attempts at conventional ART procedures.

Hormonal contraceptives (HCs) are commonly prescribed medications that have had immeasurable impacts on quality of life and health of women and families globally. However, usage of exogenous hormones is not without risks, and patients often report a variety of side effects, ranging from burdensome to life-threatening. For some patients, side effects of HCs are severe enough to cause medication discontinuation or switching to alternative forms of contraception. Variability in side effect profiles may indicate heritable risk factors for some side effects. Understanding these patterns or risk profiles may help clinicians anticipate severe adverse events, match patients with suitable medications more rapidly, and improve patient outcomes and adherence. To support further research in this field, this narative review summarizes what is currently known about pharmacogenetic interactions with respect to HCs and specific polymorphisms suspected to contribute to adverse side effects and outcomes.

Menopause, characterized by ovarian function cessation and estrogen decline, affects over a billion women globally, leading to vasomotor symptoms (VMS), genitourinary syndrome of menopause (GSM), mood disturbances, osteoporosis, and cardiovascular risks. Pharmacological management is essential for symptom alleviation and long-term health, yet debates on hormone therapy risks necessitate personalized approaches. This review synthesizes recent advances in menopause pharmacology, evaluating hormonal therapies, non-hormonal alternatives, emerging options, challenges, and future directions. A systematic literature search, following PRISMA guidelines, was conducted via PubMed, Cochrane Library, and Web of Science (2015-2025) using keywords like "menopause pharmacological therapy," "hormone replacement risks," "non-hormonal VMS treatments," and "ovarian aging modulators." Two independent reviewers screened abstracts and full texts, including RCTs, meta-analyses, and expert consensuses focused on efficacy, safety, pharmacokinetics, and mechanisms; exclusions applied to non-English or pre-2015 studies. Hormonal therapies (MHT/HRT), evolved from WHI trials, effectively reduce VMS by 70%-90% and preserve bone density via estrogen receptor modulation, with low-dose transdermal regimens minimizing VTE and breast cancer risks per NAMS/IMS guidelines. Non-hormonal options like SSRIs/SNRIs (40%-60% efficacy) and NK3R antagonists (fezolinetant, 50%-65% VMS reduction) suit contraindicated patients. Emerging therapies, including phytoestrogens, testosterone for libido, and ovarian aging modulators (e.g., AMH analogs), address unmet needs. Special populations (e.g., POI, cancer survivors) require tailored strategies, while challenges include access inequities and long-term data gaps. Advancements underscore precision pharmacology's shift to individualized, non-hormonal treatments. Future priorities: biomarker-guided personalization, AI-driven discovery, and novel delivery systems to enhance efficacy, reduce risks, and improve QoL for menopausal women.

Background: Birth cohort studies are essential to investigate maternal and child health outcomes, yet they face persistent methodological challenges. A major concern is attrition, as participant loss over successive waves can compromise validity and introduce bias. These challenges are particularly acute in low- and middle-income countries, where socioeconomic inequalities and structural barriers further exacerbate participant loss and complicate long-term follow-up.

Objective: This paper compares attrition between participants who remained and those who dropped out of the birth cohort study, SEMILLA. We analyze reasons for drop out, and the sociodemographic characteristics and predictive factors associated with attrition.

Material and methods: Recruitment occurred over 30 months. Events such as the COVID-19 pandemic and social conflicts between 2019 and 2022 affected the final follow-up. The baseline sample included 409 pregnant women, divided into two Final Waves (FW): FW1 completed participation up to the baby's 12 months (n = 115), and FW2 up to 18 months (n = 294). Dropouts were identified by miscarriage, loss to follow-up, voluntary withdrawal, or protocol non-compliance. Baseline variables included ethnicity, years of schooling, maternal occupational activity, and per capita income. Attrition was calculated for each criterion overall and by Final Wave. Fisher's Exact Test, Pearson's chi-square, and Wilcoxon rank-sum tested differences between participants and dropouts. Logistic regression identified predictors of attrition in each Final Wave. All analyses were conducted with 95% confidence.

Results: Of 409 participants, 94 dropped out: 19 in FW1 and 75 in FW2. The main reasons were protocol non-compliance (54%), voluntary withdrawal (21%), miscarriage (13%), and loss to follow-up (12%). In FW1, younger age was associated with attrition (p = 0.031), while in FW2, Mestiza ethnicity (p = 0.037) and lower income (p = 0.014) were significant. Logistic regression showed that older maternal age (OR = 0.87, p = 0.026) and higher income (OR = 0.99, p = 0.034) predicted lower attrition.

Conclusion: Dropouts increased with longer follow-up, mainly due to time constraints. Age and income disparities significantly predicted continued participation. In contexts with socioeconomic challenges, these factors also affected protocol compliance. Findings underscore the importance of addressing socioeconomic determinants to strengthen the validity and sustainability of longitudinal studies in similar settings.

Background: Adolescent Girls and Young Women (AGYW; ages 15-24) continue to use contraceptives at lower rates than older women in sub-Saharan Africa. We describe contraceptive use among AGYW in seven Southern African countries (Botswana, Eswatini, Lesotho, Malawi, Mozambique, Zambia and Zimbabwe).

Methods: Cross-sectional, nationally representative household-based data from seven Population-based HIV Impact Assessment surveys (conducted between November 2019 and February 2022) were analyzed using survey weights to create descriptive results and pooled odds of modern contraceptive use.

Results: Among the 11,094 AGYW, contraceptive use (male or female sterilization, IUD, implants, injectables, pills, condoms) ranged from 45.0% in Mozambique to 75.1% in Botswana. Condoms were the most frequently reported method in four of seven countries (Botswana 61% of those using modern methods use condoms, Eswatini 66%, Lesotho 49% and Mozambique 33%). Dual method (use of any modern contraceptive method plus a condom) ranged from <1% in Malawi to 15% in Botswana. When conducting a pooled multivariable logistic regression, higher odds of modern contraceptive use was associated with higher education [Odds Ratio (OR) 1.7, 95% Confidence Interval (CI) 1.5-2.0], being in the highest wealth quintile (OR 1.5, 95% CI 1.2- 2.0), and having children (one birth: OR 2.0 95% CI 1.7-2.4), two or more: (2.5, 95% CI 2.0-3.0), but was lower among AGYW living with HIV (OR 0.7 95% CI 0.6-0.9).

Conclusions: Contraceptive prevalence rates varied by country but across countries, AGYW in Southern Africa commonly use short-acting methods, and specifically condoms: a user-dependent method prone to inconsistent use. Efforts to expand access to diverse, youth-friendly contraceptive options - particularly short-acting and multipurpose methods - could better align with the needs of AGYW. These findings can inform policies and programs aiming to reduce unmet contraceptive need and improve reproductive health outcomes among AGYW in the region.

Introduction: Adolescence is a critical period of hormonal changes that affect growth, development, and behaviour. Estrogen, progesterone, and androgen are sex hormones that play important roles in reproductive development and functions. Factors including diet, Health care, and genetic variation, affect hormone production/levels. However, the effect of different environments has not been explored in detail. This study aimed to evaluate hormonal levels in adolescent girls from two regions in Ghana and also assess associated socioeconomic status.

Method: One hundred and sixteen (116) blood samples were drawn from in-school adolescent girls aged 10-19 years who were involved in a qualitative study to explore adolescent girls' knowledge, perceptions and experiences of hormonal imbalance in Northern and Southern Ghana between June and October 2022. Their hormonal levels were assessed in respect of androgen, estrogen and progesterone to determine the influence of environmental and parents' socio-economic factors. Using the Enzyme-Linked Immunosorbent Assay (ELISA), serum levels were determined.

Results: Generally, average serum levels of estrogen, androgen, and progesterone were 195.5 (29.2-899.2.0) pg/ml, 60.7 (8.2-687.3) pg/ml, 46.0 (5.2-130.6) ng/ml respectively. When categorized by location, serum estrogen level was 195.8 (35.7-899.2) pg/ml in the north compared to 195.3 (29.2-899.2) pg/ml, in the south, p = 0.63. Androgen was 52.8 (8.2-687.3) pg/ml vs. 61.2 (16.0-683.33) pg/ml, p = 0.81, and progesterone level was 53.3 (9.2-130.6) ng/ml vs. 43.0 (5.2-111.3) ng/ml, p = 0.0019. Northern participants whose mothers did not have any formal education had higher androgen (p = 0.009) and estrogen (p = 0.0012) levels compared to those from the south. Also, girls with educated fathers had higher progesterone levels (p = 0.03). The proportion of parental unemployment was low across locations. Other covariates did not influence hormonal levels (p > 0.05).

Conclusion: This study provides useful information on the hormonal profiles of adolescent girls in Ghana which can inform the School Health Education Programme's (SHEP) intervention activities related to reproductive health issues. The study shows that there were some variations in the levels of serum progesterone between the two locations with participants from Northern Ghana having higher levels. It also highlights the need for practices that address the differences in hormonal levels among adolescent girls based on the educational levels of mothers, recognizing its potential implications for their health, fertility, and well-being.

Introduction: HIV prevention is paramount for adolescent girls and young women (AGYW) in Uganda, and oral pre-exposure prophylaxis (PrEP) is not always a suitable option. With emerging novel HIV prevention products (e.g., ring, injectables), there are opportunities to explore AGYW preferences to inform strategies for integrating PrEP choice into routine care.

Methods: From January-September 2024, we recruited AGYW aged 16-25 years from community sites in Kampala, Uganda for a cross-sectional discrete choice experiment (DCE) to determine the most preferred attributes and levels of multi-product PrEP programs. The DCE was developed via literature review, informal conversations with AGYW, and cognitive interviewing among AGYW using a prototype instrument. In the final iteration, attributes (and levels) included: method of PrEP information dissemination (WhatsApp, brochure, in-person consultations), PrEP counseling delivery (virtual, group, in-person counselling), proximity of PrEP location (nearer to or far from work/school/home), type of facility (private or government clinic, pharmacy), availability of additional services (STI testing and treatment, family planning, no additional services), client wait times (5, 30, 90 min), and associated costs (small, none). Participants responded 9 times to the question "Which PrEP program would encourage you to use PrEP?" and each time a different set of randomly-assigned choices of 2 scenarios were presented. Multinomial logit modeling was used to estimate preference weights and importance scores.

Results: Of 343 AGYW screened, 300 consented to participate (median age: 21 years, IQR: 20-23), with 38.3% having oral PrEP experience and 71.7% reporting recent condomless sex. "Access to other services" in conjunction with PrEP dispensing had the greatest influence on PrEP program choice (importance score: 27%) with preferences for STI testing and treatment (preference weight: 0.39, 95% CI: 0.32, 0.47) and family planning (PW: 0.14, 95% CI: 0.07, 0.21) greater than stand-alone PrEP programs. The type of facility offering PrEP (importance score: 9.7%), method used for PrEP information dissemination (importance score: 10.2%), and proximity of the PrEP location (importance score: 6.9%) were not very influential.

Discussion: Young women's preference for PrEP services to be offered in conjunction with STI and/or reproductive health services indicates an opportunity to integrate current and future PrEP delivery within these existing services.

Introduction: Hypertensive disorders of pregnancy represent a leading cause of maternal and perinatal morbidity and mortality worldwide. However, prevalence estimates of preeclampsia, eclampsia, and HELLP syndrome vary considerably across studies and regions.

Objective: To determine the global prevalence of preeclampsia, eclampsia, and HELLP (Hemolysis, Elevated Liver enzymes, and Low Platelet count) syndrome, analyze their geographical distribution, and evaluate temporal and methodological trends.

Methodology: A systematic review with meta-analysis was conducted. SCOPUS, Web of Science, PubMed, and EMBASE databases were searched through May 2025. Observational studies reporting prevalence data using standardized diagnostic criteria were included. Prevalences were pooled using a random-effects model with Freeman-Tukey double arcsine transformation. Subgroup analyses by diagnostic criteria and countries and meta-regressions by publication year and sample size were performed.

Results: Seventy studies on preeclampsia (2,465,570 participants), 21 on eclampsia (9,782,257 participants), and nine on HELLP syndrome (133,611 participants) were analyzed. The global prevalence of preeclampsia was 4.43 (95% CI: 3.73-5.20), with significant differences between ACOG (4.68%) and ISSHP (3.66%) criteria. For eclampsia, the prevalence was 0.43% (95% CI: 0.19%-0.76%), while the estimate for HELLP syndrome is 0.39% (95% CI: 0.16%-0.72%), which must be interpreted with considerable caution as it is derived from a limited pool of only nine studies. Marked regional disparities were identified, with higher prevalences in low-income countries. Meta-regression for preeclampsia revealed a non-significant increasing trend over time (p = 0.23) and a significant inverse correlation with sample size (p < 0.01). For eclampsia, neither the temporal trend (p = 0.68) nor the association with sample size (p = 0.65) was statistically significant.

Conclusions: Hypertensive disorders of pregnancy affect 4.43% (95% CI: 3.73%-5.20%) of pregnancies globally for preeclampsia, 0.43% (95% CI: 0.19%-0.76%) for eclampsia, and 0.39% (95% CI: 0.16%-0.72%) for HELLP syndrome, with considerable variations according to regions and diagnostic criteria. The upward trend underscores the need to strengthen epidemiological surveillance systems and preventive programs, especially in high-prevalence areas.