Frontiers in reproductive health最新文献

Background: Acupuncture is frequently employed during the process of embryo transfer. Nevertheless, its precise function in enhancing the likelihood of successful clinical pregnancy or live birth remains ambiguous.

Objective: To evaluate the efficacy of acupuncture as a complementary intervention to embryo transfer in managing female subfertility, compare the effects of acupuncture vs. sham acupuncture on clinical pregnancy rate in assisted reproductive technology, and clarify the optimal timing of acupuncture administration within in vitro fertilization protocols.

Methods: All literatures which described randomized controlled trials of acupuncture during the process of embryo transfer were obtained through searches of Cochrane Central, PubMed and Embase database (all to May 2025). Eleven randomized controlled trials were incorporated into the review. Selection of studies, quality assessment and data extraction were carried out independently by two review authors. Meta analysis was conducted, incorporating both risk ratios and 95% confidence intervals. The primary outcome measure was the clinical pregnancy rate, defined as the proportion of patients with an intrauterine gestational sac confirmed by ultrasound with or without a fetal heart. The secondary outcome measure was the live birth rate, defined as the proportion of patients with a pregnancy lasting ≥20 weeks or a birth weight of at least 400 g.

Results: Eleven studies were selected for review, and nine of these were deemed acceptable based on their discussion of clinical pregnancy rate. By combining the studies and analyzing the results, it was concluded that acupuncture has demonstrated a positive impact on clinical pregnancy rate in contrast with the blank control group [1.25 (1.05-1.50), P = 0.013]. A statistical analysis revealed no significant differences between the sham acupuncture group and the acupuncture group [1.01(0.87-1.17), P = 0.907]. No statistically significant discrepancy between the Pulus Protocol [1.083(0.946-1.240)] and Delphi Consensus [1.164(0.938-1.445)]. Acupuncture has no positive impact on live birth rate during embryo transfer [1.01(0.88-1.15), P = 0.930]).

Conclusions: The results of this meta-analysis suggest that a positive correlation has been demonstrated between acupuncture and clinical pregnancy rate during embryo transfer when compared to the blank control group; however, this advantage does not hold when compared to the use of sham acupuncture. The Delphi Consensus revealed no discrepancy in clinical pregnancy rate when compared with the Pulus Protocol. It should be noted that the impact of acupuncture on live birth rate remains to be elucidated.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251067805, identifier (CRD420251067805).

Introduction: In vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) patients often experience stress, which exacerbates the burden associated with infertility and may lead to an increased risk of mental-health difficulties. In this systematic review and meta-analysis, we examined the effects of IVF or ICSI on female patients' mental health.

Methods: A database search was conducted in PubMed, Web of Science, and PsychInfo to select relevant studies. Forty-four studies involving 858,966 participants were included in the systematic review. The results of these studies were very heterogeneous and yielded contradictory findings. Two meta-analyses, comprising a total of seven studies, were conducted. The first calculated the standardized mean difference of symptoms of depression between women who became pregnant through IVF and those who conceived spontaneously. In the second, we compared symptoms of anxiety between these two groups.

Results: Five studies examined depressive symptoms and showed no significant difference between the two groups: SMD = -.15; 95% CI [-.33,.03], p = .10. A meta-analysis of six studies on anxiety symptoms revealed significantly higher levels in the IVF groups compared to the controls: SMD = .33; 95% CI [.17,.49], p < .001.

Discussion: The results suggest that the psychological effects of IVF/ICSI, especially with respect to anxiety, require attention and support from healthcare providers, although the effect size is small. Further studies with adequate sample sizes, including women with both successful and unsuccessful treatment, and adequately controlling for important confounders are needed to fully understand the effects of IVF/ICSI on mental health.

Systematic review registration: PROSPERO (CRD42023461472).

Objective: To systematically evaluate whether the melatonin supplementation could improve the embryo development and pregnancy outcomes of infertile women undergoing assisted reproductive technologies (ART).

Methods: This systematic review and meta-analysis followed the PRISMA guidelines and was prospectively registered in PROSPERO (CRD420251003042). The randomized controlled trials (RCTs) published before March 5, 2025 are included to evaluate the efficacy of melatonin on infertile women undergoing ART. Eligible studies reported at least one embryo development or pregnancy-related outcome. Primary outcome was clinical pregnancy rate; secondary outcomes including oocyte yield, fertilization rate, MII oocyte number, and high-quality embryo formation. Subgroup analyses were conducted based on stimulation protocols, melatonin dosage, and population characteristics. Risk of bias was assessed using the Cochrane Risk of Bias tool, and pooled effect sizes were calculated using fixed- or random-effects models depending on heterogeneity. Totally, eleven RCTs with a total of 1,481 participants were analyzed here.

Data sources: PubMed/MEDLINE, Embase, and Cochrane Library.

Results: Melatonin supplementation significantly improved clinical pregnancy rate (OR = 1.59, 95% CI: 1.22-2.07). Regarding embryo development, melatonin significantly increased the number of high-quality embryos (MD = 0.43, 95% CI: 0.07-0.79), MII oocyte (SMD=0.99, 95% CI: 0.29-1.69), and fertilization rates (OR = 1.32, 95% CI: 1.01-1.73). No significant difference was observed in oocyte yield (SMD = 0.45, 95% CI: -0.04 to 0.94). Subgroup analysis revealed enhanced clinical pregnancy outcomes with ≤3 mg/day melatonin and under GnRH-a long protocols. Moderate to high heterogeneity was observed in some secondary outcomes, with publication bias suggested for the MII oocyte outcome.

Conclusions: Melatonin supplementation may improve intermediate outcomes such as fertilization, embryo quality, and clinical pregnancy rates in women undergoing ART. With a favorable safety profile, it could be a low-cost adjunct for selected patients, though standardized guidelines are lacking and large-scale RCTs are needed to clarify long-term effects.

Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD420251003042, PROSPERO CRD420251003042.

Introduction: Utero-vaginal prolapse is a significant public health concern in developing countries such as Ethiopia, where access to health care is limited. It is a major reproductive crisis in women that affects a woman's quality of life and has a great negative impact on women's social, physical, economic, and psychological wellbeing. Despite this, there is limited evidence on risk factors in the study area. Therefore, this study aimed to identify the risk of utero-vaginal prolapse among women visiting gynecologic outpatient departments in governmental hospitals.

Methods: A facility-based unmatched case-control study was conducted among 286 women visiting gynecologic outpatient departments in selected governmental hospitals. The data were collected via a pretested structured questionnaire designed with a Kobo tool box. The Kobo tool is an easy, open electronic data collection tool suitable for field research and helps ensure data security. The data were subsequently exported to SPSS for analysis. Descriptive statistics were performed. To assess associations, independent t-tests and binary and multivariate logistic regression analyses were performed. Finally, a 95% confidence interval and adjusted odds ratio with a p value <0.05 were used to examine the associations between the dependent and independent variables.

Results: A total of 277 respondents, 91 patients with utero-vaginal prolapse and 186 controls, were included in the study. According to the multivariable logistic regression analysis, early childbirth [AOR = 3.98 (95% CI: 1.08-14.58)], a history of multiple pregnancies [AOR = 2.88 (95% CI: 1.27-6.49)], home delivery [AOR = 4.9 (95% CI: 1.3-18.6)], prior pelvic surgery [AOR = 3.9 (95% CI: 1.08-13.8)], and a history of instrumental delivery [AOR = 3.1 (95% CI: 1.08-9.14)] were found to be significant determinants of utero vaginal prolapse.

Conclusion: These findings underscore that in utero vaginal prolapse is a common reproductive health problem. Early childbirth, a history of multiple pregnancies, home delivery, prior pelvic surgery, and a history of instrumental delivery were risk factors for UVP. Therefore, social and health care system determinants are critical. Therefore, prevention of UVP requires promoting health facility deliveries, integrating obstetric care, and addressing the societal norms that may lead to early childbirth. Consequently, context-based interventions addressing these determinants can greatly improve women's quality of life, decrease the prevalence of UVP, and improve overall maternal health.

Background: The Triple Elimination initiative is a global effort aimed at eliminating vertical transmission of HIV, hepatitis B and syphilis. This paper describes HIV, syphilis and hepatitis B testing and diagnosis in young women and men accessing sexual and reproductive health services and identifies opportunities to integrate prevention interventions.

Methods: The study was conducted in eight primary healthcare and four mobile clinics in South Africa, integrating HIV PrEP within prevention services. Programme data were collected and analysed from women and men ≥15 years accessing services for the first time between June 2023 and March 2024.

Results: Of 10,007 clients, 89.4% were female and 65.5% 18─24 years. Overall, 70.9% were provided HIV PrEP. Among females, 16.8% were provided contraceptives for the first time. HIV was identified in 1.2% of males and 2.2% of females tested and with results available, syphilis in 5.6% and 5.0%, and hepatitis B in 1.7% and 0.9% respectively. An HIV diagnosis was less likely among older age groups and those enrolled in school and more likely among those with part-time relative to full-time employment. Syphilis was less likely among older age groups and those reporting consistent condom use. Hepatitis B was more likely among those who had used oral PrEP before.

Conclusions: Opportunities for integrated prevention interventions, aligned to triple elimination, include condom programming, contraception, point-of-care testing, PrEP and vaccination. Integrated care delivered through HIV prevention programmes provides an opportunity to treat and prevent HIV, syphilis and hepatitis B, and offer contraception to prevent unintended pregnancies.

Background: Uterine fibroids (UF) are the most common benign tumors of the female reproductive system, imposing a significant health burden. A comprehensive understanding of their global, regional, and national burden is essential for targeted public health planning. This study aimed to analyze the spatiotemporal trends of UF burden from 1990 to 2021 and project future trends to 2036.

Methods: Data on the incidence, prevalence, and disability-adjusted life years (DALYs) of UF from 1990 to 2021 were extracted from the Global Burden of Disease (GBD) 2021 study, covering 204 countries and territories. We analyzed trends using estimated annual percentage changes (EAPC) for age-standardized rates. Socio-demographic Index (SDI) was used to assess the association between development level and disease burden. The Slope Index of Inequality (SII) and concentration index were employed to quantify health inequalities. A Bayesian age-period-cohort (BAPC) model was used to project the burden to 2036.

Results: Between 1990 and 2021, the global ASIR of UF rose from 234.36 (95%UI: 171.06, 309.92) to 250.93 (183.44, 330.94) per 100,000 [EAPC 0.24 (0.23, 0.25)]. The ASPR increased from 2799.88 (2133.46, 3650.54) to 2841.07 (2164.43, 3682.27) [EAPC 0.04 (0.03, 0.06)]. DALYs grew from 81,142 (57,125, 111,989) to 142,885 (102,183, 192,988), while ASDR showed little change, from 3.48 (2.46, 4.77) to 3.39 (2.43, 4.59). Regional analysis indicated that South Asia exhibited the highest incidence and prevalence of UF, whereas Oceania and Australia experienced a lower burden. Analysis of health inequality revealed a shift in the burden of UF incidence and prevalence from high to low Socio-Demographic Index (SDI) countries between 1990 and 2021, indicating a reduction in health inequality. Future predictions from the BAPC model indicate that both ASIR and ASPR are expected to continue to rise, while ASDR is likely to decline.

Conclusions: From 1990 to 2021, the global incidence of UF has steadily risen, with South Asia experiencing the greatest impact. Despite the stabilization of ASDR, the rise in ASIR and ASPR remains a significant public health challenge worldwide. Health inequality analysis indicates that the burden of UF is shifting toward low SDI countries. Future prevention and treatment strategies for UF should focus on middle- and low-income countries, specifically by implementing targeted screening programs, investing in low-cost diagnostic tools, and launching public health awareness campaigns. Global public health cooperation, along with early diagnosis and treatment strategies for UF, will be crucial in reducing the disease burden.

Despite the advent of ART and the conversion of human immunodeficiency virus (HIV) into a chronic disease, little is known regarding the experiences of women living with HIV (WLWH) in accessing knowledge support and supplies for menstrual health. The inability to access supplies or manage vaginal bleeding safely negatively impacts menstrual equity, a term used to address vaginal bleeding needs across the reproductive life course. For WLWH, these inequities are compounded with additional externalized and internalized stigma, making them especially vulnerable to poor gynecological care utilization and menstrual health management. This review introduces recent research on the nascent topic of menstrual equity in the United States and explores existing data on menstrual health and its intersections with stigma and access in WLWH. The goal of this review is to highlight current evidence and persisting gaps in menstrual health research for WLWH in the United States and emphasizing potential future developments in addressing the common yet hidden issue of menstrual inequity in this population.

Background: Polycystic Ovary Syndrome is an endocrine disorder that affects reproductive, metabolic, and mental health. In LMICs, PCOS management is hindered by late diagnosis, lack of awareness, and high treatment costs which leads to long-term complications.

Objective: The aim of the review is to document the challenges in PCOS diagnosis and management in LMICs and provide public health solution to overcome these barriers in accordance with SDG goals.

Methods: A narrative review synthesizing existing literature on PCOS epidemiology, barriers to diagnosis and treatment, and potential solutions relevant to LMICs.

Results: Key challenges include lack of uniformity in diagnosis and treatment, lack of trained HR and equipment. High cost of care, stigma and fragmented health care.

Outcomes/proposed solutions: Develop national PCOS guidelines, bring the management of PCOS under the reproductive health program, shift some of the tasks to primary health workers, like generating awareness and screening for symptoms. Invest in research to find public health solutions.

Conclusion: Addressing PCOS in LMICs requires a multi-sectoral public health approach, including prevention, early detection, and affordable care. Strengthening healthcare systems through policy reforms and community-based interventions can improve outcomes for affected women.

Background: Adolescent girls and young women (AGYW) in Uganda face a disproportionate burden of HIV and unintended pregnancies, with low condom use exacerbating these risks. Despite efforts to promote condom use, uptake remains inconsistent among this young demographic. Additionally, there is limited research on the factors influencing condom use among unmarried sexually active AGYW in Uganda. This study aimed to assess the prevalence and factors associated with condom use in this high-risk group using data from the 2016 Uganda Demographic and Health Survey (UDHS), to inform targeted interventions aimed at improving sexual health outcomes for this specific demographic.

Methods: A cross-sectional analysis was conducted using secondary data from the 2016 UDHS. The study included 2,132 unmarried sexually active AGYW aged 15-24. Data were analyzed using weighted logistic regression to identify factors associated with condom use, adjusting for survey design characteristics. The outcome of interest was condom use and some of the potential predictor variables examined were; age, region, education, wealth, marital status, and exposure to family planning messages. All data processing and analysis was done using STATA v14.

Results: Only 10.36% of AGYW participants reported using condoms. Factors significantly associated with condom use included region (lower use in Northern and Western regions), marital status (lower use among those ever in a union), exposure to family planning messages (higher use), and having multiple sexual partners (higher use). Recent sexual activity was also linked to increased condom use.

Conclusions/recommendations: The low prevalence of condom use highlights the urgent need for targeted interventions to address barriers such as regional disparities, limited access to sexual health education, and gender dynamics. Recommendations include implementing region-specific sexual health programs, expanding family planning messaging, and establishing youth-friendly health services. Empowering AGYW to negotiate condom use and addressing socio-economic barriers are crucial for improving sexual health outcomes.

Background: Around 20% of patients undergoing assisted reproductive technology are at risk of hypo-response to ovarian stimulation. The aim of this study was to describe the real-world use of follitropin delta for ovarian stimulation in these patients, as defined by POSEIDON groups 3 and 4 [an anti-Müllerian hormone (AMH) level of <1.2 ng/ml].

Materials and methods: This study was a post-hoc analysis of participants from DELTA, a multi-centre, prospective, observational study conducted in normal care settings in fertility clinics at 14 active sites in France. A subset of 35 patients at risk of hypo-response to ovarian stimulation (mean AMH 0.7 ± 0.29 ng/ml) and treated with follitropin delta were included. Patients were followed for 10-11 weeks after the first fresh or frozen embryo transfer in case of subsequent pregnancy, and data on real-world follitropin delta use collected.

Results: Most patients (92.9%) had undergone their first IVF or ICSI. The prescribed daily dose was usually based on the approved algorithm (N = 26; 74.3%) with a mean daily dose of 14.2 ± 4.1 mcg, resulting in a mean total dose of 187.7 ± 135.6 mcg. The mean duration of ovarian stimulation was 11.6 ± 6.7 days with no premature discontinuations, while the mean number of oocytes retrieved among patients that started stimulation was 6.3 ± 4.3. A fresh transfer was performed for 21 patients (84.0%), with a mean of 1.04 ± 0.98 embryos transferred per patient. Seven patients (20.0%) achieved an ongoing pregnancy (28% per transfer). No adverse drug reactions were reported.

Conclusions: The results describe the real-world use of follitropin delta and demonstrate its suitability for POSEIDON group 3 and 4 patients. These data complement clinical trial outcomes, supporting clinician decision-making and improving IVF/ICSI outcomes.