Frontiers in reproductive health最新文献

Background: Endometriosis affects approximately 10% of women of reproductive age; this prevalence may be underestimated, mostly in developing countries, including Mexican and Hispanic populations, due to socioeconomic barriers and limited access to specialized diagnosis. Although laparoscopy remains the gold standard for diagnosis, highlighting the need for non-invasive biomarkers. Haplotype expression of specific miRNAs acts as a circulating signature in both healthy and disease states, including endometriosis. However, their applicability in Hispanic populations has been unexplored.

Method: This study evaluated the discriminatory capacity of a miRNA expression haplotype in the blood plasma of a Hispanic cohort with laparoscopic confirmed diagnosis (15 patients with endometriosis and 7 from a reference group). The expression levels of miR-451a, miR-3613, miR-125b, let-7b, miR-150, and miR-342 were quantified using qRT-PCR, and their diagnostic performance was assessed through individual ROC curves and multivariate classification models: Logistic regression, CRT, and stacking-based ensemble model.

Results: The miRNA expression haplotype demonstrated high diagnostic accuracy with logistic regression (AUC = 0.914), CRT (AUC = 0.990), and an ensemble model using stacking (AUC = 0.990). Individually, miR-451a (AUC = 0.79), miR-3613 (AUC = 0.714), and let-7b (AUC = 0.667) were the most relevant markers and demonstrated more relevance in the expression haplotype.

Conclusion: These findings suggest that a miRNA-based diagnostic panel could provide a highly sensitive and specific alternative for diagnosing endometriosis in Hispanic populations. However, validation in larger cohorts is essential to confirm reproducibility and assess its clinical utility in different healthcare settings.

Introduction: While most postpartum women in Ghana report they would like to limit or space their births, few are using a highly effective method of family planning. We sought to better understand the reasons behind these seemingly contradictory stances.

Methods: We interviewed 48 postpartum women who had given birth 3-6 months prior and were seeking childhood immunization services at 2 hospitals in urban Kumasi, Ghana. Participants offered their opinions on previous, current, and future family planning use. Interviews were conducted by a trained, bilingual, female research assistant after the infant's appointment in a private room near the Child Welfare Clinic. Interview data were translated and transcribed verbatim and analyzed thematically using NVivo 14.0.

Results: While all participants reported wanting to wait at least 2 years before becoming pregnant again, only 3 were currently using a method of modern contraception. Many of our participants expressed aversion to contraception, driven mainly by the perceived risk of contraception being dangerous to their health and future fertility as reported by members of their social network. Many of those, however, were using either fertility-awareness-based methods, emergency contraception, condoms, or some combination. Those who had had negative personal experience with modern contraceptives were reluctant to use it again due mainly to menstrual side effects. Additionally, some participants had no reason for not wanting to use contraception, they simply do not want to.

Discussion: This qualitative study of women in Kumasi, Ghana, provides a framework to better understand family planning readiness and need. Many participants expressed limited knowledge about modern contraception, highlighting the importance of tailoring counseling to address women's unique questions and concerns. Potential contraceptive users appeared open to and curious about modern methods but had been deterred by stories and misconceptions about adverse consequences. Some women simply chose not to use contraception. Ensuring women have complete, unbiased information on which to base their decisions about contraceptive use and method selection represents a promising avenue for future interventions that seek to improve women's ability to meet their fertility goals.

Background: Vocational high school students in China exhibit higher rates of sexual activity than their academic counterparts; however, existing studies predominantly focus on college populations, leaving a critical gap in longitudinal data tracking the evolution of sexual knowledge and behavioural patterns among vocational students. This study aimed to evaluate changes over time in sexual safety knowledge, STIs/HIV and reproductive health-related sexual behaviours among boys who have had sex in Chinese vocational high schools.

Methods: In 2015 and 2021, an anonymous survey was conducted separately using the same questionnaire and survey method among students in Years 1-2 of the same vocational high school in a district of Zhejiang Province. The results of the two surveys were compared using univariate analyses, and multivariate analyses.

Results: In 2015 and 2021, 180 and 90 male students, respectively, had ever had sex, representing rates of 17.44% (180/1,032) and 8.49%(90/1,060). The results of the multivariate analysis showed that, in 2021, those who knew that sexual contact was the main mode of HIV transmission(OR = 14.14, 95% CI: 7.16-27.92), knew that contracting an STI increased the likelihood of HIV infection (OR = 7.83, 95% CI: 4.30-14.29), and knew that condom use could reduce both STIs(OR = 33.51, 95% CI: 15.08-74.49) and HIV infection(OR = 16.77, 95% CI: 8.58-32.76) were significantly more prevalent than in 2015. Furthermore, students who had received sex and STI/HIV prevention education and rated it as "good" (OR = 5.62, 95% CI: 2.72-11.64), who believed they could confidently refuse sex without a condom(OR = 1.95, 95% CI: 1.14-3.32), and who reported consistent condom use(OR = 2.27, 95% CI: 1.21-4.25) were also more prevalent in 2021. Use of contraception methods such as condoms(OR = 2.76, 95% CI: 1.50-5.09), the pill(OR = 2.42, 95% CI: 1.35-4.35), extracorporeal ejaculation (OR = 1.77, 95% CI:1.02-3.09), and the safe period(OR = 2.22, 95% CI: 1.22-4.04) also increased significantly. However, the proportion of students who had their first sexual relationship with a non-regular partner decreased(OR = 0.47, 95% CI: 0.24-0.93).

Conclusion: The participants' knowledge of safe sex and sexual behaviour improveed between the two surveys. However, these positive changes have not had a significant enough impact to prevent STIs/HIV transmission and reduce pregnancy. Further efforts are needed to ensure that these changes lead to effective STIs/HIV prevention and reduction among students.

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.