Frontiers in reproductive health最新文献

Introduction: Ashwagandha (Withania somnifera) is widely recognized in Ayurvedic medicine as a potent Rasayana and aphrodisiac herb, with preclinical studies demonstrating androgen-modulating, anxiolytic, and antioxidant properties that may enhance male reproductive physiology. The present study aimed to rigorously evaluate the efficacy and safety of a standardized Ashwagandha Root Extract (ARE) in improving sexual function in healthy adult men.

Methods: A prospective, randomized, double-blind, placebo-controlled, parallel-group clinical trial was conducted over 8 weeks in 76 healthy males aged 30-50 years. Participants were randomized (1:1) to receive either 300 mg ARE twice daily or a matched placebo. Sexual functioning was evaluated using validated instruments, including the Sexual Desire Inventory-2 (SDI-2), number of Satisfying Sexual Events (SSEs), and the International Index of Erectile Function (IIEF). Semen parameters were analyzed using WHO-standardized procedures, and quality of life was assessed with the Short Form-12 Health Survey. Both intention-to-treat and safety analyses were performed with a significance threshold of α = 0.05.

Results: ARE supplementation resulted in statistically significant improvements across multiple domains of sexual function compared with placebo, including SDI-2 scores, SSEs, sexual desire, and overall IIEF outcomes (p ≤ 0.001). Semen analysis demonstrated a 36% increase in ejaculate volume, 38% improvement in total sperm count, and an 87% increase in total sperm motility after 8 weeks, with moderate to large effect sizes indicating clinically meaningful benefits. No adverse events or safety concerns were reported.

Discussion: These findings suggest that standardized ARE may serve as an effective and well-tolerated natural intervention to support male sexual health.

Clinical trial registration: https://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=NzY3ODE=&Enc=&userName=, identifier CTRI/2,022/11/047,501.

Public health guidance and human rights standards recommend states to decriminalize abortion, and further recommend that they legalise abortion care to ensure that abortion seekers can access quality and human rights consistent care. This paper explores abortion decriminalization and legalization globally, including by clearly distinguishing between them to discuss the content, implications, and consequences of each. Furthermore, it uses data from the GAPD to identify trends and patterns in how countries have approached these regulatory questions, outlining four models of legalization identified through the texts of national laws and policies.

Background: China's total fertility rate has reached a critically low level, dropping to approximately 1.0 by the end of 2023which is significantly below the population replacement level of 1.5. This decline reflects a marked reduction in fertility intention among reproductive-aged women, exacerbating population aging and threatening long-term labor supply and social sustainability. Despite policy adjustments and governmental support initiatives, intended outcomes have not been realized. Current literature largely focuses on isolated determinants of fertility intention, overlooking heterogeneity within the population. Moreover, the pathways through which psychosocial factors operate across different subgroups remain poorly understood.

Methods: Data for this study were derived from the 2021 Psychological and Behavioral Investigation of Chinese Residents (PBICR 2021), a nationally representative cross-sectional survey. Latent profile analysis (LPA) was employed to identify subtypes of fertility intention among reproductive-aged women, followed by multinomial logistic regression, which examined factors associated with different profiles.

Results: Among 2,973 reproductive-aged female participants, three distinct fertility intention profiles were identified via latent profile analysis: the Fertility Intention Decline Group (25.1%), the Low Fertility Intention Group (51.3%), and the High Fertility Intention Group (23.6%). Multinomial logistic regression analysis revealed that, compared with the Fertility Intention Decline Group, the Low Fertility Intention Group was significantly associated with family type, aged 20-40 years, residential location, having 2 children, and retirement status (all p < 0.05). In contrast, the High Fertility Intention Group was significantly associated with having no children and with higher depression scores (all p < 0.05).

Conclusions: Fertility intention among reproductive-aged women demonstrates significant heterogeneity. This study identified three distinct latent profiles, each characterized by unique patterns of influencing factors. The findings highlight the necessity of moving beyond one-size-fits-all policy approaches and emphasize the importance of developing tailored interventions that account for the specific characteristics and determinants of each subgroup.

Background: Endometriosis is a heterogeneous gynecological disease manifesting in three distinct phenotypes: superficial peritoneal endometriosis (SUP), ovarian endometrioma (OMA), and deep infiltrating endometriosis (DIE). While Genome-Wide Association Studies (GWAS) have identified numerous susceptibility loci-such as WNT4, FN1, and VEZT-the functional translation of these genetic risks into phenotype-specific pathophysiology remains unclear.

Objectives: This systematic review aims to analyze the differential activation and expression patterns of known endometriosis-susceptibility genes across SUP, OMA, and DIE to determine if distinct genetic signatures define each phenotype.

Methods: A systematic search was conducted in PubMed, Scopus, and Embase up to September 2025. We included observational case-control and cohort studies comparing the mRNA or protein expression of GWAS-identified susceptibility genes in ectopic endometrial tissue, stratified by phenotype. Quality assessment was performed using the Newcastle-Ottawa Scale (NOS).

Results: A total of 15 studies involving 1,240 tissue samples were included in the final synthesis. The analysis revealed significant heterogeneity in gene activation. Genes associated with cell adhesion and invasion (e.g., FN1, MMP2) were predominantly upregulated in DIE lesions (Fold Change > 2.5 vs. eutopic), correlating with the fibrotic nature of the disease. Conversely, OMA lesions exhibited a distinct upregulation of oxidative stress-related genes and iron metabolism regulators (e.g., HMOX1), likely driven by the hemoglobin-rich environment of the ovary. SUP lesions showed variable expression profiles, often characterized by acute inflammatory markers (e.g., IL-6, COX-2).

Conclusion: Endometriosis phenotypes are not merely anatomical variations but represent biologically distinct entities driven by unique gene activation profiles. These findings support a move toward phenotype-specific molecular diagnostics and targeted therapies.

Introduction: In Ghana, disparities in screening behaviours and sexual autonomy persist across socioeconomic and geographic lines. This study examined the spatial distribution, determinants, and socioeconomic inequalities in HIV testing, breast, and cervical cancer screening, and sexual autonomy among young women using nationally representative data.

Methods: Data were drawn from the 2022 Ghana Demographic and Health Survey (GDHS) comprising 1,183 currently partnered women aged 15-24 years. Weighted analyses were performed to estimate screening and autonomy prevalence across regions. Multilevel mixed-effects logistic regression identified predictors of screening behaviours, while socioeconomic inequalities were assessed using the Wagstaff concentration index and Theil's index. Spatial analyses were conducted to map regional variations and clustering patterns.

Results: Nationally, 63.9% of young women had ever tested for HIV, while only 12.1% and 3.6% had undergone breast and cervical cancer screening, respectively. Sexual autonomy prevalence was 77.2%. Education, wealth, health insurance, and media exposure significantly predicted screening uptake. Sexual autonomy independently increased the likelihood of breast (AOR = 2.75; 95% CI: 1.27-5.93) and cervical cancer screening (AOR = 5.45; 95% CI: 1.43-20.73). Spatial maps revealed strong north-south gradients, with higher autonomy and screening uptake clustered in southern and coastal regions (Eastern, Volta, and Central), and markedly lower levels in the northern belt (Northern, North-East, and Savannah). Wealth-related inequalities were pronounced for HIV (CI = 0.288) and breast cancer screening (CI = 0.334), but not for cervical cancer screening. Theil's indices confirmed substantial inequity across region and residence.

Conclusions: Targeted strategies such as expanding school-and-community-based health education for young women, integrating HIV and cancer screening into routine primary and antenatal care, strengthening health insurance coverage for preventive services, leveraging mass media to promote screening awareness, and prioritizing mobile and outreach screening services in northern and rural regions are critical for reducing socioeconomic and spatial inequalities in preventive healthcare among young women in Ghana.

Background: Access to sexual and reproductive health (SRH) services remains limited among university students in Albania, despite global progress in HIV/STI prevention. Low awareness, stigma, and fragmented youth-friendly services continue to hinder preventive healthcare utilization. Understanding the factors shaping SRH-seeking behavior is essential for designing effective interventions.

Methods: A cross-sectional study was conducted among 7,679 students from public and private universities in Albania (2024-2025). A structured, validated questionnaire assessed SRH knowledge, awareness of testing locations, condom access, and use of preventive services. Descriptive statistics, chi-square tests, and multivariable logistic regression were performed to identify predictors of HIV/STI testing, guided by Andersen's Behavioral Model.

Results: SRH service utilization was low, with only 11.4% of students reporting STI screening and 7.6% HIV testing. Students who were aware of testing locations had significantly higher odds of ever being tested (OR = 7.52; 95% CI: 6.21-9.09). Gender differences were pronounced, female students were more likely to report condom non-use and uncertainty about access points. Although sexual health education was associated with testing in bivariate analyses, only parental communication remained significant in the adjusted model.

Conclusions: Significant gaps in SRH awareness, access, and preventive healthcare engagement exist among Albanian university students. Enabling factors, particularly knowledge of service availability, play a greater role in influencing utilization than individual or predisposing characteristics, consistent with Andersen's Behavioral Model. Strengthening youth-friendly SRH services, increasing the visibility of testing sites, integrating SRH education into university programs, and addressing gender-specific barriers are essential to improve uptake of preventive SRH services in Albania.

Aims: To demonstrate the long-term stability and clinical utility of endometrial receptivity analysis (ERA) test in guiding personalized embryo transfer (pET) for patients with a history of recurrent implantation failure (RIF), even after an intervening live birth.

Methods: Two RIF patients, who had previously achieved a live birth via ERA-guided pET, sought a second pregnancy. For their subsequent personalized frozen-thawed embryo transfer cycles, progesterone administration timing was adjusted based on the receptive window identified by a single ERA test conducted more than four years earlier. No repeat endometrial biopsy was performed in either patient.

Results: Both patients underwent pET following the recommendations derived from their original ERA results. Both achieved successful clinical pregnancies and subsequently delivered healthy live infants.

Conclusion: These findings preliminarily suggest that repeat endometrial biopsy might not be necessary for subsequent pET in RIF patients with similar clinical backgrounds. However, given the small sample size of this case series, further large prospective studies are still needed to confirm the long-term utility of initial ERA results and the appropriateness of omitting repeat biopsies.

Since the invention of the microscope, physicians and gynecologists have utilized wet mount microscopy of vaginal fluids. A significant milestone was the discovery of Trichomonas vaginalis by Alfred François Donné in 1836. As the century progressed, research by Albert Döderlein shifted focus to the presence of lactobacilli. In the early 1920s, Christine Marie Berkhout provided a detailed description of the fungus Candida. For many years, understanding the microbiology of vaginal fluids in health and disease played a crucial role in diagnosing vaginitis and sexually transmitted infections. The development of culturing techniques on Petri dishes and later molecular biology methods, which became widespread and commercially accessible, offered more accurate diagnostic options, leading to the gradual decline of office microscopy. In this perspective article, we explore the advantages of maintaining office microscopy as a crucial component of gynecological examinations at point of care, especially for diagnosing vaginitis.

Introduction: Chromosomal abnormalities (CA) are a key genetic contributor to infertility, particularly in regions with high consanguinity. Despite growing utilization of assisted reproductive techniques (ART) in the Gulf region, large-scale cytogenetic data remain scarce. This study aimed to determine the prevalence and distribution of CA and chromosomal polymorphisms (CP) among infertile patients undergoing ART in the United Arab Emirates (UAE), providing region-specific evidence to support diagnostic decision-making and genetic counseling.

Methods: A retrospective cohort analysis was performed on 4,672 infertile patients (2,193 males and 2,479 females) who underwent conventional G-banded karyotyping between 2016 and 2024 at Al Ain Fertility Center. Semen parameters for all male participants were evaluated according to World Health Organization (WHO) standards. Cytogenetic findings were categorized into numerical abnormalities, structural abnormalities, and CP. Data were stratified by gender, infertility type, semen phenotype, and marital consanguinity (couple-level).

Results: A total of 305 patients (6.5%) showed CA or CP. The prevalence of abnormalities was higher in males, with sex-chromosome aneuploidies and autosomal structural rearrangements more frequently observed among azoospermic and severely oligozoospermic men. Consanguinity (marital relatedness) was descriptively compared across couple-level karyotype groups. The proportion of consanguineous couples was 39% (644/1,639) in the normal karyotype group, 34.6% (8/24) among couples with CA, and 45.1% (40/88) among couples with CP, with no statistically significant differences between groups. These findings reinforce the diagnostic value of karyotyping, particularly in males with severe sperm abnormalities.

Discussion/conclusion: This study represents the largest cytogenetic dataset on infertile patients in the UAE and the wider Gulf region, offering population-specific insights into chromosomal determinants of infertility. Routine karyotyping especially for azoospermic men remains essential for accurate diagnosis, informed counseling, and optimized ART planning. These findings provide UAE-specific prevalence data and support risk-stratified counseling; however, the consanguinity analysis reflects marital consanguinity within couples and does not assess parental consanguinity or causality.

Adenomyosis is an estrogen-dependent uterine disorder increasingly recognized as a major cause of infertility and adverse obstetric outcomes, yet optimal medical preparation before embryo transfer (ET) remains uncertain. Adenomyotic lesions create a hyperestrogenic, inflammatory, and architecturally distorted uterine environment that may impair endometrial receptivity and increase miscarriage risk, compromising assisted reproductive technology (ART) success. This review summarizes current evidence on extended hormonal suppression in patients with adenomyosis undergoing in vitro fertilization and ET. We examine the rationale, protocols, and reproductive outcomes of ultra-long gonadotropin-releasing hormone agonist (GnRHa) regimens, intensified suppression with GnRHa plus aromatase inhibitors, levonorgestrel-releasing intrauterine systems, oral dienogest, and continuous combined oral contraceptives. Available data suggest that prolonged GnRHa pretreatment, particularly in freeze-all strategies with frozen ET, may improve implantation and reduce miscarriage, with additional benefit from deeper suppression in selected severe cases. Progestin-based approaches appear promising but remain less well studied, while combined oral contraceptives mainly provide symptom control. The review highlights the heterogeneity and methodological limitations of existing studies and underscores the need for well-designed trials to define the optimal regimen, duration, and patient selection criteria for extended hormonal suppression before ET in women with adenomyosis.