Frontiers in reproductive health最新文献

Background: Prior studies show that people with larger bodies experience pervasive weight stigma, which is often directly perpetuated by healthcare providers. This pattern has also been observed in women receiving prenatal and postpartum care. Individuals seeking treatment for infertility commonly encounter concrete barriers, such as formalized BMI-based restrictions. These limitations may further compound the isolating and stigmatizing experiences already known to affect women with infertility.

Methods: Qualitative study exploring the experiences and perceptions of patients with larger bodies and infertility. Women seeking fertility care within the past 2 years with a BMI ≥ 30 kg/m² were eligible for participation. Demographic surveys and one-on-one semi-structured interviews were performed. Interviews were deidentified, transcribed, and analyzed inductively using a thematic analysis approach. Major themes and subthemes were identified by two coders with discrepancies being resolved with a third coder.

Results: A total of 33 subjects were included in the analysis. Mean age of participants was 36.9 years. Key themes identified included stigmatizing treatment, perceptions of substandard care, complex body relationships, and quality care as an achievable goal. Many participants reported receiving shaming and judgmental care throughout their healthcare encounters including fertility care, which for several directly influenced their decision to pursue treatment. Participants often reported receiving abbreviated, substandard diagnostic evaluations that in many cases missed critical diagnoses. Participants conveyed significant awareness of the impact of weight on fertility and complex weight cycling histories, and this knowledge paired with these experiences often went unaddressed by providers.

Conclusion: Consistent with the experiences of patients with larger bodies broadly, patients with infertility similarly report receiving stigmatizing treatment and perceived substandard care from their fertility providers. This potential harm to patients is not inevitable; participants report receiving quality care where providers offer humanizing and individualized care. There is a clear need for personalized and patient-centered treatment for this population of patients, that while marginalized, account for an increasing percentage of fertility patients.

Background: Strengthening the pelvic floor muscles through non-invasive Kegel exercises before the onset of clinical symptoms is the most effective method for reducing postpartum complications.

Aim: This study seeks to investigate the impact of the Kegel exercise on maternal postpartum pain, pelvic floor dysfunction, and sexual function among women in the obstetrics and gynecology department of the National Guard Hospital, King Abdul-Aziz Medical City, Jeddah, Saudi Arabia.

Methods: a quasi-experimental design with six weeks apart pre- and post-tests was used, having 31 participants per group recruited with a convenience sample method. An interviewer-administered questionnaire containing a 20-item Pelvic Floor Disability Index (PFDI-20), a 19-item Female Sexual Function Index (FSFI), and the Visual Analog Scale with the Faces Pain Rating Scale was used to measure pelvic floor dysfunction, sexual function, and postpartum pain, respectively. These tools were valid and reliable.

Results: Results revealed a significant increase in the Female Sexual Function Index in the experimental group after the intervention and a substantial decrease in the Visual Analog Scale with the Face Pain Rating Scale in both groups after the intervention. There were no statistically significant differences between the experimental and control groups in the total score of pelvic floor dysfunction. However, the Colorectal-Anal Distress Inventory subscale showed a substantial increase in the control group post-test. In conclusion, the current study has shown that Kegel exercises can increase sexual drive and reduce pain in women with postpartum complications.

Introduction: The menstrual cup is worn intravaginally, holding blood up to 12 h before emptying and reinserting. It offers protection from sexually transmitted infections and bacterial vaginosis, whilst preserving a Lactobacillus crispatus-dominant vaginal microbiome. The menstrual disc, a type of menstrual cup, is positioned near the cervix and can remain in place during sex, enabling female sex workers (FSWs) to avoid unsafe practices to conceal menstruation during work. In this study, we aim to examine the perceptions and experiences of a convenience sample of FSWs 6 months after they received a menstrual disc, along with client views.

Methods: In a qualitative design, our Kenyan study recruited 38 FSWs in 4 focus group discussions (FGDs) and 86 clients in 9 FGDs. Using a semi-structured guide, a Kenyan moderator and note-taker facilitated audio-recorded discussions. Following translation and transcription, the discussions were analysed using deductive thematic analysis.

Results: Six themes emerged: Anticipation and reaction to seeing the menstrual cup, Apprehension and determination to use, Benefits, Challenges, Secrecy, and Use during sex. Some FSWs were able to insert the cup on initial attempt, typically others encountered discomfort, pain, or misalignment during insertion or difficulty in removing. By the end of the third month, the majority were using the cup without experiencing any leakage, pain, or concerns. Benefits noted included ease, convenience, reduced leakage, and comfort. Financial advantage over pads and ability to work regularly were also noted. Nearly all FSWs used the cup during sex, despite prior anxiety that a client would detect it and react negatively. In three instances, the FSWs reported that a client "may" have felt the disc, whilst noting just two clients "may" have felt something. None reacted badly. In summing up their experience, the FSWs spoke very positively about the disc, with the intention to keep wearing it in the future. Many clients were supportive of the disc but did not want to know whether an FSW was wearing it.

Conclusions: The FSWs quickly adapted to using the disc, finding it a comfortable, reliable menstrual product with financial advantages. With clients remaining mostly unaware of its use, the FSWs enthusiastically embraced the disc with the intention to keep using it. These positive outcomes have implications for future scale-up and roll-out to other vulnerable female populations.

Background: Even after the transfer of euploid embryos selected by Preimplantation Genetic Testing for Aneuploidy (PGT-A), clinical pregnancies may still result in miscarriage. The subsequent detection of chromosomal copy number variations (CNVs) in the products of conception in some cases reflects the inherent limitations of PGT-A technology.

Case report: Two couples underwent PGT-A treatments at assisted reproduction center of Northwest Women's and Children's Hospital, with the respective indications of recurrent pregnancy loss and advanced maternal age. For both, ovarian stimulation was conducted by an antagonist protocol, followed by intracytoplasmic sperm injection (ICSI). The embryos were cultured to the blastocyst stage, at which timepoint trophectoderm biopsy was performed. Following genetic analysis, available euploid blastocysts were identified for both couples. However, both pregnancies were identified as missed abortions during the first trimester after transferring one euploid blastocyst each. Subsequent CNV analysis carried out on the products of conception showed the presence of embryonic mosaicism.

Conclusion: The two cases highlight the critical need for thorough patient counselling regarding the technical constraints as well as the potential risks of PGT-A. Additionally, they emphasize the indispensable value of prenatal diagnosis after transfer of euploid blastocyst identified by PGT-A.

Background: Pregnancy among adolescent girls and young women (AGYW) remains a key public health concern, shaped by wider socio-cultural and structural factors. Although global birth rates among adolescent girls are declining, South Africa's rates continue to rise. This study examined AGYW's attitudes, experiences with pregnancy and antenatal care, and views on accessing related services.

Methods: The study employed a descriptive qualitative design, using in-depth interviews to explore the experiences of AGYW aged 15-24 years from seven South African provinces, regardless of pregnancy history. Participants were selected from the HERStory 3 survey database and interviewed remotely by telephone, with sixty-eight participants. Interviews were transcribed and translated into English. Data analysis followed an integrated, cyclical thematic approach that identified themes through deductive and inductive methods to identify and define themes, patterns, and relationships.

Results: The study identified four main themes: support during pregnancy, mental health, health service experiences, and social or cultural factors affecting pregnancy experiences. Family, particularly parents, played a major role in the pregnancy experiences of AGYW, but limited partner communication and difficulty confiding in families often weakened support networks. Participants reported issues, like premature birth and miscarriage, highlighting a need for postpartum care. Experiences with health services were mixed, with some unaware of available programs. Decisions about abortion involved financial, educational, health, and moral considerations.

Conclusions: This study examined AGYW's experiences of pregnancy and pregnancy-related services. Findings suggest that SRH services for AGYW in high-risk communities can be improved by training support professionals to be more sensitive and non-judgmental.

Introduction: Adolescents are at risk of sexually transmitted infections and unintended pregnancies. Consistent condom use is effective in curbing the double burden of diseases and unplanned conceptions. Condom negotiation influences consistent condom use. However, a clear operational definition is lacking. This paper analyzes the concept of adolescent condom negotiation and examines its defining attributes, antecedents, and consequences to promote conceptual clarity and enhance sexual health research and practice.

Methods: Norris's (1982) concept clarification method guided this analysis. This framework systematically observes, describes, and organizes conceptual evidence to support the development of an operational definition and a preliminary conceptual model of adolescent condom negotiation. A comprehensive literature review was conducted using PubMed, CINAHL, and PsycINFO, as well as the reference lists of relevant studies. Studies were included if they addressed communication, negotiation, or decision-making related to condom use among adolescents.

Results: Twenty-seven sources met the inclusion criteria. Two core attributes of adolescent condom negotiation were identified: (1) communication strategies used to express preferences regarding condom use, and (2) negotiation behaviors aimed at reaching mutual agreement with a partner. The analysis resulted in an operational definition and a preliminary conceptual model that illustrates how communication and negotiation processes influence condom use among adolescents. No existing instrument designed to specifically measure adolescent condom negotiation was identified.

Discussion: The findings of this study will help researchers, nurses, doctors, and sexual health educators design more precise measurements and focused interventions for teenagers, especially in environments with high STI and teenage pregnancy burdens and gendered power inequalities. Operationalizing adolescent condom negotiation marks a critical step toward advancing adolescent sexual health research and practice. A clear, evidence-based definition supports targeted education and interventions to promote consistent condom use among adolescents, thereby reducing the risks of sexually transmitted infections STIs and unintended pregnancies.

Objective: To compare the effects of frozen-thawed embryo transfer at different times after hysteroscopic endometrial polyp resection on pregnancy outcomes and to provide evidence for individualized clinical treatment.

Methods: This study was a single-center retrospective cohort study involving 756 infertile patients who underwent hysteroscopic polypectomy for endometrial polyps from 2023 to 2024 and underwent natural cycle frozen-thawed embryo transfer for the first time after surgery, divided into two groups: Group A (178 cases) underwent transfer during the menstrual cycle after the operation, while Group B (578 cases) underwent transfer after next menses after the operation. Baseline characteristics, clinical pregnancy rate, live birth rate and miscarriage rate were compared between the two groups. Additionally, a correlation analysis between the interval from surgery to embryo transfer and pregnancy outcomes in the immediate transfer group.

Results: There were no significant differences in baseline characteristics such as age, BMI, AMH level between the two groups. Unadjusted, there were no statistically significant differences in clinical pregnancy rate (60.7% vs. 58.3%), live birth rate (57.9% vs. 56.4%), early miscarriage rate (2.8% vs. 8.9%), and late miscarriage rate (1.9% vs. 2.7%) between group A and group B (all P > 0.05). After adjusting for confounding factors such as age, prevalence of endometritis, and type of transplanted embryo, the timing of transplantation still had no significant effect on pregnancy outcomes (clinical pregnancy rate OR = 0.99, 95% CI: 0.68-1.42; live birth rate OR = 1.02, 95% CI: 0.71-1.46). However, binary logistic regression showed a negative correlation between maternal age and pregnancy rate and live birth rate. In group A, the interval from surgery to transplantation was not significantly correlated with clinical pregnancy and live birth outcome.

Conclusion: There was no significant difference in pregnancy outcomes between frozen-thawed embryo transfer in the current menstrual cycle and the next menstrual cycle after hysteroscopic endometrial polyp resection, and the choice of transfer timing was not a key factor affecting pregnancy outcomes. For patients with special clinical needs, transplanting in the same menstrual cycle after surgery is a feasible option, which helps to shorten the waiting time and reduce mental stress.

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.