Frontiers in reproductive health最新文献

Autoimmune and inflammatory rheumatic diseases (RDs) are more prevalent in women and often affect gynecological health. Particularly, heavy menstrual bleeding (HMB) and dysmenorrhea are more common in patients with RD. A link between RDs and endometriosis has been shown, whereas the association with adenomyosis remains unexplored. The present study evaluates the prevalence of adenomyosis in women of reproductive age with RD (n = 76) who were referred to the Gynecology Unit, compared with an age-matched control population (n = 305). A detailed clinical history and pelvic imaging findings obtained via transvaginal ultrasound were collected, excluding menopausal women and those with endometriosis or gynecological malignancies. Adenomyosis was significantly more prevalent in RD patients than in controls (40.8% vs. 19.7%, OR 2.81, 95% CI 1.64-4.82; p < 0.001), whereas the prevalence of uterine fibroids did not differ significantly between groups. These findings highlight the need for greater awareness of adenomyosis among both rheumatologists and gynecologists, as timely and adequate recognition is crucial to improving quality of life and reproductive health in patients with RDs.

Testicular ischemia-reperfusion injury (TIRI) is the outcome of the repair of torsion of the testis. It has been reported to cause loss of testicular function in both the ipsilateral and contralateral testes in the long run, thus resulting in male infertility. Its prevention is complex due to activation of oxidative stress, inflammation and apoptotic pathways in the ischemic and reperfusion phases. Previous experimental studies have successfully mitigated TIRI by applying ischemic preconditioning, ischemic postconditioning and pre-treatment regimens, which may not be appropriate for humans due to limitations associated with their application in real-life situations. However, pharmacological postconditioning, which involves the use of drugs to block key points in the TIRI pathway, can be proactively applied in humans, offering a better TIRI management strategy. Pathophysiological events in the TIRI pathway include activation of: xanthine oxidase (XO)-reactive oxygen species (ROS) pathway in the ischemic phase, calcium-mediated apoptotic pathway in the early reperfusion phase, and ROS-burst in the late reperfusion phase, among others. Hence, this review recommends that blocking the XO-ROS pathway with febuxostat after the onset of testicular torsion (TT), minimizing the calcium-mediated apoptotic pathway and restoring the loss of vasomotor tone with amlodipine on reperfusion, as well as blocking ROS-burst with vitamin E in the later phase of reperfusion, may help to mitigate the effect of TIRI in humans and thus prevent future infertility. Nevertheless, further research is needed to verify this claim and delineate the possible drug-drug interactions, as well as potential effects on other organs.

Aims: Multiple morphological abnormalities of the sperm flagella (MMAF) represents a rare and severe form of male infertility, characterized by defects in sperm flagella. Mutations in genes essential for flagellar function, such as CFAP43, have been implicated in MMAF. Flagella and motile cilia share a conserved axonemal structure essential for their motile function and the asthenospermia-related infertility of MMAF overlaps with primary ciliary dyskinesia (PCD) symptoms, characterized by chronic airway disease and infertility due to ciliary and flagellar dysfunction. This study investigates the genetic basis of MMAF in two siblings, who also exhibited respiratory symptoms.

Methods: Clinical assessment and semen analysis were conducted for two brothers presenting with infertility and chronic respiratory symptoms. Whole-exome sequencing (WES) was performed to identify potential genetic defects.

Results: Both siblings exhibited classic MMAF features, including asthenospermia with various flagellar abnormalities, in addition to chronic respiratory symptoms including sinusitis and wet cough. WES identified a novel homozygous missense genetic variation in CFAP43 [c.421T>A p.(Trp141Arg)].

Conclusion: Our findings provide additional evidence of the genetic contribution of CFAP43 in MMAF and suggest an expanded phenotypic spectrum of CFAP43-associated conditions to encompass chronic respiratory symptoms attributed to airway ciliary dysfunction. Further research is needed to uncover the underlying mechanisms linking CFAP43 mutations to these phenotypes.

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.