Frontiers in reproductive health最新文献

Introduction: Frozen embryo transfer (FET) is a standard procedure that improves live birth rates and reduces ovarian hyperstimulation risks. Optimizing luteal phase support with hormone replacement therapy (HRT), particularly by progesterone supplementation, enhances endometrial receptivity and embryo implantation success. Despite advances in cryopreservation techniques, optimal protocols for progesterone supplementation in HRT-FET cycles remain uncertain. This study aims to evaluate the effects of an individualized luteal phase protocol using subcutaneous progesterone on live birth rates in HRT-FET cycles.

Methods: In this retrospective cohort study, we analyzed data from 433 autologous FET cycles prepared with HRT. Serum progesterone levels were measured the day before FET. Two groups were compared according to serum progesterone measurement the day before FET. The control group (≥ 11 ng/ml), received standard luteal support (800 mg vaginal progesterone daily); and the rescue group (<11 ng/ml), received an additional 25 mg subcutaneous progesterone daily. Pregnancy outcomes, including biochemical pregnancy, clinical pregnancy, miscarriage, and live birth rates, were assessed across both groups.

Results: Despite overall similar pregnancy rates, the rescue group, receiving combined subcutaneous and vaginal progesterone, demonstrated a higher live birth rate compared to the control group (36.9% vs. 24.7%, p = 0.006). By Day 12 after FET, progesterone levels in the rescue group were comparable to those in the control group.

Conclusion: Our findings suggest that adding subcutaneous progesterone to standard vaginal support in HRT-FET cycles may improve reproductive outcomes in patients with low serum progesterone levels the day before transfer. These results support tailoring progesterone supplementation to optimize luteal phase support. Further controlled trials are needed to establish standardized protocols for HRT-FET cycles.

Introduction: This study aimed to evaluate current practices in assisted reproductive technology (ART) patient care, identifying potential areas for improvement. Collective data will further provide key insights in gaps and potential new tools to enhance ART care practices for patients and healthcare professionals.

Methods: An online questionnaire comprising 22 multiple choice questions was distributed to ART specialists in France and Belgium between September and November 2023. Responses were analyzed overall and by country. Descriptive analysis used 5-point Likert scales (converted to numerical scores) for comparative insights. Qualitative data were reported as frequencies (%), and quantitative data as means and standard deviations.

Results: A total of 166 IVF specialists participated in the survey out of 487 contacted, 130 from France (78.3%) and 36 from Belgium (21.7%). Most respondents (92.8%) scheduled the first consultation within three months, with all Belgian specialists meeting this timespan compared to 90.8% in France. Notably, 30.8% of French specialists and 29.5% of Belgian specialists scheduled appointments within one month. During initial consultations, 73.3% provided patients with informational materials, and 61.5% informed them about psychological support options. To assess lifestyle factors, clinicians primarily used oral questionnaires (91.9%), with a higher prevalence of written questionnaires in Belgium compared to France (37.1% vs. 15.9%). When patients struggled to understand treatment instructions, 82.6% of clinicians took time to re-explain, and 60.9% referred patients to nursing staff for further assistance. Most respondents (90.7%) provided digital tools for injection training, while 74.7% offered training sessions conducted by paramedical staff. Most reported treatment errors included dosage and handling mistakes and nurse injection errors. Psychological support was offered by 80% of respondents for IVF failures, with variations between countries in follow-up approaches. Overall, clinicians rated patients' knowledge of different ART aspects as relatively low, with average scores ranging from 2.43/5 to 3.30/5, depending on the items.

Discussion: The main areas for improvement highlighted in this study were patient education and support throughout the care pathway. Differences in practices between France and Belgium were also observed, highlighting the importance of context-adapted approaches. Our observations may further facilitate the development of tailored tools aimed at improving ART care practice.

Objective: To investigate the temporal variations in male semen quality parameters before, during, and after a major regional COVID-19 outbreak wave.

Methods: This retrospective cohort study analyzed initial semen samples collected at our hospital between June 1, 2022, and June 30, 2023. Based on regional epidemiological data corresponding to a major outbreak, participants were stratified into three groups by sample collection date: a pre-outbreak group (Group A, September 1, 2022-December 31, 2022, n = 330), a peak-outbreak group (Group B, January 1, 2023-March 31, 2023, n = 413), and a post-outbreak group (Group C, April 1, 2023-June 30, 2023, n = 480). Conventional semen parameters, sperm acrosin activity, and sperm DNA fragmentation index (DFI) were compared.

Results: The peak-outbreak group (Group B) showed significantly lower sperm concentration compared to both the pre-outbreak group (49.1 vs. 59.6 × 10⁶/ml, P = 0.009) and the post-outbreak group (49.1 vs. 62.6 × 10⁶/ml, P < 0.001). Similarly, progressive motility was significantly lower in the peak-outbreak group (37.7%) compared to the pre-outbreak (45.1%, P < 0.001) and post-outbreak groups (43.4%, P < 0.001). No significant differences were found in these parameters between the pre-outbreak and post-outbreak groups (P > 0.05). Sperm acrosin activity and DFI remained stable across all three groups (P > 0.05).

Conclusion: Semen concentration and motility were significantly lower in samples collected during the peak of a major COVID-19 outbreak wave, with parameters returning to pre-outbreak levels in the subsequent 3-month period. Key sperm functional biomarkers, including acrosin activity and DNA integrity, appeared resilient throughout these distinct epidemiological phases.

Background: Erectile dysfunction (ED) is a prevalent condition impacting men's quality of life and is often linked to cardiovascular and metabolic disorders. Conventional treatments like phosphodiesterase type 5 (PDE5) inhibitors could be ineffective for severe cases, indicating a need for innovative approaches. This study aimed to evaluate the efficacy and safety of a multimodal protocol combining low-intensity shockwave therapy (LiST), intrapenile and intravenous umbilical cord-mesenchymal stem cell (UC-MSCs) therapy, and hyperbaric oxygen therapy (HBOT) in men with ED. A retrospective pragmatic observational study was performed by reviewing medical records of 22 men treated at a private clinic in Costa Rica. Erectile function was measured using the Sexual Health Inventory for Men (SHIM) questionnaire before treatment and three months post-treatment.

Results: The protocol significantly improved SHIM scores, with a mean increase of 3 points from baseline (p = 0.0017). No major adverse events were reported during follow-up.

Conclusion: The multimodal protocol demonstrated a significant improvement in erectile function with a favorable safety profile, suggesting potential as a viable option for patients with ED. Further prospective randomized controlled trials are needed to validate these findings.

Introduction: Domestic and sexualized violence, including intimate partner violence, are an increasing public health concern across Canada. Beginning with the province of Nova Scotia, several jurisdictions have now declared this violence to be "an epidemic", with renewed calls for health systems to be part of prevention efforts. Recent research has shown that while many health professionals are seeing cases of violence in their work, their training, resources, and workplace supports are inadequate. The current paper aimed to qualitatively analyze how discourses around domestic and sexualized violence affect health professionals' readiness to respond.

Methods: From November 2023 to February 2024, we conducted an online, mixed-methods survey of professionals working in health-related fields in Nova Scotia (N = 1,649). We qualitatively analyzed responses from 828 participants who answered at least one open-ended question using reflexive thematic analysis within a feminist poststructuralist framework.

Results: We generated two themes in our analysis. The first theme, "inconsistent approaches to addressing violence", described how many participants were aware of the impacts of violence on their patients but relied on different discourses for whether (or not) the issue falls within their scope of practice. Participants highlighted key organizational challenges limiting their potential responses to violence (e.g., protocols, training, staffing, time constraints). The second theme, "the limits of downstream health responses amid structural barriers", highlighted how individual health professionals experienced their positions as too "downstream" to provide significant responses to an issue rooted in structural factors (e.g., housing insecurity) that has only exacerbated since the onset of the COVID-19 pandemic. Many participants reflected on how fragmented systems of support may increase the risk of survivors experiencing violence. Respondents expressed frustration as they recounted limited capacity to meet the needs of survivors without social and structural infrastructures.

Conclusion: Our results provide important insights into current organizational and systems-level barriers and facilitators for responding to domestic and sexualized violence among Canadian health professionals. Government and organizational policy should more clearly define how domestic and sexualized violence is within scope of practice for different health professionals, with appropriate, ongoing training and resourcing. Likewise, structural causes of violence must be recognized, both in terms of identifying and supporting patients and communities at greatest risk and creating opportunities for the health sector to be a part of primary prevention efforts.

Background: The number of international migrants has steadily increased over the past decade. Among them, undocumented in-transit migrant women (UITMW) face heightened vulnerability to gender-based violence and complex sexual and reproductive health (SRH) needs. However, limited evidence exists on the challenges state and non-state actors face in delivering SRH services to this population. This qualitative study explores the barriers encountered by service providers and decision-makers in Mexico when addressing UITMW's social and health needs through an SRH lens, and identifies facilitators that may support more effective service delivery.

Methods: Between August and November 2023, we conducted 31 in-depth interviews with 36 service providers, migration experts, and local and federal decision-makers in Ciudad Juárez, Chihuahua City, and Mexico City. Guided by McLeroy et al.'s socioecological model, we examined challenges and facilitators at individual, institutional, community, and structural levels. Data were analyzed using a framework analysis approach.

Results: Participants identified 11 challenges and 9 facilitators influencing SRH service provision for UITMW. Key challenges included: (1) policies and resource allocations are shaped by the perception of migration as temporary; (2) growing anti-immigrant sentiment undermine community-level service delivery; (3) religious restrictions in faith-based shelters limit access to certain SRH services; and (4) biases among healthcare providers affect quality of care. Notable facilitators included structural reforms such as strengthened migration and health governance and improved multi-level collaboration to enhance service access.

Conclusion: This study underscores the complex, multi-level barriers to delivering SRH care to UITMW in Mexico. Findings point to research and policy priorities, including examining the long-term impacts of migration and health policies on SRH service availability, evaluating alternative delivery models, analyzing the role of media in shaping public opinion, and involving UITMW and local stakeholders in policy development. Addressing these gaps could improve SRH outcomes for UITMW and strengthen the broader health system response for both migrant and local populations.

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.