Contraception and reproductive medicine最新文献

Introduction: Little research has focused on measuring free contraceptive choice, or whether individuals can make decisions about contraception without barriers or coercion. To advance measurement, we pilot survey questions focused on experiences of provider-imposed contraceptive coercion using population-based data collected among contraceptive users in Kisumu, Kenya.

Methods: We describe the percentage of women who reported provider-imposed coercion-related outcomes. We then examine demographic and facility-level correlates of feeling pressured or unable to say no to contraception and compare the extent that measures of feeling pressured and unable to say no to contraception overlap using 2 × 2 tables and Cohen's Kappa Statistic.

Results: The percentage of participants who reported provider-imposed coercion ranged by question from 1% to 57%. There were no associations between demographic or facility characteristics, including age, marital status, parity, and facility type (public or private), and either reporting feeling pressured or reporting feeling unable to say no to using contraception. There was no agreement between measures of feeling pressured and unable to say no to contraception (Kappa statistic - 0.11).

Conclusions: Our findings suggest that many women in Kisumu report experiencing some form of provider-imposed contraceptive coercion, though the proportion who report such experiences varies based on survey question. Further research is needed to improve reliable measurement of free contraceptive choice.

Background: Few studies have examined the sociodemographic characteristics associated with modern contraceptive use in Japan. This study investigated these associations using data from the National Fertility Survey.

Methods: Data were retrieved from the National Fertility Survey targeting unmarried individuals and married women in Japan. The analysis included unmarried individuals with sexual experience and sexually active married women intending to stop or space childbirths. Modern contraceptive use was examined in relation to sociodemographic characteristics, including age group, number of children, educational attainment, employment status, and income, among unmarried men and women as well as married women. Modified Poisson regression models were employed for the analysis.

Results: Data from 4,874 unmarried individuals and 1,533 married women were used in the analysis. Among both groups, younger age was associated with a higher prevalence of modern contraceptive use. Among unmarried individuals, having one or two children was significantly negatively associated with modern contraceptive use. Conversely, among married women, having multiple children was positively associated with modern contraceptive use. Additionally, a significant negative association was found between being a junior high or high school graduate and modern contraceptive use among unmarried men. Similarly, a significant negative association was observed among married women who were high school graduates. Conversely, modern contraceptive use was significantly positively associated with being an unemployed wife.

Conclusions: Modern contraceptive use in Japan was associated with various sociodemographic characteristics, including the number of children, educational attainment, and employment status.

Background: Postpartum contraception plays a vital role in extending interpregnancy intervals and reducing adverse maternal and neonatal outcomes. However, patients at elevated risk due to geographic and social barriers may experience disruptions in postpartum care. We examine associations between residential distance to the delivery hospital and social determinants of health (SDoH) with contraception uptake at delivery discharge.

Methods: We conducted a retrospective cohort study of live births born at 22.0 gestational age and greater at a single urban academic center from March 2020 to March 2022. Demographic, obstetric, and SDoH data were extracted from electronic medical records. Contraceptive method recorded for all births as part of the delivery discharge note was manually reviewed classified into long-acting reversible contraception (LARC) or non-LARC methods. Univariate analyses were used to compare characteristics across groups living within 10.0 miles and those living 10.1 miles or further from the hospital. Logistic regression was used to identify predictors of LARC uptake.

Results: A total of 3,644 births were included; 54.6% of patients were Black, 30.3% Hispanic, and 73.7% utilized public insurance. A total of 74.2% of patients resided within 10.0 miles of the delivery hospital. Patients living farther away were more likely to face transportation barriers, lower educational attainment, and higher SDoH personal risk scores. Overall, 18.6% living closer and 22.3% living further from the delivery hospital received LARC at discharge [X² (2) = 7.45, p < .05]. After adjustment for race, ethnicity, insurance, maternal age, partnership status, and a combined risk factor that assigned a positive binary indicator if the neonate was delivered via cesarean section, had a NICU stay, and/or, the maternal length of hospital stay was greater than 3 days, odds for LARC uptake at delivery discharge was elevated for those living further from the hospital as compared to those living closer to the delivery hospital (OR = 1.20, 95% CI = 1.01-1.43). Those with high personal SDoH risk also had significantly higher odds of LARC uptake at discharge (OR = 1.24, 95% CI 1.02-1.50) as compared to those without SDoH personal risk noted.

Conclusion: Several factors remained associated with LARC uptake at delivery discharge including residential distance, SDoH, and insurance. Our findings support the importance of inpatient contraceptive counseling and provision, particularly for socially vulnerable populations.

Background: Contraceptive use plays a significant role in reducing fertility and improving maternal and child health. Understanding utilization patterns and preferences is essential for addressing unmet needs in family planning among married women in India.

Objective: This study aims to analyse the usage of contraceptive methods among the married women aged 15-49 years in India, and to identify the factors associated with contraceptive uptake.

Methods: Cross-sectional data from the fifth round of the National Family Health Survey, (2019-21) were used for this analysis. NFHS is a periodic cross-sectional survey conducted using a multistage household sampling design in India. The total sample consisted of 512,408 women aged 15-49 years currently in a marital union. Cross-tabulation was conducted to evaluate the levels of contraceptive use, and logistic regression was utilized to identify factors associated with contraceptive uptake. The entire analysis was performed using the STATA 17.0 statistical software.

Results: Contraceptive usage among married women has increased from 53.5% in NFHS-4 (2015-16) to 65.7% in NFHS-5 (2019-21). The likelihood of contraception usage among the married women in India is significantly influenced by the factors like age of the women, educational attainment, desire for children, caste, religion, wealth index, exposure to mass media and place of residence.

Conclusion: Despite advancements in reproductive health, contraceptive uptake among married women in India remains insufficient. To address this, interventions should prioritize the provision of diverse contraceptive options, along with comprehensive counselling, to emphasize the benefits and proper use of these methods. Addressing socio-demographic disparities is essential for improving equitable access to family planning services.

Background: Long-acting reversible contraception is a key strategy for preventing unintended pregnancies, unbalanced human population growth, and unsafe abortions. There is limited evidence on the quality of long-acting reversible contraceptive services in Ethiopia, particularly in the study area. Therefore, this study aimed to evaluate the quality of long-acting reversible contraception services in the health Posts of Manna Woreda, Southwest Ethiopia.

Method: A case study evaluation design using a mixed method was employed from May 9 to June 25, 2021. Eight health posts were purposively selected from the 26 health posts in Woreda. Client exit interviews, direct observation, 3-month document review, resource inventories, and key informant interviews were also conducted. The quantitative data were entered into Epi-Data version 4.6 and exported to SPSS version 24 for analysis. Qualitative data were transcribed, translated, coded, and analyzed using thematic analysis. The overall quality of program implementation was measured based on predetermined judgmental criteria.

Results: The overall quality of long-acting reversible contraceptive services was 66.8%, with availability at 77.15%, provider compliance with national guidelines at 53.1%, and client satisfaction at 70%. Notable gaps included poor information provision during consultation, absence of supportive supervision, guidelines, and lack of infrastructure and information education materials. Additionally, there were gaps in the provision of services according to national guidelines.

Conclusion: The overall quality status of long-acting reversible contraception services was judged to be good, although service providers' compliance with the national guidelines was fair, and client satisfaction was judged to be good. Shortage of infrastructure, such as electricity, water, guidelines, and information education communication aids. Therefore, the Woreda Health Office should provide guidelines, equipment, and regular supportive supervision to improve the service quality.

Introduction: Long-acting reversible contraceptives (LARCs) are increasingly gaining popularity due to their high efficacy and ease of use compared to short-acting reversible contraceptives (SARCs). Among available LARCs, the etonogestrel (ENG) subdermal implant represents a particularly effective contraceptive method. However, many patients request early removal of the device due to the persistence of unfavourable bleeding patterns.

Methods: We developed a short, multiple-choice ad hoc questionnaire distributed online from October 2024 to March 2025 to investigate the attitude of Italian gynaecologists towards medical treatment of unfavourable bleeding in women using the ENG-releasing implant. A total of 141 physicians responded reporting their first- and second-line treatments for patients with and without a contraindication to combined oral contraceptives (COC). We discuss the results of our survey in the light of the existing literature, through a systematic review including studies evaluating medical treatments in ENG implant users experiencing troublesome bleeding.

Results and conclusion: The results of our survey and the review of the literature highlight the diverse, sparse, and sometimes confused approaches to unfavourable bleeding in ENG implant users. In our survey, up to 19% of practitioners indicated they would not know what to do in different case scenarios. In order to help gynaecologists gain greater confidence in managing this symptom, large randomised controlled trials (RCTs) with long-term follow-up on which clinical guidelines and standardized training programs can be based, are needed.

Background: Anti-Mullerian hormone (AMH) is an indicator of a woman's ovarian reserve or the number of follicles remaining in her ovaries. While the level of AMH is typically low among poor responders, there is significant variation in its levels among poor responders.

Objective: This study aimed to investigate the AMH level in poor-responder women and examine its association with nutrition, lifestyle, and reproductive characteristics.

Methods: A total of 119 infertile women with poor-responder were randomly selected from the infertility clinic of Al-Zahra Hospital, Tabriz, in 2022. Clinical, lifestyle, and reproductive characteristics were measured using valid instruments and para-clinical tests. Multiple linear regression analysis was carried out to estimate the variations of AMH level among poor-responder women.

Results: The average age of the participants was 36.6, and a significant negative correlation was found between advanced age and AMH level (r = -0.35, P = 0.001). In the final analysis, after adjusting for potential confounders using multiple linear regression, each unit increase in age, passive smoking, the cold season, poor or no vegetable consumption, and poor physical activity resulted in a decrease in AMH level by -0.162, -0.123, -0.321, -0.199, and - 0.212, respectively.

Conclusion: Findings indicated that lifestyle and nutrition are correlated with AMH levels in infertile women with poor responder. Promoting a healthy lifestyle can improve ovarian reserve in these women with with low level of AMH.

Clinical trial number: Not applicable.

Introduction: Embryo selection remains a key challenge in in vitro fertilization (IVF), as many morphologically "normal" embryos fail to implant. Artificial intelligence (AI) offers a promising tool for improving embryo assessment by providing more objective and accurate predictions of pregnancy outcomes. This study aims to systematically review and conduct a diagnostic meta-analysis to evaluate the effectiveness of AI-based tools in embryo selection for predicting pregnancy outcomes in IVF.

Methods: We conducted a systematic review following PRISMA guidelines, searching Web of Science, Scopus, and PubMed. Original research articles evaluating AI's diagnostic accuracy in embryo selection were included, while duplicates, non-peer-reviewed papers, abstracts, and conference proceedings were excluded. Data on sample sizes, AI tools, and diagnostic metrics were extracted, with quality assessed using the QUADAS-2 tool.

Results: AI-based embryo selection methods showed strong diagnostic performance, with pooled sensitivity of 0.69 and specificity of 0.62 in predicting implantation success. The positive likelihood ratio was 1.84 and the negative likelihood ratio was 0.5. The area under the curve reached 0.7, indicating high overall accuracy. The Life Whisperer AI model achieved 64.3% accuracy in predicting clinical pregnancy, while the FiTTE system, which integrates blastocyst images with clinical data, improved prediction accuracy to 65.2% with an AUC of 0.7.

Conclusion: AI offers a promising advancement in embryo selection for IVF, with the potential to enhance clinical outcomes and improve decision-making. Future studies should focus on refining these models to achieve the ultimate goal of a healthy live birth by developing more sophisticated algorithms and validating them with larger, diverse datasets.

Background: Women with disabilities face higher risks of maternal morbidity and mortality, particularly in low- and middle-income countries like sub-Saharan Africa (SSA). Barriers such as socio-cultural stigma, health facility inaccessibility, and lack of supportive healthcare contribute to their limited access to maternity services, exacerbating their vulnerability. Despite significant research on maternal health in SSA, studies focusing on women with disabilities remain scarce, and current healthcare services often fail to accommodate their needs. This scoping review explores barriers to maternity care accessibility among women with disabilities in SSA, highlighting gaps in research necessary for developing interventions that align with global health goals, such as reducing maternal mortality by 2030.

Methods: This current scoping review was informed by the methodological framework proposed by Arksey and O'Malley. Exploratory searches were conducted in JSTOR, PubMed, PsycINFO, African Journals Online, and Web of Science, etc., to identify studies conducted in SSA that focused on access, utilisation, and barriers to maternity services such as antenatal care (ANC) visits, facility delivery, and postnatal care visits among women with disabilities in SSA since the introduction of the sustainable development goals (SDGs). Twenty-two studies were included, spanning from June 1st 2016 to 30th May 2024.

Results: Of the 22 eligible studies out of 416 identified studies published between 2016 and 2024, 20 were conducted across eight countries in SSA. Eight studies employed quantitative methods, 12 used qualitative approaches, and two used mixed-methods analysis. These studies focused on all or either of the maternal health services measured in this study, which include antenatal care (ANC), facility delivery, and postnatal care (PNC) among women with disabilities. Findings indicate that, despite a strong desire for ANC, physical impairments, mobility issues, and unsupportive infrastructure hinder access. Although facility deliveries were high, support gaps and negative provider attitudes were common. The WHO health system framework categorisation shows that more barriers are within the service delivery and health workforce domains.

Conclusion: The review found limited studies on access to and utilisation of ANC, facility delivery, and PNC for women with disabilities in SSA. This gap restricts understanding of the issue and hampers interventions, increasing risks to maternal and child health. Urgent research and interventions are needed to address equity challenges in these services for disabled women in SSA.

Premature ovarian Insufficiency (POI) is characterized by amenorrhea, hypergonadotropic hypogonadism, estrogen deficiency, and reduced follicle counts leading to infertility under the age of 40. It occurs in 1 to 3% of women. Several therapeutic strategies have been explored in clinic for POI. Platelet Rich Plasma (PRP) a blood product applied in regenerative medicine, which is based on the releasing of the growth factors present in platelet. Mesenchymal Stem Cells derived from Bone marrow, adipose tissue or cord blood tissue are undifferentiated cells with a potential for self-renewal and differentiation into multiple mature cell type. Mesenchymal stem cells secretome can stimulate cellular process and activate multipotent stem cells to generate new younger tissue and blood vessels relevant to ovarian rejuvenation and endometrial regeneration. This review provides a critical analysis on novel treatments that have not achieve routine clinical practice status yet but have recently emerged as promising potential therapy.