Search Results (95)

Introduction: Uterine fibroids are benign tumors arising from uterine smooth muscle and significantly affect women’s health worldwide. While conventional treatments often involve hormonal therapies or invasive surgeries, these approaches are limited by cost, side effects, and fertility concerns. This study aimed to evaluate the in vivo bioactivity of four medicinal plant extracts, Lepidium sativum, Prunus armeniaca, Solenostemma argel, and Stachys palustris, in ameliorating monosodium glutamate (MSG)-induced uterine changes in rats, providing preliminary preclinical evidence. Methods: The extracts were evaluated for their flavonoid and total phenolic contents, antioxidant capacity, and hormonal modulatory effects. Female Wistar rats were treated with monosodium glutamate to induce uterine changes, followed by interventions with herbal extracts. Outcomes were evaluated via biochemical, hormonal, and histological analyses. Results: Among the four extracts, Lepidium sativum and Stachys palustris showed superior antioxidant activity, restoring catalase, glutathione, and superoxide dismutase levels. These extracts also significantly reduced estrogen levels and estrogen receptor expression, correlating with improved histological outcomes, including reduced endometrial hyperplasia and myometrial thickness. Solenostemma argel and Prunus armeniaca exhibited moderate effects. Conclusions: This study underscores the potential of Lepidium sativum and Stachys palustris as natural therapeutic agents for fibroid management through antioxidant activity and hormonal modulation. Future research should focus on clinical validation to translate these findings into effective treatments. Full article

Background: Does maternal body mass index (BMI) influence embryo morphokinetics in fresh embryo transfer cycles, and how does this relate to clinical outcomes and obstetric complications? Methods: A retrospective cohort study was conducted on 2238 fresh embryo transfer (ET) cycles, categorized into four BMI groups: underweight, normal weight, overweight, and obese. Baseline characteristics, stimulation parameters, hormonal profiles, morphokinetic data, and pregnancy and delivery outcomes were analyzed. Results: Higher BMI was associated with more anovulatory infertility and greater endometrial thickness. Peak estradiol and estradiol-to-oocyte ratios declined progressively with increasing BMI, despite preserved oocyte yield and embryo quality scores. Interestingly, the underweight group exhibited a significantly distinct biphasic morphokinetics developmental pattern compared with the overweight and obese groups. Pregnancy rates, including clinical and live birth, did not differ significantly across BMI groups. However, obese women had markedly higher cesarean section rates (51.9% vs. ~25–28% in other groups) and a non-significant trend toward more gestational diabetes. Other perinatal outcomes, such as preeclampsia and preterm birth, were not significantly different. Conclusions: In fresh IVF cycles, a higher BMI does not impair pregnancy achievement but is linked to altered hormonal response and increased obstetric risk, particularly cesarean delivery. These findings highlight the importance of preconception counseling and targeted obstetric management for women with elevated BMI undergoing fresh ET. Full article

Granulocyte colony-stimulating factor (G-CSF) has been suggested as a supplementary approach for endometrial preparation in IVF. Clinical results continue to be inconsistent. This narrative review synthesises molecular and clinical information to elucidate the function of G-CSF in modifying endometrial receptivity and to identify patient categories most likely to benefit. A thorough assessment was conducted on published research on G-CSF administration in women with treatment-resistant thin endometrium, recurrent implantation failure, and unselected IVF populations. The research demonstrates that G-CSF has phenotype-dependent effects. Improvements in pregnancy and live birth rates are inconsistent and seem dependent on the reversibility of underlying tissue disease; nevertheless, G-CSF reliably increases endometrial thickness in instances of thin endometrium and may restore eligibility for transfer. G-CSF improves implantation and early pregnancy outcomes in repeated implantation failure patients without modifying endometrial morphology, indicating a functional mechanism linked to immune-stromal synchronisation rather than structural expansion. In contrast, randomised controlled studies show no therapeutic benefit in unselected IVF groups. Discrepancies in research outcomes may mostly be attributed to variations in patient phenotype, initial endometrial function, and the therapy setting. Thus, G-CSF should be considered a specific approach for endometrial conditioning rather than just a supplementary component of IVF. Full article

Background/Objectives: Lifestyle interventions are first-line treatment for women with polycystic ovary syndrome (PCOS) to improve metabolic health. Impacts on reproductive function are less clear. Previous research has been limited by inconsistencies in evaluation of ovulatory function and lack of comparisons between women with and without PCOS. Methods: The present study implemented a prospective clinical trial of 28 women (PCOS, N = 10 and Non-PCOS Control, N = 18) undergoing a 1-month baseline assessment followed by a 6-month hypocaloric dietary intervention. Results: Both groups reached clinically meaningful weight loss with the intervention (PCOS group: 6.5 ± 5.5%; Non-PCOS Control group: 10.0 ± 4.7%). Largest follicle diameter and growth rate of ovulatory dominant follicle, menstrual cycle length and luteal phase length did not change during the intervention in either group (all p > 0.05). The Non-PCOS Control group had increased mid-luteal phase progesterone levels and secretory phase maximum endometrial thickness during the intervention (all p < 0.05), whereas the PCOS group showed a reduction in follicular phase length (p < 0.05). Additionally, changes in ovulatory function and endometrial development were not associated with the rate of weight loss (all p > 0.05). Conclusions: This study demonstrates that women with PCOS are unlikely to experience changes in menstrual cyclicity and endometrial development with a short-term hypocaloric dietary intervention. The shortening of the follicular phase suggests that women with PCOS may need a longer intervention to achieve clinically meaningful improvements in ovulatory function and endometrial health. Full article

Background: In young women with cervical cancer, fertility preservation remains challenging, as chemoradiotherapy can severely compromise ovarian reserve and endometrial function. Although ovarian transposition prior to pelvic radiotherapy is well established in early-stage disease, evidence regarding ovarian and endometrial outcomes in advanced stages, particularly in the International Federation of Gynecology and Obstetrics (FIGO) stage IIIC1, remains extremely limited. Case Presentation: We report the case of a 31-year-old nulliparous woman with a histopathologically confirmed FIGO IIIC1 cervical squamous cell carcinoma who underwent a lateral ovarian transposition followed by external beam radiotherapy (ERBT) of the pelvis and interstitial high-dose-rate (HDR) brachytherapy combined with five cycles of cisplatin-based chemotherapy. A detailed dosimetrical analysis demonstrated extremely low ovarian radiation exposure (mean dose < 2 Gy bilaterally). Menstruation resumed seven months after treatment completion, with regular 27–30-day cycles. A day-3 hormonal assessment showed a partial preservation of the ovarian reserve, and the pelvic ultrasound confirmed a thickness of 7 mm in the proliferative phase, implying endometrial function despite full-dose pelvic irradiation. Conclusions: To our knowledge, this is a very unique case of preserved menstruation after ovarian transposition and chemoradiotherapy for FIGO IIIC1 cervical carcinoma. This case challenges the conventional assumptions regarding ovarian failure and endometrial destruction in such cases, suggesting that reproductive potential may occasionally be retained. Although fertility remains a challenging point, this case report underscores the need for individualized counseling and prospective oncofertility research. Full article

Objective: In this study, we aimed to develop and internally validate a clinically applicable nomogram for predicting live birth following in vitro fertilization (IVF) using routinely available clinical and embryological parameters. Methods: This retrospective study was conducted at a single tertiary IVF center. Women undergoing IVF/ICSI were included if their baseline demographic and clinical data were available, they had undergone at least one fresh or frozen–thawed embryo transfer, and they had a known live birth outcome. Women with cycles without embryo transfer and those missing key outcome data were excluded from the analysis. As a result, a total of 2119 IVF/ICSI treatment cycles resulting in embryo transfer were included in the analysis. To identify independent predictors of live birth, multivariable logistic regression analysis was performed. Results: Among the 2119 treatment cycles analyzed, 541 resulted in live birth (25.5%). Multivariable logistic regression with backward stepwise selection identified female age (OR: 0.959, p < 0.001), high embryo quality (OR: 2.752, p < 0.001), day of embryo transfer (day 5 vs. day 3, OR: 1.427, p = 0.001), and endometrial thickness on the day of transfer as independent predictors of live birth (OR: 1.086, p < 0.001). These variables were incorporated into a nomogram (the Zübeyde Hanim IVF Nomogram) to estimate individualized live birth probability. The model demonstrated acceptable discrimination, with a bootstrap-corrected area under the receiver operating characteristic curve (AUC) of 0.64 (95%CI: 0.61–0.66), and it showed satisfactory calibration across deciles of predicted risk. Conclusions: The Zubeyde Hanim IVF Nomogram provides an individualized and clinically practical tool for predicting live birth following IVF treatment. Based on routinely available parameters, this model may assist clinicians in patient counseling and treatment planning. Full article

Background: Optimizing pregnancy outcomes while minimizing gonadotropin exposure and treatment burden remains a major goal in ovulation induction for intrauterine insemination (IUI), particularly for patients with polycystic ovary syndrome (PCOS) or high ovarian reserve. Sequential protocols combining early letrozole with late-onset recombinant FSH (rFSH) have been proposed to enhance efficiency while reducing medication requirements. However, real-world comparative data adjusting for baseline differences are limited. Methods: This retrospective comparative cohort study included 764 IUI cycles performed between January 2022 and October 2025. Cycles were stimulated either with conventional rFSH (n = 372) or letrozole plus late-onset rFSH (n = 392). The primary outcome was pregnancy per cycle, defined by a positive serum β-hCG. Secondary outcomes included clinical pregnancy, total gonadotropin dose, endometrial thickness, cycle cancelation, and obstetric outcomes. Confounding was addressed using multivariable logistic regression, propensity score matching (PSM), inverse probability of treatment weighting (IPTW), and doubly robust estimation. Results: The crude pregnancy rate was higher in the letrozole plus late rFSH group compared with conventional rFSH (14.8% vs. 9.9%, p = 0.042). Women in the sequential stimulation group had higher AMH levels, higher antral follicle counts, and a higher prevalence of PCOS (32.4% vs. 16.3%, p = 0.001). After adjustment for age, ovarian reserve, and other baseline characteristics using regression, PSM, and IPTW, the stimulation protocol was not independently associated with pregnancy (adjusted OR 1.09, 95% CI 0.68–1.74; p = 0.657). Female age remained the strongest predictor of pregnancy (adjusted OR 0.70 per year increase; p < 0.001). The sequential protocol required a significantly lower total gonadotropin dose (median 375 IU vs. 750 IU; p < 0.001) while maintaining comparable cycle cancellation and safety outcomes. Conclusions: Sequential stimulation with letrozole plus late-onset rFSH achieves pregnancy outcomes comparable to conventional rFSH stimulation while significantly reducing gonadotropin requirements. After adjustment for PCOS status and ovarian reserve, the protocol itself did not independently influence pregnancy, suggesting that crude differences reflected baseline imbalances rather than true treatment effects. This approach represents a clinically efficient, gonadotropin-sparing option for IUI, particularly in patients at risk for excessive ovarian response. Full article

Background/Objectives: Dual stimulation starting in the follicular phase allows retrieval of more oocytes than single follicular-phase controlled ovarian stimulation (COS). However, dual stimulation excludes fresh embryo transfer (ET), forcing us to postpone the first ET. If dual stimulation is performed in a reverse way (“reverse”-dual stimulation, R-DS), fresh ET can be performed, potentially reducing the time to pregnancy. The aim of the present study is to investigate reproductive outcomes of R-DS compared to two consecutive COS starting in the follicular phase (2FP-COS). Methods: A retrospective study was performed on 146 poor responders matching Bologna criteria, among which 45 underwent R-DS and 101 received 2FP-COS. In the R-DS group, the first COS began 5 days after ovulation and the second 5 days after oocyte retrieval. The primary outcome was the time to pregnancy. Results: In R-DS, stimulation length, retrieved oocytes, and blastocyst formation rate were comparable in the luteal and follicular COS rounds. Circulating progesterone was always <1.0 ng/mL at ovulation trigger, and fresh ET was performed with a mean endometrial thickness of 9.27 ± 2.28 mm. Comparing R-DS and 2FP-COS, no differences were found in terms of retrieved oocytes and cumulative live birth rate; however, the R-DS group showed significantly shorter time to pregnancy (52.9 ± 11.6 vs. 103.2 ± 23.2 days, p < 0.05). Conclusions: This study suggests that R-DS is not inferior to two consecutive COS starting in the follicular phase in terms of oocytes retrieved and cumulative live birth rate. R-DS allows immediate fresh ET and can significantly shorten the time to pregnancy, a relevant issue for poor responders’ patients. Full article

Background/Objectives: Currently, no non-invasive detection method for endometrial cancer (EC) is recommended in clinical practice worldwide. This study aimed to evaluate the clinical value of detecting DNA methylation of CDO1 and CELF4 (CDO1m/CELF4m) in exfoliated cervical cells for the detection of EC in women with suspected endometrial lesions. Methods: A total of 2164 patients scheduled for hysteroscopic surgery due to suspected endometrial lesions at the Obstetrics and Gynecology Hospital of Fudan University between July 2023 and May 2024 were prospectively enrolled. Preoperative exfoliated cervical cells were collected for dual-gene methylation testing. Clinical data and endometrial thickness measured by transvaginal sonography (TVS) were recorded. Hysteroscopic histopathological diagnosis served as the gold standard to evaluate the performance of methylation testing alone and in combination with TVS. Results: This study included 2164 patients, comprising 33 EC cases, 31 cases of endometrial intraepithelial neoplasia (EIN), and 2100 cases of non-endometrial lesions, with mean ages of 51.7 ± 6.4, 49.5 ± 8.9, and 44.7 ± 9.8 years, respectively (p < 0.001). For EC detection, CDO1m/CELF4m positivity showed a sensitivity of 93.94% (95% CI: 79.77–99.26%), specificity of 96.7% (95% CI: 95.92–97.47%), positive predictive value (PPV) of 31.0% (95% CI: 25.96–36.53%), and negative predictive value (NPV) of 99.90% (95% CI: 99.63–99.98%). For EIN detection, the sensitivity was 83.87%, specificity 97.95%, PPV 37.68%, and NPV 99.76%. Combining TVS with DNA methylation detection further improved the sensitivity and NPV for both EC and EIN detection. Conclusions: DNA methylation detection in exfoliated cervical cells demonstrates high sensitivity and specificity for EC detection. The combination with TVS further enhances sensitivity and NPV, offering a simple and non-invasive triage strategy for patients with suspected endometrial lesions. This study was registered in China Clinical Trial Registry (ChiCTR2200055991) on 30 January 2023. Full article

Evidence indicates that seminal plasma (SP) has pregnancy-favorable biological effects, but there is no definitive proof that exposure to SP increases pregnancy rates in assisted reproductive techniques. We previously showed that this discrepancy may be due to male stress altering SP composition. This study investigated the association between male stress biomarkers in saliva, serum and SP and key determinants of female fertility in women exposed to their partner’s SP during the intracytoplasmic sperm injection (ICSI) cycle. The prospective pilot study included couples with tubal infertility who had unprotected intercourse during the ICSI cycle, supplemented by intravaginal SP injection on the oocyte retrieval day. Salivary cortisol and seminal noradrenaline were quantified by enzyme-linked immunosorbent assay to assess the activity of the hypothalamic–pituitary–adrenal axis and sympathetic nervous systems. Seminal interleukin-18 was measured using LegendPlex™ technology. Cluster analysis of male stress biomarkers identified two neuroendocrine-immune (NEI) phenotypes, characterized by signs of acute (phenotype-1) and chronic (phenotype-2) stress. Women with NEI phenotype-2 partners had fewer collected, mature, and fertilized oocytes, thinner endometrium, and significantly lower pregnancy rates (18.2%) compared to those with NEI phenotype-1 partners (84.6%). These data may suggest a dual role for SP in female fertility, depending on the type of male stress. Full article

Background/Objectives: Adenomyosis (A) is a benign but invasive uterine condition frequently associated with structural changes in the uterine wall that may contribute to infertility. Methods: This is a retrospective study involving 140 patients: 100 diagnosed with primary infertility (PI) or secondary infertility (SI) and 40 in the control group. All patients were assessed using transvaginal two-dimensional, three-dimensional, and hysterosalpingo-contrast sonography (HyCoSy), performed in the early proliferative phase. Evaluated parameters included uterine dimensions, endometrial thickness, and characteristics of the junctional zone (JZ). Criteria such as JZmax > 5 mm or JZmax − JZmin > 5 mm, alongside other findings, supported the diagnosis of adenomyosis. Results: Patients with PI showed larger uterine longitudinal diameters, while SI patients had thicker JZ measurements. PI patients were significantly younger. Histopathological examination confirmed the presence of endometrial glands and periglandular stroma disrupting myometrial architecture, forming chronic lesions potentially linked to infertility. Conclusions: HyCoSy revealed variable depths of myometrial invasion by A, with some cases extending near the serosa. The chronic lesions found in histopathological examination were potentially linked to infertility. Full article

Background/Objectives: Non-receptive endometrium is associated with recurrent implantation failure, which leads to a decrease in the frequency of pregnancy during IVF; therefore, new treatment methods such as the use of Platelet-Rich Plasma (PRP) are gaining popularity in the treatment of infertility in women with repeated unsuccessful IVF attempts. Methods: A total of 38 women were included in this study, with the main complaint being the inability to conceive or maintain pregnancy. Medical examination, laboratory tests, ultrasound of the pelvic organs and hysteroscopy were performed. After that, whole blood was taken to prepare an autologous PRP; then, the PRP was inserted into the uterine using an intrauterine catheter in the first phase of the menstrual cycle (1–7 procedures). The primary outcome of this study was an increase in endometrial thickness and improvement of the receptive endometrial layer. The secondary outcome was pregnancy rate. This was a single-center prospective interventional clinical study. Results: Statistical analysis of changes in endometrial thickness after PRP therapy showed that endometrial thickness indicators after treatment significantly exceeded the values before the intervention. This may be evidence of the effectiveness of PRP therapy for thin endometrium. When analyzing pregnancy status, it was noted that after receiving PRP, more than half (56% of cases) became pregnant and the majority of them successfully gave birth. Conclusions: Based on the results of our study, we can conclude that intrauterine injection of PRP may be a new therapeutic approach in the treatment of thin endometrium and associated infertility. The use of PRP demonstrated effectiveness in increasing the thickness of the endometrium, regardless of pregnancy, while the secondary indicator was the frequency of successful pregnancies among the participants. Full article

Background: The incidence of endometrial cancer (EC) is rising globally across all age groups. Endometrial intraepithelial neoplasia (EIN) is a premalignant lesion that may progress to EC if untreated. A clinical model is needed to efficiently identify women requiring prompt evaluation while avoiding unnecessary invasive procedures. Obesity is a major risk factor, but whether Asian women require a lower body mass index (BMI) cutoff than the World Health Organization (WHO) definition remains debated. This study aimed to develop a multivariable risk prediction model to guide biopsy decisions and determine an appropriate BMI cutoff for predicting EIN/EC risk among Asian women. Methods: This study retrospectively reviewed 1192 women aged ≥18 years who underwent hysteroscopy between 2010 and 2023 at a tertiary hospital. Candidate predictors included patient age, parity, BMI, postmenopausal status, symptom of abnormal uterine bleeding (AUB), diabetes mellitus, hypertension, polycystic ovary syndrome (PCOS), use of oral contraceptives, intrauterine devices, or menopausal hormone therapy, tamoxifen treatment, presence of multiple polyps, and endometrial thickness (EMT) measured by transvaginal ultrasonography. Multivariable logistic regression with stepwise selection identified independent predictors, and model stability and calibration were assessed using 1000 bootstrap resamples. Results: EIN/EC was diagnosed in 55 patients (4.6%). Six independent predictors were identified: postmenopausal status (adjusted odds ratio [aOR] 5.93, 95% CI 2.92–12.04), AUB (aOR 4.07, 1.51–10.97), multiple polyps (aOR 2.49, 1.33–4.66), PCOS (aOR 2.37, 1.08–5.22), BMI (aOR 1.13 per kg/m²; 1.84 per +5 kg/m²), and EMT (aOR 1.07 per mm, 1.02–1.11). When using categorical cutoffs, Obese II (BMI ≥ 30 kg/m²) and markedly increased EMT (≥20 mm) remained significant. Predicted probabilities ranged from 0.3% with no risk factors to 90.9% with all six risk factors present. The final model demonstrated good discrimination (AUC 0.79, 95% CI 0.73–0.86) and excellent calibration on bootstrap validation (mean absolute error 0.005). Conclusions: This six-factor clinical model stratifies individual EIN/EC risk using readily available variables and may guide timely, risk-based biopsy decisions by identifying high-risk patients while minimizing unnecessary procedures in low-risk cases. BMI ≥ 30 kg/m² (WHO obesity threshold) was confirmed as a meaningful cutoff, but external validation is warranted to confirm its generalizability and clinical applicability. Full article

Background: This study explores the role of inflammatory hematological markers from complete blood count (CBC) parameters in predicting the in vitro fertilization (IVF) treatment success of patients. It focuses particularly on the immature granulocyte (IG) percentage, a novel inflammatory marker. To our knowledge, this is the first study in the literature examining the relationship between IG percentage and pregnancy outcomes in IVF. Methods: Conducted retrospectively, this study included 311 IVF cycles from 311 distinct patients. A binomial logistic regression model identified factors affecting pregnancy outcomes. Various predictors were analyzed, including embryo quality, white blood cell (WBC) count, IG percentage, systemic inflammatory index (SII), endometrial thickness on the day of human chorionic gonadotropin (hCG) administration, number of mature (MII) oocytes, and the number of embryos generated. Results: The IG percentage significantly impacted clinical pregnancy and live birth outcomes (OR = 0.40, 95% CI (confidence interval): 0.317–0.51, p < 0.001), unlike other inflammatory markers. Each millimeter increase in endometrial thickness measured on the day of hCG administration was associated with a slight increase in the likelihood of IVF success (OR: 1.20, 95% CI 1.004–1.44, p = 0.044). Neither SII nor mature oocyte count significantly affected pregnancy outcomes. Conclusions: A low IG percentage correlates positively with clinical pregnancy and live birth outcomes. Measuring IG percentage offers a rapid, inexpensive, and readily available method to predict IVF success. Full article

Background/Objectives: Accurate prediction of reproductive outcomes remains a key challenge in assisted reproductive technologies (ARTs). While embryo quality assessment has been extensively studied, endometrial receptivity has received less attention despite its critical role in implantation. Endometrial compaction (EC), i.e., the reduction in endometrial thickness between ovulation and embryo transfer, has been proposed as a potential predictor, but the current literature data is inconclusive. This study aimed to develop and validate a novel implantation predictor (IMP), based on extended assessment of endometrial shape and dynamics, which would be useful in determining reproductive success. Methods: The study analyzed data from 61 couples undergoing infertility treatment at the Kriobank Clinic (Białystok, Poland) between December 2021 and February 2025. Endometrial measurements were taken at the day following the ovulatory peak and on the day of embryo transfer. A set of normalized parameters describing endometrial dimensions was proposed and their changes over time measured. Based on the obtained data, a multivariable logistic regression model was constructed to create the IMP. Results: The proposed model demonstrated high predictive power for implantation, with an AUC of 0.839 (95% CI: 0.739–0.938). Statistically significant differences in IMP values were observed between the pregnancy and no-pregnancy groups (p < 0.0001). Quartile analysis showed that implantation rates increased from 6.25% in the lowest IMP range to 93.3% in the highest, confirming the model’s strong predictive power. In the study group, the model is capable of predicting a quarter of cases in which implantation will almost certainly occur and another quarter in which implantation will almost certainly not occur. Conclusions: This study introduces a novel predictor (IMP) of implantation based on an extensive assessment of endometrial compaction, which may be used in predicting reproductive success. The findings show the importance of considering endometrial receptivity in ART success. They also indicate that integrating IMP with existing approaches may substantially improve predicting reproductive success. Full article