Epidemiology of infertility in China: a population-based study

The rationale, design of the Assisted reproductive technology cohort nested in a pre-pregnancy family cohort (APP-Cohort)

INTRODUCTION

Infertility has become a major global issue due to the trend of delaying marriage and advanced maternal age. Family/Birth cohort studies are essential for exploring ways to enhance health outcomes at both the individual and societal levels. However, there is a shortage of cohorts that include families who have utilized assisted reproductive technology (ART), particularly initiated at the early stages before pregnancy. The Assisted Reproductive Technology Cohort (APP-Cohort) is a prospective study aiming to investigate the epidemiology and risk factors of adverse gestational outcomes and other health issues in couples who have conceived through ART or naturally.

METHODS

The cohort study's baseline survey commenced in January 2022 at several locations in Beijing, and enrollment is currently in progress. Both spouses filled out a questionnaire covering demographic, socio-economic, and various modifiable risk factors to gather information on their lifestyle. Physical examinations and biochemical tests were carried out, alongside regular yearly health check-ups throughout pregnancy and childhood. The survey data will be connected to electronic medical records to compile health information on the couples, newborns, and children.

DISCUSSION

The APP-Cohort study collected data from both wives and husbands before conception, allowing for early assessment of environmental risk factors for maternal and offspring health. With a focus on various types of risk factors such as genetic, environmental, and shared familial traits, the ongoing follow-up of this study will enable researchers to evaluate and distinguish the impacts of these factors on pregnancy outcomes, perinatal health, and children's health for individuals conceived naturally versus those conceived through ART. By utilizing practical experience and advanced mathematical analysis of the extensive data, the APP-Cohort study will provide valuable insights to promote the administration and success rate of ART in China.

Acupuncture-assisted embryo transfer techniques: Research frontiers and future directions

BACKGROUND

Acupuncture, an ancient practice, is gaining recognition as a complementary and alternative medicine, especially in assisted reproductive technology. It plays a crucial role in enhancing embryo transfer success rates. Research indicates that acupuncture can improve blood flow, increase endometrial receptivity regulate pressure, and affect neuroendocrine activities in the ovaries and uterus during embryo implantation, therefore improving pregnancy outcomes.

AIM

To highlight recent developments related to acupuncture's influence on embryo transfer and elucidating the precise mechanisms by which acupuncture influences embryo transfer.

METHODS

We searched database including PubMed, Cochrane Library up to September 2024 for relevant studies and patents to evaluate the effects of acupuncture on women undergoing in vitro fertilization (IVF). The experimental design included an intervention group using needling, and a control group consisting of no needling or sham needling. The main outcome is clinical pregnancy rate (CPR), while secondary includes live birth rate (LBR) and biochemical pregnancy rate (BPR). We examined the influence of adjunctive needling on pregnancy outcomes by analyzing variations in the main outcomes.

RESULTS

A total of 145 randomized controlled trials involving 27748 participants were analyzed. Data revealed that the overall CPR was significantly elevated in all acupuncture cohorts compared to the control group [relative risk (RR): 1.21, 95%CI: 1.07-1.38, P = 0.01]. In contrast, the aggregated LBR did not exhibit a corresponding increase, and notable statistical heterogeneity was observed among the studies. Acupuncture-assisted frozen-thawed embryo transfer enhanced the BPR (RR: 1.51, 95%CI: 1.21-1.89, P = 0.03) and improved endometrial morphology (RR: 1.41, 95%CI: 1.13-1.75, P = 0.01). Furthermore, IVF outcomes were significantly superior in the acupuncture group when acupuncture was administered during controlled ovarian hyperstimulation (RR: 1.71, 95%CI: 1.08-2.13, 95%CI: 1.08-4.21, P = 0.03).

CONCLUSION

We find that acupuncture positively influences pregnancy rates in women receiving IVF treatment. Nonetheless, there are no established guidelines for optimal acupuncture protocols. Considering the methodological limitations identified in current research, there is a need for larger, methodologically rigorous studies.

Chain mediation of rumination and anxiety state between mindfulness and depressed mood in infertile women

The study aims to explore the relationship between mindfulness, rumination thinking, anxiety state, and depressed mood, and the chain mediating roles of rumination thinking and anxiety state in explaining how mindfulness influences depressed mood in infertile women. This cross-sectional study included 946 women with infertility from a maternal and child hospital in western China through convenience sampling. Five Facet Mindfulness Questionnaire (FFMQ), Rumination Response Scale (RRS), Self-rating Anxiety Scale (SAS), and Self-rating Depression Scale (SDS) were measured as outcome indicators. SPSS PROCESS macro program was used to test for chained mediating effects and the significance using the Bootstrap method. The total effect of mindfulness on depressed mood was  -0.390 with the direct path effect of -0.170. The total indirect path effect was  -0.220, which accounted for 56.4% of the total effect, and that the chain mediated path (FFMQ→RRS→SAS→SDS) effect was significant with a mediation effect value of -0.075. Mindfulness can not only directly affect infertile women's depressed mood, but also indirectly affect that through the chain-mediated effects of rumination thinking and anxiety state.

Maternal Exposure to Surface Ozone and Reduced Fecundity in China: Evidence from a Nationwide Survey

The influence of ground-level O3, which possesses a higher oxidative concentration than other ambient pollutants, on reproductive health has received relatively limited scrutiny. In this study, we collected information on reproductive history, sociodemographic profiles, lifestyle, and residential details of 10,153 couples at risk of pregnancy. Each participant's 1-year, 3-year, and 5-year average O3 exposure levels were estimated using a previously developed randomized trees model. We used discrete-time Cox proportional hazards models to estimate the fecundability odds ratio (FOR) for each 10 μg/m3 change in the O3, adjusting for a set of demographics, lifestyle, and environmental covariables. We observed that a 10 μg/m3 increase in the annual average level of exposure to O3 was associated with a 16% reduction in fecundity (FOR: 0.84; 95% CI: 0.82-0.85). We also observed a 40% increase in the odds of infertility (OR: 1.40; 95% CI: 1.34-1.46) for each 10 μg/m3 rise in the annual mean of O3 exposure. After adjustment for fine particulate matter, the strong association between O3 exposure of fecundity to O3 persisted. Given the increasing epidemic of infertility, we strongly advocate for heightened consideration of O3's impact on reproductive health, as it may partially counterbalance the health benefits gained from improved PM2.5 levels in a middle-income setting.

The relationship between cognitive characteristics of irrational parenthood and stigma in female patients with infertility: a potential profile analysis

OBJECTIVE

To explore the relationship between the potential profile of irrational parenthood cognition and stigma in female infertility patients.

METHODS

A cross-sectional survey was conducted among 296 infertile women using a general information questionnaire, irrational parenthood cognition questionnaire, and infertility stigma scale. A latent profile analysis was used to determine the characteristics of irrational parenthood cognition of infertile female patients, the robust three-step method was used to analyze the influencing factors of different profiles, and multiple linear regression was used to analyze the influence of the potential profile of irrational parenthood cognition on stigma.

RESULTS

Four potential profiles were identified and labeled as high irrational parenthood cognition group (19.30%), middle irrational parenthood cognition - expectation group (20.60%), middle irrational parenthood cognition - low self-esteem group (25.70%), and low irrational parenthood cognition group (34.50%). The influencing factors of the potential profile of irrational parenthood cognition in female infertility patients included ethnicity, marital status, and receiving assisted reproductive technology (P < 0.05). After controlling for confounding factors, the potential profile of irrational parenthood cognition was an important predictor of stigma (P < 0.05), which could explain 44.2% of the total variation.

CONCLUSION

There are four potential characteristics of irrational parenthood cognition in female infertility patients, which are related to stigma.

Mendelian randomization study reveals causal associations between plasma metabolites, immune cell phenotypes, and ovarian hyperstimulation syndrome

In this study, we employed Mendelian randomization (MR) analysis to explore the causal relationships between immune cell phenotypes, plasma metabolites, and ovarian hyperstimulation syndrome (OHSS). Through the analysis of 731 immune cell phenotypes and 1400 plasma metabolites, we identified 32 immune cell phenotypes that are causally related to OHSS, with 18 phenotypes identified as protective and 14 as risk factors. Notably, the TCRgd AC phenotype was the most significant risk factor associated with OHSS. Our findings also revealed that among the 10 plasma metabolites causally linked to OHSS, three acted as protective factors, while seven were identified as risk factors. The Alpha-ketoglutarate to alanine ratio stood out as the most significant protective metabolite. Further investigation established a causal link between the EM DN (CD4-CD8-) AC immune cell phenotype and the Alpha-ketoglutarate to alanine ratio. Reverse MR analysis indicated that OHSS influences the expression of HLA-DR on myeloid OC cells. Mediation analysis suggested a non-significant mediation effect of the Alpha-ketoglutarate to alanine ratio in the pathway from immune cells to OHSS, accounting for -8.68 % of the total effect. Collectively, our results underscore the role of specific immune cell phenotypes and plasma metabolites in the pathogenesis of OHSS, revealing potential targets for developing interventions aimed at reducing the risk of OHSS.

Perinatal and Neonatal Outcomes Following In Vitro Fertilisation in Poor Ovarian Responders: A Prospective Single-Centre Observational Study

OBJECTIVE

To compare the risk of adverse perinatal and neonatal outcomes between individuals with poor ovarian response (POR) and those with normal ovarian response (NOR) following in vitro fertilisation (IVF).

DESIGN

A prospective single-centre observational study.

SETTING

University hospital.

POPULATION

Overall, 1663 patients who underwent embryo transfer cycles between June 2017 and August 2019 were evaluated.

METHODS

The patients were divided into the POR and NOR groups based on the Bologna diagnostic criteria. The risk of perinatal and neonatal complications was then compared between groups with adjustment made for confounding factors.

MAIN OUTCOME MEASURES

The risk of perinatal and neonatal complications between the POR and NOR groups.

RESULTS

Compared with the NOR group, the POR group had poor pregnancy outcomes but comparable overall risks of poor perinatal and neonatal outcomes. The overall incidence rate of complications was 25.42% and 25.30% in the POR and NOR groups respectively [risk ratio (RR): 1.01; 95% confidence interval (CI): 0.63-1.59]. In subgroup analysis of singleton live births, the overall risk of total complications was higher in the POR group than in the NOR group (24.07% vs. 15.21%; RR: 1.77; 95% CI: 1.04-3.00); however, the risks became comparable between them after logistic regression adjustment.

CONCLUSIONS

The overall risk of perinatal and neonatal complications among singleton live births was higher in patients with POR than in those with NOR; however, the risks became similar after logistic regression adjustment. Our findings provide overall comforting evidence for POR patients with IVF treatment.

Gushen Antai pill for expected normal ovarian responders undergoing IVF-ET (GSATP-FreET): interim analysis of a randomized controlled trial

INTRODUCTION

Optimal luteal phase support (LPS) is essential for successful embryo transfer. In our previous study, we found that LPS combined with Gushen Antai pill (GSATP) could significantly improve ongoing pregnancy rate (OPR) and reduce threatened abortion rate after frozen-thawed embryo transfer (FET). Despite this, no high-quality studies have been performed on the combination of LPS and GSATP for the embryo transfer of fresh IVF cycles.

METHODS

A randomized, double-blind, placebo-controlled trial started on June 15, 2021 at 20 reproductive centers of public tertiary hospitals. In total, 371 eligible women with expected normal ovarian reserve (NOR) were age-stratified and randomly assigned to either the GSATP group or the placebo group at random in an equal ratio. The primary outcome is OPR. The report presents data from an interim analysis used for regulatory submissions.

RESULTS

In the per-protocol cohort, the OPR in the GSATP group and placebo group were 40.3% and 38.4%, respectively. Nevertheless, the GSATP group showed a significantly lower incidence of vaginal bleeding (11.3% vs. 21.6%, p = 0.046), threatened miscarriage (16.0% vs. 29.4%, p = 0.021), and functional constipation (16.0% vs. 29.4%, p = 0.021) than the placebo group during the first trimester of pregnancy.

DISCUSSION

In the interim analysis, while GSATP did not result in better pregnancy outcomes for NOR patients undergoing fresh embryo transfers, it did improve common symptoms observed during the early pregnancy phase, such as vaginal bleeding, threatened miscarriage, and functional constipation.

TRIAL REGISTRATION

National Institutes of Health clinical trials database, NCT04872660. Registered 4 May 2021, https//clinicaltrials.gov/study/NCT04872660.

Effectiveness of Low-Cost, Virtual Sexual Health Education and Educational Leaflets on Reducing Anxiety and Enhancing Sexual Function Among Infertile Women: A Pilot Randomized Controlled Trial

Background and Aims

Anxiety is one of the common mental illnesses affecting sexual functions among infertile women. Information and education interventions might be effective in facilitating their coping with anxiety disorder which lead to improved sexual functions and psychological wellbeing. This is the first trial to pilot-test the effectiveness of sexual health education, delivered through virtual sessions and educational booklets, in improving both psychological (reduced anxiety scores) and physical (increased sexual function) outcomes among women with infertility in Iran.

Methods

In this triple-blind pilot randomized controlled trial, 90 women seeking medical treatment for infertility were randomly divided into three groups: (a) control, (b) educational booklet, and (c) virtual education. Participants in the virtual education group received six sessions of sexual health education through educational video using the WhatsApp social network. The primary outcomes included anxiety and sexual function scores measured before and 6 weeks after the intervention.

Results

The results showed that, after the intervention, mean state anxiety scores were significantly lower in the booklet (29.27 ± 4.5, p < 0.001) and virtual education groups (13.77 ± 11.6, p < 0.001) compared with the control group (49.26 ± 6.86). Similarly, mean trait anxiety scores significantly decreased in the booklet (27.03 ± 6.29, p < 0.001) and virtual education groups (31.66 ± 11.63, p < 0.001) compared with the control group (45.93 ± 6.52). Post-intervention, there were significant differences between the intervention and control groups in mean scores across four dimensions of sexual function: sexual desire, sexual stimulation, orgasm, and sexual satisfaction. The virtual education and booklet groups did not show a statistically significant difference in the mean scores of state and trait anxiety, and sexual function.

Conclusion

Psychoeducation interventions via virtual education sessions or educational booklets appear to reduce the level of anxiety and positively affect sexual functions associated with infertility. Women seeking treatment for infertility may benefit from psychoeducational interventions, though further studies with larger sample sizes are needed to confirm these findings.

Clinical Trial Registration

The protocol has been registered at the Iranian Registry of Clinical Trials (IRCT20240915063041N1).

Identification of serum small non-coding RNA as biomarkers for endometrial receptivity

BACKGROUND

Current endometrial receptivity analysis is invasive, preventing embryo transfer during the biopsy cycle. This study aims to screen serum sncRNAs as non-invasive biomarkers for ERA tests.

METHODS

The study included 12 infertile patients undergoing IVF-ET and ERA, whose serum samples were collected for high-energy sequencing technology to detect sncRNA expression profiles. We overexpressed and knocked down tsRNA-35:73-Asp-GTC-1 in the decidualized Immortalized Human Eutopic Endometrial Stromal Cells (HESC) model cultured in vitro to further investigate the its effect on decidualization. The predicted tsRNA-35:73-Asp-GTC-1 target gene was verified by PCR analysis.

RESULTS

We screened 286 differentially expressed tsRNAs, 46 miRNAs, and 106 piRNAs. KEGG analysis indicated that differentially expressed tsRNAs were associated with pathways such as 'Calcium signaling pathway,' 'Sphingolipid signaling pathway,' etc. The results of RT-qPCR validation showed that the trends of four significantly differentially expressed tsRNAs in serum and endometrium were consistent with sequencing results. ROC curves demonstrated that these four tsRNAs have good predictive value for endometrial receptivity. Overexpression of tsRNA-35:73-Asp-GTC-1 affected the morphology of decidualized cells, and the decidualization indicators also showed a decreasing trend. While knocking down tsRNA-35:73-Asp-GTC-1 had the opposite effect. The RT-qPCR results showed that tsRNA-35:73-Asp-GTC-1 was associated with the Wnt3 target gene.

CONCLUSION

Serum sncRNA analysis shows potential for studying the molecular mechanisms of endometrial receptivity. Four serum tsRNAs can serve as novel biomarkers for non-invasive endometrial receptivity detection. TsRNA-35:73-Asp-GTC-1 may further regulate endometrial receptivity by targeting Wnt3.

Proteomic Analysis of Human Follicular Fluid-Derived Exosomes Reveals That Insufficient Folliculogenesis in Aging Women is Associated With Infertility

Although the risk of female infertility increases with advancing age, the underlying mechanisms remain unknown. Exosomes in follicular fluid are suggested to regulate folliculogenesis and influence oocyte quality, potentially playing a critical role in age-related infertility. Elucidating their content could enhance the understanding of the molecular mechanisms associated with female aging-induced infertility. In this study, we explored the proteomic profiles of exosomes derived from human follicular fluid to identify protein signatures associated with infertility in both young and aging women. Despite the lack of significant differences in the morphology and particle size of follicular fluid-derived exosomes between the two groups, proteomic analysis revealed a distinct pattern of differentially expressed proteins (DEPs). DEPs associated with B-cell activation, pathogen invasion, and disrupted metabolic processes were significantly more highly expressed in the aging group than in the young group, indicating their involvement in age-related infertility. In vivo experiments demonstrated that the application of exosomes, particularly those derived from young female group, facilitated the successful maturation of follicles. Key exosomal proteins, including ENO1, HSP90B1, fetuin-B, C7, and APOC4, were found to be associated with follicular maturation. Furthermore, the PI3K/AKT signaling pathway, which is known to be related to folliculogenesis, was activated by the application of exosomes in aging female mice. This study provides novel insights into the aging-associated protein signatures of follicular fluid-derived exosomes and their potential role in infertility. These findings suggest that aging-related protein signatures in exosomes could contribute to the treatment of age-related infertility.

Association of age at menarche and different causes of infertility: a retrospective study of 7634 women undergoing assisted reproductive technology

BACKGROUND

Infertility has become a world-wide public health problem. To identify women in a high-risk of infertility at an early stage when more treatments are available, early risk factors such as age at menarche (AAM) are being investigated. AAM is often used in epidemiological studies as a marker of the timing of pubertal development and the onset of the hypothalamic-pituitary-ovarian axis functions. Therefore, our study aimed to elucidate the association of AAM and different infertility causes in women undergoing assisted reproductive technology.

METHODS

A total of 7643 women were retrospectively included from the reproductive hospital affiliated with Shandong University between January 2017 and December 2019. Multivariate logistic regression models and restricted cubic spline (RSC) were performed to analyze the relationship between AAM and different infertility causes. Information on variables was obtained from medical records.

RESULTS

Compared with primary infertility, secondary infertility would 7.7% increase risk with each one-year increase in menarche age after adjusted odds ratio (OR) [95% confidence interval (CI)], 1.077 (1.036, 1.119). In primary infertility group, each one-year increase in menarche age corresponded with a 16.7% increase in PCOS risk OR (95% CI), 1.218 (1.138, 1.303). AAM of women with DOR were significantly decreased in primary and secondary infertility group [OR (95% CI), 0.832 (0.716, 0.965) and OR (95% CI), 0.720 (0.603, 0.859)], respectively compared with the reference group. Moreover, there is a non-linear dose-response relationship between DOR (P < 0.001) with AAM.

CONCLUSION

This study demonstrates a significant impact of AAM on endocrine-related infertility in women. Further research on the relationship between the onset of menarche and the pathogenesis of infertility is warranted.

Association between atherogenic index of plasma and infertility: a cross-sectional study based on U.S. women

BACKGROUND

A wealth of evidence indicates that dyslipidemia is associated with endothelial dysfunction, oxidative stress, and inflammation, each of which can impair reproductive function and lead to infertility. The Atherogenic Index of Plasma (AIP) is an innovative lipid biomarker that combines the triglyceride to high-density lipoprotein cholesterol (HDL-C) ratio, providing a more in-depth evaluation of lipid metabolism. This biomarker synthesizes discrete lipid disruptions into a single value, surpassing isolated lipid indicators' diagnostic value. The primary goal of our study was to explore the link between AIP and the incidence of infertility.

METHODS

Data from the National Health and Nutrition Examination Survey (NHANES) spanning 2013-2018 were subjected to cross-sectional examination. The AIP is determined through the logarithmic transformation (base 10) of the triglyceride-to-HDL-C ratio. To uncover the connection between AIP and infertility, a suite of analytical techniques was employed, encompassing weighted multiple logistic regression, stratified analyses, spline curve modeling, and determination of cutoff values.

RESULTS

Among the 1,191 participants, with a weighted mean age of 31.89 years, 12.09% were diagnosed as infertile. The multivariate-adjusted odds ratios for infertility occurrence across the AIP quartiles were 1.00 (reference), 1.96 (95% CI: 1.10-3.49), 2.62 (95% CI: 1.48-4.63), and 2.38 (95% CI: 1.31-4.32), respectively. Subgroup examinations suggest that the association between AIP and infertility remains robust and is not substantially altered by factors including age, marital status, economic status, tobacco use, alcohol intake, and body mass index. Curve fitting and threshold analyses have indicated a positive nonlinear relationship between AIP and infertility, as well as a relatively stable incidence of infertility within the AIP range from -0.21 to 0.22.

CONCLUSIONS

Incorporating an assessment of AIP into the clinical evaluation could potentially refine the accuracy of risk estimation for infertility patients.

Determinants of infertility among married women who attend gynecologic unit at health facilities of Gamo Zone and South Omo Zone, Southern Ethiopia: a case control study

BACKGROUND

Infertility defined as the failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse. Globally, infertility affects 15% of couples in the reproductive age.

PURPOSE

To identify determinants of infertility among married women who attend care at public health facilities of Gamo Zone and South Omo Zone, Southern Ethiopia.

PATIENTS AND METHODS

An Institution-based un-matched case-control study was conducted from May 1, 2022-May 30, 2023G.C. Participants were selected by systematic random sampling method after allocating the sample size proportionally to the health facilities. The data was collected by using the Open Data Kit (ODK) app through face-to-face interviews and exported to SPSS version 25 for analysis. The chi-square test and multivariable logistic regression model were used to identify determinants (P value < 0.05).

RESULT

A total of 760 married women (152 cases and 608 controls) in the reproductive age group were included in this study. The mean age of the respondents was 26.5(SD ± 5.27) years. In multivariable analysis: age, educational status of the woman, residence, family size, ever use of contraceptives, history of STI, history of abortion, menstrual pattern and current alcohol use were identified as determinants of infertility.

CONCLUSION

Factors such as older age, lower education, rural living, smaller families, lack of contraceptive use, history of STIs, past abortions, irregular periods, and current alcohol consumption were found to increase the risk of infertility. To reduce infertility rates, it is crucial to improve STI prevention, expand access to family planning services, and promote women's education.

Assessment of patient preferences for assisted reproductive technology in China: a discrete choice experiment

OBJECTIVES

Given China's low fertility rate, assisted reproductive technology (ART) can be used assist infertile patients in having children. This study aimed to analyse patients' preferences for ART and to determine the relative importance (RI) and willingness to pay (WTP) of key attributes.

DESIGN

We identified six attributes of ART and used a D-efficient design to generate choice sets for conducting a discrete choice experiment. Patients were asked to choose between two scenarios that differed in participation in treatment decision-making (TDM), clinical pregnancy rate, live birth rate, risk of maternal and neonatal complications, and out-of-pocket cost.

SETTING

Jiangsu province, China. The anonymous survey was carried out between December 2022 and February 2023.

PARTICIPANTS

Female patients aged 20-45 years, with low fertility or experience of ART treatment. We recruited 465 participants.

OUTCOMES MEASURES

Patient-reported preferences for each attribute were estimated using a mixed logit model. The latent class model was also used to investigate preference heterogeneity.

RESULTS

All attributes were associated with patient preferences. Patients considered the live birth rate as the most important attribute (RI=29.05%), followed by participation in TDM (RI=21.91%). The latent class model revealed two distinct classes named 'outcome driven' and 'cost driven'. Preferences varied according to their age, monthly household income and location.

CONCLUSIONS

This study investigated the preferences of infertile patients when seeking medical assistance for infertility. The study outcomes can contribute to evidence-based counselling and shared decision-making and provide an empirical basis for creating and implementing future policies.

Impact of sleep characteristics on IVF/ICSI outcomes: A prospective cohort study

BACKGROUND

Infertility affects millions of individuals worldwide, imposing significant personal and societal burdens. Assisted reproductive technologies (ART), such as IVF and ICSI, provide hope for many, yet clinical pregnancy rate per embryo transfer remains around 35 %. Modifiable lifestyle factors, including sleep, may influence ART outcomes. However, the relationship between specific sleep characteristics and IVF/ICSI success is unclear. This study aims to explore the associations between sleep characteristics and various IVF/ICSI outcomes. Additionally, we investigated if perceived stress mediates these relationships.

METHODS

This prospective cohort study enrolled 174 women undergoing IVF/ICSI at Zhongnan Hospital of Wuhan University from December 2021 to December 2023. Prior to initial ART treatment, participants completed the Pittsburgh Sleep Quality Index (PSQI) and the Perceived Stress Scale (PSS-10). IVF/ICSI outcomes such as the number of retrieved oocytes, matured oocytes, number of fertilized oocytes, fertilization rate, good-quality embryos, blastocyst formation rate and early pregnancy outcome (implantation and clinical pregnancy) were obtained from medical records. We employed multivariate generalized linear models to assess the associations between sleep characteristics and IVF/ICSI outcomes. Dose-response relationships between napping duration and maturation rate were analyzed using generalized additive models. Mediation analysis was used to assess the role of stress in the relationship between sleep characteristics and IVF/ICSI outcomes.

RESULTS

Women reporting poor sleep quality had significantly fewer retrieved oocytes (-22.89 %, 95%CI: 37.82 %, -4.00 %) and matured oocytes (-22.01 %, 95%CI: 37.54 %, -2.62 %). Those sleeping ≥10 h per night had fewer retrieved oocytes (-30.68 %, 95%CI: 48.88 %, -6.00 %), matured oocytes (-27.17 %, 95%CI: 46.57 %, -0.73 %), and good-quality embryos (-45.64 %, 95%CI: 65.43 %, -14.51 %). Women experiencing difficulty falling asleep more than three times a week had a significant reduction in blastocyst rates (-64.40 %, 95 % CI: 85.55 %, -12.30 %). Those reporting difficulty falling asleep less than once a week had fewer retrieved oocytes (-28.89 %, 95%CI: 47.34 %, -3.98 %), and matured oocytes (-27.77 %, 95%CI: 46.90 %, -1.73 %). Napping exceeding 1 h daily was associated with a significantly lower oocyte maturation rate (-73.8 %, 95%CI: 88.91 %, -38.06 %). A significant non-linear dose-response relationship was observed between napping duration and maturation rate (p < 0.001), with maturation rates initially increasing slightly with short naps but declining significantly with longer naps, particularly beyond 1 h. This relationship was significant among women with good sleep quality (PSQI ≤5) (p < 0.001) and those with normal BMI (p = 0.0005). Perceived stress did not significantly mediate these associations.

CONCLUSION

Our findings suggest that sleep characteristics, particularly poor quality, difficulty falling asleep, long sleep durations, negatively impact various IVF/ICSI outcomes. Longer daytime napping is inversely associated with oocyte maturation rates, especially among women with good sleep quality and normal BMI. Perceived stress did not appear to influence the relationship between sleep and IVF outcome. While optimizing sleep patterns may hold promise for improving IVF/ICSI success rates, it is essential to approach lifestyle guidance with caution, given the current limitations in confirming causative roles. Further studies are needed to clarify the extent and nature of the relationship between sleep characteristics and IVF/ICSI outcomes.

The first multiple center prospective study of rhFSH CTP in patients undergoing assisted reproductive technology in China

We assessed the safety and efficacy of rhFSH-CTP, a novel long-acting FSH agent, in controlled ovarian hyperstimulation for patients undergoing ART. A multi-center, open-label, randomized, positive-control, non-inferiority clinical trial was conducted. The study consisted of a phase III randomized design, with a 1:1 ratio favoring the rhFSH-CTP group over the control group. Eligible patients in the rhFSH-CTP group received a single dose of rhFSH-CTP at 100-150 µg for the first 7d of stimulation following a gonadotropin-releasing hormone antagonist protocol. In total, 142 and 141 patients received rhFSH-CTP and rhFSH, respectively. At a confidence interval of 95%, the difference in the number of oocytes (1.13-4.22, 2.67) suggested that rhFSH-CTP was not inferior to rhFSH. Additionally, the top-quality embryos, implantation rates, and pregnancy outcomes were similar between the two groups (P > 0.05). In the rhFSH-CTP group, no cases of severe OHSS were observed, which was a significant improvement compared to the 1.4% incidence in the rhFSH group. With regard to another safety endpoint, no patients tested positive for adenosine deaminase (ADA) in the rhFSH-CTP group. The results demonstrated that the product had a comparable safety profile to pregnancy outcomes and newborn information in the control group, indicating its suitability for use.

Nomogram to predict cumulative live birth rate following in vitro fertilization/intracytoplasmic sperm injection cycles in patients with endometriosis

BACKGROUND

The success of in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) in endometriosis patients varies widely, and predicting the likelihood of achieving a live birth remains a clinical challenge. This study aims to develop a predictive nomogram for assessing the cumulative live birth (CLB) rate following IVF/ICSI cycles among patients with endometriosis.

METHOD

A retrospective cohort study was conducted to analyze the clinical data of 1457 patients with endometriosis after IVF/ICSI treatment from January 2017 to August 2022. The patients were divided into a training set (70%) and a validation set (30%) using a random number table. Univariate analysis and multifactorial logistic regression analysis were employed to identify relevant predictive factors affecting CLB rate. A predictive model was then established based on the identified factors.

RESULTS

Univariate analysis and multifactorial logistic regression analysis revealed that patients with concurrent adenomyosis had a decreased CLB rate (OR = 0.51, 95% CI: 0.31-0.82). As the duration of infertility increased, the CLB rate decreased (OR = 0.93, 95% CI: 0.88-0.99). Higher numbers of fertilized oocytes and high-quality embryos were associated with an increased likelihood of CLB. A nomogram predictive model for CLB rate, based on age, concurrent adenomyosis, duration of infertility, number of fertilization, and number of high-quality embryos, was developed. The area under the curve (AUC) for the training set and validation set was 0.823 (95% CI: 0.798-0.849) and 0.773 (95% CI: 0.729-0.818), respectively. The stratified analysis demonstrated the applicability of the model in the validation cohort.

CONCLUSION

This predictive nomogram for CLB rate in patients with endometriosis provides valuable and precise information for personalized decision-making, which could be a visual and easily applied tool for IVF/ICSI counselling.

Phthalate exposures, blood coagulation function, and assisted reproductive technology outcomes: Results from the TREE cohort study

BACKGROUND

Phthalate exposures have been shown to be inversely associated with reproductive success among women undergoing assisted reproductive technology (ART). However, the underlying mechanisms are unknown.

OBJECTIVES

To explore blood coagulation function as the mediating role of associations between exposure to phthalates and ART outcomes.

METHODS

A total of 735 women from the Tongji Reproductive and Environmental (TREE) study were included. Urine samples collected at recruitment were quantified for 8 phthalate metabolites, and blood clotting time and platelet indices were also determined. Generalized linear regression, logistic regression, weighted quantile sum (WQS) regression, or Bayesian kernel machine regression (BKMR) models were applied to investigate the associations among individual and mixture of phthalate metabolites, blood coagulation parameters, and ART outcomes. The mediation role of blood coagulation parameters was estimated by mediation analysis.

RESULTS

Mono-n-butyl phthalate (MBP), mono-isobutyl phthalate (MiBP), monobenzyl phthalate (MBzP), mono(2-ethyl-5-carboxypentyl) phthalate (MECPP), and molar sum of di(2-ethylhexyl) phthalate metabolites (∑DEHP) were positively associated with platelet indices. Phthalate metabolite mixture was also positively associated with platelet count (PLT), mean platelet volume (MPV), and plateletcrit (PCT), whereas inversely associated with international normalized ratio (INR). Meanwhile, PLT and PCT were inversely associated with the odds of implantation success and live birth, while prothrombin time and INR were positively associated with the odds of implantation success. Mediation analyses showed indirect effects of above-mentioned phthalate metabolites and phthalate mixture on the odds of implantation success and live birth through PLT or PCT, with the proportion mediated ranging from 3.44% to 8.96%.

CONCLUSIONS

Phthalates may increase the risks of ART failure through enhancing blood coagulation function. More studies are warranted to verify the findings.

A Glimpse of Research Trends and Frontiers in the Etiology of Premature Ovarian Insufficiency via Bibliometric Analysis

INTRODUCTION

Premature Ovarian Insufficiency (POI) is the most common reproductive aging disorder in women of reproductive age, which is characterized by decreased ovarian function in women before the age of 40. Etiology research of POI has garnered interest and attention from scholars worldwide over the past decades.

METHODS

However, to the best of our knowledge, no comprehensive survey with bibliometric analysis has been conducted yet on the research trends of POI etiology. This article aimed to analyze current scientific findings on the etiology of POI, offering innovative ideas for further research. Research articles on the etiology of POI from 1994 to 2023 were collected from the Web of Science Core Collection. A total of 456 research articles were included, and the total number of publications increased annually. We used VOSviewer and bibliometric.com to analyze the keywords, terms, institution, publication country/region, author name, publication journal, and the sum of times the articles have been cited.

RESULTS

This study has shown that a research hotspot is the genetic etiology of POI; however, there is still a lack of research on the impact of epigenetic alterations, iatrogenic injuries, environmental pollution, social stress, and unhealthy lifestyles on the pathogenesis of POI.

CONCLUSION

The factors illustrated here represent potential future directions for POI etiology research and warrant more attention from researchers.

Machine learning algorithms in constructing prediction models for assisted reproductive technology (ART) related live birth outcomes

Currently applicable models for predicting live birth outcomes in patients who received assisted reproductive technology (ART) have methodological or study design limitations that greatly obstruct their dissemination and application. Models suitable for Chinese couples have not yet been identified. We conducted a retrospective study by using a database includes a total of 11,938 couples who underwent in vitro fertilization (IVF) treatment between January 2015 and December 2022 in a medical institution of southwest China Yunnan province. Multiple candidate predictors were screened out by using the importance scores. Four machine learning (ML) algorithms including random forest, extreme gradient boosting, light gradient boosting machine and binary logistic regression were used to construct prediction models. An initial assessment of the predictive performance was conducted and validated by using cross-validation and bootstrap methods. A total of seven predictors were identified, namely maternal age, duration of infertility, basal follicle-stimulating hormone (FSH), progressive sperm motility, progesterone (P) on HCG day, estradiol (E2) on HCG day, and luteinizing hormone (LH) on HCG day. Of the four predictive models, the random forest model and the logistic regression model were considered to have the optimal performance, with the areas under the receiver operating characteristic curve (AUROC) curves of 0.671 (95% CI 0.630-0.713) and 0.674 (95% CI 0.627-0.720). The Brier scores were 0.183 (95% CI 0.170-0.196) and 0.183 (95% CI 0.170-0.196), respectively. Considering the simplicity of model fitting, we recommend the logistic regression model as the best predictive model for live birth. Furthermore, maternal age, P on HCG day and E2 on HCG day were deemed to have the highest contribution to model prediction.

Pathway analysis of the impact of family function and self-efficacy on depression and anxiety in patients undergoing in vitro fertilization-embryo transfer

BACKGROUND

Patients undergoing assisted reproductive technology (ART) experience significant psychological distress due to infertility, with depression and anxiety being the most common manifestations. This study investigates the influence of family support and self-efficacy on the mental health of patients undergoing in vitro fertilization-embryo transfer (IVF-ET). The aim is to assess the direct and indirect effects of family function and self-efficacy on depression and anxiety in IVF-ET patients through pathway analyses, thereby providing novel insights for improving patients' psychological well-being.

METHODS

A cross-sectional study was conducted from March to July 2021, employing convenience sampling to recruit 291 participants from a tertiary care hospital's reproductive medicine center. Data were collected using the Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS), General Self-Efficacy Scale (GSES), Family APGAR index (APGAR), and a Demographic Characteristics Form. Descriptive analysis, Pearson correlation analysis, and multiple linear regression analysis were performed. A Structural Equation Model (SEM) was utilized for pathway analysis to evaluate the direct and indirect influences of family function and self-efficacy on anxiety and depression.

RESULTS

The scores for the SAS and SDS were 46.15 ± 7.35 and 51.71 ± 8.65, respectively. Multiple regression analysis indicated that family function, self-efficacy, and economic status significantly predicted anxiety and depression. Path analysis revealed that economic status directly (β=-0.447, -0.232) and indirectly (β=-0.066, -0.068) affected anxiety and depression, while family function both directly and indirectly affected depression (β=-0.323, -0.104), directly affected anxiety (β=-0.351), and self-efficacy directly influenced only depression (β=-0.509).

CONCLUSION

The findings underscore the pivotal role of a supportive family environment and self-efficacy in alleviating anxiety and depression among IVF-ET patients. The mediating role of family function between economic status and mental health highlights the importance of integrated support systems. Enhancing family function and self-efficacy as part of comprehensive care for individuals undergoing ART is crucial for promoting patient well-being.

Effects and safety of propofol intravenous anesthesia in transvaginal oocyte retrieval on outcomes of in vitro fertilization and embryo transplantation

Purpose

Propofol, a widely utilized anesthetic, is employed to alleviate pain and anxiety in outpatient oocyte retrieval procedures. However, its potential impact and safety profile in the context of in vitro fertilization and embryo transfer (IVF-ET) remain unclear.

Methods

This retrospective study enrolled 1187 patients undergoing IVF-ET, and divided into two groups depending on whether they received propofol (propofol group, n=140) or not (control group, n=1047) for anesthesia during oocyte retrieval.

Results

The baseline characteristics were comparable between the groups. Compared with control group, the number of oocytes retrieved in propofol group was more (p=0.012), while both the estradiol (E2) level on the trigger day and the pre-ovulatory follicle count were higher in propofol group ((p<0.01). Additionally, the rate of preterm delivery was significantly higher in the propofol group (p<0.001). To further analyze the effect of propofol on the oocyte retrieval rate, patients were divided into three subgroups depending on the pre-ovulatory follicle count (≤10, 11-20, and >20) to eliminate the influence of inconsistency in the estimation of the pre-ovulatory follicle count between the two groups. Analysis revealed that the use of propofol during oocyte retrieval was particularly advantageous in the subgroup with a pre-ovulatory follicle count of 11-20, yielding a higher oocyte retrieval rate (p<0.001).

Conclusion

The use of propofol in oocyte retrieval did not adversely affect fertilization, embryo quality, or clinical outcomes. Moreover, it was found to increase the oocyte retrieval rate among patients with an estimated pre-ovulatory follicle count of 11-20. These findings offer valuable evidence supporting the clinical application of propofol in oocyte retrieval procedures.

Research Progress of Ribosomal Proteins in Reproductive Development

Ribosomal proteins constitute the principal components of ribosomes, and their functions span a wide spectrum. Recent investigations have unveiled their involvement in oocyte and embryo development, playing a pivotal role in reproductive development. Numerous pieces of evidence indicate that ribosomal proteins participate in the regulation of various cellular activities, including nucleolar stress, oxidative stress, cell proliferation and autophagy. Despite these findings, the precise mechanisms through which ribosomal proteins influence reproductive development via these cellular activities remain elusive. Therefore, elucidating the mechanisms of action is essential for a comprehensive understanding of the role and function of ribosomal proteins in reproductive development. This paper systematically reviews the progress in research on nucleolar stress, oxidative stress, cell proliferation and autophagy concerning ribosomal proteins during reproductive development. Furthermore, we explore the potential of ribosomal proteins as diagnostic markers for various diseases. Additionally, we propose the development of drugs and therapies targeting ribosomal proteins, underscoring the potential for novel medical interventions in the context of reproductive health.

Exposure to ambient particulate matter and ovarian reserve impairment among reproductive age women in China

Ovarian aging, characterized by a decline in ovarian reserve, is a critical concern in female reproductive health. However, the evidence linking ambient air pollution exposure with ovarian reserve impairment remains limited. We aimed to estimate the association between exposure to fine particulate matter (PM2.5) and respirable particulate matter (PM10) and key indicators of ovarian reserve, including antral follicle count (AFC), ovarian volume (OV), anti-Müllerian hormone (AMH), follicle-stimulating hormone (FSH), estradiol (E2), luteinizing hormone (LH), FSH/LH ratio, and inhibin B (INHB). The cohort consisted of women attending an infertility clinic at the Tongji Reproductive and Environmental (TREE) study between 2018 and 2020. We used multivariate linear and Poisson regression models to estimate the association between PM2.5 and PM10 exposure and these ovarian reserve indicators. Our results showed that PM2.5 and PM10 exposure were associated with a reduction in AFC and an increase in E2 levels, highlighting the adverse effects of ambient air pollution on ovarian reserve. Our findings have important public health implications, emphasizing the urgent need for interventions to safeguard female reproductive health and reduce exposure to ambient air pollution.

Investigating the role of oviductal mucosa-endometrial co-culture in modulating factors relevant to embryo implantation

Background

Intrauterine adhesions (IUAs) are a significant clinical challenge, affecting reproductive health and leading to infertility or recurrent pregnancy loss. Understanding the molecular mechanisms underlying IUA prevention is crucial for developing effective treatment strategies.

Objective

To investigate the interaction between oviductal mucosal cells and endometrial cells and their effects on the expression of key molecules involved in embryo implantation, specifically leukemia inhibitory factor (LIF), avβ3, estrogen receptor (ER), and progesterone receptor (PR).

Methods

Tubal mucosa and endometrium specimens were collected from 22 patients undergoing surgical interventions. Cells were cultured alone and co-cultured at ratios of 1:1, 1:0.5, and 1:0.1. LIF, avβ3, ER, and PR expression levels were measured using real-time fluorescence quantitative polymerase chain reaction and enzyme-linked immunosorbent assay.

Results

Our results demonstrated that LIF expression was significantly augmented in co-culture conditions, particularly in the 1:1 ratio, compared to oviductal mucosa monoculture (P < 0.05). Although LIF expression was also elevated in 1:0.5 and 1:0.1 co-culture ratios, these increases were not statistically significant (P > 0.05). For avβ3, increased expression was observed in the 1:1 co-culture group (P < 0.05), but no significant differences were detected in 1:0.5 and 1:0.1 co-culture groups. ER expression showed a downward trend in co-culture, but without statistical significance (P > 0.05), and PR expression remained stable across all groups.

Conclusion

Co-culture modulates key molecules involved in embryo implantation, particularly LIF and avβ3. These findings highlight the potential roles of LIF and avβ3 in IUA prevention strategies and provide important insights for future clinical interventions. Tubal mucosal cells can not only grow in the endometrial cell microenvironment, but also the tolerance of tubal mucosal cells can be improved when they are co-cultured.

Clinical evidence of coenzyme Q10 pretreatment for women with diminished ovarian reserve undergoing IVF/ICSI: a systematic review and meta-analysis

BACKGROUND

To quantitatively evaluate the effect of coenzyme Q10 (CoQ10) pretreatment on outcomes of IVF or ICSI in women with diminished ovarian reserve (DOR) based on the existing randomized controlled trials (RCTs).

METHODS

Nine databases were comprehensively searched from database inception to November 01, 2023, to identify eligible RCTs. Reproductive outcomes of interest consisted of three primary outcomes and six secondary outcomes. The sensitivity analysis was adopted to verify the robustness of pooled results.

RESULTS

There were six RCTs in total, which collectively involved 1529 participants with DOR receiving infertility treatment with IVF/ICSI. The review of available evidence suggested that CoQ10 pretreatment was significantly correlated with elevated clinical pregnancy rate (OR = 1.84, 95%CI [1.33, 2.53], p = 0.0002), number of optimal embryos (OR = 0.59, 95%CI [0.21, 0.96], p = 0.002), number of oocytes retrieved (MD = 1.30, 95%CI [1.21, 1.40], p < 0.00001), and E2 levels on the day of hCG (SMD = 0.37, 95%CI [0.07, 0.66], p = 0.01), along with a reduction in cycle cancellation rate (OR = 0.60, 95%CI [0.44, 0.83], p = 0.002), miscarriage rate (OR = 0.38, 95%CI [0.15, 0.98], p = 0.05), total days of Gn applied (MD = -0.89, 95%CI [-1.37, -0.41], p = 0.0003), and total dose of Gn used (MD = -330.44, 95%CI [-373.93, -286.96], p < 0.00001). The sensitivity analysis indicated that our pooled results were robust.

CONCLUSIONS

These findings suggested that CoQ10 pretreatment is an effective intervention in improving IVF/ICSI outcomes for women with DOR. Still, this meta-analysis included relatively limited sample sizes with poor descriptions of their methodologies. Rigorously conducted trials are needed in the future.

Maternal Hypertension and Fecundability: A Population-Based Cohort Study

BACKGROUND

The association of hypertension and blood pressure control with fecundability among women is not yet elucidated. The purpose of this study was to evaluate the hypothesis that maternal preconception hypertension would be associated with reduced fecundability and that blood pressure control could reduce excess risk.

METHODS

Using the National Free Preconception Checkup Projects in Guangdong Province, China, 1422 couples whose female partners had been diagnosed with hypertension and 997 703 reference couples whose female partners were without hypertension were included in this prospective cohort study. Fecundability was measured by time to pregnancy (TTP) and infertility (TTP >12 months).

RESULTS

Compared with women without hypertension, those with controlled hypertension (time ratio, 1.47 [95% CI, 1.24-1.73]) or uncontrolled hypertension (time ratio, 1.59 [95% CI, 1.34-1.90]) were associated with prolonged TTP and increased risk of infertility (relative risk, 1.19 [95% CI, 1.09-1.31]; relative risk, 1.24 [95% CI, 1.14-1.34]). However, using instrumental variable analyses, there was no significant association between blood pressure control and TTP (time ratio, 0.68 [95% CI, 0.34-1.36]; P=0.270) or infertility (relative risk, 0.97 [95% CI, 0.70-1.34]; P=0.849) among women with hypertension. These results were consistent in the propensity score matching and inverse probability of treatment weighting analyses.

CONCLUSIONS

Maternal hypertension, with or without controlled blood pressure, was independently associated with prolonged TTP and an increased risk of infertility. These findings may provide insights for the implementation of preconception hypertension screening and the design of future trials.

Network analysis of stress and stigma symptoms and their associations with quality of life among Chinese female infertility patients

BACKGROUND

This study has employed network analysis while investigating the interrelationships among stress and stigma symptoms and their associations with quality of life among Chinese female infertility patients.

METHODS

In this cross-sectional study, 428 female patients who visited the Department of Reproductive Center of Dalian Women and Children's Medical Group with chief complaints of infertility symptoms were recruited using convenience sampling from November 2022 to December 2023. Fertility-related stress and stigma status were examined by the Fertility Problem Inventory (FPI) and Infertility Stigma Scale (ISS), respectively. Quality of life was examined by the Fertility Quality of Life (FertiQoL). Network analysis was conducted to estimate the network of stress and stigma symptoms. The flow network approach was used to identify specific stigma and stress symptoms related to quality of life. Expected influence (EI) and bridge expected influence (bEI) were used to quantify central and bridge symptoms in the network, respectively. The bootstrapping method evaluated the accuracy and robustness of the network estimates.

RESULTS

The average predictability of FPI and ISS symptoms was 0.67. The "relationship concern" was the most central symptom across all centrality indices, followed by "public stigma" and "social concern". The main symptoms bridging the FPI and ISS clusters were "self-devaluation", "social concern", and "relationship concern". The network demonstrated robustness in stability and accuracy tests. In the flow network, "social withdrawal" and "self-devaluation" showed strong negative associations with FertiQoL.

CONCLUSIONS

"Relationship concern," "public stigma," "social concern," and "self-devaluation" have been identified as the main central and bridge symptoms in the stress and stigma network in this study. Notably, stigma symptoms, particularly "social withdrawal" and "self-devaluation", showed stronger associations with FertiQoL compared to stress symptoms, highlighting their importance in potential treatment strategies.

How do marital conflicts influence post-traumatic growth among infertile women? The moderation role of coping strategies

In the current study, the authors aimed to investigate the post-traumatic growth (PTG) among infertile women who experience conflicts with their spouses, and the role of personal coping strategies in mitigating such influences. A total of 267 infertile female patients were recruited from a reproductive medical center in China. OLS regressions with moderation effects of coping strategies were conducted. Our results showed that coping strategies had the main influence on infertile women's PTG, and minimizing and avoiding marital conflicts had a particularly negative effect on PTG when infertile women adopted greater maladaptive coping strategies. Possible practical implications, such as improving infertile women's coping strategies were discussed.

Exploring lncRNA expression in follicular fluid exosomes of patients with obesity and polycystic ovary syndrome based on high-throughput sequencing technology

BACKGROUND

Infertility is a reproductive health problem that attracts worldwide attention. Polycystic ovary syndrome (PCOS) is a major cause of female infertility and patients with obesity and PCOS are particularly common in clinical practice. Long non-coding RNA (lncRNAs) are a functional core in cells that regulate gene expression, transcription, and chromatin modification processes, and participate in epigenetics, cell cycle, and cell differentiation. LncRNAs are assumed to play a role in the occurrence and development of PCOS; however, their specific mechanism of action remains to be elucidated.

METHODS

High-throughput sequencing technology has been used to sequence and analyze lncRNAs in exosomes from the follicular fluid of patients with obesity and PCOS and those who underwent assisted reproductive therapy owing to male factors. Specific expression profiles of patients with obesity and PCOS were obtained and functional information analysis combined with a literature review were performed to screen for differentially expressed lncRNAs, which were validated using real-time reverse transcription quantitative polymerase chain reaction (RT-qPCR).

RESULTS

High-throughput sequencing analysis revealed that compared to normal patients with male infertility, patients with obesity and PCOS had a total of 20 lncRNAs with significant expression differences in follicular fluid exosomes. Among them, 17 lncRNAs were upregulated and three were downregulated. Functional analysis showed that differentially expressed genes were mainly enriched in "cell metabolism," "cell adhesion," and other aspects: related gene pathways mainly involved Huntington's disease, Parkinson's disease, spliceosomes, non-alcoholic fatty liver disease, and ribosomes. Verification of differentially expressed lncRNAs revealed that the expression of lncRNAs TPT1-AS1, PTOV1-AS1, PTPRG-AS1, and SNHG14 in follicular fluid exosomes was consistent with the sequencing results.

CONCLUSION

A preliminary differential expression profile of lncRNAs in exosomes of patients with obesity and PCOS was established by transcriptomic analysis of these individuals. Our bioinformatics analysis results may be applicable to further study of the impact mechanism involving obesity and PCOS. These differentially expressed lncRNAs maybe served as potential biomarkers for in-depth studies of the occurrence, development on Follicle quality and function for patients with PCOS in the future.

The Timing and Dose Effect of Acupuncture on Pregnancy Outcomes for Infertile Women Undergoing In Vitro Fertilization and Embryo Transfer: A Systematic Review and Meta-Analysis

Background: Women undergoing in vitro fertilization and embryo transfer (IVF-ET) often utilize acupuncture to enhance pregnancy outcomes. Yet, the optimal timing for acupuncture sessions and the relationship between dosage and effect remain uncertain. Objectives: To investigate the impact of the timing and dosage of acupuncture on pregnancy outcomes, drawing on existing research. Methods: A comprehensive search of eight databases was conducted from their inception to January 14th, 2023, without restrictions on language. Only randomized controlled trials comparing acupuncture with either sham acupuncture or no adjuvant treatment were selected for inclusion. This meta-analysis assessed the efficacy of acupuncture in IVF-ET, analyzing the influence of varied timing and dosage on pregnancy outcomes. Subgroup analyses were undertaken to address any heterogeneity across the studies. Results: A total of 38 RCTs involving 5,991 participants were analyzed. In infertile women undergoing IVF fresh cycles, acupuncture performed during controlled ovarian hyperstimulation (COH) significantly increased the clinical pregnancy rate (CPR) (relative risk [RR] = 1.33, 95% confidence interval [CI]: 1.07-1.65, p = 0.01), whereas acupuncture administered either before COH or on the day of ET did not demonstrate reproductive benefits. Regarding frozen cycles, acupuncture before freeze-thaw embryo transfer (FET) significantly enhanced the CPR (RR = 1.71, 95% CI: 1.36-2.16, p < 0.00001) and live birth rate (LBR) (RR = 2.40, 95% CI: 1.20-4.79, p = 0.01). Improvements in CPR were observed across all dosage groups, but only the high-dosage group showed a significant increase in LBR (RR = 1.75, 95% CI: 1.05-2.92, p = 0.03). Conclusions: Timing and dosage of acupuncture are crucial factors affecting pregnancy outcomes in IVF-ET. For women undergoing IVF fresh cycles, acupuncture during COH yielded more significant reproductive benefits. In addition, acupuncture before freeze-thaw embryo transfer (FET) was associated with improved pregnancy outcomes in frozen cycles. Furthermore, higher dosages of acupuncture were linked to more favorable outcomes.

Serum iron status and the risk of female infertility in European populations: A two-sample Mendelian randomization study

The relationship between iron status and female infertility has been observed in several studies, yet its causal nature remains ambiguous. We employed univariate Mendelian randomization (MR) analyses to explore the potential causal connection between these 2 factors. For our analysis, genetic instrumental variables pertaining to iron status were selected using data from the Iron Status Genetics Consortium, encompassing 48,972 individuals of European descent from 19 cohorts (11 discovery and 8 replication). For female infertility data, we referred to FinnGen Consortium Release 9, which includes 11,442 cases and 107,564 controls. Our MR approach utilized both a conservative strategy (involving single nucleotide polymorphisms pertinent to general iron status) and a liberal strategy (encompassing single nucleotide polymorphisms linked to any iron status indicator). The conservative approach relied on inverse variance-weighted methods, whereas the liberal strategy integrated inverse variance weighted with MR-Egger regression, the weighted median approach, and simple mode techniques. The conservative strategy did not reveal a significant link between iron status and female infertility risk. Conversely, the liberal strategy indicated a positive correlation specifically between serum iron levels and female infertility risk (odds ratio from MR: 1.225; 95% confidence interval: 1.064-1.410; P = .030), while no significant associations were found for other iron indicators (P > 0.05). Our MR investigation suggests a potential positive association between serum iron levels and the risk of female infertility, while other iron markers do not appear to significantly influence this risk. These findings highlight the need for further research into the possible connection between serum iron status and female infertility risk.

Tuberculosis in infertility and in vitro fertilization-embryo transfer

ABSTRACT

Tuberculosis (TB) is a prominent infectious disease globally that imposes a substantial health burden. Genital TB (GTB), an extrapulmonary manifestation, leads to complications such as tubal adhesions, blockage, and diminished ovarian function, culminating in infertility, and is recognized as a prevalent cause of infertility in nations with high-burden TB. In regions with low TB rates, infertility and active TB during pregnancy have been reported to be most common among female immigrants from countries with high-burden TB. In the context of TB, pregnant women often exhibit exacerbated symptoms after in vitro fertilization-embryo transfer (IVF-ET), heightening the risk of dissemination. Miliary pulmonary TB and tuberculous meningitis pose a serious threat to maternal and fetal health. This article integrates recent epidemiological data and clinical research findings, delineating the impact of TB on infertility and assisted reproduction and particularly focusing on the diagnosis and treatment of GTB, underscored by the imperative of TB screening before IVF-ET. Our objective is to increase awareness among respiratory and reproductive health professionals, promoting multidisciplinary management to enhance clinical vigilance. This approach seeks to provide patients with judicious reproductive plans and scientifically rigorous pregnancy management, thereby mitigating adverse pregnancy outcomes related to TB activity.

Association between BMI and increased time-to-pregnancy in planned pregnancy couples: a cohort study in Guangzhou, China

BACKGROUND

This study examines the relationship between overweight and obesity and fertility in the context of China's fertility. Given the inconsistent results in previous research, which mostly focused on females, our study targets couples in Guangzhou. We investigate the relationship between Body Mass Index (BMI) and time-to-pregnancy (TTP) to provide evidence-based strategies for enhancing reproductive outcomes in China.

METHODS

This cohort study, utilizing the National Free Pre-pregnancy Checkups Project (NFPCP), employs a Cox regression model to assess the associations between different BMI categories and TTP. Heatmaps are utilized to investigate the association between various BMI combinations of couples and TTP. Additionally, restricted cubic spline (RCS) curves were used to explore the impact of different ranges of male and female BMI on TTP.

RESULTS

The results showed that females and males classified as overweight and obese (fecundability ratios (FR) 0.78, 95% CI 0.64, 0.95 for females; FR 0.86, 95% CI 0.76, 0.97 for males) had longer TTP compared with those in the normal weight category, regardless of controlled covariates, while those classified as underweight also had longer TTP, but the difference was not statistically significant (P > 0.05). Across all BMI combinations, couples in the overweight and obese groups exhibited the longest TTP, experiencing a 34% increase in TTP compared to couples in the normal BMI combination (FR 0.66; 95% CI 0.50, 0.85). After adjusting for all covariates in the RCS model, a male BMI within the range of 23.40 to 29.44 was significantly associated with an increase in TTP (FR<1).

CONCLUSIONS

Increased BMI in both females and males is associated with a certain predictive effect on prolonged TTP. Scientific BMI management is crucial for couples preparing to conceive.

Exposure of women undergoing in-vitro fertilization to per-and polyfluoroalkyl substances: Evidence on negative effects on fertilization and high-quality embryos

In April 2023, the World Health Organization (WHO) reported that 17.5% of the global adult population experience infertility. What may be the contribution of per-and polyfluoroalkyl (PFAS) to this global public health problem? This study explored the associations between in vitro fertilization (IVF) outcomes and plasma concentrations of individual PFAS and PFAS mixtures in women undergoing in vitro fertilization and embryo transfer (IVF-ET) and how these exposures might affect IVF outcomes. We analyzed 8 PFASs in plasma samples from women (N = 259) who underwent IVF treatment. In multivariable generalized linear mixed models, there were statistically significant associations of higher plasma concentrations of PFNA with reduced numbers of total retrieved oocytes [12.486 (95%CI: 0.446,25.418), p trend = 0.017], 2 PN zygotes [6.467(95%CI: 2.034,14.968), p trend = 0.007], and cleavage embryos [6.039(95%CI: 2.162,14.240), p trend = 0.008]. Similarly, there was a continuous decline in the numbers of retrieved 2 PN zygotes and cleavage embryos with increasing concentration of PFOS [6.467(95%CI: 2.034,14.968), p trend = 0.009 and 6.039(95%CI: 2.162,14.240), p trend = 0.031,respectively] and a negative association between PFHxS concentrations and clinical pregnancy during the initial cycles of frozen ET [0.525(95%CI:0.410,0.640), p trend = 0.021]. To investigate the joint effect of PFAS mixtures, a confounder-adjusted BKMR model analysis showed inverse relationship between PFAS mixtures and the number of high-quality embryos, 2 PN zygotes and cleavage embryos, to which the greatest contributors to the mixture effect are PFDeA and PFBS, respectively. It demonstrated that PFAS exposure might exert negative effects on oocyte yield, fertilization and high-quality embryo in women undergoing IVF. These findings suggest that exposure to PFAS may increase the risk of female infertility and further studies are needed to uncover the potential mechanisms underlying the reproductive effects associated with PFAS.

Relationship between relative fat mass and infertility: A cross-sectional study

Infertility is closely related to obesity. Relative fat mass (RFM) is a newer index for assessing percentage of body fat, which reflects the amount of body fat better than body mass index (BMI), but its relationship with infertility needs further study. The purpose of this study was to assess whether there was an association between RFM and infertility in women aged 20 to 44 years in the United States. The corresponding participants were selected from the National Health and Nutrition Examination Survey (NHANES) 2013 to 2018. RFM was used as the independent variable and infertility as the dependent variable. Multiple logistic regression and generalized additive models were used to explore the association between RFM and infertility, 2-stage linear regression models were used to calculate threshold effects, and subgroup analyses and tests of interactivity were used to find sensitive populations. A total of 2328 women aged 20 to 44 years were included. In the fully adjusted model, the risk of infertility increased by 6% for each increase in RFM (OR = 1.06, 95% CI: 1.00-1.12). There was a nonlinear relationship between RFM and infertility with 2 breakpoints of K1 = 31.04 and K2 = 48.4. There was a positive association between RFM and infertility on the right side of K1 and, on the left side of K2 (OR = 1.08, 95% CI: 1.01-1.16; OR = 1.07, 95% CI: 1.01-1.14). In contrast, no statistically significant association between RFM and infertility was found on the left side of K1 as well as on the right side of K2. There was a nonlinear relationship between RFM and infertility, with a positive association with infertility when RFM was in the range of 31.04 to 48.4.This suggests that RFM may be an alternative to BMI in the management of obese infertile women, but this needs to be further confirmed by prospective studies.

Effects of male hepatitis B virus infection and serostatus on sperm quality, pregnancy outcomes, and neonatal outcomes following intrauterine insemination

OBJECTIVE

To evaluate the impact of male hepatitis B virus (HBV) infection and serostatus on sperm quality, pregnancy outcomes, and neonatal outcomes following intrauterine insemination for infertility.

DESIGN AND METHODS

We retrospectively analyzed data from 962 infertile couples undergoing intrauterine insemination treatment at a single center. The case group comprised 212 infertile couples with male HBV infection, and the control group comprised 750 noninfected infertile couples. The couples were further divided into subgroups according to their hepatitis B e antigen (HBeAg)/anti-HBe status: hepatitis B surface antigen (HBsAg)+HBeAg- (group A), HBsAg+HBeAg+ (group B), and HBsAg-HBeAg- (control group). The main outcome parameters, including the seminal parameters, clinical pregnancy rate, miscarriage rate, live birth rate, preterm delivery rate, multiple pregnancy rate, delivery type, birth weight, and sex ratio, were compared.

RESULTS

A lower sperm acrosin activity, higher cesarean rate, and newborn sex ratio were observed in the HBV-infected group and group A in comparison with the control group (P < 0.05). However, the standard sperm parameters, clinical pregnancy rate, miscarriage rate, live birth rate, preterm delivery, and birth weight showed no statistically significant differences among the groups.

CONCLUSION

Male HBV infection does not adversely impact standard sperm parameters or pregnancy outcomes but can influence sperm acrosin activity and some neonatal outcomes. Moreover, the effect may vary among different HBV serostatuses.

Reliability and validity of the Chinese version of the Copenhagen Multi-Centre Psychosocial Infertility-Fertility Problem Stress Scales

AIMS

The aim of this study is to introduce the Copenhagen Multi-Centre Psychosocial Infertility (COMPI)-Fertility Problem Stress Scales (COMPI-FPSS) into China and test its applicability in Chinese infertile population.

BACKGROUND

Infertility-related stress not only influences patients' psychological well-being but is also strongly associated with reduced pregnancy rates and poorer assisted conception outcomes, thus warranting focussed attention.

DESIGN

The design used in this study is a cross-sectional survey.

METHODS

A total of 418 participants were recruited by convenience sampling from March to July 2022. The data were randomly divided into two parts: one for item analysis and exploratory factor analysis and the other for confirmatory factor analysis and reliability test. The critical ratio and homogeneity test were used to verify the differentiation and homogeneity of the COMPI-FPSS; the construct validity was determined by explanatory and confirmatory factor analyses; Cronbach's α coefficient and Spearman-Brown coefficient were used to assess the reliability; and criterion validity was expressed using correlation coefficients for the Perceived Stress Scale and the Negative Affect Scale as the validity criteria.

RESULTS

The revised Chinese version of COMPI-FPSS has 11 items and 2 dimensions (i.e., personal stress domain and social stress domain). Exploratory factor analysis showed that the cumulative variance contribution rate of the two factors was 68.6%, and confirmatory factor analysis indicated that the model fitted well. The score of the COMPI-FPSS was significantly and positively associated with perceived stress and negative affect. The Cronbach's α coefficient of the total scale was 0.905, and the Spearman-Brown coefficient was 0.836, explaining excellent reliability.

CONCLUSION

The revised Chinese version of COMPI-FPSS shows good reliability and validity, and it can be used to evaluate the infertility-related stress of infertile patients in China.

Searching for Love and Babies: A Qualitative Study on Online Social Support Among Women with Infertility

With the popularity of computer-mediated communication, accessing online social support has become more accessible for women confronting infertility, yet the role of such support for Chinese women remains understudied. This study investigates the online social support experiences of Chinese women navigating infertility within the framework of Cutrona and Suhr's social support. Employing netnography and semi-structured interviews alongside thematic analysis, the findings highlight challenges in informational support due to limitations in online information dissemination, with some degree of overlap observed between informational support and network support. Emotional support proves crucial and esteem support aids in mitigating self-blame among online forum members. Tangible assistance primarily involves expressed willingness to help. This research advances social support theory by exploring new areas, clarifying online support mechanisms using Daena Goldsmith's normative approach, highlighting sociocultural influences, and enhancing understanding of esteem support in the context of stigmatization.

Effect of ART treatments on maternal and neonatal outcomes in singleton live births: A large-scale retrospective cohort study

Background

The increased risk of pregnancy complications in the ART population has been reported, but the source of these risks remains controversial. The study aims to evaluate the association between ART treatments and patient characteristics with maternal and neonatal outcomes.

Methods

This was a retrospective analysis of 45,159 singleton pregnant women at a hospital between 2018 and 2021. The maternal and neonatal outcomes included pregnancy-induced hypertension (PIH), preeclampsia (PE), gestational diabetes mellitus (GDM), placental abruption (PA), placenta accreta spectrum (PAS), postpartum hemorrhage (PPH), cesarean section, iatrogenic and spontaneous preterm birth, small for gestational age (SGA), low birth weight (LBW), macrosomia, and birth defects. We assessed the outcomes among the fresh embryo transfer (ET), frozen embryo transfer (FET), and spontaneous conception (SC) groups. Potential risk factors were further analyzed in the ART population.

Results

FET was associated with higher risks for PIH (SC: AOR, 1.97(1.51-2.57); fresh ET: AOR, 1.68(1.03-2.72)), PE (SC: 2.28(1.86-2.80); fresh ET: AOR, 1.61(1.11-2.33)), PAS (SC: AOR, 3.89(3.39-4.46); fresh ET: AOR, 2.23(1.70-2.92)), PPH (SC: AOR, 3.46(2.76-4.34)); fresh ET: 2.09(1.39-3.14)), and macrosomia (SC: 1.53(1.25-1.86); fresh ET: AOR, 2.87(1.89-4.35). Fresh ET was associated with higher risks for PA (SC: AOR, 2.19(1.51-3.18); FET: AOR, 0.39(0.17-0.90)), SGA (SC: AOR, 1.56(1.06-2.31), FET: AOR, 0.42(0.19-0.91)), and LBW (SC: AOR, 2.24(1.82-2.77), FET: AOR, 0.63 (0.44-0.89)), and fresh ET is an independent risk factor for PA and SGA. Furthermore, the risk of GDM was associated with the biological characteristic of low-fertility patients.

Conclusions

Embryo status (fresh or frozen) is a key factor affecting the maternal and neonatal outcomes in ART treatments, while biological characteristics of infertile patients also play a certain role.

The relationship between cardiometabolic index and infertility in American adults: a population-based study

Background

Infertility is a fertility disorder caused by various factors, with lipid metabolism playing a crucial role in its development. The cardiometabolic index (CMI), which combines blood lipids (TG/HDL-C) and obesity-related parameters (WHtR), is a new quantitative indicator. This study used NHANES data to investigate the relationship between CMI and the incidence of infertility.

Methods

We utilized data from women who took part in the National Health and Nutrition Examination Survey (NHANES) from 2015 to March 2020 to calculate the CMI index. Subsequently, we used multivariate logistic regression, smooth curve fitting, and subgroup analysis to investigate the relationship between the CMI index and infertility.

Results

The logistic regression model revealed a significant positive correlation between the CMI index and infertility, even after adjusting for all confounding variables (OR=3.23, 95%CI: 1.55-6.73, p=0.0017). This association remained consistent across all subgroups (p>0.05 for all interactions). Smooth curve fitting demonstrated a positive nonlinear relationship between CMI and infertility. However, the CMI index had limited diagnostic power for infertility (AUC=0.60, 95%CI: 0.56-0.65). However, the CMI-BMI index combined with BMI had good predictive performance (AUC=0.722, 95%CI: 0.676-0.767).

Conclusion

The CMI index shows a positive correlation with infertility, but its diagnostic value is restricted. The combination with BMI has good diagnostic value. Further investigation is required to determine the effectiveness of the CMI index as an early indicator of infertility.

A Study of Sperm DNA Damage Mechanism Based on miRNA Sequencing

To analyze the differential expression profiles of microRNAs (miRNAs) in spermatozoa of patients with sperm DNA damage and to investigate the role of miRNAs in sperm DNA damage. Male infertility patients with sperm DNA damage who attended the First Affiliated Hospital of Henan University of Chinese Medicine from October 2023 to December 2023 were selected and included in this study as a case group. Fertile healthy men who were seen at the health check-up center during the same period and diagnosed by examination were also included as a control group. Sperm miRNA expression was detected in patients with sperm DNA damage (case group, n = 5) and healthy medical check-ups (control group, n = 5) using high-throughput sequencing technology. The differentially expressed miRNAs between the two groups were bioinformatically analyzed to explore the main biological functions of the target genes. We found that 63 miRNAs were significantly changed in the spermatozoa of patients with sperm DNA damage,|log2 (foldchange)| ≥ 1, p < .05. Gene Ontology (GO) enrichment analysis indicated that these differential miRNAs might be involved in developmental process, anatomical structure development, cellular macromolecule metabolic process, multicellular organism development, system development, and so on. Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis showed that that they mainly affect the PI3K-AKT signaling pathway. The present study suggests that the altered expression of miR-1255a, miR-921, and miR-3156-5p may play an important role in the sperm DNA damage process, and the mechanism may involve the phosphatidylinositol-3'-kinase-AKT (PI3K-AKT) signaling pathway.

Infertility-related stress is associated with quality of life through negative emotions among infertile outpatients

Infertility is not a fatal disease but it really produces infertility-related stress and affects individuals' quality of life to a great extent. This study aims to investigate the relations among infertility-related stress, negative emotions and quality of life in infertile outpatients, and suppose gender difference as well as Dark Triad, which contained three dark personality traits: Machiavellianism, narcissism, and psychopathy, would moderate the relations. 105 infertile outpatients age range 20-49 completed a cross-sectional questionnaire on the Fertility Quality of Life scale, the Fertility Problem Inventory, the Hospital Anxiety and Depression Scale a the Chinese version of Dirty Dozen. Results showed that negative emotions mediated the relations between infertility-related stress and quality of life. Dark Triad could not moderate the relations between infertility-related stress, negative emotions, and quality of life, but gender can moderate the associations between infertility-related stress and negative emotions. Specifically, the association between infertility-related stress and negative emotions was stronger in men than in women. Infertility-related stress has direct and indirect effects on infertile outpatients' quality of life. It is important to consider the important roles of emotions and gender difference between patients, and delivering targeted intervention programs.

Economic evaluation of GnRH-agonist long protocol and GnRH-antagonist protocol in IVT/ICSI among the Chinese population: using pharmacoeconomic models

OBJECTIVE

This paper uses health economics methods to discuss the cost-effectiveness value of long protocol and antagonist protocol for in vitro fertilisation and embryo transfer (ET) in the Chinese population.

DESIGN

Health economic evaluation study.

SETTING

The data needed to construct the model for this study were derived from published studies and other secondary sources in China.

PARTICIPANTS

No patients participated in the study.

MEASURES

The main outcomes were live birth rate (LBR) and cost. From the societal perspective, we considered the direct and indirect costs over the course of the treatment cycles. A cost-effectiveness was measured using the incremental cost-effectiveness ratio and the probability that a protocol has higher net monetary benefit. Sensitivity analysis was carried out to verify the reliability of the simulation results.

RESULTS

For the Chinese population, the long protocol resulted in a higher LBR than the antagonist protocol (29.33% vs 20.39%), but at the same time, it was more expensive (￥29 146.26 (US$4333.17) vs ￥23 343.70 (US$3470.51)), in the case of considering only one fresh ET cycle. It was the same when considering subsequent frozen ET (FET) cycles (51.78% vs 42.81%; ￥30 703.02 (US$4564.62) vs ￥24 740.95 (US$3678.24)). The results of most subgroups were consistent with the results of the basic analysis. However, for certain populations, the long protocol was the inferior protocol (less effective and more expensive).

CONCLUSION

For the Chinese population, when the monetary value per live birth was greater than ￥65 420 (US$9726) and ￥66 400 (US$9872), respectively, considering only one fresh cycle and considering subsequent frozen cycles, the long protocol is the preferred protocol. This threshold also varies for women of different ages and ovarian response capacities. For women in POSEIDON (Patient-Oriented Strategies Encompassing IndividualizeD Oocyte Number) group 2, group 3 and group 4, antagonist protocol is recommended as the preferred protocol. The results of this study need to be verified by further large-scale randomised controlled trials.

Irrational parenthood cognition and infertility stigma among infertile women: A cross-sectional study in Changsha, China

Background

Stigma is among the most prevalent and disturbing consequences of being infertile among women, yet it remains unknown whether fertility stigma is affected by irrational parenthood cognitions (IPC). The current study aimed to assess IPC, infertility stigma, and their interrelationship among a group of Chinese women referred to an infertility center in Changsha, Hunan, China.

Methods

A cross-sectional study was conducted among 376 women seeking treatment for infertility in Changsha City, China. Pearson correlation test was used to explore the association between IPC and infertility stigma, while multivariate linear regression was used to explore the independent influencing factors of infertility stigma.

Results

Participants had a mean score of 42.41 ± 13.03 for IPC and 62.89 ± 24.50 for ISS. IPC was highly correlated with infertility stigma with a large effect size (r = 0.55, p < 0.001). Multivariate linear regression showed that patients' infertility stigma was positively associated with IPC (β = 1.06, p < 0.001) while negatively associated with education (β = -5.4, p = 0.036) and disclosure of infertility (β = -8.39, p = 0.001) (R 2  = 36 %). In addition, various influencing factors were identified for the four dimensions of infertility stigma.

Conclusion

This study is the first to identify a positive association between irrational parenthood cognitions and infertility stigma among infertile women in China. Our findings provide useful guidance for the future development of effective anti-stigma intervention programs among infertile women.

Feasibility of acupuncture as an adjunct intervention for ovulatory disorder infertility: A systematic review and meta-analysis

BACKGROUND

Acupuncture (AT) is widely used in treatment of ovulatory disorder infertility (ODI), but the safety and efficacy of AT for ODI still lack an evidence-based basis.

AIM

To evaluate the feasibility and effectiveness of AT as an adjunct intervention for ODI.

METHODS

The Cochrane Library, Embase, PubMed, VIP, China National Knowledge Infrastructure, WanFang Data, and Chinese biomedical literature databases were searched from inception to January 20, 2024. Two reviewers independently selected studies, collected data, and evaluated methodological quality through the Cochrane Risk of Bias tool. Revman 5.4 was used for meta-analysis, and the Grade system was performed to evaluate the level of evidence for the outcomes of the meta-analysis.

RESULTS

A total of 20 randomized controlled trials with 1677 ODI patients were included. Compared with the clomiphene citrate (CC) group, the AT plus CC group exhibited significant improvement of the pregnancy rate [relative risk (RR) = 1.68, 95% confidence interval (CI): 1.45-1.95, P < 0.00001, I² = 23%], ovulation rate (RR = 1.34, 95%CI: 1.22-1.47, P < 0.00001, I² = 32%), serum E₂ level [mean difference (MD) = 31.36, 95%CI: 21.83-40.88, P < 0.00001, I² = 97%], thickness of endometrium (MD = 1.76, 95%CI: 0.71-2.81, P = 0.001, I² = 98%) and decreasing miscarriage rate (RR = 0.25, 95%CI: 0.09-0.65, P = 0.005, I² = 0%), serum follicle-stimulating hormone level (MD = -2.10, 95%CI: -3.27 to -0.94, P = 0.0004, I² = 99%), serum luteinizing hormone level (MD = -6.94, 95%CI: -9.89 to -4.00, P < 0.00001, I² = 100%), and serum progesterone level (MD = -1.66, 95%CI: -2.98 to -0.34, P = 0.01, I² = 96%). The AT group had a more favorable effect than CC group for improving pregnancy rate (RR = 1.52, 95%CI: 1.33-1.73, P < 0.00001, I² = 0%), thickness of endometrium (MD = 2.48, 95%CI: 2.15-2.81, P < 0.00001, I² = 0%) and reducing miscarriage rate (RR = 0.23, 95%CI: 0.13-0.44, P < 0.00001, I² = 0%), serum follicle-stimulating hormone level (MD = -0.55, 95%CI: -0.86 to -0.24, P = 0.0005, I² = 0%), and serum progesterone level (MD = -0.24, 95%CI: -0.28 to -0.20, P < 0.00001). However, the level of evidence was predominantly assessed as very low to moderate.

CONCLUSION

AT can improve the pregnancy outcomes and sex hormone levels for patients with ODI. However, further studies are needed to confirm these findings.

Relationship between marital satisfaction and defeat in IVF-ET: based on actor-partner interdependence model approach

OBJECTIVE

A person's marital satisfaction is a strong predictor of their own mental health outcomes. However, marital satisfaction results from both spouses' experiences, so a partner's marital satisfaction also affects his or her mental health outcomes. This study adopted the actor-partner interdependence model approach (APIM) to evaluate the relationship between marital satisfaction and sense of defeat in vitro fertilization-embryo transfer (IVF-ET) couples.

METHODS AND MEASURES

In this cross-sectional study, 181 infertile couples undergoing IVF-ET treatment were recruited using the Marital Satisfaction Scale of the ENRICH Marital Quality Questionnaire and Defeat Scale. Through APIM and Pearson analysis, the path relationship between marital satisfaction and defeat was analyzed.

RESULTS

The varying degrees of defeat in IVF-ET couples, are closely related to actors' and partners' marital satisfaction. In terms of actor effects, the Marital Satisfaction of both husbands (β = -0.71, p < 0.001) and wives (β = -0.46, p = 0.001) have a significant effect on individual Defeat. With regard to partner effects, husbands' Marital Satisfaction (β = -0.23, p = 0.038) has a significant impact on wives' Defeat and the wives' Marital Satisfaction (β = -0.45, p = -0.005) has a significant impact on husbands' Defeat.

CONCLUSION

IVF-ET couples must be looked at as a whole, and it is critical to include couples and not just men or women when studying infertility. The importance of their interaction is essential to improve the psychosocial adaptation of infertile couples in IVF-ET treatment.

Identification of novel compound heterozygous ZFP36L2 variants implicated in oocyte maturation defects and female infertility

PURPOSE

To explore the pathogenesis of oocyte maturation defects.

METHODS

Whole exome sequencing was conducted to identify potential variants, which were then confirmed within the pedigree through Sanger sequencing. The functional characterization of the identified variants responsible for the disease, including their subcellular localization, protein levels, and interactions with other proteins, was verified through transient transfection in HeLa cells in vitro. Additionally, we employed real-time RT-PCR and single-cell RNA sequencing to examine the impact of ZFP36L2 pathogenic variants on mRNA metabolism in both HeLa cells and mouse or human oocytes.

RESULTS

A novel compound heterozygous variant in ZFP36L2 (c.186T > G, p.His62Gln and c.869 C > T, p.Pro290Leu) was discovered in a patient with oocyte maturation defects. Our findings indicate that these variants lead to compromised binding capacity of the ZFP36L2-CONT6L complex and impaired mRNA degradation in HeLa cells and mouse oocytes. Furthermore, we characterized the changes in the human oocyte transcriptome associated with ZFP36L2 variants, with a particular emphasis on cell division, mitochondrial function, and ribosome metabolism.

CONCLUSIONS

This study broadens the mutation spectrum of ZFP36L2 and constitutes the first report of human oocyte transcriptome alterations linked to ZFP36L2 variants. In conjunction with existing knowledge of ZFP36L2, our research lays the groundwork for genetic counseling aimed at addressing female infertility.

Exploring depressive symptoms and coping strategies in Chinese women facing infertility: A cross-sectional observational study

Infertility can lead to significant psychological distress among women, yet the roles of hope and resilience in mitigating depressive symptoms remain inadequately explored, particularly within the Chinese context. We performed a cross-sectional observational study to investigate the psychological impacts of infertility among Chinese women as well as to discern whether hope and resilience can influence their depressive symptoms. We recruited 364 Chinese women seeking infertility treatment in the Shandong region. Participants completed validated assessments including the Hospital Anxiety and Depression Scale, Connor-Davidson Resilience Scale, and Herth Hope Index. Demographic and clinical data were also collected. We observed elevated levels of depressive symptoms and anxiety among women with infertility. Particularly, demographic factors such as an older age, rural residence, lower income, lower education, adverse life events, and longer infertility duration were associated with increased depressive symptoms. Individuals who experienced adverse life events were at a 2.42-fold increased risk of developing depressive symptoms (P = .04). Depressive symptoms were inversely correlated with both hope levels (r = -0.25; P < .05) and resilience levels (r = -0.32; P < .05). Hope levels were positively correlated with resilience (R = 0.67; P < .05). After controlling for the interaction of hope and resilience, we found that only depressive symptoms and resilience were negatively correlated. The psychological burden of infertility among Chinese women is widespread and affects many individuals from different demographic backgrounds. Interventions aimed at increasing resilience may be helpful to mitigate depressive symptoms.