Fertility and sterility最新文献

{"title":"\"Beyond Transparency: The Limits of Trial Registration in Establishing Trustworthiness\".","authors":"Abigail Combs, Bronwyn Bedrick, Katie Cameron","doi":"10.1016/j.fertnstert.2026.04.021","DOIUrl":"https://doi.org/10.1016/j.fertnstert.2026.04.021","url":null,"abstract":"","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":" ","pages":""},"PeriodicalIF":7.0,"publicationDate":"2026-05-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147856176","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intracytoplasmic sperm injection for nonmale factor indications: a Committee opinion.","authors":"","doi":"10.1016/j.fertnstert.2026.03.032","DOIUrl":"https://doi.org/10.1016/j.fertnstert.2026.03.032","url":null,"abstract":"<p><p>Intracytoplasmic sperm injection, although typically effective for overcoming low or absent fertilization in couples with a clear abnormality of semen parameters, is frequently used in combination with assisted reproductive technologies for other etiologies of infertility in the presence of semen parameters that meet the World Health Organization normative reference values. This committee opinion provides a critical review of the literature, where available, to identify situations in which this may or may not be beneficial. This document replaces the previously published document of the same name, last published in 2020 (Fertil Steril 2020;114:239-45).</p>","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":" ","pages":""},"PeriodicalIF":7.0,"publicationDate":"2026-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prognostic Utility of Serum Beta Human Chorionic Gonadotropin Level following Single Euploid Embryo Transfer for Live Birth.","authors":"Emily A Clarke, Charlotte Jones, Jensen Reckhow, Kerry Flannagan, Diana Shaari, Morgan Baird, Joseph A Lee, Lucky Sekhon, Alan B Copperman, Phillip A Romanski","doi":"10.1016/j.fertnstert.2026.04.025","DOIUrl":"https://doi.org/10.1016/j.fertnstert.2026.04.025","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate live birth outcomes based on initial serum human chorionic gonadotropin (hCG) level following single euploid embryo transfer.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Subjects: </strong>Single center study that included patients who underwent single euploid embryo transfer with initial positive hCG (>2.5 mIU/mL), measured nine days after transfer. Cycles were grouped by hCG range: Group 1 (hCG 2.5 to <11 mIU/mL), Group 2 (11 to <25), Group 3 (25 to <50), Group 4 (50 to <75), Group 5 (75 to <100), and Group 6 (≥100).</p><p><strong>Exposure: </strong>Initial serum hCG level.</p><p><strong>Main outcome measures: </strong>The primary outcome was live birth per positive hCG. Subgroup analysis was performed by blastocyst biopsy day (days 5, 6, or 7). Poisson regression models were used to estimate stepwise comparisons between adjacent hCG groups; receiver operating characteristic analysis was performed to determine the predictive value of initial hCG level for live birth.</p><p><strong>Results: </strong>6,410 single euploid embryo transfer cycles with initial positive serum hCG were included. Overall live birth after positive hCG was 71.0%. Higher initial hCG level increased live birth chance in a stepwise fashion, with lowest chance of live birth in Group 1 (hCG 2.5 to <11) (1.6%), and highest in Group 6 (hCG ≥100) (87.8%) (p<0.01). Adjusted analysis demonstrated increasing probability of live birth between adjacent groups: Group 2 vs. 1 aRR 6.76 [3.02-15.11], Group 3 vs. 2 aRR 3.08 [2.27-4.19], Group 4 vs. 3 aRR 1.80 [1.59-2.04], Group 5 vs. 4 aRR 1.16 [1.08-1.25], and Group 6 vs. 5 aRR 1.15 [1.10-1.21]. Live birth was similar across blastocyst biopsy subgroups, except in Group 3 (25 to <50 mIU/mL), where Day 5 blastocysts had the lowest live birth (28.8%) versus Days 6 and 7 blastocysts (42.7%, 41.9%) (p<0.01). The area under the receiver operating characteristic curve was 0.83 (0.81-0.84), with an hCG of 75.7 mIU/mL representing the optimal threshold.</p><p><strong>Conclusion: </strong>Initial serum hCG level after single euploid embryo transfer is a strong predictor of live birth, with a stepwise relationship between rising hCG thresholds. Findings from this study provide a valuable counseling tool for both physicians and patients utilizing single euploid embryo transfer.</p>","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":" ","pages":""},"PeriodicalIF":7.0,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medically assisted reproduction and Congenital Heart Disease: Emerging Risks with Frozen Embryo Transfer.","authors":"Cavoretto Pi, Borzillo I, Chessa M","doi":"10.1016/j.fertnstert.2026.04.020","DOIUrl":"https://doi.org/10.1016/j.fertnstert.2026.04.020","url":null,"abstract":"","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":" ","pages":""},"PeriodicalIF":7.0,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835702","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Testosterone-to-Follicle Stimulating Hormone Ratio Predicts Sperm Retrieval Success in Men with Idiopathic Non-Obstructive Azoospermia.","authors":"Jayant Siva, Bryan Naelitz, Sanjay Vallabhaneni, Keisha Baffour-Addo, Jack Considine, Amelia Khoei, Camryn Hawkins, Leila Momtazi-Mar, Ali Dabaja, Catherine S Nam, Scott D Lundy","doi":"10.1016/j.fertnstert.2026.04.023","DOIUrl":"https://doi.org/10.1016/j.fertnstert.2026.04.023","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate novel preoperative hormonal predictors of sperm retrieval success in men with idiopathic non-obstructive azoospermia (NOA) undergoing microsurgical testicular sperm extraction (mTESE).</p><p><strong>Design: </strong>Multi-institutional retrospective cohort study conducted between 2014 and 2024.</p><p><strong>Subjects: </strong>60 men with strictly defined idiopathic NOA from multiple sites participating in the MOBYUS Male Infertility Research Consortium were included, comprising a prediction cohort (n=30) and an independent multi-institutional validation cohort (n=30). Idiopathic NOA was defined by azoospermia on two separate semen analyses without prior paternity, evidence of obstruction, prior genitourinary surgery, documented genetic abnormalities, or use of empirical medical therapy within one year prior to surgery. Sensitivity analyses were performed by excluding men with FSH <7.6 IU/L and men with hypospermatogenesis on pathology.</p><p><strong>Exposure: </strong>Preoperative serum follicle-stimulating hormone (FSH), luteinizing hormone (LH), and total testosterone (T) levels measured within one year prior to mTESE. Hormone-derived ratios, including T/FSH, T/LH, and LH/FSH, were subsequently derived for analysis.</p><p><strong>Main outcome measures: </strong>Successful sperm retrieval at mTESE served as the primary outcome. Predictive performance was evaluated using logistic regression to assess hormonal predictors, area under the receiver operating characteristic curve (AUC), and partition analysis to identify optimal clinical thresholds for sperm retrieval prediction.</p><p><strong>Results: </strong>Men with successful sperm retrieval had significantly lower gonadotropin levels and a higher T/FSH ratio (43.0 vs. 20.9, p=0.004). Among all hormonal metrics, T/FSH demonstrated the strongest discriminative ability (AUC=0.81). The significance remained after excluding men with hypospermatogenesis noted on testicular pathology. In external validation, T/FSH was the only variable that maintained statistical significance (p=0.03; AUC=0.74). Partition analysis further revealed a two-step model (T/FSH>20 and LH<10) that achieved 93% sensitivity and 81% specificity for predicting sperm retrieval success.</p><p><strong>Conclusion: </strong>This multi-institutional study demonstrates that the T/FSH ratio is a reproducible and clinically meaningful predictor of sperm retrieval success in men with idiopathic NOA. Across two independent and diverse cohorts, this ratio consistently outperformed single-hormone predictors and remained the only externally validated preoperative predictor of mTESE success.</p>","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":" ","pages":""},"PeriodicalIF":7.0,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835705","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Historical and Contemporary Look at Donor Sperm Pricing in the United States.","authors":"Cassie L Hobbs, Caitlin E Martin","doi":"10.1016/j.fertnstert.2026.04.022","DOIUrl":"https://doi.org/10.1016/j.fertnstert.2026.04.022","url":null,"abstract":"","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":" ","pages":""},"PeriodicalIF":7.0,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835745","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Natural cycle frozen embryo transfer reduces obstetric complications: an inverse probability of treatment-weighted analysis.","authors":"Shuhei So, Nao Murabayashi, Wakasa Yamaguchi, Naomi Miyano, Misa Namba, Fumiko Tawara","doi":"10.1016/j.fertnstert.2026.04.024","DOIUrl":"https://doi.org/10.1016/j.fertnstert.2026.04.024","url":null,"abstract":"<p><strong>Objective: </strong>To compare obstetric complications between hormone replacement treatment (HRT) and natural cycle (NC) frozen embryo transfer (FET) using inverse probability of treatment weighting (IPTW) with generalized estimating equations (GEE), and to evaluate the impact of an institutional policy change actively adopting NC on clinical outcomes.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Subjects: </strong>Patients undergoing FET at a single center between September 2015 and September 2023. After exclusions, 11,873 cycles (HRT: 5,115; NC: 6,758) from 4,216 unique patients were analyzed.</p><p><strong>Exposure: </strong>Endometrial preparation using HRT or NC, and a progressive shift in treatment policy from HRT-predominant to NC-predominant protocols over the study period.</p><p><strong>Main outcome measures: </strong>Live birth rate, miscarriage rate, and obstetric complications including cesarean section, hypertensive disorders of pregnancy (HDP), placenta accreta spectrum (PAS), and postpartum hemorrhage (PPH) in singleton live births.</p><p><strong>Results: </strong>In the IPTW-GEE doubly robust analysis, the HRT group showed a significantly higher miscarriage rate (adjusted relative risk [aRR] 1.26, 95% confidence interval [CI] 1.14-1.41) and lower live birth rate (aRR 0.92, 95% CI 0.87-0.99) compared with NC. Among singleton live births, HRT was associated with significantly higher risks of HDP (aRR 1.56, 95% CI 1.21-2.02), PAS (aRR 5.13, 95% CI 3.25-8.12), and cesarean section (aRR 1.38, 95% CI 1.26-1.53). PPH ≥1,000 mL in vaginal deliveries was also significantly higher in the HRT group (aRR 2.74, 95% CI 2.08-3.63). Sensitivity analyses excluding low-dose aspirin users and restricting to matched luteal phase support confirmed these findings. In the policy analysis, each 10% increase in the annual NC proportion was associated with significant reductions in PAS (aRR 0.80, 95% CI 0.74-0.88), HDP (aRR 0.90, 95% CI 0.84-0.96), cesarean section (aRR 0.95, 95% CI 0.93-0.98), PPH ≥1,000 mL (aRR 0.92, 95% CI 0.86-0.99), and LGA (aRR 0.92, 95% CI 0.87-0.97) after adjusting for covariates.</p><p><strong>Conclusion: </strong>NC is associated with significantly lower risks of miscarriage and major obstetric complications compared with HRT in singleton deliveries. The institutional policy shift toward NC was associated with significant reductions in adverse outcomes, supporting a shift toward treatment strategies prioritizing NC.</p>","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":" ","pages":""},"PeriodicalIF":7.0,"publicationDate":"2026-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147835696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Witnessing and protocol deviations in the in vitro fertilization and andrology laboratory: a committee opinion.","authors":"","doi":"10.1016/j.fertnstert.2026.03.014","DOIUrl":"https://doi.org/10.1016/j.fertnstert.2026.03.014","url":null,"abstract":"<p><p>A number of key misidentification risk points occur during an in vitro fertilization cycle in the laboratory that require robust witnessing. Witnessing protocols, both manual and electronic, are described. In the event of a protocol deviation, guidance for grading, reporting, and risk mitigation is provided.</p>","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":" ","pages":""},"PeriodicalIF":7.0,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147812904","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"OBESITY IS ASSOCIATED WITH AN INCREASED RISK OF EARLY PREGNANCY LOSS FOLLOWING EUPLOID FROZEN EMBRYO TRANSFER.","authors":"Christine Whitehead, Kristin Lefebvre, Emre Seli","doi":"10.1016/j.fertnstert.2026.04.016","DOIUrl":"https://doi.org/10.1016/j.fertnstert.2026.04.016","url":null,"abstract":"<p><strong>Objective: </strong>To determine whether obesity is associated with an increased risk of pregnancy loss in patients undergoing autologous euploid frozen embryo transfer (FET).</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Subjects: </strong>Patients with recorded body mass index (BMI) from nine clinical sites during January 2019 to December 2024 undergoing first, autologous, single, euploid FET were included. Other PGT indications were excluded.</p><p><strong>Exposure: </strong>Patients were stratified into two groups; patients with obesity (BMI≥30.0kg/m²) and non-obese patients (BMI<30.0kg/m²).</p><p><strong>Main outcome measures: </strong>Primary outcome was biochemical pregnancy loss (bHCG>5mIU/ml without ultrasound evidence of pregnancy until bHCG <5mIU/ml) or clinical pregnancy loss (ultrasound evidence of at least an intrauterine gestational sac, which did not progress to live birth). Secondary outcomes included implantation, ectopic, clinical and ongoing pregnancy (8-9 weeks gestational age with cardiac activity) and live birth (neonate > 24 weeks gestational age).</p><p><strong>Results: </strong>14,990 patients were included: 11,179 non-obese and 3,811 with obesity. Compared to non-obese, patients with obesity were older. Parity, anti-mullerian hormone (AMH) and blastulation day were similar between groups. After adjustment, patients with obesity had a 19% increased risk of pregnancy loss (aRR 1.19, 95% CI 1.14-1.24, p<0.001) compared to non-obese. When stratified by BMI categories; class I (BMI 30.0-34.9 kg/m²), II (BMI 35.0-39.9 kg/m²) and III (BMI ≥40.0 kg/m²) obesities had 12%, 22% and 41% increased risk of pregnancy loss while underweight (BMI <18.0 kg/m²) and overweight (BMI 25.0-29.9 kg/m²) groups performed similarly to healthy weight (BMI 18.5-24.9 kg/m²). The predicted probability of pregnancy loss was lowest at a BMI of 25.3 kg/m². While there was no difference in implantation (aRR 0.98, 95% CI 0.86-1.37, p=0.09), patients with obesity had lower chances of clinical (aRR 0.96, 95% CI 0.94-0.99, p=0.002) and ongoing pregnancy (aRR 0.94, 95% CI 0.92-0.96, p<0.001) and livebirth (aRR 0.92, 95% CI 0.91-0.94, p<0.001). Risk of pregnancy loss was attenuated in parous patients with obesity (aRR 0.90, 95% CI 0.79-1.02, p=0.09).</p><p><strong>Conclusion: </strong>When accounting for embryonic aneuploidy in the setting of euploid only transfers, patients with obesity had a 19% increased risk of early pregnancy loss compared to non-obese patients, with risk rising across BMIs and BMI categories.</p>","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":" ","pages":""},"PeriodicalIF":7.0,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147812894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Non-invasive prenatal testing as a prenatal screening test in pregnancies following assisted reproductive technologies: a diagnostic test accuracy systematic review and meta-analysis.","authors":"Vandana Kamath, Madhu Balaji Sivakumar, Gustavo Yano Callado, Anandhita Neelakandan, Aravind Dharmaraj, Prasanna Samuel, Mary Purna Chacko, Daniel L Rolnik, Mohan S Kamath","doi":"10.1016/j.fertnstert.2026.04.017","DOIUrl":"https://doi.org/10.1016/j.fertnstert.2026.04.017","url":null,"abstract":"<p><strong>Importance: </strong>The accuracy of the non-invasive prenatal testing (NIPT) for common trisomies remains unclear in pregnancies following assisted reproductive technology (ART), and the adoption of NIPT as a prenatal screening test in ART pregnancies has been cautious due to the absence of clear recommendations.</p><p><strong>Objective: </strong>To estimate the accuracy of NIPT for screening for common chromosomal abnormalities compared with conventional karyotype or microarray testing in ART pregnancies.</p><p><strong>Data source: </strong>A comprehensive search of the following: PubMed, Scopus, and Embase.</p><p><strong>Study selection and synthesis: </strong>A systematic review and meta-analysis was conducted, and cross-sectional and cohort studies with antenatal women who conceived following ART and opted for prenatal testing with NIPT were included.</p><p><strong>Main outcome measure (s): </strong>Pooled sensitivity and specificity of NIPT for common chromosomal abnormalities (trisomy 21, 18, and 13).</p><p><strong>Result (s): </strong>We identified a total of 548 records through electronic searches and finally included 13 studies for quantitative synthesis. The pooled sensitivity and specificity for combined abnormalities in singleton ART pregnancies were 88.2% (95% confidence interval, CI 61.0-97.3%) and 99.6% (95% CI 98.4-99.9%), respectively. Similarly, for twin ART pregnancies, the pooled sensitivity and specificity for combined abnormalities were 88.2% (95% CI 66.4-96.6%) and 99.8% (95% CI 99.6-99.9%), respectively. The pooled sensitivity and specificity for trisomy 21 in singleton ART pregnancies were 87.2% (95% CI 59.0-97.0%) and 99.7% (95% CI 98.8-99.9%), respectively, while in ART twin pregnancies, the pooled sensitivity was 86.9% (95% CI 63.4-96.2%) and the specificity was 99.8% (95% CI 99.6-99.9%).</p><p><strong>Conclusion and relevance: </strong>While the specificity of NIPT is high in ART-conceived pregnancies, its sensitivity in the detection of common fetal chromosomal aneuploidy, in particular trisomy 21, is substantially lower than in naturally-conceived pregnancies.</p>","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":" ","pages":""},"PeriodicalIF":7.0,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147812755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}