Fertility and sterility最新文献

{"title":"FERTILITY PRESERVATION AFTER GONADOTOXIC TREATMENT: CURRENT EVIDENCE, FEASIBILITY, AND OUTCOMES.","authors":"Emanuela Angelini, Kutluk H Oktay","doi":"10.1016/j.fertnstert.2026.10.005","DOIUrl":"https://doi.org/10.1016/j.fertnstert.2026.10.005","url":null,"abstract":"<p><p>Improved cancer survival has made reproductive health an essential component of survivorship care. Although fertility preservation has traditionally focused on interventions before gonadotoxic therapy, many survivors received no pretreatment intervention, stored insufficient reproductive material, or later require additional gonadotoxic therapy. Evidence guiding fertility preservation after exposure remains limited and heterogeneous. This review examines treatment-induced ovarian injury, assessment of residual reproductive potential, candidate selection and timing, available fertility-preservation strategies, reproductive outcomes, safety, and emerging restorative technologies. Previous gonadotoxic therapy should not be considered an absolute barrier to intervention. Management should instead integrate age, pretreatment and current ovarian reserve, treatment type and cumulative exposure, disease status, anticipated further therapy, and reproductive goals. Oocyte or embryo cryopreservation is generally preferred for postpubertal survivors with recruitable follicles, whereas ovarian tissue cryopreservation may be considered selectively. As the fertility preservation field continues to evolve, individualized prediction of residual reproductive potential and the development of safe fertility-restoring strategies are expected to redefine reproductive care for cancer survivors who present after gonadotoxic treatment.</p>","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":" ","pages":""},"PeriodicalIF":8.1,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149180415","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":"FERTILITY PRESERVATION IN PATIENTS WITH GENETIC CONDITIONS PREDISPOSING TO POI.","authors":"Emanuela Angelini, Kutluk H Oktay","doi":"10.1016/j.fertnstert.2026.10.007","DOIUrl":"https://doi.org/10.1016/j.fertnstert.2026.10.007","url":null,"abstract":"<p><p>Advances in genomic medicine have substantially expanded the spectrum of genetic conditions associated with primary ovarian insufficiency (POI), enabling the identification of women and girls at risk of premature reproductive decline before irreversible loss of ovarian reserve occurs. Genetic forms of POI comprise a heterogeneous group of disorders characterized by distinct pathogenic mechanisms, highly variable trajectories of ovarian reserve decline, and markedly different windows of reproductive opportunity. Consequently, fertility preservation requires a disease-specific, individualized approach rather than a uniform management strategy. Current evidence indicates that successful fertility preservation depends on understanding the biological basis of ovarian dysfunction, accurately identifying the optimal window for intervention, and selecting the most appropriate strategy according to the underlying disorder and residual ovarian reserve. This review critically appraises the available evidence across major genetic conditions that predispose to POI or otherwise threaten reproductive potential, including Turner syndrome, FMR1 premutation, classic galactosemia, rare monogenic disorders, and hereditary cancer predisposition syndromes, focusing on mechanisms of reproductive impairment, patient selection, timing of intervention, fertility preservation strategies, reproductive outcomes, safety, and emerging technologies. Current evidence supports early referral following genetic diagnosis and longitudinal monitoring of ovarian reserve, as the opportunity for fertility preservation may be brief and unpredictable in many disorders. In hereditary cancer predisposition syndromes, reproductive risk may derive from intrinsic ovarian vulnerability, gonadotoxic treatment, and/or risk-reducing surgery, even when a direct gene-specific risk of POI is uncertain.</p>","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":" ","pages":""},"PeriodicalIF":8.1,"publicationDate":"2026-10-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149180350","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":"Expanding the Clinical Perspective on Endocrine Disease and Pregnancy Loss.","authors":"Aaron D Masjedi, Zachary S Anderson","doi":"10.1016/j.fertnstert.2026.10.001","DOIUrl":"https://doi.org/10.1016/j.fertnstert.2026.10.001","url":null,"abstract":"","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":" ","pages":""},"PeriodicalIF":8.1,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149169934","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":"Advancing Equitable Oncofertility Care for Transgender and Gender-Diverse Patients.","authors":"Kathryn Coyne, Vidya Visvabharathy, Katherine Daunov, Michelle Caster, Rebecca Flyckt, Lindsay Ferguson","doi":"10.1016/j.fertnstert.2026.10.004","DOIUrl":"https://doi.org/10.1016/j.fertnstert.2026.10.004","url":null,"abstract":"<p><p>Transgender and gender-diverse (TGD) patients with cancer face unique and intersecting challenges related to fertility preservation. Although professional societies recommend early fertility counseling for both patients with cancer and individuals undergoing gender-affirming treatment, evidence specifically addressing oncofertility in TGD populations remains limited. Gender-affirming hormone therapy may affect gonadal function and gametogenesis, while interruption of hormone therapy for fertility preservation may exacerbate gender dysphoria. Fertility preservation options include oocyte, embryo, sperm, ovarian tissue, and testicular tissue cryopreservation, with selection dependent on reproductive anatomy, pubertal status, prior treatment, and oncologic considerations. TGD patients also face substantial barriers to fertility preservation, including cost, inadequate counseling, insufficient provider expertise, discrimination or bias, and lack of access to fertility care. This narrative review examines current evidence regarding fertility and fertility preservation in TGD patients, with particular attention to patients with cancer, and identifies critical gaps in counseling, clinical practice, research, and policy. Improving care will require early and individualized counseling, multidisciplinary collaboration, equitable access to these services, longitudinal research addressing reproductive outcomes in TGD cancer survivors, and the creation of inclusive clinical environments that support patients throughout fertility preservation and cancer care.</p>","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":" ","pages":""},"PeriodicalIF":8.1,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149165920","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":"The measure of a place: neighborhood disadvantage and menstrual disturbances.","authors":"Joshua Goyert, Natalie C Stentz","doi":"10.1016/j.fertnstert.2026.10.002","DOIUrl":"https://doi.org/10.1016/j.fertnstert.2026.10.002","url":null,"abstract":"","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":" ","pages":""},"PeriodicalIF":8.1,"publicationDate":"2026-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149164435","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":"Not All Aneuploidy is Equal - Implications in Live Birth Outcomes and Counseling.","authors":"Amanda Ferraro, Lauren Pierce, Karl R Hansen","doi":"10.1016/j.fertnstert.2026.09.021","DOIUrl":"https://doi.org/10.1016/j.fertnstert.2026.09.021","url":null,"abstract":"","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":" ","pages":""},"PeriodicalIF":8.1,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149147611","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":"BRCA Mutations and Embryo Aneuploidy: Is There a Link?","authors":"Barbara Lawrenz, Hamidreza Didar, Human Fatemi","doi":"10.1016/j.fertnstert.2026.09.020","DOIUrl":"https://doi.org/10.1016/j.fertnstert.2026.09.020","url":null,"abstract":"","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":" ","pages":""},"PeriodicalIF":8.1,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149147744","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":"Preimplantation genetic testing laboratory classification strategies are associated with diagnostic yield and downstream clinical performance.","authors":"Mina Popovic, Erkan Kalafat, Denny Sakkas","doi":"10.1016/j.fertnstert.2026.09.022","DOIUrl":"https://doi.org/10.1016/j.fertnstert.2026.09.022","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate whether PGT-A laboratory was associated with diagnostic yield and live birth per single euploid embryo transfer.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Subjects: </strong>We analyzed a total of 9,630 PGT-A cycles performed between January 2015 and December 2023, comprising 40,308 blastocysts tested using trophectoderm biopsy and next generation sequencing. Three commercial PGT-A laboratories were utilized: Laboratory A (n = 18,480), Laboratory B (n = 19,261), and Laboratory C (n = 2,567). Clinical outcome analyses were restricted to 7,333 single euploid embryo transfers performed at the network's main clinic.</p><p><strong>Exposure: </strong>PGT-A laboratory.</p><p><strong>Main outcome measures: </strong>Euploidy rate, likelihood of having at least one euploid embryo available for transfer, and live birth rate per single euploid embryo transfer.</p><p><strong>Results: </strong>Overall, 52.3% (21,093/40,308) of blastocysts were diagnosed as euploid. Diagnostic yield differed between laboratories and varied according to maternal age. Compared with Laboratory A, Laboratory B had lower euploidy rates and a lower likelihood of obtaining at least one euploid embryo in younger patients, with higher euploidy rates observed among patients aged >42 years. Laboratory C had a consistently lower diagnostic yield in patients younger than 41 years. Among 7,333 single euploid embryo transfers performed at the main clinic, live birth rates per transfer were 49.8%, 41.6%, and 50.7% for Laboratories A, B, and C, respectively. After adjusting for maternal age, BMI, infertility indication, endometrial preparation and thickness, embryo grade, and biopsy day, Laboratory B remained associated with lower odds of live birth per single euploid embryo transfer compared to Laboratory A (OR=0.71, [95%CI: 0.64-0.79]; p<0.001), while Laboratory C was comparable (OR=1.08, [95%CI: 0.89-1.32]; p=0.418).</p><p><strong>Conclusion: </strong>PGT-A laboratory classification strategy was associated with both diagnostic yield and live birth per transfer. The discordance between these outcomes shows that euploidy rates alone do not provide a complete measure of laboratory performance and should be interpreted alongside downstream clinical outcomes.</p>","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":" ","pages":""},"PeriodicalIF":8.1,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149147196","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":"Premature progesterone elevation during controlled ovarian stimulation has limited impact on embryologic outcomes.","authors":"Devika Sachdev, Erkan Kalafat, Lea George, Christine Whitehead, Marie Werner, Juan García-Velasco, Emre Seli","doi":"10.1016/j.fertnstert.2026.09.017","DOIUrl":"https://doi.org/10.1016/j.fertnstert.2026.09.017","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the impact of elevated progesterone (P4) level on embryology outcomes in patients undergoing in vitro fertilization (IVF).</p><p><strong>Design: </strong>Retrospective cohort study using propensity-score matched analysis (PSM).</p><p><strong>Subjects: </strong>Patients undergoing their first freeze-all cycle between January 2017 and December 2024 at an academic-affiliated center.</p><p><strong>Exposure: </strong>Trigger day serum P4 level.</p><p><strong>Main outcome measures: </strong>Primary outcome was blastulation rate per fertilized zygote (2PN). Secondary outcomes included oocyte maturation, fertilization, and euploidy rates. Outcomes were compared between elevated (≥1.5 ng/mL) versus normal (<1.5 ng/mL) P4 levels, as well as across P4 quartiles. An additional analysis was performed to assess the probability of persistent P4 elevation in a subsequent cycle. Analysis cohort was formed after PSM on oocyte age, partner age, day 3 FSH, sperm type, BMI, AMH, antral follicle count, pituitary suppression protocol, follicle count at trigger, trigger type, and stimulation duration. Multivariable regression analyses doubly adjusting for AMH, FSH, oocyte age, >15mm follicle count, and trigger estradiol (E2) levels were conducted.</p><p><strong>Results: </strong>16,321 cycles were initially analyzed - 3,749 with trigger day P4 ≥1.5 ng/mL and 12,572 with P4 <1.5 ng/mL. Following PSM, 6,620 cycles (3,310 per group) were analyzed. Despite matching, patients with P4 elevation had higher trigger day E2 (median 3,369 vs. 3,105.5 pg/mL, p<0.001) and follicles >15mm (median 16.0 vs. 15.0, p<0.001). P4 elevation was associated with a small but statistically significant decrease in oocyte maturation rate (67.2 vs 68.5%; adjusted Risk Ratio [aRR] 0.98, 95% CI 0.97-0.98, p<0.001), fertilization rate (82.1 vs. 82.6%; aRR 0.99, 95% CI 0.99-1.00, p=0.018) and blastulation rate per 2PN (67.0 vs 68.3%; aRR 0.98, 95% CI 0.97-0.99, p=0.001), but no difference in euploidy rate. A higher percentage of immature oocytes was noted in the higher P4 quartiles. The probability of P4 elevation in a subsequent cycle was significantly higher for those with a first cycle elevation compared to those with no first cycle elevation (57.5% vs. 14.3%, respectively, p<0.001).</p><p><strong>Conclusion: </strong>Premature P4 elevation is associated with significant decreases in oocyte maturation, fertilization, and blastulation rates; however, the magnitude of these differences is small and may not be clinically meaningful.</p>","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":" ","pages":""},"PeriodicalIF":8.1,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149126888","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":"Insurance Coverage for In Vitro Fertilization is Associated with Higher Live Birth Rates in a National Sample of Privately Insured Patients.","authors":"James M Dupree, Benjamin J Peipert, Phyllis Yan, Rodney L Dunn, David Suh, Brandon Swinney, Edward C Norton, Vanessa K Dalton, Erica E Marsh, Marissa S Weiss","doi":"10.1016/j.fertnstert.2026.09.019","DOIUrl":"https://doi.org/10.1016/j.fertnstert.2026.09.019","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate associations between employer-sponsored insurance coverage for in vitro fertilization (IVF) and pregnancy, live birth, and multiple birth rates for patients with and without insurance coverage for their IVF.</p><p><strong>Design: </strong>Retrospective cohort study SUBJECTS: US women aged 22-44 in Optum's de-identified Clinformatics® Data Mart Database (Optum® CDM) who underwent IVF from 2013 to 2020.</p><p><strong>Exposure: </strong>Insurance coverage for IVF MAIN OUTCOME MEASURES: Cumulative live birth rates within 2.5 years of the first IVF cycle; pregnancy, live birth, and multiple birth rates per IVF cycle; and the number of IVF cycles initiated within 2.5 years of the first IVF cycle.</p><p><strong>Results: </strong>Patients with employer-sponsored insurance coverage for IVF had a higher probability of having a living birth within 2.5 years after the first IVF cycle compared to patients without insurance coverage for IVF [63% vs 53%; odds ratio (OR) 1.52, 95% Confidence Interval (CI): 1.35-1.73; all results are adjusted]. IVF cycles covered by insurance had a higher probability of having a pregnancy than IVF cycles not covered by insurance (53% vs 49%, respectively; OR 1.20, 95% CI: 1.09-1.31; all results are adjusted). IVF cycles covered by insurance had a higher probability of having a live birth than IVF cycles not covered by insurance (37% vs 33%, respectively; OR 1.17, 95% CI: 1.07-1.29; all results are adjusted). The rate of multiple births was similar among IVF cycles with and without insurance coverage (13% vs. 13%; OR 1.04, 95% CI: 0.84 to 1.29; all results are adjusted). We also found that patients with employer-sponsored insurance coverage for IVF initiated more IVF cycles within 2.5 years of their first IVF cycle than patients without insurance coverage for IVF (1.9 vs. 1.7 IVF cycles, respectively; count ratio 1.12, 95% CI: 1.08-1.17; all results are adjusted).</p><p><strong>Conclusion: </strong>Employer-sponsored insurance coverage for IVF was associated with an increase in cumulative live birth rates, largely driven by patients with insurance coverage for IVF initiating more IVF cycles and having higher live birth rates per IVF cycle. There is increasing interest in expanding access to IVF in the US, and our findings should inform policymakers, including employers, about the importance of employer-sponsored insurance coverage for IVF as a tool to help patients build their families.</p>","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":" ","pages":""},"PeriodicalIF":8.1,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149126917","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}