Fertility and sterility最新文献

{"title":"Key standards and principles for developing evidence-based clinical guidelines: balancing health professional, patient, funder, and government needs.","authors":"Chau Thien Tay, Anju E Joham, Helena J Teede","doi":"10.1016/j.fertnstert.2025.01.023","DOIUrl":"10.1016/j.fertnstert.2025.01.023","url":null,"abstract":"<p><p>Clinical practice guidelines are critical tools to inform healthcare decision-making, yet development faces significant challenges in ensuring rigorous, reliable, and globally applicable recommendations. This review examines the essential standards and evolving approaches for creating high-quality, evidence-based guidelines that can effectively support clinical practice across diverse healthcare settings. Key standards for high-quality clinical practice guideline development emerge from leading global health organizations, emphasizing several critical components-establishing a multidisciplinary development group, defining a clear and relevant scope, conducting systematic evidence reviews and meta-analyses, and ensuring transparency throughout the development process. Innovative principles address emerging challenges such as research integrity assessment, incorporation of patient-centered methodologies, promotion of global collaborative approaches, and development of strategic implementation strategies. These evolving principles recognize the complex landscape of modern healthcare, where guidelines should adhere to rigorous standards to genuinely improve patient outcomes and encourage best practice care across diverse healthcare settings.</p>","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143064862","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":"Extended intrauterine balloon stent use to prevent adhesion reformation after hysteroscopic adhesiolysis: a randomized trial.","authors":"Yiyang Luo, Yuhuan Liu, Yu Xiao, Qiaoyun Zhou, Zhoulin Zhang, Xiaoyu Li","doi":"10.1016/j.fertnstert.2025.01.024","DOIUrl":"10.1016/j.fertnstert.2025.01.024","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the efficacy and safety of retaining a balloon stent in the uterus for 8 weeks to prevent adhesion reformation after hysteroscopic adhesiolysis.</p><p><strong>Design: </strong>A single-center randomized controlled study.</p><p><strong>Subjects: </strong>A total of 160 women with severe intrauterine adhesions (American Fertility Society intrauterine adhesion scores ≥9 and European Society for Gynaecological Endoscopy grade ≥IV).</p><p><strong>Intervention: </strong>The participants were randomized 1:1 into two groups. In the study group, the balloon stent was left in place for 8 weeks after surgery and removed at the second-look hysteroscopy, with a third-look hysteroscopy performed 4 weeks later. In the control group, the balloon stent was maintained for 1 week, with participants undergoing second- and third-look hysteroscopies at 4 and 8 weeks postoperatively, respectively. Among 160 randomized patients, 136 (69 and 67 in the study and control groups, respectively) completed the study.</p><p><strong>Main outcome measures: </strong>The primary outcome was the adhesion recurrence rate on third-look hysteroscopy.</p><p><strong>Results: </strong>On third-look hysteroscopy, the adhesion reformation was significantly lower in the study group than in the control group (17.4% vs. 43.3%; relative risk, 0.40; 95% confidence interval, 0.22-0.72; rate difference, -25.89%; 95% confidence interval, -40.75% to -11.04%). Additionally, the reduction in American Fertility Society adhesion scores was significantly larger in the study group than in the control group (10 vs. 7). The outcomes of the second- and third-look hysteroscopies were consistent. No safety concerns were observed regarding extended stent placement.</p><p><strong>Conclusion: </strong>In this randomized controlled study, extending the balloon stent application to 8 weeks proved an effective and safe method for preventing adhesion reformation after hysteroscopic adhesiolysis for severe intrauterine adhesions.</p>","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143064853","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":"Filling in the gaps on outcomes of ovarian tissue cryopreservation in girls with Turner syndrome.","authors":"Victoria A Elliott,Leena Nahata,Gwendolyn P Quinn","doi":"10.1016/j.fertnstert.2025.01.017","DOIUrl":"https://doi.org/10.1016/j.fertnstert.2025.01.017","url":null,"abstract":"","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":"60 1","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-01-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143062036","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":"Sleep variability and time to achieving pregnancy: findings from a pilot cohort study of women desiring pregnancy.","authors":"Peinan Zhao, Emily S Jungheim, Bronwyn S Bedrick, Leping Wan, Patricia T Jimenez, Ronald McCarthy, Jessica Chubiz, Justin C Fay, Erik D Herzog, Siobhan Sutcliffe, Sarah K England","doi":"10.1016/j.fertnstert.2025.01.019","DOIUrl":"10.1016/j.fertnstert.2025.01.019","url":null,"abstract":"<p><strong>Objective: </strong>To determine whether chronodisruption is associated with achieving pregnancy.</p><p><strong>Design: </strong>Pilot prospective cohort study.</p><p><strong>Setting: </strong>Academic Medical Center.</p><p><strong>Patient(s): </strong>One hundred eighty-three women desiring pregnancy were recruited from the local community of an academic medical center located in the Midwest and provided sleep information between February 1, 2015, and November 30, 2017.</p><p><strong>Intervention: </strong>Sleep and activity data were obtained via actigraphy watches worn continuously for 2 weeks to assess measures of chronodisruption, including sleep period onset, offset, midtime, and duration; as well as variability in each of these measures.</p><p><strong>Main outcome measures: </strong>Time to becoming pregnant over 1-year of follow-up.</p><p><strong>Results: </strong>Of the 183 eligible women, 82 became pregnant over a median of 2.8 months of follow-up. Greater interdaily variability in time of sleep onset and variability in sleep duration were associated with a longer time to achieving pregnancy after adjusting for age, body mass index, race, education, income, and smoking status (adjusted hazard ratio [aHR], 0.60; 95% confidence interval [CI], 0.36-0.999 comparing participants with a standard deviation of >1.8 hours to <1.8 hours in daily time of sleep onset; and aHR, 0.58; 95% CI, 0.36-0.98 comparing participants with a standard deviation of >2.3 hours to <2.3 hours in daily sleep duration). In adjusted analyses, no statistically significant associations were observed for average time of sleep onset and offset, midsleep time, and sleep duration, or for variability in time of sleep offset and midtime.</p><p><strong>Conclusions: </strong>Higher day-to-day variability in time of sleep onset and sleep duration-two measures of chronodisruption-were associated with a longer time to achieving pregnancy over 1 year of follow-up in women desiring pregnancy. If replicated in additional studies, these findings could point to lifestyle interventions to help women achieve a desired pregnancy.</p>","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-01-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143046107","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":"Systemic progesterone optimizes programmed frozen embryo transfer outcomes: the only Level I evidence still indicates intramuscular administration.","authors":"Allison A Eubanks, Dominique de Ziegler, Kate Devine","doi":"10.1016/j.fertnstert.2025.01.014","DOIUrl":"10.1016/j.fertnstert.2025.01.014","url":null,"abstract":"","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-01-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143037776","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":"Accessory uterine cavities: a review of cases and an appeal for standard terminology.","authors":"Aalia Sachedina Parhar, Amy Mellor, Saman Moeed, Sonia R Grover","doi":"10.1016/j.fertnstert.2025.01.015","DOIUrl":"https://doi.org/10.1016/j.fertnstert.2025.01.015","url":null,"abstract":"<p><strong>Objective: </strong>To study and address the diagnostic, management, and classification challenges of unilocular myometrial cystic lesions adjacent to a normal uterine cavity.</p><p><strong>Design: </strong>Describe 23 further cases, and undertake a systematic review using Medline, PubMed and Ovid for similar lesions.</p><p><strong>Subjects: </strong>23 cases of accessory uterine cavities presenting to pediatric and adolescent gynecologists in Australia and New Zealand.</p><p><strong>Main outcome measures: </strong>92 similar cases of cavitated myometrial masses were identified in the literature. The cases in our series and in the literature were examined for age at presentation, site of lesion, pathology, and presence of other anomalies.</p><p><strong>Results: </strong>All patients in our series were aged ≤ 32 years. All presented with unilocular blood-filled myometrial lesions that did not communicate with the uterine cavity. All were located on the lateral aspect of the uterus in proximity to the round ligament. Of the 22 that have been resected, all were lined by endometrium and smooth muscle. These characteristics are mirrored in the previously described cases in the literature.</p><p><strong>Conclusion: </strong>The frequency of these myometrial cystic masses is such that they can no longer be considered rare. Nevertheless, their etiology remains unclear. These lesions have often been given names suggesting that they are an early representation of adenomyosis. The alternative possibility of a Müllerian anomaly is supported by consistent anatomical location and young age of presentation in most reported cases. Yet the absence of documented associated anomalies raises concerns about this theory. To progress understanding of these lesions, consistent reporting of features including location and the presence or absence of other anomalies is required. In view of this ongoing uncertainty, we recommend the use of the term \"accessory uterine cavity (AUC).\" This terminology avoids the implication of either a pathological process or a congenital anomaly.</p>","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143037772","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":"Robotic-assisted neovaginal creation: stepwise approach to the Davydov technique in a patient with Mayer-Rokitansky-Küster-Hauser syndrome.","authors":"Haticegul Tuncer, Hasan Volkan Ege, Utku Akgor, Murat Gultekin, Zafer Selcuk Tuncer, Nejat Ozgul, Derman Basaran","doi":"10.1016/j.fertnstert.2025.01.011","DOIUrl":"10.1016/j.fertnstert.2025.01.011","url":null,"abstract":"<p><strong>Objective: </strong>To demonstrate the robotic-assisted Davydov technique for neovaginal creation in Mayer-Rokitansky-Küster-Hauser syndrome.</p><p><strong>Design: </strong>Stepwise demonstration of the technique with narrated video.</p><p><strong>Setting: </strong>Gynecologic unit of a tertiary center.</p><p><strong>Subjects: </strong>A 27-year-old patient has been diagnosed with Mayer-Rokitansky-Küster-Hauser syndrome since the age of 18 years. Three months ago, vaginal dilation was attempted at another medical center but was unsuccessful because of intolerance. Pelvic examination revealed a shallow vaginal dimple.</p><p><strong>Exposure: </strong>After identification of the anatomical structures, the rectovaginal and vesicovaginal spaces were dissected, creating a space for the neovaginal canal and forming anterior and posterior peritoneal flaps. After complete dissection of the rectum from the posterior pelvic peritoneum, the vaginal remnant was bluntly dissected externally under guidance of a blunt-tipped curette handle and connected adequately to the introitus. Subsequently, the created anterior and posterior flaps were individually interrupted with sutures to form the neovaginal entrance. After the neovaginal entrance was established, the robot was used again to continuously suture the uterine remnants to create the anterior neovaginal wall. The uterine remnants, rectal serosa, and internal portions of the flaps were then joined together to form the neovaginal vault.</p><p><strong>Main outcome measures: </strong>Demonstration of the steps for the robotic management of neovaginal creation in Mayer-Rokitansky-Küster-Hauser syndrome.</p><p><strong>Results: </strong>The patient was discharged on postoperative day 1 with a soft mold in the vagina. On postoperative day 3, the soft mold was replaced with a medium-sized rigid mold. By postoperative day 6, the patient could insert a full-size rigid mold. The patient achieved full penetration and engaged in sexual activity within 1 month, with no postoperative complications observed. At the 8-month follow-up, the neovaginal cavity measured 13.4 cm in depth and 4.7 cm in diameter.</p><p><strong>Conclusions: </strong>Creating a neovagina using the robotic-assisted Davydov technique in patients with Mayer-Rokitansky-Küster-Hauser syndrome is a safe, feasible, beneficial, and highly effective method. Although the superiority of robotic systems over laparoscopy has not yet been fully established through extensive publications, the advantages provided by high-image quality, magnification, and maneuverability are highlighted in this study. Robotic technology could be particularly beneficial for patients with obesity or those with complex pelvic anatomy because of prior surgeries.</p>","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143037774","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":"Targeted removal of a small gestational sac in early pregnancy loss via hysteroscopy: distinguishing the true gestational sac from two pseudogestational sacs and a submucosal fibroid.","authors":"Xiaoyan Guo, Yiqi Yu, Weihai Xu, Yanpeng Wang, Jing Shu","doi":"10.1016/j.fertnstert.2025.01.016","DOIUrl":"10.1016/j.fertnstert.2025.01.016","url":null,"abstract":"<p><strong>Objective: </strong>To demonstrate the techniques and advantages of targeted gestational sac removal via hysteroscopy in a case of early miscarriage.</p><p><strong>Design: </strong>Video article.</p><p><strong>Subjects: </strong>A 41-year-old woman with a missed miscarriage at 7⁺¹ weeks presented with a human chorionic gonadotropin level of 1,070 mIU/mL and an intrauterine gestational sac measuring 3.8 mm, which showed enhanced peripheral echogenicity without a visible yolk sac. Ultrasound identified three additional small hypoechoic areas within the uterine cavity, which were difficult to differentiate by ultrasound. The patient had a strong desire to preserve the chorionic villi for chromosomal analysis. However, the small size of the gestational sac and the presence of multiple hypoechoic lesions were expected to complicate the task of locating chorionic villi within the expelled products of conception after expectant management, medication, or suction aspiration. The patient(s) included in this video gave consent for publication of the video and posting of the video online including social media, the journal website, scientific literature websites (e.g., PubMed, ScienceDirect, and Scopus), and other applicable sites.</p><p><strong>Exposure: </strong>Non-contact hysteroscopy was conducted without uterine probing or cervical dilation using HEOS-mini hysteroscope (Delmont, France). The true gestational and pseudogestational sacs and submucosal fibroids were identified and removed using a grasper. Intraoperative intravenous oxytocin (10 IU in 500 mL normal saline) was administered to enhance the visualization of fibroids. Surgical skills were discussed in detail. This study was approved by the Ethics Committee of The First Affiliated Hospital, Zhejiang University School of Medicine (IIT2024-0505).</p><p><strong>Main outcome measures: </strong>Successful targeted removal of the gestational sac and intrauterine lesions.</p><p><strong>Results: </strong>Cytogenetic analysis of the chorionic villi revealed a 45,XO karyotype. Histopathological findings confirmed the hysteroscopic diagnosis. The postoperative recovery was uneventful.</p><p><strong>Conclusion: </strong>Targeted removal of the gestational sac in early pregnancy loss via hysteroscopy is both feasible and effective. It offers valuable diagnostic and therapeutic benefits for patients with recurrent pregnancy loss who require precise sampling or those with concurrent intrauterine abnormalities.</p>","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143037778","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":"Erratum to \"Higher live birth rates are associated with a normal body mass index in preimplantation genetic testing for aneuploidy frozen embryo transfer cycles: a Society for Assisted Reproductive Technology Clinic Outcome Reporting System study\" [Fertil Steril 2024;121:291-98].","authors":"Andrea Peterson, Haotian Wu, Michelle Kappy, Alexander Kucherov, Manvinder Singh, Harry Lieman, Sangita Jindal","doi":"10.1016/j.fertnstert.2024.11.025","DOIUrl":"https://doi.org/10.1016/j.fertnstert.2024.11.025","url":null,"abstract":"","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143022782","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":"Comparing gestational carrier with uterine transplantation in uterine-factor infertility: a cost-effectiveness analysis.","authors":"Joshua C Combs, Meghan U Yamasaki, Maura Dougherty, Kiley Hunkler, Elizabeth B Osmundsen, Jaime Roura-Monllor, Robert J Stillman, Micah J Hill, Kate Devine, Alan H DeCherney, Richard E Nelson, Jeanne E O'Brien","doi":"10.1016/j.fertnstert.2025.01.012","DOIUrl":"10.1016/j.fertnstert.2025.01.012","url":null,"abstract":"<p><strong>Objective: </strong>To compare the cost-effectiveness of a gestational carrier (GC) to a uterine transplantation (UTX) in the treatment of absolute uterine-factor infertility.</p><p><strong>Design: </strong>We performed a cost-effectiveness analysis using a decision-tree mathematical model comparing a GC with a UTX.</p><p><strong>Subjects: </strong>Published literature was used to derive costs for solid organ transplant, immunosuppression, GC obtainment, in vitro fertilization, preimplantation genetic testing, and frozen embryo transfer (FET).</p><p><strong>Exposure: </strong>Gestational modality: GC or UTX. We assumed graft failures occurred immediately and FETs at least 6 months after transplant.</p><p><strong>Main outcome measure(s): </strong>The primary outcomes were costs per live birth, number of children born, and quality-adjusted life years for each gestational modality.</p><p><strong>Results: </strong>Uterine transplantation was more expensive than a GC by $1.4 million with a lower utility by 23.74 quality-adjusted life years using the same average number of children born per 2 FETs. After 10,000 simulated iterations, the GC arm had 2 children born 42% of the time, compared with only 17% of the time in the UTX arm. No children were born 56% of the time in the UTX arm vs. 16% for the GC arm. Deterministic and probabilistic sensitivity variance of all cost parameters by ±75% ($39,292-$275,044 for GC vs. $390,761-$2,735,329 for UTX) and other input parameters by ±20%, including graft failure (21%-31%) and live birth per embryo transfer (29%-78%), produced the same outcomes in >99% of scenarios simulated, as did variation in immunosuppression time (2-18 months) between delivery and subsequent FET. UTX was no longer absolutely dominated if the probability of a live birth per transfer using UTX increased beyond 85%, startup cost for UTX decreased to <$13,646.28, or GC costs increased to >$359,200.</p><p><strong>Conclusions: </strong>Our model suggests that GC use is currently more cost effective than UTX for treating absolute uterine-factor infertility. However, the desire to carry one's own child is an intangible factor not captured in cost analyses, and improvements in UTX success rates or reduced costs may alter these results in the future.</p>","PeriodicalId":12275,"journal":{"name":"Fertility and sterility","volume":" ","pages":""},"PeriodicalIF":6.6,"publicationDate":"2025-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143028201","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}