Frontiers in reproductive health最新文献

{"title":"Diagnostic approaches for tubal factor infertility: a systematic review of HSG, HyCoSy, HyFoSy, and laparoscopy.","authors":"Adalyat Alenova, Almagul Kauysheva, Anuar Korkan, Islam Magalov","doi":"10.3389/frph.2026.1861471","DOIUrl":"10.3389/frph.2026.1861471","url":null,"abstract":"<p><strong>Introduction: </strong>Tubal pathology remains a major cause of female infertility, making accurate assessment of tubal patency and morphology important for clinical decision-making. Several diagnostic approaches are available, including hysterosalpingography (HSG), hysterosalpingo-contrast sonography (HyCoSy), hysterosalpingo-foam sonography (HyFoSy), and laparoscopy with chromopertubation. This systematic review aimed to synthesize current evidence on their diagnostic performance, clinical applicability, and role in contemporary diagnostic pathways.</p><p><strong>Methods: </strong>PubMed/MEDLINE, Embase, the Cochrane Library, and Web of Science were searched for studies published between January 2015 and March 2026. Studies evaluating methods for tubal patency or morphological assessment in women undergoing infertility investigation were considered. A total of 21 studies were included. Owing to clinical and methodological heterogeneity, particularly differences in study populations, diagnostic thresholds, and reference standards, the findings were synthesized qualitatively.</p><p><strong>Results: </strong>HSG generally demonstrated high sensitivity but variable specificity, limiting its reliability for confirming tubal occlusion. HyCoSy showed potentially useful diagnostic performance as a non-invasive screening method, although estimates varied across studies. Several studies reported favorable specificity, predictive values, and agreement measures for HyFoSy, together with improved patient tolerability; however, findings were not uniform and were influenced by methodological heterogeneity and differences in reference standards. Laparoscopy with chromopertubation remained the reference standard for assessing tubal patency and identifying concomitant pelvic pathology, although its invasive nature limits its routine use.</p><p><strong>Discussion: </strong>Current evidence supports a stepwise approach to tubal assessment in which less invasive methods may be used initially, with confirmatory or invasive techniques reserved for selected cases. Such an approach may improve diagnostic confidence while reducing unnecessary procedural burden and risks. Further well-designed comparative studies using standardized reference standards and outcome definitions are needed to clarify the relative diagnostic value of available techniques.</p>","PeriodicalId":73103,"journal":{"name":"Frontiers in reproductive health","volume":"8 ","pages":"1861471"},"PeriodicalIF":3.1,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13683700/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149240510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Using qualitative data to build causal pathways on perceived associations between poor menstrual health and hygiene and harms among schoolgirls in western Kenya.","authors":"Ellie Ansell, Israa Saleh, Garazi Zulaika, David Obor, Anna Maria van Eijk, Kelvin Oruko, Sandra Oketch, Penelope A Phillips-Howard, Linda Mason","doi":"10.3389/frph.2026.1931799","DOIUrl":"10.3389/frph.2026.1931799","url":null,"abstract":"<p><strong>Background: </strong>Poor menstrual health and hygiene (MHH) is a global public health concern, particularly in low- and middle-income countries. It can result in adverse health and educational impacts. Narratives from baseline focus group discussions (FGDs) conducted during a pilot intervention study in rural western Kenya were explored to reveal perceived associations.</p><p><strong>Methods: </strong>Transcripts of 19 FGDs involving 87 post-menarche schoolgirls, 47 parents, and 46 teachers were analysed thematically to identify perceived causal links between menstrual issues and health and educational outcomes. Quotes illustrating these perceived cause-and-effect relationships were logged and synthesised into a series of pathways, from which an overarching causal pathway model was produced.</p><p><strong>Results: </strong>Poverty underpinned poor MHH, characterised by the inability to afford products, the use of inadequate products, and the prolonged use of products. Key outcomes included menstrual issues, menstrual accidents (e.g., leaking), psychosocial distress (e.g., humiliation), poor educational outcomes (e.g., school absence), transactional sex, adolescent pregnancy, and infections (e.g., localised or reproductive tract infections). Poor MHH outcomes were often perceived as \"nodes\" or drivers that led to further distal outcomes. Four pathways emerged, all stemming from poverty. In pathway 1, poverty led to poor educational outcomes via inadequate menstrual materials, menstrual accidents, and psychosocial stress. In pathway 2, poverty led to poor educational outcomes via inadequate menstrual materials and physical discomfort. In pathway 3, poverty caused infections through the use of inadequate materials. In Pathway 4, inadequate materials resulted in transactional sex.</p><p><strong>Conclusion: </strong>Four perceived pathways linking poverty and poor MHH to an endpoint were used to develop a single overall causal pathway. The most frequently perceived outcome was school absence, with pregnancy and school dropout noted much less frequently. As poverty, the perceived underlying cause in this pathway, is a complex target, focusing interventions on proximal perceived key nodes in the pathway, such as poor MHH, would be of value.</p>","PeriodicalId":73103,"journal":{"name":"Frontiers in reproductive health","volume":"8 ","pages":"1931799"},"PeriodicalIF":3.1,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13683675/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149240563","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Case Report: Sequential blastocyst transfer for women with unexplained recurrent implantation failure: a case series.","authors":"Ping Yin, Yuanyuan Wu, Min Jiang, Yan Li","doi":"10.3389/frph.2026.1942865","DOIUrl":"10.3389/frph.2026.1942865","url":null,"abstract":"<p><strong>Background: </strong>Repeated implantation failure (RIF) is a frustrating situation for patients and medical physicians. In spite of extensive research, the underlying mechanisms of RIF are not fully understood. Endometrial receptivity is considered a critical factor for embryo implantation, particularly in patients with unexplained RIF who have usable embryos. Sequential embryo transfer (ET) has been demonstrated to improve clinical pregnancy rates in RIF patients by optimizing embryo-endometrium synchronization and interaction. In this study, we propose a strategy of sequential blastocyst transfer within a single frozen embryo transfer cycle to improve <i>in vitro</i> fertilization (IVF) outcomes in unexplained RIF patients who have failed conventional sequential cleavage/blastocyst ET.</p><p><strong>Case presentation: </strong>Three women under 40 years of age had undergone repeated failed embryo transfer cycles in our hospital. Based on ESHRE recommendations for RIF investigation, no significant causative or contributory factors were identified, apart from mild intrauterine adhesion or chronic endometritis, treated before embryo transfer. Further embryo transfers still failed, even with regular sequential cleavage/blastocyst transfer. However, all three patients achieved positive clinical pregnancies with sequential blastocyst embryo transfer. Two of the patients had live births and the remaining patient experienced an early spontaneous miscarriage for which a pathogenic deletion of chromosome 21 was identified.</p><p><strong>Conclusion: </strong>Repeated implantation failure is a complex, challenging, and burdensome condition, which causes considerable psychological and physical suffering for patients and reproductive specialists. Sequential blastocyst transfer is a potential option for patients with unexplained RIF undergoing IVF.</p>","PeriodicalId":73103,"journal":{"name":"Frontiers in reproductive health","volume":"8 ","pages":"1942865"},"PeriodicalIF":3.1,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13683134/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149240468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fertility in Ethiopia: factors associated with the number of live births -a survey-adjusted poisson regression analysis of the 2019 ethiopian mini demographic and health survey.","authors":"Melese Dereje Mesfin, Amare Yirga Wondu, Dahabo Adi Galgalo, Leman Atmaca, Ágnes Buda, Viktória Prémusz","doi":"10.3389/frph.2026.1928107","DOIUrl":"10.3389/frph.2026.1928107","url":null,"abstract":"<p><strong>Background: </strong>Fertility is a key demographic and public health phenomenon reflecting actual childbearing within a population. It can be characterized using several measures, including total fertility rate, age-specific fertility rates, children ever born, and the number of births occurring within a defined reference period. These measures capture different dimensions of reproductive experience and are associated with a complex interplay of socioeconomic, demographic, cultural, biological, and policy-related factors.</p><p><strong>Methods: </strong>By dividing the nine regions into urban and rural categories, twenty-one sampling strata were created. The survey employed a two-stage stratified cluster sampling design. In the first stage, 305 enumeration areas (EAs) were selected from the national sampling frame using probability proportional to size. A total of 8,885 women were included in the descriptive analysis, while the primary multivariable analysis was restricted to 6,585 ever-married/partnered women. A survey-adjusted Poisson regression model was used to examine associations between explanatory variables and the number of live births during the five years preceding the survey. Statistical significance was assessed using a two-sided <i>p</i>-value of <0.05.</p><p><strong>Result and conclusion: </strong>The mean age of the participants was 27.6 years. More than four-fifths of women had either no formal education (40.4%) or primary education (41.7%). Compared with women aged 15-19 years, the expected number of recent live births was higher among women aged 20-24 years (aIRR = 2.129, 95% CI: 1.759-2.577). Women residing in Amhara had a lower expected number of recent live births than women residing in Tigray (aIRR = 0.765, 95% CI: 0.658-0.890). Lower expected counts were also observed in Addis Ababa (aIRR = 0.818, 95% CI: 0.684-0.979) and Dire Dawa (aIRR = 0.792, 95% CI: 0.659-0.952). An inverse association was observed between household wealth and recent live-birth counts. These findings highlight the multifactorial nature of recent live births in Ethiopia and suggest that fertility patterns are associated with a combination of individual, household, and contextual factors. These insights may help inform evidence-based reproductive health and family planning policies tailored to the Ethiopian context.</p>","PeriodicalId":73103,"journal":{"name":"Frontiers in reproductive health","volume":"8 ","pages":"1928107"},"PeriodicalIF":3.1,"publicationDate":"2026-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13683705/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149240517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultrasound modalities and age-specific normative findings in pediatric and adolescent gynecology.","authors":"Martina Asia Policriti, Nina Cooper, May-Ai Seah, Bara'a Elhag, Dirk Timmerman, Tom Bourne, Maya Al-Memar","doi":"10.3389/frph.2026.1953961","DOIUrl":"https://doi.org/10.3389/frph.2026.1953961","url":null,"abstract":"<p><p>Ultrasound is the first-line modality for imaging the female gynecological organs in children and adolescents. Its interpretation relies on understanding the physiological changes in organ appearance from birth through puberty. This narrative review considers different ultrasound approaches including transabdominal, transvaginal, transrectal, transperineal, Doppler and three-dimensional ultrasound, and when magnetic resonance imaging may add useful information. It then describes how normal uterine, ovarian, and endometrial appearances change across development. Although the evidence is drawn mainly from cross-sectional studies using different equipment, measurement methods, and reporting approaches, the studies describe a broadly consistent developmental pattern. A central practical message emerges: thresholds and diagnostic criteria derived from adults translate poorly to the developing pelvis, so interpretation rests not on memorizing cut-offs but on knowing what to expect at each age and stage, and on recognizing how wide normal physiological variation is. The review also identifies the principal evidence gaps: sparse data at the youngest ages, limited representation of diverse populations, an absence of longitudinal studies, a reliance on adult-derived criteria for diagnosing pathology such as adnexal masses, adenomyosis and endometriosis, and the lack of a standardized reporting framework. It then sets out priorities for future research.</p>","PeriodicalId":73103,"journal":{"name":"Frontiers in reproductive health","volume":"8 ","pages":"1953961"},"PeriodicalIF":3.1,"publicationDate":"2026-10-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13682351/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149240525","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Correction: BRIDGES: a patient-centered, community-informed HIV doula program that supports infant feeding choice among Hispanic and Caribbean families: a study protocol.","authors":"Rachel Mpanu-Mpanu, Melanie Francis, Kassandra N Garcia, Lunthita M Duthely","doi":"10.3389/frph.2026.1989121","DOIUrl":"https://doi.org/10.3389/frph.2026.1989121","url":null,"abstract":"<p><p>[This corrects the article DOI: 10.3389/frph.2026.1896729.].</p>","PeriodicalId":73103,"journal":{"name":"Frontiers in reproductive health","volume":"8 ","pages":"1989121"},"PeriodicalIF":3.1,"publicationDate":"2026-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13678432/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149229540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endovascular mechanical thrombectomy for the treatment of extensive postpartum cerebral venous sinus thrombosis: a case report.","authors":"Mariana Acosta Chiquillo, Rafael Leonardo Aragón Mendoza, Andrés Contreras, María Lucia Suárez Benítez, Víctor S Rangel, Angela María Muñoz, Jorge L Campo, Jose Alejandro Flórez Cardona","doi":"10.3389/frph.2026.1925471","DOIUrl":"10.3389/frph.2026.1925471","url":null,"abstract":"<p><strong>Background: </strong>Cerebral venous sinus thrombosis (CVST) is a rare but potentially life-threatening complication of pregnancy and the postpartum period. Although systemic anticoagulation remains the standard first-line treatment, evidence supporting endovascular mechanical thrombectomy in postpartum patients is limited.</p><p><strong>Case presentation: </strong>A 22-year-old woman presented 12 days after an uncomplicated vaginal delivery with progressive headache and vomiting. Neuroimaging confirmed extensive CVST involving the superior sagittal, cortical, left transverse, and sigmoid sinuses, extending to the left jugular bulb. An initially suspected bilateral parieto-occipital convexity subarachnoid hemorrhage was subsequently ruled out following further imaging review. Despite prompt anticoagulation with low-molecular-weight heparin, she developed rapid neurological deterioration with decreased level of consciousness. Following multidisciplinary evaluation, endovascular mechanical thrombectomy was performed using aspiration and stent-retriever techniques, achieving successful venous recanalization. The procedure was complicated by transient vasospasm, which resolved after intra-arterial milrinone administration. An extensive evaluation excluded inherited and acquired thrombophilia, autoimmune disease, malignancy, and infection, identifying the postpartum period as the most likely predisposing factor. The patient was discharged 12 days after the intervention with therapeutic anticoagulation and anti-seizure medication. At six-month follow-up, she demonstrated complete neurological recovery without residual deficits.</p><p><strong>Conclusion: </strong>This case highlights that endovascular mechanical thrombectomy may represent a valuable therapeutic option in carefully selected postpartum patients with extensive CVST who develop progressive neurological deterioration despite anticoagulation. Although current evidence remains limited, this report supports the role of a multidisciplinary approach and timely endovascular intervention in achieving favorable neurological outcomes.</p>","PeriodicalId":73103,"journal":{"name":"Frontiers in reproductive health","volume":"8 ","pages":"1925471"},"PeriodicalIF":3.1,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13672580/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149217504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of vasopressin-assisted laparoscopic endometrioma excision on ovarian reserve: a randomized controlled trial.","authors":"Jaehoon Lee, Eunhyang Park, Hyemin Park, Inha Lee, Young Sik Choi, SiHyun Cho, Sang Wun Kim","doi":"10.3389/frph.2026.1906041","DOIUrl":"10.3389/frph.2026.1906041","url":null,"abstract":"<p><strong>Introduction: </strong>Laparoscopic cystectomy is the standard surgical treatment for ovarian endometrioma; however, inadvertent removal of healthy ovarian tissue and thermal injury during hemostasis may compromise ovarian reserve. Vasopressin injection has been proposed as a surgical adjunct to reduce bleeding and limit the need for electrocoagulation, thereby potentially minimizing ovarian damage. However, evidence regarding its effectiveness in preserving ovarian reserve remains limited.</p><p><strong>Methods: </strong>This randomized controlled trial was conducted at a tertiary university-affiliated medical center between September 2018 and July 2021. Seventy-five women undergoing laparoscopic cystectomy for unilateral ovarian endometrioma were stratified according to baseline serum anti-Müllerian hormone (AMH) levels and randomly assigned to either a vasopressin-assisted surgery group or a control group. The primary outcome was the change in serum AMH level 12 months after surgery. Secondary outcomes included operative parameters, including cyst stripping time and time required for bleeding control. Outcomes were analyzed using intention-to-treat and per-protocol approaches. Longitudinal changes in AMH were evaluated using linear mixed-effects models.</p><p><strong>Results: </strong>In the intention-to-treat analysis, vasopressin injection significantly reduced the time required for cyst stripping (8.9 ± 7.9 vs. 14.4 ± 13.7 min, <i>p</i> = 0.054) and bleeding control (2.2 ± 2.5 vs. 6.5 ± 6.8 min, <i>p</i> = 0.002) compared with the control group. However, the decline in AMH levels at 12 months after surgery did not differ significantly between the vasopressin and control groups (-0.96 ± 1.11 vs. -1.14 ± 0.92 ng/mL, <i>p</i> = 0.488). Subgroup analyses according to baseline AMH levels (<3 ng/mL and 3.0-<7.0 ng/mL) yielded similar findings. Linear mixed-effects modeling demonstrated a significant decline in AMH at 3 months after surgery, followed by partial recovery at 6 and 12 months, with no significant group-by-time interaction (<i>p</i> = 0.816). Per-protocol analyses produced consistent results. Histopathological evaluation revealed no significant between-group differences in the thickness or proportion of excised ovarian tissue.</p><p><strong>Conclusion: </strong>Although vasopressin reduced operative time and electrocoagulation exposure during endometrioma surgery, it did not prevent postoperative decline in ovarian reserve.</p>","PeriodicalId":73103,"journal":{"name":"Frontiers in reproductive health","volume":"8 ","pages":"1906041"},"PeriodicalIF":3.1,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13671997/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149217462","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of contraceptive initiation on the cervicovaginal mucosa: results from the UMPALA multicentre, partially randomized patient-preference interventional trial.","authors":"Betty Njoroge, Nelly Mugo, Carolina Herrera, Karen Dominguez, Louise A Ouattara, Nazita Yousefieh, Neelima Chandra, Agnieszka Kurczewska, Stephanie Nartey, Julie Lewis, Andrea R Thurman, Matilda Saina, Raina N Fichorova, Jacques Ravel, Reem Sharaf Alddin, Nicola Richardson-Harman, Kenneth Ngure, Gustavo F Doncel","doi":"10.3389/frph.2026.1882772","DOIUrl":"10.3389/frph.2026.1882772","url":null,"abstract":"<p><strong>Background: </strong>Long-acting contraceptives are widely used, providing superior efficacy and systemic safety; however, the impact of contraceptive initiation on female genital tract function and health has been understudied.</p><p><strong>Methods: </strong>Non-pregnant, HIV-uninfected women aged 18-50 years were enrolled in a dual-centre partially randomized patient-preference interventional trial (NCT04814927) and allowed to choose one of four contraceptive options, etonogestrel contraceptive implant, depot medroxyprogesterone acetate subcutaneous injection, levonorgestrel intrauterine device, and copper IUD, with a minimum target of 12 participants per arm and site. Sampling took place at baseline, 1 and 3 months after contraceptive initiation, and 1 month post-contraceptive discontinuation. Primary outcomes focused on mucosal function and health, while secondary and tertiary outcomes pertained to systemic and mucosal susceptibility to HIV-1 and HSV-2.</p><p><strong>Results: </strong>Cervicovaginal samples from 112 enrolled participants showed transient, statistically significant changes in endpoints comparing baseline vs. 1 and 3 months after contraceptive initiation. Changes in pH, epithelial thickness, E-cadherin expression, antimicrobial peptides, glycogen, and lactic acid varied with contraceptive type and were typically transient. Serum oestradiol level was correlated with cervicovaginal epithelial function and glycogen and lactic acid secretion. Contraceptive initiation did not result in detectable <i>ex vivo</i> or <i>in vitro</i> increase of HIV-1 and HSV-2 susceptibility in cellular and tissue models.</p><p><strong>Conclusions: </strong>Contraceptive initiation during the first 3 months of use induced transient and variable changes in mucosal epithelial and immune markers, not leading to persistent alterations of the vaginal milieu or increased susceptibility to viral infections during the 3 months after contraception initiation.</p><p><strong>Clinical trial registration: </strong>https://clinicaltrials.gov/study/NCT04814927?term=NCT04814927.&viewType=Card&rank=1, identifier NCT04814927.</p>","PeriodicalId":73103,"journal":{"name":"Frontiers in reproductive health","volume":"8 ","pages":"1882772"},"PeriodicalIF":3.1,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13672642/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149217468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond the embryo: reframing recurrent implantation failure through immunopriming and endometrial immune dysregulation.","authors":"Jayesh Amin","doi":"10.3389/frph.2026.1892030","DOIUrl":"10.3389/frph.2026.1892030","url":null,"abstract":"<p><p>Recurrent implantation failure (RIF) remains one of the most debated and emotionally challenging conditions in assisted reproductive technology (ART). Despite remarkable advances in embryology, including blastocyst culture, time-lapse imaging and preimplantation genetic testing for aneuploidy (PGTA), a significant proportion of patients continue to fail implantation even after transfer of morphologically good-quality or euploid embryos. Contemporary reproductive medicine has largely adopted an embryocentric model of implantation, often defining RIF based upon repeated failed embryo transfers. However, this framework may represent a statistical oversimplification that inadequately reflects the biological complexity of implantation and the clinical realities faced by infertile couples. Emerging evidence increasingly supports the concept that implantation is not solely dependent on embryo competence but also requires synchronized endometrial receptivity and finely regulated maternal immune tolerance. The endometrium functions as an active immunological organ populated by uterine natural killer cells, macrophages, dendritic cells, cytokines, chemokines, and regulatory T cells, all of which contribute to embryo acceptance, trophoblast invasion, angiogenesis, and placentation. Dysregulation of this immune-endometrial dialogue may contribute substantially to implantation failure in selected patients. This perspective article critically examines the limitations of current RIF definitions, the overemphasis on embryo quality, and the under-recognized role of reproductive immunology. Furthermore, it explores the emerging concept of immunopriming and discusses potential immunological markers, peripheralendometrial immune crosstalk, individualized immune profiling, and immunomodulatory therapies such as intravenous immunoglobulin (IVIG) and lymphocyte immunotherapy (LIT). Although current evidence remains heterogeneous and definitive randomized controlled trials are lacking, outright dismissal of immune contributions to implantation failure may no longer be scientifically justified. We propose that implantation failure should be reconsidered as a multifactorial disorder involving embryo competence, endometrial receptivity, and immune equilibrium, thereby advocating for a more integrated and individualized approach to implantation medicine.</p>","PeriodicalId":73103,"journal":{"name":"Frontiers in reproductive health","volume":"8 ","pages":"1892030"},"PeriodicalIF":3.1,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13668873/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149217465","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}