Frontiers in reproductive health最新文献

{"title":"Association of admission C-reactive protein levels and histological chorioamnionitis in patients with preterm premature rupture of membranes: a systematic review and meta-analysis.","authors":"Cunling Zhang, Zhuo Wei, Dan Wu, Meiyi Xu, Wen Li","doi":"10.3389/frph.2026.1912720","DOIUrl":"10.3389/frph.2026.1912720","url":null,"abstract":"<p><strong>Background: </strong>Preterm premature rupture of membranes (PPROM) is a high-risk obstetric complication. Ascending infection and histological chorioamnionitis (HCA) frequently occur after membrane rupture, contributing to severe adverse maternal and fetal outcomes. Early prediction of HCA using non-invasive biomarkers allows timely clinical management, while the predictive efficacy of C-reactive protein (CRP) for subsequent HCA in PPROM patients remains inconsistent across existing studies. This meta-analysis aimed to systematically evaluate the predictive association.</p><p><strong>Methods: </strong>We systematically searched PubMed, Scopus, Web of Science and the Cochrane Library from inception to May 20, 2026 for studies on serum CRP and subsequent HCA in PPROM patients. Pooled mean differences (MD) of admission CRP concentrations were calculated using random-effects meta-analysis with results visualized via forest plots. Leave-one-out sensitivity analysis confirmed robustness. Subgroup analyses and meta-regression were applied to explore potential sources of heterogeneity. Funnel plots, combined with Egger's test and Begg's test, were used to evaluate publication bias. All statistical analyses were conducted using R software (version 4.6.0).</p><p><strong>Results: </strong>Initially, 11 studies were screened. After excluding one low-quality study, 10 studies (1,791 participants) were ultimately included. The pooled results demonstrated that PPROM patients who subsequently developed HCA exhibited higher admission CRP levels than non-HCA controls (MD = 0.439, 95% CI: 0.179-0.700), with substantial heterogeneity (<i>I</i> ² = 87.7%). Meta-regression and subgroup exploration suggested sample size may partially drive cross-study heterogeneity; this moderator accounted for 31.19% of total variance, with a borderline significant association (<i>P</i> = 0.05). Sensitivity analysis confirmed the stability of the pooled estimates. Egger's test revealed no significant publication bias (<i>P</i> > 0.05), but the substantial heterogeneity warrants caution in interpretation.</p><p><strong>Conclusion: </strong>This meta-analysis suggests that elevated admission CRP levels are modestly correlated with subsequent HCA in PPROM populations. CRP may serve as an auxiliary indicator to assist early risk stratification; however, its clinical utility is limited by the small effect size and substantial heterogeneity across studies. Given the observational design of the included studies, these findings represent association rather than causation. Prospective cohort studies with standardized protocols are needed to confirm these results and assess the incremental value of CRP over existing clinical predictors.</p><p><strong>Systematic review registration: </strong>https://www.crd.york.ac.uk/PROSPERO/, identifier CRD420261404654.</p>","PeriodicalId":73103,"journal":{"name":"Frontiers in reproductive health","volume":"8 ","pages":"1912720"},"PeriodicalIF":3.1,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655316/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149167172","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":"Ovarian endometrioid adenofibroma in a perimenopausal woman with intermittent vaginal bleeding: a case report.","authors":"Zhigang Niu, Hongwei Liang, Ning Wang, Jiazhen Huang","doi":"10.3389/frph.2026.1839813","DOIUrl":"10.3389/frph.2026.1839813","url":null,"abstract":"<p><p>Ovarian endometrioid adenofibroma (EA) is an exceptionally rare benign epithelial tumor of the ovary with nonspecific clinical and imaging manifestations, and its diagnosis relies mainly on pathological examination. This case describes a 55-year-old perimenopausal woman with a 1-year history of intermittent vaginal bleeding and a progressively enlarging right adnexal mass. Imaging revealed a solid mass in the right adnexal region with minimal blood flow signal. Serum tumor markers were within normal ranges, and the sex hormone profile showed no evidence of estrogen excess. Serial ultrasonography showed no interval increase in endometrial thickness; therefore, a causal relationship between the ovarian tumor and the abnormal bleeding could not be established. The patient underwent laparoscopic total hysterectomy and bilateral salpingo-oophorectomy. Postoperative uterine pathology demonstrated proliferative endometrium and endometrial polyps, providing a plausible uterine explanation for the bleeding. Histopathological examination of the ovarian lesion confirmed benign endometrioid adenofibroma with focal epithelial crowding but without cytological atypia, increased mitotic activity, or destructive stromal invasion. The postoperative course was uneventful, and no abnormal findings were detected during the 11-month follow-up. EA lacks specific clinical manifestations, and definitive diagnosis depends on histopathological and immunohistochemical evaluation. Management is primarily surgical, but the extent of surgery should be individualized according to patient age, menopausal status, fertility considerations, and preoperative suspicion of malignancy. Although the prognosis of benign EA is generally favorable, careful follow-up may be considered in cases with atypical histological features. This case highlights the diagnostic challenge of ovarian EA and emphasizes its consideration in the differential diagnosis of solid adnexal masses in peri- and postmenopausal women, particularly when imaging findings raise concern for malignancy.</p>","PeriodicalId":73103,"journal":{"name":"Frontiers in reproductive health","volume":"8 ","pages":"1839813"},"PeriodicalIF":3.1,"publicationDate":"2026-09-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13655068/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149172357","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":"Oligozoospermic infertile sperm with high ROS are more prone to epigenetic alterations.","authors":"Anamika Kumari, Syed Waseem Andrabi, Rajender Singh","doi":"10.3389/frph.2026.1933266","DOIUrl":"10.3389/frph.2026.1933266","url":null,"abstract":"<p><strong>Introduction: </strong>Oxidative stress has been found to play a critical role in sperm quality and function. In this study, we asked if oligozoospermic samples with high ROS display a higher degree of methylation alterations in comparison to normozoospermic samples.</p><p><strong>Methods: </strong>We investigated genome-wide DNA methylation in normozoospermic (presumptive fertile) and oligozoospermic infertile samples with high and low ROS levels. Fifty samples each for oligozoospermia and normozoospermia were analyzed for their ROS levels. Two samples each in the normozoospermic low ROS, normozoospermic high ROS, oligozoospermic low ROS and oligozoospermic high ROS categories were selected for genome-wide DNA methylation profiling.</p><p><strong>Results and discussion: </strong>A comparison between oligozoospermic and normozoospermic samples showed a low number of differentially methylated genes (about 100). The normozoospermic high ROS group in comparison to the normozoospermic low ROS group showed a moderate number of differentially methylated genes (538). On the other hand, oligozoospermic high ROS versus oligozoospermic low ROS comparison showed the highest number of genes (1,755) to be differentially methylated, of which a majority displayed hypomethylation. These findings underscore the vulnerability of oligozoospermic sperm to epigenetic disruptions induced by oxidative stress. We conclude that oligozoospermic samples with high ROS carry a high degree of methylation alterations.</p>","PeriodicalId":73103,"journal":{"name":"Frontiers in reproductive health","volume":"8 ","pages":"1933266"},"PeriodicalIF":3.1,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13642678/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149129471","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":"Changes in tubal permanent contraception rates in South Carolina following the <i>Dobbs</i> decision: a retrospective cohort study.","authors":"Isabella Mateu, Erica Lowing, Jessica Britt, Erica F Robinson","doi":"10.3389/frph.2026.1946711","DOIUrl":"10.3389/frph.2026.1946711","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;The Supreme Court finalized its decision in &lt;i&gt;Dobbs v Jackson Women's Health Organization&lt;/i&gt; on June 24, 2022, overturning nearly 50 years of constitutional protection for abortion in the United States under &lt;i&gt;Roe v Wade&lt;/i&gt; (1973) and &lt;i&gt;Planned Parenthood v Casey&lt;/i&gt; (1992). This subsequently allowed states to implement or enforce more restrictive abortion policies and bans. Multiple studies have demonstrated increased demand for permanent contraception at the national level and across institutions in states with varying degrees of abortion policies. Whether a similar increase occurred in South Carolina, one of the most restrictive states with regards to access to abortion care, has not yet been described and is the focus of this study.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;We aim to assess the potential impact of the &lt;i&gt;Dobbs&lt;/i&gt; decision on tubal permanent contraception by comparing the proportion of patients undergoing these procedures at a large multi-hospital system in South Carolina before and after the Supreme Court ruling.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Study design: &lt;/strong&gt;This observational, retrospective cohort study included 141,375 reproductive-age patients who were active at a large multi-hospital health system between June 24, 2021 and June 25, 2023. The primary outcome was the proportion of active patients undergoing sterilization in the year following the Supreme Court's ruling (June 2022-June 2023, \"Post-&lt;i&gt;Dobbs\"&lt;/i&gt;) compared to the year preceding the ruling (June 2021-June 2022, \"Pre-&lt;i&gt;Dobbs\"&lt;/i&gt;). Secondary outcomes included demographic measures to assess how factors differed between those who did and did not receive permanent contraception. Statistical analysis included chi square and t-tests, as appropriate, and multivariable logistic regression was used to estimate adjusted odds of sterilization.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Results: &lt;/strong&gt;The proportion of patients undergoing permanent contraception was 2.34% in the \"Post-&lt;i&gt;Dobbs&lt;/i&gt;\" period compared to 1.83% in the \"Pre-&lt;i&gt;Dobbs&lt;/i&gt;\" period, representing an absolute increase of 0.51%. Patients in the \"Post-&lt;i&gt;Dobbs\"&lt;/i&gt; period had higher odds of undergoing sterilization compared to the \"Pre-&lt;i&gt;Dobbs\"&lt;/i&gt; period [OR 1.28 (95% CI 1.19-1.38); adjusted OR 1.24 (95% CI 1.14-1.35); adjusted for race, ethnicity, healthcare payor, marital status, parity, gravidity, and maternal age]. The proportion increased from 1.52% in the six months prior to the &lt;i&gt;Dobbs&lt;/i&gt; decision to 1.83% in the six months following the decision (&lt;i&gt;p&lt;/i&gt; = 0.0006) and further increased to 2.12% in the subsequent six months (&lt;i&gt;p&lt;/i&gt; = 0.002). Additionally, demographic differences were observed between patients who did and did not receive permanent contraception.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;The proportion of patients undergoing permanent contraception increased following the &lt;i&gt;Dobbs&lt;/i&gt; decision and continued to rise for at least one year. These findings suggest an association between in","PeriodicalId":73103,"journal":{"name":"Frontiers in reproductive health","volume":"8 ","pages":"1946711"},"PeriodicalIF":3.1,"publicationDate":"2026-09-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13642272/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149129464","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":"<i>MTHFR</i> (rs1801133) and <i>SERPINE1</i>/PAI-1 (-675 4G/5G) gene polymorphisms and their association with spontaneous abortion and missed pregnancy in an ethnic Uzbek population: a case-control study.","authors":"Farkhod Akhmedov, Gulnoza Axmadjonova, Nigora Axmadaliyeva, Habibaxon Negmatshayeva, Saxibaxon Kasimova, Nigina Nasimova","doi":"10.3389/frph.2026.1943185","DOIUrl":"10.3389/frph.2026.1943185","url":null,"abstract":"<p><p>Spontaneous abortion and missed (non-developing) pregnancy are common early reproductive losses in which disturbed folate metabolism and inherited thrombophilia are implicated. Variants of methylenetetrahydrofolate reductase (<i>MTHFR</i>) and of the plasminogen activator inhibitor-1 gene (<i>SERPINE1</i>/PAI-1) may increase this risk, but data from Central Asian populations are scarce. We assessed the association of <i>MTHFR</i> rs1801133 (c.665C>T; p.Ala222Val, classically C677T) and the <i>SERPINE1</i>/PAI-1 -675 4G/5G promoter insertion/deletion polymorphism (rs1799889) with early pregnancy loss in a case-control study of ethnic Uzbek women. Eighty-one women with a history of spontaneous abortion (<i>n</i> = 40) or missed pregnancy (<i>n</i> = 41) and 83 women with a physiologically progressing pregnancy were genotyped. In controls, both loci conformed to Hardy-Weinberg equilibrium. The <i>MTHFR</i> Val allele (40.1% vs. 20.5%) and the Val/Val genotype (22.2% vs. 3.6%) were significantly more frequent in cases, the mutant homozygote conferring an approximately sevenfold increase in odds (OR 7.6, 95% CI 2.5-23.3; <i>p</i> < 0.01), whereas the Ala/Ala genotype was associated with lower odds of loss (OR 0.4). Similarly, the PAI-1 4G allele (46.9% vs. 30.1%) and the 4G/4G genotype (25.9% vs. 6.0%) were over-represented in cases (4G/4G: OR 5.5, 95% CI 2.1-14.2; <i>p</i> < 0.01). Associations were strongest in women with spontaneous abortion. Exploratory ROC analysis indicated moderate, high-specificity discrimination, greatest for the mutant homozygous genotypes (<i>MTHFR</i> Val/Val AUC 0.69; PAI-1 4G/4G AUC up to 0.73). In ethnic Uzbek women, the <i>MTHFR</i> Val/Val and PAI-1 4G/4G genotypes were associated with spontaneous abortion and missed pregnancy; given the case-control design, these are associations requiring confirmation in larger studies.</p>","PeriodicalId":73103,"journal":{"name":"Frontiers in reproductive health","volume":"8 ","pages":"1943185"},"PeriodicalIF":3.1,"publicationDate":"2026-09-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13638649/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119572","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":"Association of concomitant laparoscopy with reproductive outcomes after hysteroscopic septum resection: a longitudinal cohort study.","authors":"Yu Lu, Mi Su, Qinqin Yuan, Li He","doi":"10.3389/frph.2026.1950477","DOIUrl":"https://doi.org/10.3389/frph.2026.1950477","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate whether concomitant laparoscopy during hysteroscopic uterine septum resection is associated with perioperative characteristics and postoperative reproductive outcomes, and to explore the prognostic roles of ESHRE/ESGE classification and septum depth.</p><p><strong>Methods: </strong>This single-center retrospective cohort study included 361 patients who underwent hysteroscopic septum resection between 2017 and 2024. Of these, 241 underwent hysteroscopy alone and 120 underwent concomitant laparoscopy. Multivariable logistic regression was used to evaluate postoperative pregnancy, live birth, and miscarriage. Kaplan-Meier analysis and Cox regression were used to assess time to first postoperative pregnancy. Anatomical analyses included U2a/U2b classification and septum depth.</p><p><strong>Results: </strong>Postoperative pregnancy rates were 56.8% and 60.8% in the hysteroscopy-only and concomitant-laparoscopy groups, respectively (<i>P</i> = 0.469), while live-birth rates were 42.7% and 39.2% (<i>P</i> = 0.517). After adjustment for clinical characteristics and ESHRE/ESGE classification, concomitant laparoscopy was not significantly associated with pregnancy (aOR, 1.27; 95% CI, 0.72-2.23) or live birth (aOR, 0.82; 95% CI, 0.47-1.44). Time to first pregnancy was also similar between groups (adjusted hazard ratio, 1.03; 95% CI, 0.75-1.41). U2b morphology, compared with U2a morphology, was not independently associated with pregnancy or live birth. Septum depth was not consistently associated with reproductive outcomes.</p><p><strong>Conclusion: </strong>No statistically significant association was detected between concomitant laparoscopy and postoperative pregnancy, live birth, miscarriage, or time to first pregnancy. Laparoscopy should be selected according to pelvic indications, anatomical complexity, and intraoperative safety requirements rather than routinely used to improve reproductive outcomes.</p>","PeriodicalId":73103,"journal":{"name":"Frontiers in reproductive health","volume":"8 ","pages":"1950477"},"PeriodicalIF":3.1,"publicationDate":"2026-09-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13630746/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119396","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":"Anogenital distance as a biomarker for endometriosis in adolescents: a prospective, matched case-control study.","authors":"Jessica Y Shim, Ava Scatoni, Daniel W Cramer, Steven J Staffa, Marc R Laufer, Elizabeth R Boskey","doi":"10.3389/frph.2026.1951393","DOIUrl":"https://doi.org/10.3389/frph.2026.1951393","url":null,"abstract":"<p><strong>Objectives: </strong>To determine whether anogenital distance (AGD), a potential non-invasive biomarker reflecting prenatal androgen exposure, differs between adolescents with laparoscopically confirmed endometriosis and matched controls.</p><p><strong>Methods: </strong>This IRB-approved, matched case-control study was conducted at a single pediatric hospital between March 2024 and June 2025. Twenty adolescents aged 13-25 years were enrolled: 10 with laparoscopically confirmed endometriosis and 10 controls (three asymptomatic, seven laparoscopically confirmed without endometriosis), matched by age (±1 year) and body mass index (BMI) (±2 kg/m²). AGD was measured under anesthesia from the clitoral surface to the anus (AGD-AC) and from the posterior fourchette to the anus (AGD-AF). Within-pair mean differences were calculated using paired <i>t</i>-tests.</p><p><strong>Results: </strong>The mean AGD-AC was 9.4 ± 1.2 cm in cases versus 9.7 ± 1.4 cm in matched controls; the mean AGD-AF was 3.5 ± 0.5 cm in cases versus 3.2 ± 0.8 cm in matched controls. Paired <i>t</i>-tests showed no significant differences in either [mean difference AGD-AC = 0.297, 95% CI (-0.85 to 1.44) <i>p</i> = 0.57; AGD-AF = -0.327, 95% CI ( -0.88 to 0.23) <i>p</i> = 0.22]. Substantial overlap was observed across groups, and no significant differences were identified for either AGD measure.</p><p><strong>Conclusion: </strong>We did not detect a difference in AGD measurements between adolescents with laparoscopically confirmed endometriosis and age and BMI-matched controls; however, with only 10 matched pairs, this study was powered to detect only a large effect, and therefore, these null findings should be interpreted cautiously. Larger longitudinal studies are warranted to assess whether AGD correlates with disease onset, severity, or progression.</p>","PeriodicalId":73103,"journal":{"name":"Frontiers in reproductive health","volume":"8 ","pages":"1951393"},"PeriodicalIF":3.1,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13627344/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119398","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":"A comparative cross-sectional evaluation of generative AI chatbots for patient-oriented bacterial vaginosis health advice: safety, accuracy, guideline concordance, empathy, and readability.","authors":"Ling Miao, Lina Gu, Zhaole Gong, Zhengfeng Gu, Xiaoli Qian","doi":"10.3389/frph.2026.1967818","DOIUrl":"https://doi.org/10.3389/frph.2026.1967818","url":null,"abstract":"<p><strong>Background: </strong>Bacterial vaginosis (BV) concerns involve intimate symptoms, stigma, diagnostic uncertainty, medication use, pregnancy, sexual health, and self-care. Publicly accessible generative artificial intelligence chatbots offer immediate and potentially non-judgmental information, but the quality and safety of specific responses remain uncertain.</p><p><strong>Objective: </strong>To compare five publicly accessible generative AI chatbot interfaces using standardized, researcher-developed patient-oriented questions about BV. In this study, patient-oriented denotes consumer-facing wording and does not imply direct patient derivation or validation.</p><p><strong>Methods: </strong>Sixty-one standardized English-language questions were submitted once to ChatGPT, Gemini, Microsoft Copilot, DeepSeek, and Doubao in separate single-turn sessions, yielding 305 responses. Five senior obstetrician-gynecologists independently evaluated safety, accuracy, study-specific guideline-anchored concordance, and empathy using a question-specific reference framework. Independent ratings were locked before adjudication and were used to estimate inter-rater agreement. Consensus scores were used for primary comparisons, and a sensitivity analysis used the median of the five locked ratings. Readability was assessed separately using six formula-based indices. Paired comparisons used Cochran's Q, Friedman, McNemar, and Wilcoxon signed-rank tests with Benjamini-Hochberg adjustment.</p><p><strong>Results: </strong>Thirty-one responses (10.2%) were classified as unsafe or potentially unsafe. Observed interface-specific rates ranged from 6.6% (95% CI, 2.6%-15.7%) to 14.8% (95% CI, 8.0%-25.7%), while the matched binary comparison did not detect an overall difference (Cochran's Q = 2.596, df = 4, <i>P</i> = 0.627). Under the documented query conditions, differences were detected in accuracy (Kendall's W = 0.686), study-specific guideline-anchored concordance (W = 0.243), empathy (W = 0.322), and all six readability indices (W range, 0.482-0.679; all <i>P</i> < 0.001). The sensitivity analysis produced the same inferential conclusions. Unsafe content occurred in every interface and was concentrated in recurrent-BV, sexual-health, medication, and self-care scenarios.</p><p><strong>Conclusions: </strong>This exploratory study characterizes a recorded sample of specific chatbot responses, not stable or repeatable performance characteristics. Clinically relevant risks were observed in every interface, and the non-significant safety comparison should not be interpreted as equivalence. Because each researcher-developed prompt was submitted once and the interfaces were queried on different dates in a fixed order, the findings do not establish a stable ranking of underlying model capability, clinical effectiveness, or suitability for unsupervised care.</p>","PeriodicalId":73103,"journal":{"name":"Frontiers in reproductive health","volume":"8 ","pages":"1967818"},"PeriodicalIF":3.1,"publicationDate":"2026-09-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13627438/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119203","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":"Corifollitropin alfa versus daily recombinant FSH for ovarian stimulation in women of advanced maternal age: a cost-minimization analysis in an out-of-pocket setting.","authors":"G N Cecchino, B R Carvalho, Y Ramires, R L P Bueno, L A Lucio, V P Santana","doi":"10.3389/frph.2026.1939114","DOIUrl":"https://doi.org/10.3389/frph.2026.1939114","url":null,"abstract":"<p><strong>Background: </strong>In many countries, Assisted Reproductive Technology (ART) remains funded predominantly out-of-pocket, with no private insurance reimbursement and only limited public provision. For many individuals, the cost of a single ART cycle may exceed monthly income, rendering treatment financially inaccessible. Therefore, even modest differences in medication costs can meaningfully influence treatment initiation and cycle completion.</p><p><strong>Aim: </strong>Given the limited regional evidence and the need for context-specific economic evaluations in Latin America, the present study aims to evaluate the economic impact of using Corifollitropin Alfa (CFA), a long-acting gonadotropin, compared with daily recombinant FSH for controlled ovarian stimulation (COS) in ART treatments in Brazilian women, under the assumption of equivalent clinical effectiveness.</p><p><strong>Method: </strong>A cost-minimization analysis was conducted from a Brazilian private-sector, out-of-pocket patient perspective, following national and international guidelines for healthcare economic evaluations. Medication reference prices, including taxes, were obtained from the official Brazilian regulatory database as of May 2025. Sensitivity analyses were performed to evaluate different gonadotropin dosing strategies in standardized COS protocols for women aged 35-42 years.</p><p><strong>Results: </strong>Across all scenarios tested, CFA was consistently associated with substantial cost reductions compared with daily rFSH. Assuming the equipotency between a single injection of CFA 150 µg and rFSH 300 IU/day for the first 7 days of COS, CFA plus follitropin alfa versus follitropin alfa alone reduced the pharmacological cost by approximately 52.1%. Similarly, CFA plus follitropin beta showed a reduction of approximately 56.3% in medication costs when compared to follitropin beta alone. These findings remained robust across all sensitivity analyses.</p><p><strong>Conclusion: </strong>CFA was associated with substantial pharmacological cost savings of more than 50% when compared to follitropin alfa or follitropin beta, assuming that a single injection of CFA 150 µg is equipotent to daily injections of rFSH 300 IU for the first 7 days of COS. Although further real-world studies are needed to validate and expand on these findings, this analysis provides meaningful evidence to support patient-centered decision-making and healthcare planning in resource-constrained settings.</p>","PeriodicalId":73103,"journal":{"name":"Frontiers in reproductive health","volume":"8 ","pages":"1939114"},"PeriodicalIF":3.1,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624120/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119328","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":"A mobile app compared with an educational pamphlet on menopause hormone therapy initiation: a randomized pilot study.","authors":"Juliana M Kling, Courtney A French, Ekta Kapoor, Mary S Hedges, Margaret M Paul, Yihong Deng, Rajeev Chaudhry, Jamie L Smith, Regina Castaneda, Kristin C Cole, Chrisandra L Shufelt, Arjan Karens, Stephanie S Faubion","doi":"10.3389/frph.2026.1952673","DOIUrl":"https://doi.org/10.3389/frph.2026.1952673","url":null,"abstract":"<p><strong>Background: </strong>Menopause-related symptoms are common but undertreated. Digital tools that support symptom assessment and patient education may improve engagement.</p><p><strong>Objective: </strong>To assess whether a previsit digital menopause symptom assessment and education tool increased treatment initiation and patient engagement compared to an educational pamphlet.</p><p><strong>Design: </strong>Women aged 45-55 years with upcoming primary care appointments were invited to participate. Those with a total Menopause Rating Scale (MRS) score ≥5 indicating bothersome menopause symptoms were included. Participants were randomized to a digital menopause symptom assessment tool or a digital educational pamphlet and completed a post-visit survey (NCT06919887).</p><p><strong>Participants: </strong>Of the 14,726 women invited to participate between May 12, 2025, and December 5, 2025, there were 653 (4.4%) enrolled that met eligibility criteria.</p><p><strong>Interventions: </strong>Randomized to an mHealth app called emmii or a standard digital menopause educational pamphlet.</p><p><strong>Main measures: </strong>Menopause treatment initiation within 30 days of the clinical visit was assessed by electronic health data. Baseline and post-visit surveys were collected assessing patient experience, engagement, and perceived usefulness. Rates of menopause hormone therapy (HT) prescribing were compared with a reference population of nonparticipants aged 45-55 who had a primary care appointment at Mayo Clinic during the same period and received no study education materials.</p><p><strong>Key results: </strong>Of 653 participants enrolled and randomized, 383 completed both the baseline and post-surveys (171 intervention and 212 control). HT initiation among study participants was significantly higher than in the reference population of women (9.3% vs. 4.4%, <i>p</i> < 0.001). There was no difference in HT initiation between the intervention (9.1%) and control groups (9.6%) (<i>p</i> = 0.83). Initiation rates were 3.8% and 4.5%, respectively (<i>p</i> = 0.64) for nonhormone therapies.</p><p><strong>Conclusions: </strong>Among women with bothersome menopause symptoms, those who underwent previsit symptom screening and received educational materials had higher rates of HT initiation than women who did not participate in the study. These findings suggest that structured menopause education may improve recognition and management of menopause symptoms in routine clinical practice.</p>","PeriodicalId":73103,"journal":{"name":"Frontiers in reproductive health","volume":"8 ","pages":"1952673"},"PeriodicalIF":3.1,"publicationDate":"2026-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13624152/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149119255","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}