JBRA assisted reproduction最新文献

Objective: To evaluate the test-retest reproducibility of "chaotic" embryo calls (≥ 6 whole-chromosome abnormalities) by non-invasive preimplantation genetic testing for aneuploidy (niPGT-A) using cell-free DNA (cfDNA) from spent culture medium (SCM), by repeating niPGT-A after embryo warming and short-term reculture, and to discuss implications for diagnostic validity.

Methods: This prospective pilot study included seven vitrified blastocysts previously classified as "chaotic" by niPGT-A. After warming, embryos underwent 4 to 8 hours of individual reculture to enable additional cfDNA release. SCM was collected and processed for repeat niPGT-A using the same whole-genome amplification method (MALBAC), sequencing platform (Illumina MiSeq), and bioinformatic pipeline (ChromGo) employed in the initial test.Laboratory staff were blinded to the original results. An embryo-free negative media control was processed in parallel to monitor environmental contamination. Agreement between the initial and repeat classifications was assessed descriptively.

Results: All cfDNA samples were successfully amplified and generated high-quality sequencing libraries. On repeat analysis, 3/7 embryos (43%) yielded a euploid call. The remaining 4/7 embryos (57%) showed abnormal findings; however, their chromosomal profiles differed from the initial reports, indicating limited agreement for the "chaotic" designation and for individual chromosomal calls.

Conclusions: In this pilot cohort, embryos initially classified as "chaotic" by SCM-based niPGT-A showed substantial discordance upon retesting after warming and short-term reculture. These findings raise concerns about end-to-end reproducibility and support a cautious interpretation of "chaotic" results until larger studies clarify technical from biological sources of discordance and validate SCM calls against embryo tissue and clinical outcomes.

Objective: Fertility awareness has become crucial for informed reproductive decision-making in the context of rising infertility rates, delayed parenthood, and evolving social norms. Research shows that adolescents have limited fertility knowledge, which may lead to poorly informed future reproductive decisions, making adolescence a particularly important period for fertility education. This study assessed fertility knowledge among Portuguese adolescents using an innovative digital assessment tool, the 12-question serious game "MyFActs!". Patterns of fertility knowledge and demographic predictors across multiple fertility dimensions were examined.

Methods: A total of 970 adolescents aged 15-18 years participated in this study. Data were analysed using analysis of variance (ANOVA), chi-square tests, and stepwise binary logistic regression models to examine demographic differences and relationships among fertility knowledge dimensions.

Results: Participants answered a mean of 8.77 qutions correctly (SD=1.88). Significant gender differences were observed, with girls demonstrating greater knowedge than boys in some dimensions. Age-related diffeenes were also found, with older adolescents (17 and 18 years) demonstrating greater knowledge than youner paicipants (15 and 16 years). Binary logistic regrsion analses revealed strong associations among fertility knowledge dmensions.

Conclusion: These findings suggest that fertilty knowedge among Portuguese adolescents remains moeate, with persistent demographic disparities that rquire tareed educational interventions. The interconnected nature of fertility knowledge dimensions supports comprehensive rather than fragmented educational approaches. The sucessful use of the serious-game format demostrates the potential of digital platforms to engage adlecents with sensitive health topics and overcome tradtioal educational barriers.

Objective: To develop and pilot-test TRUST-PAPER, a structured framework for evaluating the methodological trustworthiness of individual studies in assisted reproduction, and to examine whether papers published in higher-impact journals receive higher TRUST-PAPER and Practice Change Confidence (PCC-PAPER) scores than papers published in lower-impact journals.

Methods: Forty original studies in assisted reproduction were assessed using the frozen TRUST-PAPER framework and its complementary PCC-PAPER scale. Twenty papers originated from higher-impact journals and 20 from lower-impact journals. Journal-impact group allocation was disclosed only after all paper-level scores had been assigned and frozen. The primary comparison was TRUST-PAPER score between groups; PCC-PAPER and the association between both constructs were secondary analyses.

Results: Mean TRUST-PAPER was 72.15±9.36 in higher-impact journals and 56.00±12.08 in lower-impact journals (mean difference 16.15, 95% CI 9.22-23.08; Welch p=0.000035; Mann-Whitney p=0.000136; Hedges' g=1.46). Mean PCC-PAPER was 3.90±1.25 versus 2.20±1.20 (difference 1.70, 95% CI 0.92-2.48; Welch p=0.000088). TRUST-PAPER and PCC-PAPER were strongly correlated (Spearman rho=0.868, p<0.001). Score distributions overlapped.

Conclusion: Journal impact was associated with higher average methodological trustworthiness and practice-change confidence, but did not reliably determine the trustworthiness of an individual paper. TRUST-PAPER may complement journal-level prestige metrics by providing an auditable paper-level assessment.

Varicocele remains the most common correctable cause of male infertility and one of the few male-factor conditions in which targeted intervention may improve both sperm quality and reproductive outcomes. Despite a robust body of evidence supporting its clinical relevance, the role of varicocele repair has increasingly been challenged by the widespread dissemination of health misinformation through digital platforms. Simplified narratives frequently suggest that assisted reproductive technologies (ART) have rendered surgical correction obsolete, that varicocelectomy carries significant risk, or that its impact on fertility is minimal. These claims are not supported by contemporary evidence. Microsurgical varicocelectomy, particularly through the subinguinal approach, is associated with a favorable safety profile, including low recurrence rates, minimal hydrocele formation, and an exceptionally low risk of ischemic testicular injury when performed by experienced surgeons. In appropriately selected men with clinical varicocele, infertility, and abnormal semen parameters or elevated sperm DNA fragmentation, repair leads to clinically meaningful improvements in sperm concentration, motility, total motile sperm count, and genomic integrity. These biological changes translate into higher spontaneous pregnancy and live birth rates, as well as improved outcomes in ART, including fertilization, clinical pregnancy, and live birth. In addition to clinical outcomes, varicocelectomy may reduce the need for more invasive and costly reproductive interventions, reinforcing its role as a fertility optimization strategy rather than a competing alternative to ART. Evidence also supports a selective role for varicocele repair in non-obstructive azoospermia, where it may improve sperm retrieval or, in a minority of cases, restore sperm to the ejaculate. The persistence of misinformation highlights the need for critical appraisal and synthesis of the available evidence. This expert opinion provides a comprehensive, pathophysiologically grounded, and quantitatively supported reappraisal of microsurgical varicocelectomy in modern male infertility care, while addressing the impact of health misinformation in the digital era and emphasizing the role of the urologist in evidence-based patient counseling.

Objective: To assess whether the TRUST-MA framework produces reproducible methodological and clinical reliability judgments when independently applied by two large language models.

Methods: In this pilot calibration study, 51 reproductive-medicine meta-analyses published in 2025- 2026 were randomly selected from PubMed. ChatGPT (AI-X) and Claude (AI-Y) independently received the same full articles and available supplements and applied TRUSTMA in July 2026, without access to each other's outputs. Practice Change Confidence (PCC) was introduced during the sequence and was available for a consecutive nested subgroup of 24 cases (cases 27-50). Agreement was evaluated using paired comparisons, intraclass correlation coefficients (ICC), Lin's concordance correlation coefficient, Bland-Altman analysis, and weighted Cohen's kappa.

Results: Mean TRUST-MA scores were 56.21±19.90 for ChatGPT and 64.28±18.22 for Claude. Claude scored 8.07 points higher on average (95% confidence interval [CI], 5.33-10.82; p<0.001). Absolute-agreement ICC was 0.800 (bootstrap 95% CI, 0.698-0.868). Exact A/B/C agreement was 68.6%, with linear weighted κ=0.451. PCC means were identical (3.54 for both models; Wilcoxon p=0.794), with ICC=0.844 (bootstrap 95% CI, 0.541-0.955), exact fivetier agreement of 66.7%, and linear weighted κ=0.653. TRUST-MA and PCC scores were correlated for each evaluator (Spearman ρ=0.677 and 0.631; both p<0.001).

Conclusion: TRUST-MA and PCC showed good scorelevel reproducibility across independent AI evaluators. However, systematic calibration differences in TRUST-MA scores and only moderate categorical agreement preclude treating the models as interchangeable. Standardized version reporting, threshold rules, and human adjudication remain necessary.

Objective: Excess body weight is associated with subfertility and delayed conception, yet its effect on in vitro fertilization (IVF) outcomes in women with preserved ovarian reserve remains uncertain. This study examined the impact of overweight and obesity on IVF outcomes.

Methods: This retrospective cohort study included 159 infertile women aged 20-35 years who underwent IVF between December 2022 and May 2025. All participants had adequate ovarian reserve (anti-Müllerian hormone ≥1 ng/mL and antral follicle count ≥5) and infertility due to polycystic ovary syndrome, mild male factor, tubal factor, or unexplained causes. Based on body mass index (BMI), women were classified as normal weight, overweight, or obese. All patients received a standardized long agonist ovarian stimulation protocol. Study outcomes included gonadotropin dose, stimulation duration, number and quality of oocytes and embryos, fertilization rates, clinical pregnancy rates per initiated cycle and per embryo transfer, and cycle cancellation rates. Multivariable regression analyses adjusted for age, AMH, and AFC were performed.

Results: Baseline characteristics were comparable among groups. Obese women required significantly higher gonadotropin doses and exhibited poorer ovarian response, with fewer retrieved and mature oocytes, reduced high-quality embryo yield, and lower fertilization rates. Clinical pregnancy rates declined with increasing BMI, while cycle cancellation rates were significantly higher in obese patients. Overweight status showed no independent adverse effect after adjustment.

Conclusion: In women with preserved ovarian reserve, obesity independently impairs ovarian response, embryo development, and IVF success, whereas overweight does not. Weight optimization before IVF may improve treatment outcomes.

This pragmatic narrative review provides a phenotype-informed framework for counseling and managing women with endometriosis undergoing IVF/ICSI, with emphasis on cumulative live birth and preservation of ovarian reserve. A focused literature search was conducted in PubMed/MEDLINE, Scopus, and Google Scholar, covering studies published from 2021 to 2026 and including selected earlier landmark studies when relevant. Evidence was synthesized according to disease phenotype, the presence of adenomyosis, prior surgery, and key reproductive outcomes, including ovarian response, embryo cohort size, implantation, and cumulative live birth. Endometriosis appears to act predominantly as a quantitative ovarian constraint, characterized by reduced anti-Müllerian hormone levels, lower antral follicle count, and decreased oocyte yield, particularly in women with ovarian endometrioma or prior cystectomy. Fertilization and embryo competence are generally preserved, suggesting that the main limitation is embryo cohort size rather than intrinsic embryo quality. Implantation may be modestly impaired in selected phenotypes, especially in the presence of adenomyosis, whereas live birth per transfer may remain broadly comparable after adjustment. Adenomyosis is heterogeneous, and its variable presentation may influence reproductive outcomes and treatment response. Endometriosis does not preclude successful IVF/ICSI. Counseling should therefore emphasize cumulative outcomes, preservation of ovarian reserve, and avoidance of unnecessary ovarian surgery within a pragmatic, phenotype-informed management strategy.

We report a rare case involving a 34-year-old woman with a 3-year history of recurrent pregnancy loss (RPL), referred to our infertility center for comprehensive evaluation, which included patient history, physical and ultrasound examination, diagnostic hysteroscopy, laparoscopy and histopathological analysis. A complete Müllerian anomaly (U2bC2V1) and a hemorrhagic cyst located in the isthmic portion of the left fallopian tube were diagnosed, with no signs of endometriosis or pelvic inflammation. The cyst was laparoscopically drained and excised. A congenital cystic dilatation of the fallopian tube was suspected. RPL can be associated with congenital Müllerian anomalies, but the current classifications do not take tubal anomalies into account. The presence of a coexisting proximal tubal lesions is rare and may contribute to infertility. This case highlights a rare association between a complete Müllerian anomaly and a proximal hemorrhagic tubal cyst with impaired ipsilateral tubal patency. Further research on tubal anomalies would be valuable.

Objective: Obesity is a major metabolic condition linked to reduced fertility. Excess adipose tissue disrupts the neuroendocrine axis and impairs several reproduc-tive processes. Evidence shows that, even when assisted reproductive technologies are used, women with obesity experience lower oocyte recovery, fewer viable embryos, and higher rates of miscarriage and gestational complica-tions. This study evaluated the relationship between obe-sity and female infertility by analyzing in vitro fertilization outcomes.

Methods: This quantitative, cross-sectional, retro-spective study included all in vitro fertilization cycles per-formed at a private assisted reproduction clinic in Goiânia between January and December 2022. Ethical approval was obtained from the Research Ethics Committee. After applying the inclusion and exclusion criteria, 226 cycles from women aged 24-46 years were analyzed. Logistic regression models were used to assess associations be-tween maternal and paternal body mass index and in vitro fertilization outcomes, as well as metabolic comorbidities, gestational, intrapartum, and neonatal complications, and miscarriage, prematurity, and newborn birth weight.

Results: Women with overweight (body mass index ≥25kg/m2) were 2.4 times more likely to develop gesta-tional complications (odds ratio, 2.42; 95% confidence in-terval, 1.048-5.598) and 2.8 times more likely to develop neonatal complications (odds ratio, 2.80; 95% confidence interval, 1.712-6.70) compared with eutrophic women. No other significant association was identified.

Conclusion: Higher maternal body mass index was as-sociated with increased gestational and neonatal compli-cations, but not with in vitro fertilization success. Further research using broader clinical and anthropometric indica-tors is needed to better characterize the impact of obesity and to guide preventive strategies.