Adequate thyroid hormone production is critical for fertility and the successful maintenance of pregnancy. Thyroid autoimmunity (TAI), characterized by the presence of thyroid peroxidase antibodies (TPOAb) and anti-thyroglobulin antibodies (TgAb), is the most common cause of thyroid dysfunction in women of reproductive age. The association between TAI and adverse reproductive outcomes, including infertility and pregnancy complications, has garnered significant attention, particularly in the context of assisted reproductive technology (ART).
This study is a systematic review and meta-analysis designed to examine the relationship between TAI and outcomes of ART. A comprehensive literature search was conducted in PubMed, Scopus, and Web of Science databases to identify relevant studies published up to May 1, 2022. In addition, articles published between May 2022 and May 2025 were included, along with earlier studies that were part of previous meta-analyses or provided novel and relevant findings. Studies were eligible for inclusion if they compared ART outcomes between women with TAI (defined by the presence of TPOAb and/or TgAb) and euthyroid women without thyroid autoantibodies. Evaluated outcomes included clinical pregnancy, miscarriage, live birth, implantation, and fertilization rates (FR). Statistical analysis was conducted using STATA version 18, with pooled odds ratios (ORs) and 95% confidence intervals (CIs), calculated using a random-effects model. Study heterogeneity was assessed using the I2 statistic.
A total of 30 studies were included in the meta-analysis to assess the association between TAI and ART outcomes. TAI was not significantly associated with clinical pregnancy rate (CPR) (OR: 0.91; 95% CI: 0.76–1.08), miscarriage rate (MR) (OR: 1.13; 95% CI: 0.93–1.38), or live birth rate (LBR) (OR: 0.97; 95% CI: 0.78–1.22). However, significant negative associations were found between TAI and both implantation rate (IR) (OR: 0.82; 95% CI: 0.72–0.93) and FR (OR: 0.87; 95% CI: 0.83–0.90). Subgroup analysis revealed a more pronounced adverse effect of TAI on CPR among women undergoing in vitro fertilization (IVF) compared to intracytoplasmic sperm injection (ICSI). These findings suggest TAI may impair specific ART outcomes, particularly embryo implantation and fertilization.
Autoimmune thyroid disease may affect certain ART outcomes, such as a reducing FR; however, no significant difference was observed in LBRs, suggesting that it may not significantly impact the overall success of ART in terms of live births. Monitoring thyroid function in women with TAI undergoing ART is recommended by multiple endocrinology society guidelines and may offer significant clinical beneficial. This includes assessing thyroid-stimulating hormone (TSH) levels at the time of the second positive human chorionic gonadotropin (hCG) result, which confirms pregnancy.
The study has been registered on https://www.crd.york.ac.uk/prospero/ (registration number: CRD42023488835; registration link: https://www.crd.york.ac.uk/PROSPERO/view/CRD42023488835).
To evaluate the efficacy of immunochemotherapy in advanced triple-negative breast cancer (aTNBC) or metastatic triple-negative breast cancer (mTNBC) by assessing overall survival (OS) and progression-free survival (PFS).
Randomized controlled trials (RCTs) of immunochemotherapy in aTNBC or mTNBC were identified through a systematic literature search from different databases. The primary endpoint included OS and PFS. Grade 3/4 adverse events were included in the toxicity analysis, with 95% confidence intervals (CIs) retrieved into the meta-analysis for hazard ratios (HRs).
A total of 7 publications with 3287 patients with aTNBC or mTNBC were enrolled. In the programmed death ligand 1 (PD-L1)-positive aTNBC or mTNBC population, immunochemotherapy was associated with significantly improved PFS than chemotherapy alone ([hazard ratio] HR = 0.84; 95% CI: 0.78–0.91; p < 0.0001). In the intention-to-treat population, immunotherapy effectively prolonged PFS in aTNBC or mTNBC patients (HR = 0.91; 95% CI = 0.88–0.94; p < 0.00001), and OS benefits were limited to combined positive score (CPS) ≥10/20 subgroups. Although immunochemotherapy was found to have some efficacy on PD-L1-positive patients, the improvement in OS was not statistically significant in either population (HR = 0.93; 95% CI = 0.82–1.05; p = 0.24; HR = 0.96; 95% CI = 0.92–1.01; p = 0.09). Regarding adverse events, immunochemotherapy was not associated with a significantly different risk compared to placebo or chemotherapy alone (HR = 0.91; 95% CI = 0.43–1.92; p = 0.73).
PD-L1 inhibitors prolong PFS in PD-L1-positive patients, with a greater effect observed in those with higher CPS.
The study has been registered on https://www.crd.york.ac.uk/prospero/ (registration number: CRD420251067972; registration link: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251067972).
This review aims to examine the nature of financial toxicity (FT) in patients with gynecologic cancers, including its occurrence, temporal trends, contributing factors, associated consequences, assessment methodologies, and coping strategies. Additionally, it discusses future directions for health policy and system-level interventions to address FT.
FT primarily arises from the significant out-of-pocket expenses associated with cancer care, together with income loss due to medical leave. It is driven by multilevel systemic factors (policy, payer, provider levels), and it is further exacerbated by intervenable, patient-level factors within clinical care delivery process.
Approximately 50% of patients with gynecologic oncology (GO) experience FT. This is associated with reduced quality of life, impaired treatment adherence, and poorer overall survival outcomes. FT disproportionately affects socioeconomically disadvantaged populations and leads to poorer economic stability and adverse health outcomes. The literature addresses the prevalence, temporal trends, contributing factors, associated consequences, and available assessment methodologies for FT. Feasible strategies to mitigate FT include early screening, provision of financial assistance and counseling, consideration of the treatment cost and value in clinical decision-making, and improved access to resources.
FT is a prevalent and serious concern in GO, with significant impacts on patient well-being and outcomes. Although systemic factors are the primary drivers, actionable patient-level interventions can mitigate FT within clinical settings. Future efforts should prioritize health insurance reforms to expand coverage and reduce under-insurance, as well as health system strategies that restrict and ineffective high-cost spending, while targeting services to high-risk GO populations.
Red blood cell distribution width (RDW) is associated with inflammation and oxidative stress. This study investigated the predictive value of RDW for hypertensive disorders of pregnancy (HDP).
This retrospective cohort study, using propensity score matching (PSM), included 1546 women admitted to the West China Second University Hospital between January 2021 and January 2022. Univariate logistic regression analysis was performed on variables that remained unbalanced after PSM. Receiver operating characteristic (ROC) curves were used to assess the predictive ability of RDW for HDP.
Following a 1:1 PSM, the analysis enrolled two cohorts: a simple hypertension group (n = 420) with a matched control group (n = 420), and a preeclampsia group (n = 353) and a matched control group (n = 353). Univariate logistic regression analysis revealed no significant association between RDW and simple hypertension (gestational or chronic); however, a significant correlation was observed between RDW and preeclampsia. ROC curve analysis demonstrated that the coefficient of variation of RDW predicted severe preeclampsia with 72% diagnostic accuracy, with a cutoff value of ≥14.65% and area under the curve (AUC) of 0.696. Additionally, the RDW standard deviation (RDWSD) predicted severe preeclampsia with 76% diagnostic accuracy, with a cutoff value of ≥51.85 fL and AUC of 0.661.
Although RDW is a significant independent predictor of preeclampsia, its diagnostic performance is moderate. Due to its speed, low cost, and wide availability, RDW is best utilized as an auxiliary component in combinatorial risk models or multi-marker panels, augmenting established predictors.
Psychological stress in infertile individuals undergoing artificial insemination with their husband’s sperm (AIH) remains understudied, despite its potential impact on reproductive outcomes. The current study aimed to evaluate the prevalence, influencing factors, and effects of psychological stress on conception success in a population undergoing AIH.
This retrospective cohort study analyzed data from 976 patients treated between June 2020 and January 2024. Standardized psychological assessments were used to evaluate anxiety, depression, somatic symptoms, and sleep quality. These included generalized anxiety disorder 7-item (GAD-7), patient health questionnaire 9-item (PHQ-9), patient health questionnaire 15-item (PHQ-15), and the Pittsburgh Sleep Quality Index. Logistic regression analysis was performed to identify predictors of stress and their association with clinical pregnancy rates.
Younger age (<30 years) was significantly correlated with higher anxiety (odds ratio (OR) = 1.801, p = 0.012). Whilst, unemployment (OR adjusted = 2.183, p = 0.002) and prolonged duration (3–5 years) of infertility (OR adjusted = 1.445, p = 0.014) were significantly correlated with somatic symptoms. Moreover, unemployment (OR adjusted = 2.020, p = 0.008) and prolonged duration (≥5 years) of infertility (OR adjusted = 1.780, p = 0.008) were also significantly correlated with sleep disorders. However, no direct links were found between anxiety, depression, somatic symptoms or sleep quality and conception outcomes.
Our findings highlight the need to target psychological interventions for specific populations, including younger individuals, unemployed persons, and patients experiencing prolonged infertility.
Pelvic pain is a significant public health problem that reduces the quality of life of women during and after pregnancy, and may have lasting effects on maternal and fetal health. The aim of this study was to investigate the multidimensional impact of pelvic pain during pregnancy and postpartum on long-term physical activity levels, functional limitations, and fatigue in women.
This prospective longitudinal study was conducted on pregnant women (n = 180) who attended gynecology and obstetrics outpatient clinics at three provincial hospitals in the Central Anatolia region of Turkey between June 2022 and December 2023. Data were collected using the visual analog scale (VAS), pelvic girdle questionnaire (PGQ), pregnancy physical activity questionnaire (PPAQ), and multidimensional assessment of fatigue (MAF). These scales were evaluated during the first, second, and third trimesters of pregnancy, and again during the postpartum period. Data were analyzed using descriptive statistics, normality tests, ANOVA, Bonferroni multiple comparison tests, linear regression, and multiple linear regression analyses.
As pregnancy progressed, VAS scores increased, PGQ scores increased significantly during the postpartum period, PPAQ scores gradually decreased, and MAF scores increased (p < 0.05). Correlations were found between VAS, PGQ, PPAQ, and MAF. Multiple regression analysis showed that decreased physical activity and increased fatigue were statistically associated with pelvic pain (R2 = 0.413); however, the overall regression model was not statistically significant (p > 0.05).
This study found that pelvic pain persists beyond pregnancy, significantly impairing the physical functioning and energy levels of affected women. The development of individualized and holistic rehabilitation programs during pregnancy may be effective in maintaining and improving the mother’s quality of life postpartum.
Balloon tamponade is an effective intervention for managing postpartum hemorrhage, particularly in resource-limited settings. However, cervical relaxation during balloon insertion may cause balloon slippage, resulting in placement failure. This complication is associated with increased blood loss, a higher risk of hysterectomy, and unnecessary use of resources.
We conducted a retrospective analysis of 10 patients who underwent modified cervical cerclage balloon fixation combined with cervical clamping for postpartum hemorrhage complicated by balloon slippage. These patients were treated between January 1, 2021, and January 1, 2024, at two hospitals in Cheng Du and Xizang, China. The primary outcome was successful hemostasis following intervention. Secondary outcomes included perioperative blood loss and drainage volume. Data analysis was performed using descriptive statistics and the Shapiro-Wilk test.
The modified method was applied in 10 patients. Hemostasis was successfully achieved in 9 of 10 cases (90%). In 1 patient, additional uterine artery embolization was required due to an arteriovenous fistula.
Modified cervical cerclage balloon fixation combined with cervical clamping is an effective and low-cost approach for preventing balloon slippage in appropriate clinical settings.
Urinary dysfunction is a common complication following vaginal delivery, yet the lack of a standardized assessment system results in delayed diagnosis and suboptimal treatment. This study aims to develop a novel urinary function grading system to evaluate the urogynecological impact of childbirth, identify associated risk factors, and guide the development of evidence-based, targeted nursing interventions.
In this prospective observational study, 370 primiparous women who experienced spontaneous vaginal delivery at Nanfang Hospital between 1 January 2020 and 1 January 2021 underwent systematic urological evaluations during hospitalization and at a 6-week follow-up. Urinary function was graded (Ⅰ–Ⅳ) based on post-void residual (PVR) volume and clinical symptoms: Grade I, normal function (PVR <50 mL without voiding dysfunction); Grade II, mild dysfunction (urinary frequency with PVR <50 mL); Grade III, moderate dysfunction (PVR >50 mL); and Grade IV, severe dysfunction (urinary retention requiring catheterization or stress urinary incontinence [SUI]). Urodynamic parameters, including urinary interval, urine volume, initiation time, and voiding duration, were collected for statistical analysis.
Progressive deterioration of urinary parameters was significantly associated with increasing severity grades (I–III) (all p < 0.001). On postpartum day 1, 74.054% of women exhibited urinary dysfunction, which declined markedly over time. By day 14 postpartum, 10.270% of women developed SUI, with a higher proportion initially classified as Grade I (84.211%). The age, neonatal weight, total duration of labor, operative vaginal delivery, episiotomy, and labor analgesia were significantly associated with urinary function grading (all p < 0.05). Among these, prolonged labor, labor analgesia, and operative vaginal delivery emerged as independent risk factors for Grade IV urinary dysfunction (all p < 0.05).
The grading system enables risk-stratified management of postpartum urinary function, promoting early identification and timely intervention for urinary dysfunction. Clinically, emphasis should be placed on managing high-risk factors and providing targeted nursing care to mitigate the impact of vaginal delivery on maternal urinary function. Further studies are needed to validate and refine this grading system.
Intramural pregnancy (IMP) is an extremely rare subtype of ectopic pregnancy, defined by the implantation of the gestational sac within the uterine myometrium, with no communication to the endometrial cavity, fallopian tubes, or uterine serosa. Compared with the other common ectopic pregnancies, IMP accounts for less than 1% of all ectopic cases, rendering it diagnostically challenging in clinical practice. Meanwhile, IMP carries substantial risks stemming from its atypical location, including uterine rupture, life-threatening hemorrhage, and maternal mortality, which underscores the critical need for early recognition. However, IMP is often missed in timely diagnosis due to its nonspecific clinical presentation and overlapping ultrasonic imaging features with other conditions such as cornual pregnancy and subserosal pregnancy. Transvaginal three-dimensional ultrasound (TDU) and magnetic resonance imaging (MRI) can clearly delineate the relationship between the gestational sac, uterine myometrium, and serosa, thereby enabling timely detection of early-stage IMP and informing clinical management.
A 27-year-old Gravida 2, Para 1 (G2P1) woman experienced 44 days of amenorrhea, accompanied by lower abdominal pain and irregular vaginal bleeding. Emergency transvaginal ultrasound examination indicated that the gestational sac was located in the left uterine horn, with dimensions of approximately 21 mm × 16 mm × 11 mm, suggesting a possible left uterine horn pregnancy, which was inconsistent with the successive results by TDU and magnetic resonance (MR) suggesting a uterine IMP. Subsequently, the intramural uterine tissue was removed by laparoscopy, and finally it was confirmed by pathological findings to be a uterine IMP.
IMP is rare and can have severe consequences if not treated promptly. TDU and MR are beneficial for early and accurate diagnosis, facilitating timely clinical treatment.
When considering laparoscopic surgery for ovarian cysts (OCs), physicians must preoperatively differentiate benign ovarian tumours (Be-OTs) from other tumours, primarily based on magnetic resonance imaging (MRI) findings. Ovarian endometriotic cysts (OECs) and ovarian mature cystic teratomas (OMCTs) can typically be identified with high accuracy using MRI. However, OCs other than OECs and OMCTs may show borderline/malignant OT (Bo/Ma-OT) features on postoperative pathology, even when no suspicious solid components are detected preoperatively. Therefore, the aim of this study was to retrospectively analyse the data of 239 patients over a 15-year period at our institution to explore the potential for preoperative prediction of Bo/Ma-OT.
From July 1, 2010 and December 31, 2024, 239 patients who underwent laparoscopic surgery for preoperatively diagnosed serous/mucinous OCs (Se/Mu-OCs) were retrospectively analysed. Among them, 26 cases, including 23 borderline and 3 malignant tumours identified on postoperative pathological examination, were the primary focus of this study. To evaluate the influence of 16 factors, including MRI findings, tumour markers, and basic patient characteristics, both univariate and multivariate analyses were performed.
According to the results of the chi-square test and multivariate analysis, none of the factors was significantly associated with an increased likelihood of Bo/Ma-OT.
Preoperative prediction of Bo/Ma-OT in patients undergoing laparoscopic surgery for Se/Mu-OCs remains challenging. Further accumulation of cases and continued analysis will be necessary.
Urodynamic studies (UDS) are diagnostic tools used to evaluate urinary function and guide the management of conditions such as detrusor overactivity (DO) and urodynamic stress incontinence (USI), both of which significantly affect the quality of life of patients. Despite their clinical importance, comprehensive data on the relationship between these outcomes and pelvic organ support are lacking. Pelvic organ prolapse (POP), commonly assessed using the standardized pelvic organ prolapse quantification (POP-Q) system, is frequently associated with lower urinary tract symptoms (LUTS). This study aimed to determine the correlation between POP-Q classification and UDS findings and to investigate the association of different types of POP with DO and USI.
This prospective observational cohort study encompassed women presenting to or referred to the Urogynecology Clinic at King Saud University Medical City, Riyadh, Saudi Arabia. Consecutively enrolled women underwent comprehensive clinical evaluations, including medical history, pelvic examination using the POP-Q system, and standardized urodynamic testing. Chi-square and analysis of variance (ANOVA) tests were used to examine the correlation between anatomical findings and urodynamic parameters, including bladder capacity, post-void residual (PVR), maximum flow rate (Q-max), flow time, time to maximum flow, first desire to void, and strong desire to void. Statistical significance was defined as p < 0.05. Multiple linear regression (MLR) was used to determine the independent predictors of each UDS diagnosis.
Out of the 153 women included, 127 had POP, among whom 74% experienced USI. The most frequent types of POP were anterior (92.1%) and posterior (91.3 %) vaginal wall prolapses, whereas apical prolapse was less frequent (39.4%). Among those with apical prolapse, a significant correlation was observed with time to maximum flow (p = 0.050), even in the earlier stages. A significant association was observed between anterior prolapse and PVR (p = 0.026). Posterior prolapse was significantly correlated with Q-max (p = 0.014) and flow time (p = 0.046). These findings indicate that some elements obstruct the urine outflow. No significant correlations were observed between the USI or DO and the different stages of apical (p = 0.51; p = 0.60), anterior (p = 0.40; p = 0.80), or posterior prolapse (p = 0.55; p = 0.59). The presence of a history of stress incontinence was associated with a four times greater likelihood of the presence of USI in UDS.
This study showed that different stages and types of POP were linked with certain urodynamic findings, suggesting the presence of partial urine outflow obstruction might occur. These findings indicate complex clinical interactions that require personalized management. Recognizing these associations enables clinicians to tailor individualized interventions, such as pessary use, pelvic floor physical therapy, or surgical correction, based on the affected compartment involved and the urodynamic profile, thereby improving symptom control and patient outcomes.
Heterotaxy syndrome is characterized by abnormal organ arrangement across the left-right (L-R) axis, often leading to complex congenital heart defects (CHDs). Genetic analysis via whole-exome sequencing revealed two novel compound heterozygous mutations in the polycystic kidney disease 1 like 1 (PKD1L1) gene (NM_138295.3: c.6659T>A and c.8104dup). These genetic alterations are implicated in the abnormal development of the L-R axis, contributing to the severe cardiac malformations observed.
This case report describes a Chinese fetus diagnosed with heterotaxy and severe cardiac anomalies identified through prenatal ultrasound.
Our results expand the known spectrum of PKD1L1 mutations and highlight the importance of genetic testing in prenatal diagnosis of heterotaxy. These findings emphasize the value of genetic testing in informing clinical decisions and guiding reproductive counseling.
The birth outcomes of neonates born to mothers with polycystic ovary syndrome (PCOS) following intrauterine insemination (IUI) remain unclear, as do the correlations with pregravid maternal characteristics, thus warranting further investigation.
Data were collected on mothers with PCOS (PCOS group, n = 101), including the birth outcomes of their offspring. Mothers without PCOS (non-PCOS group, n = 204) and their offspring served as the control group. The two groups were analyzed for correlations between neonatal birth outcomes and pregravid maternal characteristics using univariate analysis, Spearman rank correlation, and logistic regression models.
In the PCOS group, maternal body mass index (BMI) was a positive predictor of neonatal complications, independent of confounding factors (unadjusted odds ratio [OR] = 1.28, p = 0.03; adjusted OR = 1.30, p = 0.04). However, no significant association was found between maternal BMI and neonatal complications in the non-PCOS group (unadjusted OR = 1.06, p = 0.34; adjusted OR = 1.02, p = 0.71). Compared to non-PCOS mothers, each one-unit increase in the BMI among PCOS mothers was associated with a 1.30-fold increased risk of adverse neonatal complications. Secondly, maternal BMI was a positive predictor of caesarean section delivery in the PCOS group, independent of confounding factors (unadjusted OR = 1.25, p = 0.006; adjusted OR = 1.28, p = 0.005). Maternal BMI was also a positive predictor for caesarean section delivery in the non-PCOS group, independent of confounding factors (unadjusted OR = 1.15, p = 0.004; adjusted OR = 1.14, p = 0.014). However, the adjusted OR in the PCOS group was higher than that observed in the non-PCOS group (OR = 1.28 vs. OR = 1.14).
The co-occurrence of elevated maternal BMI and PCOS may be associated with an elevated risk of neonatal complications and delivery by caesarean section following IUI. Mothers with PCOS are advised to maintain a healthy pregravid BMI in order to minimize the risk of adverse neonatal complications.
The study investigated the effectiveness of a modified enhanced recovery after surgery (mERAS) protocol in emergency cesarean deliveries (CDs), where its safety and applicability remain uncertain. Postoperative recovery was evaluated in pregnant women using the Thai version of the Quality of Recovery-35 (QoR-35) questionnaire and pain scores measured by the Visual Analogue Scale (VAS).
50 pregnant women were enrolled in a randomized controlled trial conducted at the Medical Education Center of Phayao Hospital. The primary outcomes were the 24-hour QoR-35 score and the 48-hour VAS pain score. Additional parameters, including postoperative hospital stay, opioid use, and the onset of gastrointestinal function, were also assessed. Postoperative complications, such as fever, wound dehiscence, and readmission, were also evaluated.
The mERAS group showed a significant reduction in 48-hour postoperative VAS scores (mean ± standard deviation [SD]: 4.0 ± 1.7 vs. 5.0 ± 1.3; mean difference: 1.0, 95% confidence interval [CI] 0.14, 1.86, p = 0.024). No significant differences were observed between the two groups in assessments conducted immediately postoperatively or at 24 hours across all parameters. The mERAS group experienced shorter hospital stays (p = 0.017), earlier onset of burping (p = 0.049), and earlier onset of flatulence (p = 0.011). Neither group required additional opioid administration or experienced postoperative complications, such as fever, wound dehiscence, or readmission.
Implementation of the mERAS protocol effectively reduced 48-hour postoperative VAS pain scores, shortened hospital stay, and improved patient outcomes without increasing morbidity or surgical complications in patients undergoing emergency CD.
The study has been registered on https://www.thaiclinicaltrials.org/ (registration number: TCTR20250627001; registration link: https://www.thaiclinicaltrials.org/export/pdf/TCTR20250627001).
Cervical polyps are often associated with localized inflammatory foci, which may be detected during pregnancy. In symptomatic cases, polypectomy currently represents the primary therapeutic intervention. However, the impact of cervical polyps on pregnancy outcomes and the clinical significance of cervical polypectomy remain subjects of ongoing debate. This study aimed to investigate the relationship between cervical polyps and pregnancy outcomes, focusing on spontaneous preterm birth (SPTB) and late miscarriage, and to evaluate the association of polypectomy with these outcomes. This retrospective study was conducted at a tertiary university-affiliated women’s hospital.
The study included 9990 consecutive women who underwent vaginal delivery, with or without cervical polyps, over a 12-month period from January to December 2021. All patients had undergone gynecological examination and transvaginal ultrasonography during early pregnancy. The diagnosis of cervical polyps in early pregnancy (4–12 gestational weeks) was determined through gross clinical inspection and confirmed by transvaginal ultrasound. Polypectomy should be considered in cases of heavy vaginal bleeding, secondary infection, excessively long polyps or prolapse of the vaginal orifice, and when cervical malignancy is strongly suspected. The associations of cervical polyps or polypectomy with late miscarriage and SPTB were evaluated using comparative analysis, as well as univariate and multivariate logistic regression.
A comparative analysis of pregnancy outcomes was performed between two groups: 94 (0.94%) cases with cervical polyps detected in the first trimester and 9896 cases without cervical polyps. The incidence of late miscarriage and SPTB was significantly higher in the polyp group than in the non-polyp group. Multivariate analysis revealed that cervical polyps in first trimester pregnancy was a significant independent risk factor for both late miscarriage (odds ratio [OR]: 96.94, 95% CI: 34.88–269.49, p < 0.001) and SPTB before 28 (OR: 31.48, 95% CI: 11.48–86.32, p < 0.001), 34 (OR: 26.13, 95% CI: 11.58–58.94, p < 0.001), or 37 (OR: 5.13, 95% CI: 2.59–10.17, p < 0.001) weeks of gestation. Our analysis demonstrated comparable pregnancy outcomes between the polypectomy and non-polypectomy groups, with no statistically significant association observed between cervical polypectomy and pregnancy outcomes in this cohort. Vaginal bleeding was identified as an independent protective factor for SPTB before 34 weeks of pregnancy in these patients (OR: 0.27, 95% CI: 0.09–0.83, p = 0.023).
Cervical polyps detected during the first trimester were associated with a significantly increased risk of both late miscarriage and SPTB; however, polypectomy did not significantly improve in pregnancy outcomes.
The impact of previous embryo transfer failure on pregnancy outcomes following assisted reproductive technology (ART) treatments remains unclear. Thus, this study aimed to compare pregnancy outcomes between elective single blastocyst transfer (SBT) and double high-quality cleavage embryo transfer (DC-ET) after failure with SBT in the first embryo transfer cycle.
A total of 263 women who underwent a second frozen-thawed embryo transfer (FET) after failure with the SBT in the first embryo transfer cycle, from January 1, 2021 to December 31, 2023 at the Reproductive Medical Center of Peking University Shenzhen Hospital, were included. Patients were divided into the DC-ET and SBT groups based on the number and developmental stage of the embryos transferred. Clinical characteristics and pregnancy outcomes, including clinical pregnancy rate, live birth rate, embryo implantation rate, multiple pregnancy rate, and pregnancy loss rate, were retrospectively analyzed.
Baseline characteristics were similar between the DC-ET (n = 122) and SBT (n = 141) groups. However, the number of available blastocysts was significantly lower in the DC-ET group, as fewer embryos underwent blastocyst culture, whereas the implantation rate was significantly higher in the SBT group than in the DC-ET group (48.94% vs. 30.74%; p < 0.001, adjusted p = 0.002; odds ratio (OR): 2.023, 95% confidence interval (CI): 1.300–3.149). However, no differences were observed in clinical pregnancy rate, live birth rate, or pregnancy loss rate between the groups. The multiple pregnancy rate was significantly lower in the SBT group than in the DC-ET group (2.90% vs. 20.63%; adjusted p = 0.007; OR: 0.113, 95% CI: 0.023–0.549).
SBT results in similar pregnancy outcomes as DC-ET but carries a lower risk of multiple pregnancy after failure with SBT.
The association between parity and adverse outcomes has been a concern for decades; however, attention to the subgroups of low multiparity has not been adequately studied.
A retrospective study was conducted to examine the differences in maternal and neonatal outcomes among low-level multiparity subgroups, specifically women in their second, third, and fourth labors, who delivered between January 2012 and December 2016. Pregnancy outcomes were compared based on parity (second, third, and fourth labor).
A total of 1584 women were evaluated, of which 904 (57%) were in their second labor, 499 (31.5%) were in their third labor, and 181 (11.5%) were in their fourth labor. Women undergoing their second labor were younger than those in their third or fourth labors (29.6 vs. 32.3 or 32.7 years, respectively; p < 0.0001). Moreover, epidural analgesia was more common among women in their second labor compared to women in their third or fourth labor (70.0% vs. 59.5% or 52%, respectively; p < 0.0001). Women in their second labor were more likely to have a longer labor, compared to women in their third or fourth labor (8.50 vs. 7.46 and 6.24 hours, respectively; p < 0.05), and to have a higher rate of cesarean delivery (CD) compared to those in their third or fourth labor (13.2% vs. 7.8% or 6.1%, respectively; both cases, p < 0.01). There were no statistical differences in the rate of adverse outcomes between the third and fourth labor groups.
Women in their second labor were more likely to have longer labor durations and a higher risk of CD compared to women in their third or fourth labor. No difference in rates of adverse outcomes was noted between the third and fourth labors.
Patients with diminished ovarian reserve (DOR) face challenges such as inadequate follicular recruitment and decreased oocyte quality when subjected to in vitro fertilization and embryo transfer (IVF-ET) treatment.
This retrospective self-controlled study included 130 patients with DOR who underwent IVF-ET using either the progestin-primed ovarian stimulation (PPOS) or luteal-phase ovarian stimulation (LPOS) protocol. In the PPOS protocol, ovarian stimulation was initiated in the early follicular phase with medroxyprogesterone acetate (MPA) combined with gonadotropins. In the LPOS protocol, ovarian stimulation began in the luteal phase with letrozole and gonadotropins, followed by dydrogesterone. Final oocyte triggering, retrieval, and embryo culture were performed using standardized procedures. The primary outcomes included gonadotropin consumption, oocyte maturation and fertilization rates, as well as pregnancy-related outcomes.
Compared to the LPOS group, the PPOS protocol was associated with a significantly shorter duration of gonadotropin stimulation and a lower total gonadotropin dose (p < 0.05). The LPOS group did not have significantly higher metaphase II (MII) oocyte and normal fertilization rates (p > 0.05). The abnormal fertilization rate was numerically lower in the LPOS group, but the difference was not statistically significant. Multivariate logistic regression analysis revealed that the LPOS protocol remained independently associated with a higher MII oocyte rate (adjusted odds ratio [aOR]: 1.42, 95% confidence interval [CI]: 1.07–1.91, p = 0.017), even after adjusting for age, body mass index (BMI), and antral follicle count (AFC). No significant association was observed between stimulation protocol and clinical pregnancy after adjustment.
Both PPOS and LPOS protocols effectively prevent premature luteinizing hormone (LH) surges and support the development of viable embryos in patients with DOR. Multivariate analysis further confirmed LPOS as an independent predictor of improved oocyte maturity, suggesting its potential utility in individualized stimulation strategies for this patient population.
Intrauterine infection poses significant risks to both mother and fetus, especially in cases of premature rupture of membranes (PROM). Early and accurate diagnosis is crucial for timely intervention.
This was a prospective study involving 120 patients with PROM, including 32 cases diagnosed with intrauterine infection and 88 non-infected controls. Parameters such as serum beta-human chorionic gonadotropin (β-hCG), serum ferritin (SF), and gestational age (GA) were evaluated for their diagnostic efficacy using logistic regression and receiver operating characteristic (ROC) analysis.
A total of 120 patients were analyzed, with 32 (26.67%) diagnosed with intrauterine infection. Infected patients exhibited significantly higher median β-hCG (43,104.00 vs. 22,375.00 mIU/mL; p < 0.0001) and SF (34.14 vs. 27.81 ng/mL; p = 0.0020), and a shorter mean gestational age (38.63 vs. 37.78 weeks; p = 0.0040). Furthermore, the logistic regression analysis established these as independent predictors, with significant ORs for log10-β-hCG (22.41; p = 0.0010), log10-SF (6.45; p = 0.0300), and gestational age (0.61; p = 0.0300). The combined testing approach, particularly the integration of log10-β-hCG, log10-SF, and GA, showed superior diagnostic efficacy, achieving an ROC area under the curve of 0.78, with significantly enhanced sensitivity and specificity.
The combined testing of serum β-hCG, SF, and GA offers a robust tool for the early diagnosis of intrauterine infection in women with PROM. These findings support the use of comprehensive biomarker screening in clinical settings to improve diagnostic accuracy and patient outcomes.
Obesity significantly influences female reproductive health; however, its specific impact on hormonal predictors of ovarian response remains uncertain. The follicle-stimulating hormone (FSH)/ anti-Mullerian hormone (AMH) ratio has recently gained attention as a potential marker of ovarian reserve and response to controlled ovarian stimulation. This study aimed to assess the association between the FSH/AMH ratio and oocyte count and to determine whether body mass index (BMI) modifies this relationship.
In this retrospective study, 185 women undergoing ovarian stimulation were reviewed, and 92 met predefined clinical and hormonal inclusion criteria. Baseline FSH, luteinizing hormone (LH), AMH, BMI, and oocyte counts were recorded, and the FSH/AMH ratio was calculated. Associations were assessed using Spearman correlation, Kruskal-Wallis tests, and linear regression analysis.
AMH levels showed a strong positive correlation with oocyte count, while the FSH/AMH ratio demonstrated a strong negative correlation. FSH exhibited a weak negative correlation, and no significant association was observed between BMI and hormonal markers. Neither oocyte count nor the FSH/AMH ratio differed significantly across BMI categories. Linear regression analysis confirmed that the FSH/AMH ratio was an independent predictor of oocyte yield (p < 0.001), whereas BMI and its interaction with the ratio were not statistically significant.
The FSH/AMH ratio is a reliable and BMI-independent predictor of ovarian response. These findings support its clinical utility in fertility assessment and treatment planning, particularly when standard markers are inconclusive.
Endometriosis is a chronic gynecologic disorder characterized by systemic inflammation, with growing evidence implicating gut microbial dysbiosis. However, the relationship between inflammatory cytokines and gut microbiota across disease stages remains unclear.
This retrospective cross-sectional study included 150 participants, divided into healthy controls (n = 40), benign gynecologic disease controls (n = 45), and patients with stage I–II (n = 25) or stage III–IV (n = 40) endometriosis. Levels of the serum cytokines interleukin-6 (IL-6) and tumor necrosis factor-alpha (TNF-α) were evaluated by enzyme-linked immunosorbent assay (ELISA). Gut microbiota was profiled via 16S rRNA sequencing, followed by assessment of microbial alpha diversity, beta diversity (Bray-Curtis), and genus-level taxonomic composition.
Serum IL-6 and TNF-α levels increased progressively with disease severity. IL-6 levels differed significantly across groups (Kruskal-Wallis p < 0.0001), with the stage III–IV endometriosis group showing a median level that was 12.8 pg/mL higher compared to healthy controls 95% confidence interval (CI: 10.7 to 13.8). Shannon diversity decreased significantly across groups, and principal coordinate analysis (PCoA) demonstrated distinct clustering of microbial communities according to disease status. Spearman correlation analysis revealed that the genus Prevotella was positively correlated with IL-6 (ρ = 0.33, q = 0.018), whereas Blautia was negatively correlated with TNF-α (ρ = –0.32, q = 0.026), with both remaining significant after correcting for the false discovery rate (FDR).
These findings suggest that systemic inflammation and gut microbiota alterations progress alongside endometriosis severity. Specific genera, such as Prevotella and Blautia, may serve as potential microbial markers and modulators of inflammatory status in endometriosis.