Medicine and Pharmacology

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Article
Medicine and Pharmacology
Reproductive Medicine

Dorin Kalson

,

Jeremiah S. Joseph

,

Hila Nudelman

,

Eyal Kamhi

,

Shlomo Bakshi

Abstract: Background/Objectives: Follitropin delta is an approved recombinant follicle stimulating hormone (rFSH) expressed in a human cell line. The FSH protein is a heterodimer containing α and β subunits. The FSH α-subunit (FSHα) contains five intramolecular disulfide bonds: C7‑C31, C10‑C60, C28‑C82, C32‑C84 and C59‑C87. The α subunit has four closely spaced cysteine residues that form disulfide bonds. These clustered sites resist protease cleavage, making it difficult to accurately characterize the disulfide bond pairing in this type of protein therapeutic. Methods: The study uses an X-ray crystallography method to determine a high-resolution three-dimensional model structure of the recombinant FSH α-subunit. Results: The crystal structure of FSHα at 2.29 Å resolution, containing the disulfide bonds, is presented. This high-resolution structure provides definitive structural evidence that the disulfide bonds in rFSH are consistent with the expected native structural conformation. Conclusions: The rFSH structure validates the expected cysteine connectivity, overcoming limitations of prior mass spectrometry-based disulfide mapping attempts.

Interesting Images
Medicine and Pharmacology
Reproductive Medicine

Srinivas Kudavelly

,

Rama Raju GA

Abstract: Ultrasound is the primary imaging modality for evaluation of the scrotum and male reproductive tract. While high-frequency linear probes allow detailed assessment of testicular parenchyma, comprehensive visualization of epididymal anatomy and its spatial relationship to the testis may be limited using conventional two-dimensional imaging alone . This limitation is clinically relevant in the evaluation of male infertility, where epididymal abnormalities may contribute to obstructive processes We present a clinical image demonstrating a novel external scrotal application of a conventional three-dimensional (3D) transvaginal ultrasound probe. The images were obtained in an adult male undergoing infertility evaluation. With generous coupling gel and minimal probe pressure, the transvaginal probe was applied externally over the scrotum. High-resolution 2D images were first obtained, followed by volumetric 3D acquisition. The acquired dataset was analyzed using multiplanar reconstruction and volume-rendering techniques. This approach enabled clear visualization of the epididymal head, body, and tail, along with their anatomical continuity and relationship to the adjacent testis. The volume-rendered images provided an intuitive 3D depiction of epididymal curvature and spatial orientation, features that can be challenging to appreciate using standard linear scrotal ultrasound alone. Importantly, no patient discomfort, adverse effects, or technical complications were observed during the examination. This clinical image highlights the feasibility of repurposing a 3D transvaginal probe for external scrotal imaging to improve anatomical depiction of epididymal structures. While the technique is not intended to replace conventional scrotal ultra-sound, it may offer additional anatomical insight in selected infertility cases. This re-port serves as a hypothesis-generating illustration and supports further evaluation of its diagnostic utility in larger studies.

Article
Medicine and Pharmacology
Reproductive Medicine

Flavia Ultimescu

,

Carmen Ardeleanu

,

Octav Ginghina

,

Mara Mardare

,

Marius Zamfir

,

Alina Ioana Puscasu

,

Irina Bondoc

,

Andrei-Bogdan Vacarasu

,

Theodor Antoniu

,

Ariana Hudita

+7 authors

Abstract: Backgound/Objective: Breast cancer (BC) management has traditionally relied on static clinicopathologic and immunohistochemical biomarkers (hormone receptor status, HER2 expression, and proliferative activity assessed at diagnosis. However, these biomarkers are typically evaluated at a single time point and may not reflect therapy-induced mo-lecular evolution. This study evaluates whether longitudinal molecular profiling before and after treatment better characterizes tumor dynamics and provides clinically ac-tionable insights into treatment response, resistance, and prognosis. Methods: Thirty-two patients with invasive breast carcinoma were analyzed using his-topathology, immunohistochemistry, tissue-based next-generation sequencing, and plasma circulating tumor DNA (ctDNA) analysis. Paired tumor tissue and plasma sam-ples were collected before and after treatment when available. Changes in biomarker expression, molecular subtype, and genomic alterations were assessed to characterize molecular plasticity under therapeutic pressure. Results: The cohort had a median age of 54 years (range 29–86), predominantly invasive ductal carcinoma (>85%) and high-grade disease. Hormone receptor–positive tumors accounted for 78.1%. Molecular subtypes were Luminal A (34.4%), Luminal B HER2− (40.6%), Luminal B HER2+ (6.3%), HER2-enriched (6.3%), and triple-negative breast cancer (12.5%). Initial tissue sequencing identified PI3K/AKT pathway alterations in 28.1% of cases. Post-treatment analyses revealed substantial molecular discordance, including progesterone receptor loss (33.3%), HER2 status changes (33.3%), and Ki67 variability (77.8%). Plasma ctDNA analysis was informative in 53.1% of patients and identified additional clinically relevant alterations, including FGFR1 amplification and BRCA1/2 variants not detected in tissue. Conclusion: BC molecular profiles are dynamic and frequently altered by therapy. Longitudinal molecular assessment reveals clinically actionable changes overlooked by static subtyping, supporting a dynamic model of molecular classification, highlighting the potential value of adaptive molecular subtyping to improve treatment stratification and resistance monitoring.

Review
Medicine and Pharmacology
Reproductive Medicine

Massimo Menegazzo

,

Michela Cuccorese

,

Antonino Sammartano

,

Laura Roli

,

Giulia Canu

,

Francesca Gualandri

,

Marco Oliveti

,

Francesca Palazzi

,

Paola Marchini

,

Grossi Monia

+3 authors

Abstract: Background/Objectives: Fertility preservation (FP) spans oncological and non‑oncological indications, including gonadotoxic therapies, benign haematological/metabolic disorders, conditions at risk of premature ovarian insufficiency, severe andrological disease, and elective plans to defer childbearing. We provide a sex‑integrated overview of established and emerging FP strategies and their real‑world effectiveness [1–10]. Methods: Narrative synthesis of guidelines and high‑quality studies (to 2025), prioritising ASCO/ESHRE guidance, systematic reviews, and multicentre/registry data covering oocyte/embryo cryopreservation, ovarian tissue cryopreservation (OTC), GnRH agonists, ovarian transposition, in vitro maturation (IVM), sperm banking, surgical sperm retrieval (SSR), testicular tissue cryopreservation (TTC), and spermatogonial stem‑cell (SSC) approaches [1–10]. Results: For women, oocyte vitrification is the first‑line option when time allows; OTC is established when stimulation is infeasible or in prepubertal girls, with endocrine recovery common and increasing pregnancy/live‑birth reports. For men, sperm cryopreservation before therapy is standard; SSR supports selected cases. Paediatric TTC is feasible but remains experimental, whereas paediatric OTC is clinically implemented. Random‑start COS and letrozole/tamoxifen protocols minimise treatment delay and hormonal exposure; GnRHa co‑treatment preserves ovarian function as an adjunct. Utilisation of banked gametes/tissue remains modest, underscoring the need for pathway optimisation [1–10]. Conclusions: FP should be embedded across oncology and non‑oncology pathways with timely referral, clear counselling on probabilities of live birth, and robust follow‑up. Standardisation, registry‑based evidence and long‑term offspring safety data are priorities to bridge the gap between laboratory potential and clinical effectiveness [1–10].

Article
Medicine and Pharmacology
Reproductive Medicine

Evren Yeşildağer

,

Ufuk Yeşildağer

,

Sefa Arlıer

Abstract: Background: Optimizing intrauterine insemination (IUI) outcomes while minimizing gonadotropin exposure, treatment cost, and the risk of ovarian hyperstimulation syndrome (OHSS) remains a central challenge in ovulation induction, particularly among women with polycystic ovary syndrome (PCOS) or high antral follicle counts (AFC). Sequential stimulation protocols incorporating early letrozole followed by delayed recombinant follicle-stimulating hormone (rFSH) have been proposed as a strategy to improve clinical efficiency while preserving safety and pregnancy outcomes. Objective To compare pregnancy outcomes, gonadotropin consumption, and safety profiles of a letrozole plus late-onset rFSH protocol versus conventional rFSH stimulation in IUI cycles, with particular emphasis on patients with PCOS and high ovarian reserve. Methods: This retrospective comparative cohort study included 764 IUI cycles performed between January 2022 and December 2025 at a tertiary assisted reproductive technologies center. Cycles were stimulated either with early letrozole followed by late-onset rFSH (n = 392) or with conventional rFSH alone (n = 372). The primary outcome was pregnancy per cycle, defined by a positive serum β-hCG test. Secondary outcomes included total gonadotropin dose, endometrial thickness, cycle cancellation, OHSS incidence, and obstetric outcomes. Multivariable logistic regression, propensity score matching (PSM), inverse probability of treatment weighting (IPTW), mediation analysis, and doubly robust methods were applied to account for baseline imbalances and confounding. Results: In unadjusted analyses, different stimulation protocols influenced pregnancy rates, but the letrozole plus late-rFSH group used significantly lower gonadotropin doses. After accounting for factors like female age and ovarian reserve, stimulation protocol did not independently predict pregnancy outcomes; female age was the main predictor. The rates of cycle cancellation and OHSS were low and similar across protocols, including in women with PCOS and high AFC. Propensity score analyses verified that the letrozole-based protocol produced pregnancy outcomes comparable to standard rFSH stimulation while decreasing gonadotropin use. Conclusions: Sequential stimulation with letrozole plus late-onset rFSH provides pregnancy outcomes comparable to conventional rFSH stimulation while significantly reducing gonadotropin requirements and maintaining favorable safety profiles, even in high-risk populations such as PCOS and high AFC patients. These findings support individualized ovarian stimulation strategies that prioritize both clinical effectiveness and treatment efficiency in IUI cycles.

Article
Medicine and Pharmacology
Reproductive Medicine

Abul Kalam Lutful Kabir

,

Md. Najem Uddin

,

Satyajit Roy Rony

,

Sitesh Chandra Bachar

,

Emdad Hossain

Abstract: Levonorgestrel (LNG) used in contraceptive methods, necessitates accurate pharmacokinetic (PK) profiling to ensure efficacy and safety. The objective of this study was to develop and validate a highly sensitive LC-MS/MS method for quantification of LNG in human serum and its application in a pharmacokinetic study. 500 µL sample was processed using a liquid-liquid extraction (LLE) protocol optimized for LNG recovery that yielded consistent analyte recovery while minimizing matrix interferences. Chromatographic separation was performed on Waters ACQUITY UPLC BEH C18 reverse-phase analytical column (2.1× 100 mm, 1.7 µm) using mobile phase consisting of acetonitrile and water with 0.1% formic acid (70:30, v/v), delivered under a gradient elution at 300 µL/min flow rate. These conditions provided sharp peak resolution and minimized run times. Mass spectrometric analysis was run with Waters XEVO TQ ABSOLUTE triple quadrupole instrument operating in positive electrospray ionization mode and monitored LNG using multiple reaction monitoring with precursor ion at m/z 312.98>81.468, 90.921, 108.963 amu. Optimized fragmentation parameters yielded high signal-to-noise ratios, enabling trace-level detection in biological matrices. The method demonstrated linearity over calibration ranges of 32.5–2000 pg/mL, with correlation coefficients (R²) exceeding 0.997. Precision and accuracy met bioanalytical method validation guidelines, confirming the robustness of assay for PKs. The validated method was successfully employed to measure serum LNG in a PK study among women implanted in Bangladesh. The method’s sensitivity facilitated LNG detection supporting assessment of drug-release performance in clinical settings. The method proved highly reliable, sensitive, and specific for quantifying LNG in human serum, supporting its use in both clinical monitoring and research applications.

Article
Medicine and Pharmacology
Reproductive Medicine

Heli Alexandroni

,

Eadit Buhbut

,

Rinad Nabulsi

,

Nava Dekel

,

Ido Ben-Ami

Abstract: This study evaluated whether a gonadotropin-releasing hormone (GnRH) agonist can be effectively used for luteal phase support following a dual trigger in IVF. A total of 284 patients undergoing fresh embryo transfer were included: 116 received a dual trigger and 168 an hCG trigger. All patients received luteal support with Nafarelin nasal spray twice daily for two weeks, starting on the day of oocyte retrieval. Women in the dual trigger group were older (36.2 vs. 32.3 years, p <  0.01), had lower antral follicle counts (7.0 vs. 17.5, p = 0.03), and received higher total gonadotropin doses (3000 vs. 2041 IU, p <  0.01). There were no significant differences between groups in retrieved and mature oocytes, fertilization rate, or blastulation rate. Positive pregnancy rate (β-hCG ≥ 25 mIU/mL) was 46.6% in the dual trigger group and 41.1% in the hCG group, without a significant difference, with similar live birth and miscarriage rates. Logistic regression identified maternal age as a predictor of positive pregnancy (OR = 0.95; 95% CI: 0.90–0.99; p = 0.024), while trigger type was not. Propensity score matching confirmed comparable IVF and pregnancy outcomes between groups. These findings indicate that a dual trigger followed by luteal-phase GnRH agonist support yields IVF and pregnancy outcomes similar to an hCG trigger.

Brief Report
Medicine and Pharmacology
Reproductive Medicine

Da Kuang

,

John Quain

,

Cathy Tie

,

Eriona Hysolli

Abstract: Pre-birth gene correction offers a precise and potentially transformative strategy to prevent severe genetic diseases by repairing pathogenic variants in embryos or gametes. Unlike selection-based preimplantation genetic testing (PGT), which depends on the availability of unaffected embryos, pre-birth gene correction directly addresses the underlying mutation, expanding the number of viable embryos available for transfer. We modeled the prospective impact of this technology in the United States across four exemplar monogenic diseases (sickle cell disease, cystic fibrosis, Marfan syndrome, and Huntington’s disease) under scenarios reflecting current and expanded access to assisted reproductive technologies. Depending on accessibility and implementation, pre-birth gene correction could correct hundreds to thousands of affected embryos each year, offering a viable path to parenthood for families who currently lack unaffected embryos through IVF and PGT alone. While translation will require rigorous evaluation of safety, efficacy, and ethical governance, these findings underscore this technology’s potential to broaden reproductive autonomy and meaningfully reduce the burden of severe genetic disease.

Review
Medicine and Pharmacology
Reproductive Medicine

Agata Puszcz

,

Paulina Kozłowska

,

Justyna Wójcik

,

Anna Morawska

,

Małgorzata Wójcik

,

Katarzyna Plagens-Rotman

,

Monika Englert-Golon

,

Jakub Mroczyk

,

Małgorzata Mizgier

,

Ewa Jakubek

+5 authors

Abstract: Background/Objectives: Sexual health is shaped by lifestyle factors alongside biomedical determinants. This review synthesises evidence on physiotherapy, balneology/peloidotherapy and diet therapy as preventive and therapeutic adjuncts for female sexual dysfunctions and related gynaecological conditions. Methods: A structured narrative review of PubMed and Google Scholar (June–July 2025) was conducted by three independent reviewers using predefined keywords in English and Polish. Case reports, preprints and studies before 2015 were excluded. From 7322 records, 47 studies met inclusion criteria for qualitative synthesis. Results: Physiotherapy—particularly pelvic floor muscle training, multimodal manual therapy, neuromuscular electrical stimulation (including PTNS), magnetostimulation, short-wave diathermy and capacitive–resistive monopolar radiofrequency—was consistently associated with reductions in dyspareunia, chronic pelvic pain and urinary symptoms, with parallel improvements in sexual function and quality of life. Balneological procedures (brine baths/irrigations, crenotherapy, selected radon/sulphide/iodine–bromine applications) and peloidotherapy demonstrated analgesic, anti-inflammatory and perfusion-enhancing effects, with signals of benefit in vulvodynia, endometriosis and infertility support. Dietary measures—higher fruit intake (notably citrus), adequate vitamin D, targeted omega-3 use in PCOS, Mediterranean dietary pattern and prudent red-meat limitation—were associated with favourable endocrine–metabolic profiles and, in selected contexts, reduced disease risk. Conclusions: Integrating lifestyle-medicine modalities with standard care may meaningfully prevent and manage female sexual dysfunctions by addressing pain, perfusion, neuromuscular control and endocrine–metabolic drivers. Implementation frameworks and high-quality trials are warranted to refine indications, dosing and long-term effectiveness.

Review
Medicine and Pharmacology
Reproductive Medicine

József Bódis

,

József Berke

,

Bernadett Nagy

,

István Gulyás

,

Péter Hersics

,

Ákos Várnagy

,

Kálmán Kovács

Abstract: Background: Ultra-weak photon emission (UPE) from living systems has been reported and linked to oxidative reactions. Whether photons mediate communication—particularly at the level of DNA—remains unresolved. Objective: To review biochemical and quantum-biological bases of UPE, summarize measurement approaches, and evaluate whether DNA-related emission could support signalling; we also present pilot data on embryo UPE. Methods: We synthesise literature on sources (reactive oxygen species, lipid peroxidation, protein/DNA oxidation) and detectors (photomultiplier tubes, cooled CCD cameras, Complementary Metal-Oxide Semiconductor CMOS). We measured UPE from mouse embryos in a dark incubator using an ORCA-Quest CMOS system. Results: UPE is modulated by cellular state; mitochondria, membranes and peroxisomes are key contributors. Models posit DNA as a storage/emitter and potential resonator. In embryos, degenerated two-cell–stage embryos exhibited lower UPE than well-developed embryos. These findings motivate a Photon Emission Embryo Control System (PEECS) for non-invasive assessment. Conclusions: Ultra-weak cellular photon emission—especially the proposed DNA-linked mechanisms—remains a challenging yet promising field. Evidence does not convincingly show DNA acts as a biophotonic communication system, but the hypotheses suggest new ways to view biological information processing and cellular funcion.

Article
Medicine and Pharmacology
Reproductive Medicine

Grażyna Jarząbek-Bielecka

,

Agata Puszcz

,

Mariola Pawlaczyk

,

Katarzyna Plagens-Rotman

,

Małgorzata Mizgier

,

Magdalena Pisarska-Krawczyk

,

Jakub Mroczyk

,

Witold Kędzia

Abstract: Background/Objectives: Genital discomfort, manifested by vulvar itching and burning, is a frequent complaint among women of all ages and has multifactorial origins—including dermatoses, infections, allergies, and hormonal disorders. The study aimed to determine whether selected medical history factors—age, obstetric history, and body mass index (BMI)—influence the frequency of genital discomfort as a reason for gynecological consultation. Methods: A pilot study included 288 female patients aged 11–91 years who presented to outpatient gynecological clinics between September 2018 and February 2025 with symptoms of vulvar itching and genital discomfort. Qualitative data were expressed as numbers and percentages, and age was described using mean, median, quartiles, and range. Associations between categorical variables were assessed using Pearson’s chi-square test, with statistical significance set at p < 0.05. Results: The mean age of patients was 47.4 ± 20.3 years. Most were diagnosed with ICD-10 code N90 (82.6%), while 17.4% had N76. Genital discomfort was most frequently reported by women aged 41–50 years (p < 0.0001). Comorbidities (p < 0.0001) and obstetric history (p < 0.0001) significantly influenced the occurrence of genital discomfort, which was more prevalent among women with chronic conditions and those who had been pregnant. No significant associations were found with BMI (p = 0.2353) or menopausal status (p = 0.3458). Conclusions: Genital discomfort is a common and multifactorial condition requiring an interdisciplinary diagnostic and therapeutic approach. Collaboration among gynecologists, dermatologists, endocrinologists, and dietitians is crucial for effective management and prevention.

Hypothesis
Medicine and Pharmacology
Reproductive Medicine

Nicholaus Nelson-Goedert

Abstract: Female reproductive aging exemplifies accelerated, system-specific decline, with the ovary undergoing the earliest and most pronounced functional deterioration of any organ system. Traditional explanations centered on follicular depletion and oocyte aneuploidy fail to account for the interdependent biochemical pathways driving reproductive senescence. This paper extends the Conglomerate Theory of Aging to female reproductive biology, presenting a unified, systems-level framework in which reactive species-initiated processes— metal bioaccumulation, advanced glycation end product (AGE) formation, advanced lipoxidation end product (ALE) accumulation, and the emergence of metal-AGE/ALE hybrid complexes— interact as mutually reinforcing elements of a single damage network. Within this framework, bioaccumulated metals, AGEs, and ALEs function as interdependent drivers of molecular damage. Metal-catalyzed redox activity amplifies the production of reactive oxygen, nitrogen, and carbonyl species, fostering environments conducive to AGE and ALE formation, while AGEs and ALEs independently propagate redox cycling and inflammation through RAGE-mediated and mitochondrial feedback. These processes collectively erode ovarian cellular integrity, induce mitochondrial and enzymatic dysfunction, accelerate follicular depletion, and disrupt hypothalamic-pituitary-ovarian axis regulation. The model highlights the therapeutic potential of multi-target approaches addressing concurrent pathways of damage amplification. Candidate strategies include glutathione restoration with GlyNAC, selective metal chelation, carbonyl-stress inhibition via compounds such as carnosine, and γ-tocopherol for nitrosative stress. Priorities for future research include biomarker discovery and integrative clinical trials using multiomics platforms to track and modulate these overlapping mechanisms. By framing reproductive aging as a network of self-reinforcing oxidative, glycoxidative, and lipoxidative processes, the Conglomerate Theory of Female Reproductive Aging offers a cohesive biochemical explanation for reproductive decline and identifies convergent intervention points to sustain fertility and extend reproductive longevity.

Brief Report
Medicine and Pharmacology
Reproductive Medicine

Zalessky Alexandr Dmitrievich

,

Bachurin Alexey Vladimirovich

,

Osychenko Alina Anatolievna

Abstract: Near-infrared femtosecond laser is a promising tool for oocyte and embryo manipulation. In nuclear transfer and mitochondrial replacement therapy, this laser can be successfully applied for the enucleation. In addition, it can be used for zygote ploidy normalization by pronuclear destruction. The aim of this work was to develop a new technique for normalizing zygote ploidy. We applied 1033 nm femtosecond laser radiation to eliminate a pronucleus in three-pronuclear human zygotes. The study showed that destruction of pronuclear DNA occurred under the action of the femtosecond laser. At the same time, the zygotes retained their structure and even their ability to cleave. Thus, we suppose that femtosecond laser can be useful for pronuclear destruction and zygote ploidy normalization.

Article
Medicine and Pharmacology
Reproductive Medicine

Robert Milewski

,

Magdalena Skowrońska

,

Agnieszka Kuczyńska

,

Andrei Lebedzko

,

Waldemar Kuczyński

Abstract: Background/Objectives: Accurate prediction of reproductive outcomes remains a key challenge in assisted reproductive technologies (ARTs). While embryo quality assessment has been extensively studied, endometrial receptivity has received less attention despite its critical role in implantation. Endometrial compaction (EC), i.e., the reduction in endometrial thickness between ovulation and embryo transfer, has been proposed as a potential predictor, but the current literature data is inconclusive. This study aimed to develop and validate a novel implantation predictor (IMP), based on extended assessment of endometrial shape and dynamics, that would be useful in determining reproductive success. Methods: The study analyzed data from 61 couples undergoing infertility treatment at the Kriobank Clinic (Białystok, Poland) between December 2021 and February 2025. Endometrial measurements were taken at ovulation peak and on the day of embryo transfer. A set of normalized parameters describing endometrial dimensions was proposed and their changes over time measured. Based on the obtained data, a multivariable logistic regression model was constructed to create the IMP predictor. Results: The proposed model demonstrated high predictive power for implantation, with an AUC of 0.839 (95% CI: 0.739–0.938). Statistically significant differences in IMP values were observed between the pregnancy and no-pregnancy groups (p < 0.0001). Quartile analysis showed that implantation rates increased from 6.25% in the lowest IMP range to 93.3% in the highest, confirming the model’s strong predictive power. In the study group, the model is capable of predicting a quarter of cases in which implantation will almost certainly occur and another quarter in which implantation will almost certainly not occur. Conclusions: This study introduces a novel predictor (IMP) of implantation based on an extensive assessment of endometrial compaction, which may be used in predicting reproductive success. The findings show the importance of considering endometrial receptivity in ART success. They also indicate that integrating IMP with existing approaches may substantially improve predicting reproductive success.

Article
Medicine and Pharmacology
Reproductive Medicine

Othmane Adli

,

Noureddine Louanjli

,

Rachid Aboutaieb

Abstract: Infertility is a major health problem affecting about 15% of couples worldwide. Male etiology is found in almost one-third of cases. This study identified the nature of the relationship between sperm DNA fragmentation (SDF), sperm chromatin condensation (SCC) and sperm parameters. In this study, 80 samples were analyzed using two methods: the TUNEL technique to assess sperm DNA quality and aniline blue coloration to determine the level of chromatic condensation of spermatozoa. In addition, to specify the standard sperm parameters, the spermogram and the spermocytogram were analyzed. The main results revealed a significant difference between SDF and motility and, similarly, between SCC, motility, and teratozoospermia macrocephaly types (p < 0.0001, p < 0.0001, respectively), but no differences between SCC, SDF, and the other sperm parameters (p > 0.99).

Review
Medicine and Pharmacology
Reproductive Medicine

Grzegorz Mrugacz

,

Aleksandra Mospinek

,

Joanna Głowacka

,

Oskar Sprawski

,

Lidia Kawałek

,

Wiktoria Gąsior

,

Julita Machałowska

,

Yekaterina Sidorova

,

Patrycja Borecka

,

Aleksandra Bojanowska

+1 authors

Abstract:

Background: Recurrent pregnancy loss (RPL) and recurrent implantation failure (RIF) are significant challenges in reproductive medicine. For both, embryonic aneuploidy is the leading etiological factor. Preimplantation genetic testing for aneuploidy (PGT-A) via trophectoderm biopsy is the current standard for embryo selection. However, it is limited by its invasiveness, potential for embryo damage, and diagnostic errors due to mosaicism. Rationale/Objectives: This review critically evaluates the emerging role of noninvasive PGT (niPGT). NiPGT analyzes cell-free DNA from spent blastocyst culture media, thus is a potential alternative for managing RPL and RIF. Hence, the primary objective is to determine whether current evidence supports niPGT as a reliable replacement for conventional biopsy-based PGT-A in these high-risk populations. Outcomes: The analysis reveals that niPGT offers significant theoretical advantages. These include complete non-invasiveness, enhanced embryo preservation, and high patient acceptability. However, its clinical application is hampered by substantial limitations. Key amongst them is the inconsistent and often suboptimal diagnostic accuracy (sensitivity 70-85%, specificity 88-92%) compared to biopsy. Other significant factors include the high rates of amplification failure (10-50%), vulnerability to maternal DNA contamination, as well as low DNA yield. Crucially, there is a definitive lack of robust, prospective randomized controlled trial (RCT) data demonstrating improved live birth rates or reduced miscarriage rates specifically in RPL and RIF cohorts. As, niPGT is not yet ready to be a standalone clinical adoption in RPL and RIF cases. However, it may serve as a valuable adjunct for rescue scenarios following biopsy failure or for ethical reasons. Wider Implications: The integration of niPGT with artificial intelligence, time-lapse imaging, and multi-omics profiling underlies a promising future. However, its transition from a predominantly research tool to a clinical standard necessitates various critical undertakings. These include rigorous multicenter RCTs, standardizing international protocol, and tailoring validation for the RPL and RIF subgroups. This review highlights the need for cautious optimism, positing that evidence-based integration, rather than premature adoption, is essential to realizing niPGT’s full potential without compromising patient care in these complex fertility scenarios.

Article
Medicine and Pharmacology
Reproductive Medicine

Yusaku Mori

,

Linji Chen

,

Shogo Nishii

,

Miwa Sakamoto

,

Makoto Ohara

,

Akihiko Sekizawa

,

Sho-ichi Yamagishi

Abstract: Background: Assisted reproductive therapy (ART) has been utilized as an effective therapeutic strategy for addressing infertility worldwide, and one of the key determinants of ART success is the acquisition of high-quality embryos through in vitro fertilization (IVF). We investigated here which male factors were associated with embryo formation and quality in conventional IVF (cIVF). Methods: This study was a sub-analysis of a trial conducted to examine the associations of clinical and lifestyle factors with sperm abnormalities in 42 men of infertile couples without identifiable male factor infertility. From the original cohort, 21 men whose partners underwent cIVF were included. Semen samples were evaluated for standard sperm parameters and DNA fragmentation index (DFI). Blood biochemical parameters and lifestyle habits were also evaluated. Blastocysts were assessed 5 days after cIVF, and implantation success was determined 10 days after embryo transfer. Results: Normospermia and oligospermia were observed in 67% and 33% of participants, respectively, with mild sperm DFI in 76%. Blastocysts were formed in 32% of the oocytes following cIVF. Among them, good blastocyst development and quality were observed in 71% and 39%, respectively. Eighteen women underwent blastocyst transfer, resulting in an implantation success rate of 50%. Multiple regression analysis identified sperm DFI as the only variable inversely associated with blastocyst outcomes. In contrast, only female age was associated with implantation success. Conclusions: The present findings suggest that sperm DNA fragmentation may negatively affect high-quality embryo formation in cIVF, even among normospermic and oligospermic men with non-severe sperm DFI.

Article
Medicine and Pharmacology
Reproductive Medicine

Csilla Kurdi

,

Dávid Hesszenberger

,

Dávid Csabai

,

Anikó Lajtai

,

Ágnes Lakatos

,

Rita Jakabfi-Csepregi

,

Krisztina Gödöny

,

Péter Mauchart

,

Ákos Várnagy

,

Gábor L. Kovács

+1 authors

Abstract: Background/Objectives: Endometriosis is a chronic gynecological condition associated with infertility, oxidative stress and altered metabolic regulation. Follicular fluid reflects the microenvironment of the developing oocyte and changes in its amino acid composition may affect reproductive outcomes. This study aimed to characterize alterations in the amino acid composition of the follicular fluid in endometriosis and to identify potential reproductive outcomes. Methods: Targeted metabolomic analysis of 20 amino acids was performed on follicular fluid samples from 56 women undergoing in vitro fertilization (17 with endometriosis, 39 controls). Amino acid concentrations were quantified and compared between groups, adjusting for age and body mass index. Pathway, biomarker and multivariate analyses were conducted to explore metabolic alterations and potential diagnostic markers. Results: Asparagine, histidine and glycine concentrations were significantly higher in the endometriosis group, independent of age and BMI. Pathway analysis indicated perturbations in glycine/serine metabolism, glutathione metabolism and porphyrin metabolism, consistent with oxidative stress and mitochondrial dysfunction. Multivariate modeling demonstrated partial separation between groups while biomarker analysis identified asparagine (AUC=0.76), along with glycine and histidine, as potential discriminators. Additional enrichment of bile acid and methylation-related pathways suggested broader systemic metabolic changes in endometriosis. Conclusions: Endometriosis is associated with distinct amino acid alterations in the follicular fluid, particularly elevated asparagine, histidine, and glycine, which may reflect oxidative stress and impaired mitochondrial function in the follicular environment. These metabolites seem to be potential biomarkers for endometriosis-related oocyte quality changes and may help individualized in vitro fertilization approaches.

Article
Medicine and Pharmacology
Reproductive Medicine

Junbiao Mao

,

Ben Yuan

Abstract: Background Polycystic ovary syndrome (PCOS) is the most common endocrine disorder among reproductive-aged women, affecting 8–13 % of the population worldwide. It is defined by the 2003 Rotterdam criteria and is frequently accompanied by endometrial dysfunction, yet non-invasive molecular biomarkers for diagnosis remain scarce. This study aimed to identify a robust gene signature for PCOS endometrial dysfunction through comprehensive bioinformatic analyses. Methods Three public endometrial microarray datasets (GSE103465, GSE4888, GSE51901) were downloaded from the GEO database. Differential expression analysis was performed using limma (|log₂FC| > 1, FDR < 0.05). Functional enrichment analyses (GO and KEGG) were carried out using clusterProfiler. A Least Absolute Shrinkage and Selection Operator (LASSO) logistic regression model was constructed to screen the optimal gene signature, and its diagnostic performance was evaluated by receiver operating characteristic (ROC) curves in both training and validation sets. Results A total of 200 differentially expressed genes (DEGs) were identified, mainly enriched in extracellular matrix remodeling, inflammatory response and angiogenesis pathways. A 50-gene LASSO signature was established, achieving an AUC of 0.816 in the training cohort and 0.766 in the independent validation cohort. Conclusions The LASSO-derived gene signature exhibits strong discriminatory power for PCOS endometrial dysfunction and may serve as a novel diagnostic resource for clinical translation.

Review
Medicine and Pharmacology
Reproductive Medicine

Abdelmalek Sghiri

,

Michela Ciccarelli

,

Salman M Waqas

,

Abelhaq Anouassi

,

Ahmed Tibary

Abstract: Camelids are increasingly recognized as important livestock species. They are valuable sources of meat, fiber, and milk. Despite their growing popularity, many aspects of their reproductive physiology and pathology remain unclear. Their reproductive performance is reported to be low in many countries. Advances in camelid veterinary care have identified several disorders, some of which are species-specific. This article describes an approach and diagnosis of infertility and subfertility cases in alpacas, llamas, and camels referred to the authors over the past 35 years. Ultrasonography, endometrial cytology, and biopsy are the primary diagnostic tools for practitioners. However, laparoscopy, hysteroscopy, and cytogenetics are indicated for cases referred to theriogenologists. The incidence of congenital and acquired reproductive disorders is presented. A high incidence of congenital defects of the reproductive tract is found in South American camelids, which raises concerns about animal welfare. Acquired disorders are similar to those described in other species. Endometritis and endometrosis are major disorders contributing to infertility and early pregnancy loss. However, studies on uterine defense mechanisms and the pathogenesis of these disorders are lacking. Hydrobursitis, a common cause of infertility in dromedary camels, warrants further research. The implications of some contagious diseases (tuberculosis, campylobacteriosis, and brucellosis) in female infertility are discussed. These findings emphasize the importance of including camelid medicine in veterinary education to ensure a high standard of care for this species.

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