Search Results (321)

Background/Objectives: Hodgkin lymphoma (HL) and primary mediastinal B-cell lymphoma (PMBCL) affect young women, with cure rates exceeding 80%. Treatment-related gonadal insufficiency is recognized for its impact on fertility, yet fertility preservation remains underutilized, and prospective data are limited. The aim of this study is to prospectively evaluate gonadal function in women ≤40 years old with lymphoma undergoing chemotherapy. Methods: Ovarian reserve and endocrine ovarian function were evaluated by sequential measurements of follicle-stimulating hormone (FSH), luteinizing hormone (LH), anti-Müllerian hormone (AMH), progesterone, and estradiol at diagnosis, during, and after chemotherapy. Results: 81 female patients ≤40 years old were enrolled, including 53 with HL and 28 with NHL (16 with PMBCL). HL patients had significantly lower AMH values for their respective age group compared to all other diagnoses (p = 0.05), which was more striking for patients ≤30 years old (p = 0.039), indicating pre-existing reduced ovarian reserve in HL. In HL, both FSH and AMH levels indicate gonadal dysfunction for at least six months post-chemotherapy, with AMH serving as a more sensitive biomarker than FSH. For PMBCL patients treated with R-DA-EPOCH, AMH suppression was noticed, with no evidence of recovery up to 18 months post-treatment. At all time points, the PMBCL patients had significantly lower AMH values compared to the HL patients (AMH6: p = 0.03, AMH12 and AMH18: p = 0.05). AMH emerged as the most sensitive marker of ovarian damage, with pretreatment levels <7 pmol/L predicting impaired ovarian reserve in HL patients. Conclusions: For HL, the pretreatment cut-off of 7 pmol/L could discriminate patients with ovarian insufficiency post-treatment, whereas no statistically significant predictive association was identified in PMBCL. These findings require validation in larger cohorts. Full article

Urinary and recombinant follicle-stimulating hormone (FSH) are used clinically for ovarian stimulation. However, data on the efficacy of these two products are inconsistent. To examine the direct effects of urinary and recombinant FSH on follicular development and function, experiments were conducted using in vitro follicle maturation approach. Preantral follicles were isolated from ovaries of rhesus macaques and randomly assigned to three groups for individual culture, including recombinant human FSH alpha (rFSHa) and beta (rFSHb) and urinary human FSH (uFSH) supplementation. Follicle survival, growth, and cell-specific gene expression, as well as media estradiol, progesterone, and anti-Müllerian hormone (AMH) concentrations, were assessed. At week 5, antral follicle survival rates were higher in the uFSH group than rFSHa and rFSHb groups. Percentages of follicles with a diameter of >1 mm were greater in the uFSH than rFSHa group. Media concentrations of estradiol, progesterone, and AMH were comparable among groups. Bone morphogenetic protein 15 and growth differentiation factor 9 mRNA levels were higher in rFSHb-treated than rFSHa-treated follicles. Data suggest that, although in vitro follicle maturation can proceed despite FSH sources, urinary and recombinant protein preparations exhibit preferable effectiveness in supporting different aspects of folliculogenesis. Full article

Background and Objectives: Endometriosis is a chronic inflammatory disease associated with impaired fertility, but the extent to which its systemic inflammatory profile differs from that observed in infertile women without endometriosis remains incompletely understood. This study aimed to characterize and compare the systemic inflammatory profiles of women with endometriosis, infertile women without endometriosis, and healthy controls by evaluating serum interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), and high-sensitivity C-reactive protein (hs-CRP). In addition, the study explored the IL-6/TNF-α ratio as an indicator of inflammatory balance and evaluated its relationship with ovarian reserve. Materials and Methods: This observational comparative study included 87 women divided into three groups: healthy controls (n = 29), women with endometriosis (n = 29), and infertile women without endometriosis (n = 29). Serum IL-6, TNF-α, and hs-CRP concentrations were determined specifically for the present study, whereas the corresponding clinical and embryological data were retrieved from medical records. Group comparisons were performed using the Kruskal–Wallis test followed by Dunn’s post hoc test with Holm correction. The IL-6/TNF-α ratio was calculated as an exploratory indicator of inflammatory balance. Associations between inflammatory biomarkers and anti-Müllerian hormone (AMH) concentrations were assessed using Spearman’s correlation analysis. Results: Significant differences in serum inflammatory biomarkers were observed among the three groups. IL-6 concentrations were significantly increased in both women with endometriosis and infertile women without endometriosis compared with healthy controls, whereas TNF-α concentrations were significantly elevated only in infertile women without endometriosis compared with both healthy controls and women with endometriosis (adjusted p < 0.001 for both comparisons). Differences in hs-CRP were more modest but remained significant overall. Women with endometriosis exhibited a significantly higher IL-6/TNF-α ratio than infertile women without endometriosis, suggesting distinct inflammatory patterns between these conditions. No significant correlations were identified between circulating inflammatory biomarkers and AMH concentrations. Conclusions: Women with endometriosis and infertile women without endometriosis exhibit distinct systemic inflammatory profiles rather than simply different levels of inflammation. The IL-6/TNF-α ratio may provide additional information regarding the balance of inflammatory pathways beyond the isolated evaluation of individual cytokines. Larger prospective studies integrating systemic and local inflammatory biomarkers with assisted reproductive outcomes are warranted to validate these findings and further explore their clinical relevance. Full article

Endothelial dysfunction has been reported in polyendocrine metabolic ovarian syndrome (PMOS) and is associated with obesity. We hypothesised that circulating biomarkers of endothelial dysfunction would not differ between non-obese women with PMOS and age- and BMI-matched controls in the absence of major between-group differences in insulin resistance (IR), systemic inflammation or vitamin D status. Plasma concentrations of 20 endothelial-associated proteins were measured using Slow Off-rate Modified Aptamer (SOMAscan) technology in 29 non-obese women with PMOS and 29 age- and BMI-matched controls. Women with PMOS had higher Ferriman–Gallwey scores, free androgen index (FAI) and anti-Müllerian hormone (AMH), whereas HOMA-IR, C-reactive protein (CRP), vitamin D metabolites and endothelial-associated biomarkers did not differ significantly between groups. Within the PMOS cohort, FAI was strongly positively associated with E-selectin (Pearson r = 0.718, p < 0.001, FDR-adjusted q = 0.027), and HOMA-IR was positively associated with ICAM-2 (r = 0.670, p = 0.001, q = 0.046). The FAI–E-selectin association remained robust in Spearman sensitivity analysis (ρ = 0.720, p < 0.001, q = 0.009), whereas the HOMA-IR–ICAM-2 association remained nominally significant (ρ = 0.579, p = 0.007) but not after FDR correction. A positive association between 24,25(OH)₂D₃ and tumour necrosis factor (TNF) was observed using Pearson correlation (r = 0.648, p = 0.002, q = 0.042), but was not retained after FDR correction in Spearman sensitivity analysis. Thus, non-obese women with PMOS did not demonstrate a generalised alteration in circulating endothelial biomarkers compared with matched controls. Hyperandrogenism, in particular, was robustly associated with endothelial activation, whereas associations with IR were less consistent and vitamin D metabolites showed no robust relationship with the endothelial biomarker profile. Collectively, the findings suggest that variation in endothelial activation in non-obese PMOS is more closely associated with metabolic dysfunction and androgen excess than with circulating vitamin D status, while the cross-sectional design precludes inference regarding causality. Full article

Objective: Anti-Müllerian hormone (AMH) is the most widely used biochemical marker of ovarian reserve, but its associations with other reproductive hormones are usually examined one hormone at a time and without accounting for values reported at the assay floor. This study examined the associations between serum AMH and age, follicle-stimulating hormone (FSH), luteinising hormone (LH), estradiol, progesterone and prolactin in women attending a tertiary gynaecology clinic. Materials and Methods: In this retrospective, cross-sectional, single-centre study, the records of women who underwent serum AMH testing together with a reproductive hormone panel between 1 January 2020 and 31 December 2025 were reviewed. Women with polycystic ovary syndrome, primary ovarian insufficiency, pregnancy or previous ovarian surgery were excluded. Bivariate associations were assessed with Pearson and Spearman correlation coefficients on raw and Box–Cox-transformed variables. Because 12.82% (n = 15) of AMH results were left-censored at the analytical reporting floor of 0.02 ng/mL, a multivariable Tobit model with the censoring limit specified on the Box–Cox-transformed scale (λ = 0.309, threshold = −2.270) was fitted, with predictors selected a priori on clinical grounds. Sensitivity analyses examined the influence of high AMH values, an alternative transformation of AMH, and flexible modelling of age. Results: The analysis included 117 women aged 18–45 years. Mean AMH was 2.22 ± 2.24 ng/mL [median 1.61 ng/mL (Q1–Q3, 0.36–3.20)]. In bivariate correlation analysis, AMH showed statistically significant inverse associations with age (r = −0.376, p < 0.001) and FSH (r = −0.445, p < 0.001), whereas LH, estradiol, progesterone, and prolactin showed no statistically significant correlations with AMH (all p > 0.10). In the multivariable Tobit model, only age (β = −0.068; 95% CI [−0.117, −0.018]; p = 0.007) and transformed FSH (β = −3.582; 95% CI [−4.846, −2.317]; p < 0.001) remained independently associated with transformed AMH. LH, estradiol, progesterone, and prolactin were not independently associated with AMH in the multivariable model (all p > 0.05). The standardised association was greater for transformed FSH (β* = −0.559) than for age (β* = −0.234). The associations of age and FSH were consistent in direction and magnitude across all sensitivity analyses. Conclusions: In this selected clinical sample, age and FSH were the only variables independently associated with serum AMH after mutual adjustment. LH, estradiol, progesterone, and prolactin showed no statistically significant associations with AMH in either the unadjusted bivariate analyses or the multivariable model. The absence of independent associations for these hormones should be interpreted cautiously because hormone sampling was not standardised to menstrual cycle day, which may have introduced measurement variability. These findings describe associations within the study population and do not establish causal relationships, reference intervals, or a basis for modifying testing strategies. The analysis also highlights the importance of accounting for left-censoring when modelling AMH data containing a substantial proportion of results at the assay reporting floor. Full article

Objective: Polycystic ovary syndrome (PCOS) and nonclassic congenital adrenal hyperplasia (NCAH) overlap clinically, but direct comparative data specifically addressing non-National Institutes of Health (non-NIH) Rotterdam phenotypes of polycystic ovary syndrome are limited. We compared women with polycystic ovary syndrome, of whom 66.7% were classified as having non-NIH Rotterdam phenotypes, with women with nonclassic congenital adrenal hyperplasia and healthy controls to characterize the extent of phenotypic overlap and evaluate the discriminatory performance of individual androgen measures. Methods: This single-center, prospective, exploratory cross-sectional study evaluated 58 women divided into three groups: PCOS (n = 24, Rotterdam criteria), NCAH due to 21-hydroxylase deficiency (n = 16, previously confirmed by adrenocorticotropic hormone (ACTH)-stimulated 17-hydroxyprogesterone (17-OHP)), and healthy controls (n = 18). Demographic, clinical, metabolic, and hormonal parameters were compared using analysis of variance (ANOVA), Kruskal–Wallis with Dunn’s post hoc test (Bonferroni-adjusted), and chi-square or Fisher’s exact tests. A sensitivity analysis was performed after excluding 12 participants receiving oral contraceptives (n = 8) or glucocorticoids (n = 4). Results: Within the PCOS group, 66.7% had non-NIH Rotterdam phenotypes. Hirsutism, defined as a modified Ferriman–Gallwey (mFG) score ≥ 8, was more frequent in both patient groups than in controls (p = 0.003) but did not differ between PCOS and NCAH. Total testosterone levels were 0.40 [0.20–0.60], 0.59 [0.45–0.94], and 0.20 [0.15–0.20] ng/mL in the PCOS, NCAH, and control groups, respectively, and androstenedione levels were 1.40 [1.20–2.20], 2.55 [1.64–4.07], and 0.87 [0.56–1.00] ng/mL, respectively; both were higher in the patient groups than in controls (both p < 0.001), without differing between PCOS and NCAH. Basal 17-OHP was the only parameter distinguishing NCAH from both PCOS and controls (p < 0.001). Dehydroepiandrosterone sulfate (DHEAS) levels were 356.5 [217–422], 292 [156–448], and 219 [146–240] µg/dL, respectively (p = 0.020), with a significant difference only between PCOS and controls. Anti-Müllerian hormone (AMH) levels were 3.27 [3.02–4.13], 3.13 [2.87–3.54], and 3.34 [2.93–5.37] ng/mL, respectively, with no between-group difference (p = 0.600). Other metabolic parameters, gonadotropins, estradiol, and prolactin showed no between-group differences. The principal hormonal findings remained unchanged after excluding women receiving oral contraceptives or glucocorticoids. Conclusions: In this PCOS cohort, in which 66.7% of women were classified as having non-NIH Rotterdam phenotypes, PCOS and NCAH showed substantial clinical, metabolic, and hormonal overlap, whereas basal early-follicular 17-OHP was the only parameter that consistently distinguished NCAH from both PCOS and healthy controls. These findings support the inclusion of basal 17-OHP in the evaluation of women presenting with hyperandrogenism. Full article

Background: Polycystic ovary syndrome (PCOS) is a leading cause of anovulatory infertility and a frequent indication for in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI). Multivariable regression estimates adjusted associations, whereas association rule mining (ARM) can describe frequently co-occurring attributes; however, ARM outputs are unadjusted and may be sensitive to analytic specification. Objectives: We used ARM alongside multivariable logistic regression and internal robustness analyses to describe combinations of clinical and treatment-related variables that co-occurred with clinical pregnancy failure among women with PCOS undergoing IVF/ICSI. Methods: We retrospectively analyzed 733 deidentified patients with PCOS from the Reproductive Hospital of Guangxi. The original one-hot-encoded analytic file was linked to a supplemental clinical record file containing continuous age, BMI, infertility duration, anti-Müllerian hormone, total gonadotropin dose, fertilization method, embryo-transfer day, number of embryos transferred, and embryo score. Embryo quality was derived from D3 cleavage-stage and blastocyst morphology records. Multivariable logistic regression was used to estimate adjusted associations. ARM results were assessed using Fisher’s exact test, Benjamini–Hochberg false discovery rate (FDR) correction, 1000 bootstrap resamples, fivefold cross-validation, and threshold/cutoff sensitivity analyses. Results: In the multivariable model (n = 730), age remained associated with clinical pregnancy failure (adjusted odds ratio [aOR] = 1.04 per year, 95% CI 1.00–1.08, p = 0.031), whereas BMI was not independently associated with failure (aOR = 1.00 per kg/m², 95% CI 0.96–1.05, p = 0.860). Transfer of two embryos (aOR = 0.55, 95% CI 0.35–0.85, p = 0.008), D5 blastocyst transfer (aOR = 0.49, 95% CI 0.32–0.75, p = 0.001), and transfer of at least one high-quality embryo (aOR = 0.63, 95% CI 0.43–0.93, p = 0.020) were associated with lower odds of failure. Under the primary host-factor specification, age > 35 years + BMI ≥ 24 kg/m² + pelvic adhesion defined 48 patients, 30 of whom had clinical pregnancy failure (support = 0.07; confidence = 0.63; lift = 1.38; FDR q = 0.098). In the secondary treatment-inclusive analysis, infertility duration > 5 years + no high-quality embryo transferred defined 43 patients with 30 failures (support = 0.06; confidence = 0.70; lift = 1.54; FDR q = 0.026). Lift represents the subgroup failure proportion divided by the overall failure proportion and is not an adjusted risk ratio. The rule composition and the number of FDR-supported rules changed under alternative cutoffs and confidence thresholds. Conclusions: ARM described transparent but specification-sensitive co-occurrence profiles that complement, rather than compete with, regression. Treatment-inclusive profiles combine baseline and downstream cycle characteristics and are therefore especially exploratory. These findings require prospective multicenter validation before any clinical decision-support use. Full article

(1) Background: Anti-Müllerian hormone (AMH) is a key indicator for predicting ovarian reserve and fertility. Currently, B-mode ultrasound examination is the primary method for evaluating follicular development in Bactrian camels, although it has several limitations. This study aims to develop a colloidal gold strip based on AMH nanobody preparation, establishing an efficient, simple, and rapid detection method suitable for evaluating follicular development. (2) Methods: Two nanobodies specifically binding to AMH were screened and identified from an alpaca naive nanobody library using phage display technology. The nanobodies were expressed in the yeast expression vector (pMCO-AOXα) and purified by affinity chromatography on a nickel column. Based on the purified nanobodies, a colloidal gold immunochromatographic strip was constructed for detecting serum AMH levels. (3) Results: In this study, anti-AMH nanobodies (AMH-VHH-A1 and AMH-VHH-A10) were expressed and purified; these were successfully utilized to prepare colloidal gold immunochromatographic strips for detecting AMH in serum. The T-line intensity of the colloidal gold detection was positively correlated with the number of growing follicles obtained by B-mode ultrasound imaging. (4) Conclusions: The colloidal gold strips based on nanobodies against AMH established in this research provided an effective, simple, rapid, and on-site method for evaluating follicular development, thus supplying a reference for reproductive management in Bactrian camels. Full article

Background: The aim of this study was to evaluate the diagnostic performance of combined testicular function indices in patients with non-obstructive azoospermia and to investigate the clinical value of these indices in predicting the diagnosis of non-obstructive azoospermia and the success of testicular sperm extraction. Methods: This retrospective observational study included 224 male patients who underwent infertility assessment. The patients were classified into a normospermic group (n = 165) and a non-obstructive azoospermia group (n = 59). Serum anti-Müllerian hormone, follicle-stimulating hormone, luteinising hormone and total testosterone levels were assessed. The Testicular Function Index, the modified Testicular Function Index and the logarithmically transformed index were calculated. Patients in the non-obstructive azoospermia group underwent micro-TESE and were classified according to sperm retrieval status. Diagnostic performance was assessed using ROC analysis. Results: Among the 59 patients with non-obstructive azoospermia who underwent micro-TESE, sperm retrieval was successful in 26 patients and unsuccessful in 33 patients. In the non-obstructive azoospermia group, anti-Müllerian hormone and testosterone levels were lower, whilst follicle-stimulating hormone and luteinising hormone levels were higher (all p < 0.001). All combined indices were found to be significantly lower in the non-obstructive azoospermia group (all p < 0.001). In the ROC analysis, follicle-stimulating hormone demonstrated the highest discriminatory performance (AUC = 0.978). In the testicular sperm extraction analysis, anti-Müllerian hormone was found to be the marker with the highest performance (AUC = 0.930). Conclusions: (Follicle-stimulating hormone demonstrated the highest diagnostic performance for distinguishing non-obstructive azoospermia, whereas anti-Müllerian hormone was the strongest predictor of TESE success. Although the combined testicular function indices showed good diagnostic performance, they did not outperform these established hormonal markers and should therefore be regarded as complementary tools for the integrated assessment of testicular function. These findings should be considered exploratory and require further validation. Full article

Background: Anti-Müllerian hormone (AMH) is widely used as a marker of ovarian reserve and is strongly influenced by chronological age. Although inflammation has been implicated in ovarian aging and follicular dysfunction, whether routinely measured peripheral inflammatory markers provide additional information regarding AMH concentrations remains unclear. Objective: This study aimed to evaluate the age-adjusted associations of C-reactive protein (CRP) and the neutrophil-to-lymphocyte ratio (NLR) with serum AMH concentrations in reproductive-age women. Methods: This retrospective cross-sectional study included women aged 18–45 years with available AMH, complete blood count, and CRP measurements. After reapplying the prespecified eligibility criteria and excluding confirmed data-entry or analytical errors, 819 women were included in the final analysis. NLR was calculated from absolute neutrophil and lymphocyte counts. Because CRP and NLR showed right-skewed distributions, Box–Cox transformations were applied. Associations with Box–Cox-transformed AMH were evaluated using an age-adjusted left-censored Tobit regression model. Results: The mean age of the participants was 34.07 ± 6.94 years, and the median AMH concentration was 1.07 ng/mL (interquartile range, 0.29–2.50). Chronological age was inversely associated with AMH (β = −0.123, 95% CI: −0.135 to −0.111, p < 0.001). After adjustment for age, neither CRP (β = −0.038, 95% CI: −0.085 to 0.009, p = 0.114) nor NLR (β = −0.012, 95% CI: −0.222 to 0.198, p = 0.912) was independently associated with AMH. Conclusions: In this retrospective outpatient cohort, routine peripheral inflammatory markers did not explain additional variation in AMH beyond chronological age. These results do not exclude a potential role for local ovarian inflammation, which may not be adequately captured by peripheral CRP or NLR measurements. Full article

Objective: Vitamin D has been reported to act as a tissue-protective regulator by suppressing Matrix Metalloproteinases (MMPs) and upregulating Tissue Inhibitors of Metalloproteinases (TIMPs), though changes may be body mass index (BMI)-dependent; however, the relationship between vitamin D metabolism and matrix remodeling pathways in Polyendocrine Metabolic Ovarian Syndrome (PMOS) remains poorly understood. Methods: In women with PMOS (n = 28) and controls (n = 28), 12 MMPs and 3 TIMPs were determined by Slow Off-rate Modified Aptamer (SOMA)-scan plasma protein measurement and correlated to 25-hydroxyvitamin D₃ (25(OH)D₃) and its metabolites (active 1,25-dihydroxyvitamin D₃ (1,25(OH)₂D₃) and 24,25-dihydroxyvitamin D₃ (24,25(OH)₂D₃)) measured by gold standard isotope-dilution liquid chromatography tandem mass spectrometry. Results: Insulin resistance and systemic inflammation (normal C-reactive protein) were comparable between PMOS and control women, though PMOS had higher free androgen index and anti-Mullerian hormone levels. Vitamin D and its metabolites did not differ between groups. Only MMP16 was lower in PMOS than controls (549.6 ± 58.3 vs. 678.0 ± 304.1 Relative Fluorescent Units, p = 0.037) but did not pass the false discovery rate. In women with PMOS, 25(OH)D₃ and 24,25(OH)₂D₃ demonstrated significant inverse correlations with TIMP3 (r = −0.60, p = 0.005 and r = −0.58, p = 0.007, respectively). Multivariable regression confirmed independent inverse associations between TIMP3 and both 25(OH)D₃ (β = −51.1, p = 0.031) and 24,25(OH)₂D₃ (β = −858.7, p = 0.028) after adjustment for age, body mass index and Homeostatic Model Assessment-Insulin Resistance, and the association remained stable following bootstrap internal validation. Additional moderate associations were observed between vitamin D metabolites and membrane-type MMPs (MMP14, MMP16, MMP17). Conclusions: Exploratory analyses suggested potential inverse associations between vitamin D metabolites and TIMP3, together with weaker associations involving MMP14, MMP16 and MMP17, suggesting the novel hypothesis that vitamin D may influence extracellular matrix remodeling and ovarian stromal biology through regulation of TIMP3-dependent pathways independently of obesity and insulin resistance, rather than through MMPs directly. Full article

Background: Opportunistic salpingectomy is widely used in gynecological surgery as a preventive measure against ovarian carcinoma. Questions have been raised about the potential impact of salpingectomy on ovarian function, given the possibility of ovarian vascularity disruption through the utero-ovarian arch located in the mesosalpinx. The aim of this study was to evaluate the short-term effects of bilateral salpingectomy on ovarian reserve. Methods: This prospective cohort study included forty premenopausal women, aged 34–50 years, who underwent hysterectomy with bilateral salpingectomy and ovarian preservation for benign uterine conditions. Ovarian reserve was evaluated before surgery and three months postoperatively, using serum anti-Müllerian hormone (AMH), follicle-stimulating hormone (FSH) and antral follicle count (AFC). Health-related quality of life was assessed using the Women’s Health Questionnaire (WHQ). Results: Serum FSH levels increased significantly after surgery, while AMH levels decreased significantly (both p < 0.05). No significant postoperative changes were observed in AFC. The overall WHQ score increased significantly, indicating a mild deterioration in health-related quality of life. The greatest postoperative changes were observed in the depressive, somatic and sexual domains, where menstrual symptoms improved following surgery. No significant correlation was found between WHQ scores and hormonal or ultrasonographic markers of ovarian reserve. Conclusions: Bilateral salpingectomy performed during hysterectomy was associated with significant short-term hormonal changes, while AFC remained stable. Although patient-reported quality of life slightly worsened after surgery, these changes were not correlated with hormonal or ultrasonographic markers of ovarian reserve. Larger controlled studies with longer follow-up are required to determine the long-term clinical significance of these findings. Full article

Background: Buffaloes have a significant share in the agricultural economies of many developing countries; however, the industry is not well-established because of the low reproductive efficiency of buffaloes. In this study, we designed a novel strategy to enhance buffalo reproductive efficiency and examined the significance of intramuscular AMH-INH-RFRP DNA vaccine immunization on reproductive performance. Methods: Allocated into four groups (n = 30/group), female buffaloes (aged 5–8 years, n = 120) were randomly enrolled in the study. Treatment groups received 10 mL of AMH-INH-RFRP DNA vaccine intramuscularly, once daily for three consecutive days, at the following concentrations: T1—3 × 10⁸ CFU/mL, T2—3 × 10⁹ CFU/mL, and T3—3 × 10¹⁰ CFU/mL. All vaccinated groups received a booster vaccination two weeks later, while the control group received 10 mL of phosphate-buffered saline (PBS) intramuscularly on the same schedule. Serum antibody titers against anti-Müllerian hormone (AMH), inhibin (INH), and RF-amide-related peptide (RFRP) were quantified using indirect ELISA on days 14 (post-primary immunization) and 28 (post-booster immunization). Results: Following primary immunization, antibody titers against AMH, INH, and RFRP were significantly higher in the T3 group than in the T1 group (p < 0.05), and booster immunization further increased antibody positivity rates. Serum concentrations of IL-4, IFN-γ, and E₂ were significantly elevated in the T2 and T3 groups compared to the control group (p < 0.05), while P₄ levels showed no significant differences among groups. Ultrasonography revealed that the ovulatory follicle diameter and dominant follicle growth rate were significantly increased in the T2 and T3 groups compared to the control and T1 groups (p < 0.05). The estrus rate was significantly higher in the T3 group than in the control group (76.67% vs. 40.00%, p < 0.05), and ovulation rates were significantly higher in the T2 (83.33%) and T3 (86.67%) groups compared to the control group (56.67%) (p < 0.05). However, conception rates did not differ significantly between vaccinated and control groups in the primary dose comparison (p > 0.05). In exploratory post hoc analyses, antibody-positive (Ab+) buffaloes exhibited higher E₂ concentrations, larger ovulatory follicle diameters, accelerated dominant follicle growth rates, and higher estrus and ovulation rates compared to antibody-negative (Ab−) buffaloes. Furthermore, gestating buffaloes were monitored until calving, revealing no significant effect of the vaccine on newborn calf weight or body size. Conclusions: In total, intramuscular immunization with the AMH-INH-RFRP DNA vaccine, particularly at the highest dose, enhances reproductive performance in buffaloes by stimulating E₂ secretion and follicular development. Full article

Background: The aim of this study was to investigate the impact of intraovarian platelet-rich plasma (PRP) treatment on ovarian reserve markers, hormonal profiles, oocyte yield, fertilization potential, and pregnancy outcomes in infertile women with diminished ovarian reserve. Methods: This retrospective single-center study was conducted at a tertiary referral center between January 2021 and December 2024 in the Department of Obstetrics and Gynecology, IVF Clinic, Private Diyarlife Hospital, Diyarbakır, Turkey. A total of 78 infertile women with diminished ovarian reserve (DOR) were included. DOR was defined in the present study as an AMH level < 1.1 ng/mL and/or an antral follicle count (AFC) < 5 follicles. Pre-PRP and post-PRP measurements were compared in the same patients. Hormonal and clinical parameters, including prolactin, thyroid-stimulating hormone (TSH), follicle-stimulating hormone (FSH), anti-Müllerian hormone (AMH), estradiol, endometrial thickness, gonadotropin dosage, antral follicle count (AFC), mature metaphase II (MII) oocyte count, and two-pronuclear (2PN) zygote count, were evaluated before and after PRP treatment. Results: Significant increases were observed in AMH and prolactin levels, whereas FSH levels significantly decreased following PRP treatment (all p < 0.001). Post-PRP AFC, MII oocyte count, and 2PN zygote count were significantly higher than pre-PRP values (all p < 0.001). A total of 21 pregnancies (26.9%) were achieved, including 17 clinical pregnancies (81.0% of pregnancies; 21.8% of all patients), 4 biochemical pregnancies (19.0% of pregnancies; 5.1% of all patients), 11 miscarriages (52.4% of pregnancies; 14.1% of all patients), and 6 live births (28.6% of pregnancies; 7.7% of all patients). Significant positive correlations were identified between post-PRP AFC and MII oocyte count (r = 0.803, p < 0.001), post-PRP AFC and 2PN zygote count (r = 0.624, p < 0.001), and MII oocyte count and 2PN zygote count (r = 0.728, p < 0.001). Conclusions: Intraovarian PRP administration was associated with improvements in ovarian reserve markers, oocyte maturation, and fertilization-related outcomes in women with DOR. Significant increases in AFC, MII oocyte count, and 2PN zygote count were observed after PRP treatment. However, these improvements in ovarian reserve markers were not associated with significant differences between women who achieved pregnancy and those who did not. Because of the retrospective design and the absence of a control group, these findings should be interpreted as associations rather than evidence of a causal treatment effect. Although clinical pregnancies and live births were observed during follow-up, larger, multicenter randomized controlled trials are required to confirm these findings and to further evaluate the effect of PRP on reproductive outcomes. Full article

Long COVID affects multiple organ systems and disproportionately affects women, raising concerns about reproductive health. This updated narrative review summarizes evidence from PubMed, Scopus, and Web of Science through March 2026 and extends previous reviews by distinguishing Long COVID-specific findings from acute and early post-infection observations and integrating newer evidence on ovarian reserve, follicular-fluid biology, assisted reproduction, and endometrial function. Reported menstrual changes include irregular cycles, heavy or prolonged bleeding, intermenstrual bleeding, and amenorrhea. Evidence regarding ovarian reserve remains inconsistent: some studies reported lower anti-Müllerian hormone (AMH) levels and/or antral follicle count (AFC), whereas others found no significant changes. Case reports describe premature ovarian insufficiency (POI) and possible autoimmune oophoritis but do not establish causality. Proposed mechanisms include immune dysregulation, inflammation, oxidative stress, endothelial dysfunction, and hypothalamic–pituitary–ovarian axis disturbance. Available evidence does not indicate adverse effects of COVID-19 vaccination on ovarian reserve or fertility outcomes. Most studies suggest transient changes. Direct Long COVID-specific evidence for persistent ovarian or endometrial injury remains limited. However, short follow-up precludes conclusions regarding ovarian aging, menopausal timing, lifetime fertility, or long-term endometrial receptivity. Symptom-guided assessment may include menstrual tracking, AMH, early-follicular-phase follicle-stimulating and luteinizing hormones, and pelvic ultrasonography when clinically indicated. Full article