Search Results (3,538)

Background/Objectives: Infertility affects about 17.5% of people globally, with higher rates in women. Despite advances in assisted reproductive technologies, success remains limited. Endometrial scratching (ES) is proposed to enhance implantation by altering cytokines and gene expression, but evidence is conflicting. Methods: A systematic search of the PubMed, Cochrane Library, and Scopus databases was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Eight randomized controlled trials (RCTs) involving women undergoing in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI), with ES performed in the luteal phase of the cycle preceding IVF or ICSI, were included. Results: The meta-analysis included 3210 patients and 1445 clinical pregnancies (754 in the ES group and 691 in the control group). In the ES group, a significantly higher clinical pregnancy rate (CPR) (RR 1.09, 95% CI 1.01–1.18, p = 0.02) was revealed. Pooled data from six studies reporting live birth rates (1268 births) showed a significant increase in the LBR after ES (RR 1.12, 95% CI 1.03–1.22, p = 0.01). The ongoing pregnancy rate (OPR) was also statistically significant in the ES group (RR 1.13, 95% CI 1.01–1.26, p = 0.03). Conclusions: This meta-analysis shows a small but statistically significant and consistent positive effect of ES on the LBR, CPR, and OPR in women undergoing IVF or ICSI, with a modest but measurable absolute benefit of approximately 4–5 additional events per 100 individuals. This procedure may particularly benefit patients with impaired endometrial receptivity, potentially enhancing reproductive outcomes while reducing the time and cost required to achieve a successful pregnancy. Further research is warranted to optimize its use and identify patients most likely to benefit. Full article

Oxidative stress is one of the few defined causes of male infertility affecting at least one third of patients attending infertility clinics. Human spermatozoa are vulnerable to this form of attack because their stripped-down architecture means that they possess limited antioxidant protection and little capacity for biochemical repair. They also compound their vulnerability by being active generators of reactive oxygen species (ROS) and possessing multiple substrates for oxidative damage. The major sources of ROS in these cells are their mitochondria, an L-amino acid oxidase (IL4I1) and a calcium-dependent NADPH oxidase (NOX5). Spermatozoa tolerate the risks associated with ROS generation because their biology is heavily dependent on redox regulation. ROS are important mediators of sperm capacitation, stimulating the generation of cAMP and prostaglandins, inhibiting protein phosphatases and encouraging removal of cholesterol from the plasma membrane. Furthermore, during fertilization, the ability of ROS to activate metalloproteinases facilitates penetration of the zona pellucida and sperm–oocyte fusion. While ROS are physiologically important for sperm function, the over-production of these metabolites can impair sperm function. Antioxidants have therefore assumed some importance as a possible therapy for the infertile male. However, before this potential can be realized, we need to optimize the composition and dose of reagents used in such formulations and develop improved methods of diagnosing oxidative stress within the patient population. Full article

Background/Objectives: Accurate evaluation of fallopian tube patency is an essential step in infertility assessment. This study investigated the diagnostic capability of saline infusion sonography combined with color Doppler flow (SIS-CF), using laparoscopic chromopertubation as the comparator method. Methods: A prospective diagnostic accuracy study was conducted between January and November 2025 at the Infertility Unit, Chiang Mai University Hospital, Thailand. Women requiring laparoscopic assessment for infertility evaluation or preconception investigation were consecutively enrolled. Each participant underwent SIS-CF immediately before laparoscopic chromopertubation within the same operative session. Primary outcomes included diagnostic indices for tubal patency. Secondary outcomes included procedural duration and perioperative safety. Results: Forty-four women (88 fallopian tubes) were included. SIS-CF demonstrated sensitivity of 89.4% (95% CI 78.1–95.9) and specificity of 95.5% (95% CI 77.2–99.9). Positive and negative predictive values were 98.3% and 75.0%, respectively. Likelihood ratios were 19.65 (positive) and 0.11 (negative), with overall accuracy of 90.9% (95% CI 82.9–95.8). Median procedure duration was 5.7 min for SIS-CF and 3.0 min for laparoscopic chromopertubation. No adverse events were recorded. Conclusions: SIS-CF demonstrated favorable diagnostic characteristics for evaluation of tubal patency. The technique provided functional information regarding tubal status while maintaining a minimally invasive profile. Further investigation is warranted to determine its role within routine infertility workups. Full article

Congenital anomalies of the reproductive system represent a heterogeneous group of structural and functional abnormalities affecting both male and female genital organs. These anomalies typically arise during embryogenesis and may remain asymptomatic until they are incidentally identified during evaluation for infertility, recurrent pregnancy loss, or disorders of sexual development. In females, abnormalities include Müllerian duct anomalies and congenital malformations of the uterus, cervix, vagina, and ovaries, such as Mayer–Rokitansky–Küster–Hauser syndrome, septate, unicornuate, bicornuate, and didelphys uteri, and ovarian agenesis and undescended ovaries. In males, congenital conditions such as anorchia, cryptorchidism, hypospadias, ejaculatory duct obstruction, and ejaculatory dysfunction may be associated with impaired spermatogenesis and reduced fertility. Early recognition of these conditions may facilitate timely clinical evaluation and individualized management, which can include surgical correction, hormonal therapy, and reproductive counseling. When appropriate, early diagnosis may support multidisciplinary care, with the aim of optimizing sexual development, preserving reproductive potential, and reducing long-term morbidity associated with congenital anomalies. However, the clinical impact of early detection varies depending on the type and severity of the anomaly. A systematic and multidisciplinary approach may contribute to improved reproductive outcomes and better overall reproductive health in affected individuals. Further research is needed to better define the optimal timing and clinical utility of systematic evaluation strategies in this patient population. Full article

Premature ovarian insufficiency (POI) is a clinical condition characterized by loss of ovarian function indicated by amenorrhea or irregular menstrual cycles for at least 4 months and elevated gonadotrophins (FSH > 25 IU/L, measured on one occasion) and low estrogen serum levels in women under the age of 40. Premature ovarian insufficiency can be non-iatrogenic or spontaneous (idiopathic or due to genetic, autoimmune, or metabolic reasons, or infections) and iatrogenic (a consequence of oophorectomy, chemotherapy, radiotherapy, or uterine artery embolization). Women with POI are faced not only with estrogen deficiency but also with infertility and psychological implications. Hormonal replacement therapy is effective in treating the symptoms of premature ovarian insufficiency as well as in lowering the health risk of long-term consequences of premature ovarian insufficiency. Currently, oocyte donation is the standard treatment for patients with POI desiring pregnancy. Recently developed methods for the regeneration of ovarian tissue, such as stem cell therapy, platelet-reach plasma therapy and in vitro activation of ovarian tissue, are still under research and further adequate multicentric clinical studies are needed to develop standardized effective and safe protocols for the infertility treatment of patients with premature ovarian insufficiency. Full article

Polycystic ovarian syndrome (PCOS) is a complex endocrine and metabolic disorder that affects reproductive health, metabolic function, and long-term cardiovascular health in women of reproductive age. The syndrome is characterized by hyperandrogenism, chronic anovulation, insulin resistance, oxidative stress, and ovarian microenvironment remodeling. While current treatments focus on symptom relief through hormone regulation, insulin sensitizers, or ovulation induction, there is a need to target the underlying molecular and cellular processes that drive disease progression and infertility. Breakthroughs in reproductive and metabolic medicine have led to the development of next-generation therapeutics for PCOS that aim to restore ovarian function at the molecular level. Nanoparticle- and nanofiber-based drug delivery systems offer targeted delivery to the ovaries, improved bioavailability, and controlled release of insulin sensitizers, antioxidants, and anti-androgens. Metabolic reprogramming strategies that target insulin resistance, mitochondrial dysfunction, and autophagy have emerged as potential disease-modifying interventions. In addition, AI-enabled precision medicine approaches are reshaping PCOS management through phenotype-based classification, predictive modeling, and personalized fertility optimization. In this review, we highlight recent advancements in understanding the molecular pathophysiology of PCOS and introduce novel therapeutics that harness intelligent drug delivery, ovarian microenvironment restoration, and AI-based interventions. We discuss the potential of these innovative strategies to update PCOS management options for long-term ovarian restoration and fertility. Full article

Conventional hormonal and clinical models inadequately clarify the complex and diverse aspects of female infertility, resulting in poor reproductive outcomes and reduced egg viability. A growing body of research indicates that female reproductive failure is mostly due to disruptions in cellular homeostasis, especially concerning organelle quality control. Oxidative stress has emerged as a crucial mediator connecting metabolic, inflammatory, and ageing-related processes to ovarian failure, however its downstream impacts on intracellular organelle turnover remain insufficiently clarified. Our narrative review encapsulates the existing data for a unified pathogenic concept focused on the redox-regulated mitochondria–lysosome axis. We examine the interaction of oxidative stress, mitochondrial malfunction, compromised mitophagy, and lysosomal deficiency in granulosa cells and oocytes. Prolonged oxidative stress may disrupt this equilibrium, leading to defective mitochondria accumulation and impaired mitophagy. This self-perpetuating cycle may ultimately jeopardises reproductive viability and oocyte integrity. The integrated axis offers a shared molecular foundation for various infertility-related diseases, such as inadequate ovarian response, obesity-associated infertility, polycystic ovary syndrome, and ovarian ageing. Ultimately, we analyse new findings suggesting that specific antioxidant chemicals modify mitophagy and lysosomal function while also neutralising reactive oxygen species, highlighting their potential use in precision fertility treatments. Our research redefines female infertility as a condition of redox-dependent organelle quality control, thereby introducing novel avenues for identifying biomarkers, categorising patients, and targeting treatments in assisted reproduction. Full article

Proteostasis, defined as the coordinated regulation of protein synthesis, folding, trafficking, and degradation, is essential for maintaining cellular integrity and supporting normal development. During reproduction and early life stages, efficient proteostasis is crucial for gamete quality, successful fertilization, embryonic development, and neurodevelopmental outcomes. Increasing evidence suggests that impaired proteostasis contributes to infertility and may be intertwined with biological vulnerabilities associated with assisted reproductive technologies [ARTs]. This review provides an integrative perspective on the role of disrupted proteostasis in infertility, ART procedures, and neurodevelopmental differences [NDD]. We review epidemiological and molecular findings indicating proteostasis failure in both male and female infertility, with particular emphasis on molecular chaperones. Among these, heat shock protein 60 [Hsp60] is discussed as a central mediator linking mitochondrial function, protein quality control, and reproductive competence. We further highlight that ART procedures coincide with sensitive periods of epigenetic reprogramming and proteostasis regulation during early embryogenesis, indicating that disturbances in proteostasis may affect epigenetic stability and subsequent neurodevelopmental outcomes. In addition, this review emphasizes the importance of proteoforms and proteome complexity as critical determinants of reproductive success and neurodevelopmental robustness in the context of ART. Finally, we discuss the potential of proteomic and chaperone-based biomarkers as emerging tools to optimize ART strategies, improve gamete and embryo selection, and enhance risk assessment and clinical outcomes. The current review underscores proteostasis as a fundamental yet underrecognized mechanism linking reproductive biology, ART outcomes, and long-term neurodevelopment while highlighting future directions for translational investigations. Full article

Soil nutrient loss and infertility in rocky desertification areas severely constrain ecological restoration. Exploring the impacts of external field remediation technologies on soil quality in these regions may offer novel strategies for soil enhancement and ecosystem recovery. This study conducted a three-month experiment to investigate the impact of continuous electric (ET, 20 V) and magnetic (MT, 200 mT) field treatments on soil nutrients, enzyme activities, and bacterial communities in simulated moderate and severe rocky desertification soils. Results showed that although an overall declining trends in total contents of key soil nutrients (Total nitrogen, total phosphorus, and total potassium), both electric and magnetic field treatments effectively mitigated the decreases of total nitrogen and potassium content (with the exception of total phosphorus) in rocky desertification soils, while improving their available contents compared to the control (CK). Electric field application significantly reduced the pH of moderate and severe rocky desertification soils through electrolysis, shifting the soil from alkaline (pH 7.69 and 7.73, respectively) to slightly acidic (pH 6.71 and 6.37, respectively); Both electric and magnetic field treatments enhanced urease and sucrase activities in moderately and severely rocky desertified soils. Compared to the CK, the increases were 21.92%, 4.46%, 5.70%, and 66.43% in moderately rocky desertified soil, and 10.06%, 42.15%, 20.66%, and 0.93% in severely rocky desertified soil, respectively. Their effects on phosphatase and catalase activities varied with the degree of rocky desertification. However, in severely rocky desertified soil, both treatments significantly increased phosphatase and catalase activities by 19.55%, 24.63%, 61.07%, and 38.05% compared to the CK, respectively. Furthermore, both electric and magnetic treatments significantly reduced bacterial α-diversity (chao1, ACE, Shannon, Simpson, and Pielou J indices) but optimized community structure by enriching dominant phyla with specific ecological functions, such as Pseudomonadota (7.63–41.10%), Bacteroidota (13.52–69.29%), and Verrucomicrobiota (38.26–104.81%). Functional prediction revealed that the abundances of dominant pathways (such as chemoheterotrophy, aerobic chemoheterotrophy, and nitrogen fixation) was enhanced following both treatments. Mantel analysis further indicated strengthened correlations among soil nutrients, enzyme activities, and bacterial communities, particularly under magnetic field treatment. These findings demonstrate that electric and magnetic field applications effectively facilitate nutrient cycling, stimulate enzyme activities, and optimize microbial community structure, thereby improving soil ecological functions and overall quality in rocky desertification regions, highlighting their potential for ecological restoration in karst areas. Full article

Background/Objectives: The manual analysis of sperm morphology, crucial for male infertility diagnosis, is subjective and time-consuming. Automated methods using deep learning, offer a promising alternative; however, standard deep models are prone to overfitting when applied to small, heavily unbalanced clinical datasets, limiting their generalization capability. This study proposes a knowledge distillation approach that functions as a strong regularizer, improving the robustness of automated sperm morphology analysis. Methods: We utilize soft distillation to transfer knowledge from a set of high-capacity teacher models to a smaller student model (SwinV2-base). The teacher architectures include SwinV2-large, EfficientNetV2-m, and ConvNeXtV2-large. To maximize performance, we investigated two distillation strategies: a single-teacher approach, where the student learns from one specific architecture, and a multi-teacher approach, where the student learns from an averaged response of multiple teachers. The models were trained on the imbalanced Hi-LabSpermMorpho dataset, which comprises 18 different sperm morphology categories derived from three differently stained (BesLab, Histoplus, GBL) sample sets. We adopted a cross-dataset training approach in which the teacher models were fine-tuned using the combination of two stained datasets, and the student model was trained on the third, distinct stained dataset. The global loss function combined cross-entropy loss with Kullback–Leibler divergence, employing the teacher’s soft probabilities to prevent the student from over-confidence. Results: The experimental results demonstrate that the student model trained in a multi-teacher setup with augmentation and soft distillation attains higher accuracies (70.94% on BesLab, 73.61% on Histoplus, 71.63% on GBL) than the baseline models. Conclusions: This approach mitigates challenges associated with data scarcity and heavily unbalanced sperm morphology datasets, providing consistent improvements and offering a highly generalizable solution for clinical diagnostics. Full article

Zinner syndrome is a rare congenital anomaly of the male genitourinary tract, characterized by the triad of unilateral renal agenesis, ipsilateral seminal vesicle cyst, and ejaculatory duct obstruction. Owing to its low prevalence and nonspecific clinical presentation, diagnosis is often delayed or incidental, with imaging playing a central role in detection and characterization. This study presents a narrative review with an illustrative case report, aiming to summarize the imaging features of Zinner syndrome, outline the main radiologic differential diagnoses of seminal vesicle cysts, and highlight common diagnostic pitfalls, with emphasis on cross-sectional imaging techniques such as computed tomography (CT) and magnetic resonance imaging (MRI). The narrative review of the literature highlights that CT and MRI are essential for accurate anatomical localization, characterization of cystic content, and identification of associated genitourinary anomalies. MRI, in particular, provides superior soft-tissue contrast and is considered the reference modality for diagnosis and differential evaluation of male pelvic cystic lesions. Key differential diagnoses include Müllerian duct cysts, prostatic utricle cysts, and ejaculatory duct cysts. As an illustrative example, we report the case of a young adult male presenting with pelvic discomfort, infertility, and mild lower urinary tract symptoms. Imaging findings, including ultrasound and cross-sectional studies, demonstrated a seminal vesicle cyst associated with ipsilateral renal agenesis, consistent with Zinner syndrome. Zinner syndrome should be considered in the evaluation of male pelvic cystic lesions, particularly in the presence of unilateral renal agenesis. Awareness of its characteristic imaging features is essential for accurate diagnosis and appropriate management, with MRI playing a pivotal role in confirming the diagnosis and distinguishing it from other pelvic cystic entities. Full article

Obesity is associated with menstrual dysfunction, anovulation, and infertility, particularly in women with polycystic ovary syndrome (PCOS). This narrative review summarizes evidence on the effects of bariatric surgery [focusing on sleeve gastrectomy (SG) Roux-en-Y gastric bypass (RYGB)] on female reproductive function and fertility outcomes. Developed according to SANRA (Scale for the Assessment of Narrative Review Articles) principles, a structured search of PubMed, Scopus, and Web of Science (English language; inception–30 September 2025) was conducted, using fertility-related terms (e.g., fertility, ovulation, IVF/ART, AMH, PCOS, pregnancy, live birth, time to conception) combined with bariatric surgery terms (SG/VSG, RYGB, metabolic/bariatric surgery, and weight loss surgery). Guidelines from IFSO, BOMSS, and ASMBS were also reviewed. Findings were synthesized narratively. Across mainly observational studies, bariatric surgery is associated with improved menstrual regularity, increased ovulation, reduced hyperandrogenism, and improved insulin sensitivity, with higher conception rates reported after substantial weight loss. AMH responses are inconsistent across studies and their clinical significance remains uncertain. SG and RYGB appear to improve fertility-related outcomes in women with obesity. Programming of pregnancy and nutritional monitoring are critical. In conclusion, long-term, standardized reproductive endpoints are needed to clarify bariatric surgery-associated effects during pregnancy. Full article

Background and Objectives: Postoperative pain and intra-abdominal adhesions are common complications following surgery. Pain delays early mobilization, whereas adhesions can lead to bowel obstruction, chronic pain, or infertility. Current treatments, including systemic analgesics and physical barrier methods, are only partially effective. We hypothesized that combining these modalities would yield superior outcomes. Accordingly, we investigated whether a lidocaine-loaded alginate–carboxymethyl cellulose–polyethylene oxide (ACPE) electrospun film could more effectively reduce both postoperative pain and adhesion formation than either component alone. Materials and Methods: An electrospun nanofiber film composed of ACPE containing lidocaine was prepared. Its effects were evaluated in rats using an incisional pain and a peritoneal adhesion model. Four groups were compared: saline control, free lidocaine, drug-free ACPE film, and lidocaine-loaded ACPE film. Fifteen rats were allocated to each group. The primary outcome was the mechanical withdrawal threshold (MWT) after plantar incision, while secondary outcomes included histological changes and adhesion scores assessed by the Moreno system. Results: The lidocaine–ACPE film significantly increased MWT compared with all other groups, demonstrating a stronger and longer-lasting analgesic effect than free lidocaine. Adhesion scores were also lowest in the film group. Histological analysis confirmed a reduction in inflammatory cell infiltration and collagen deposition. Conclusions: A lidocaine-loaded ACPE nanofiber film effectively reduced both postoperative pain and adhesion formation in a rodent model. The combination of sustained local drug release and physical barrier function provides a promising strategy to address two major postoperative complications. Further preclinical studies are warranted before clinical application. Full article

Ovarian function relies on a network of well-coordinated molecular mechanisms that regulate follicular development, oocyte maturation, ovulation, and corpus luteum function. When these processes are disrupted, infertility can result. Extracellular matrix (ECM) remodeling represents a central regulatory component in these processes and is essential for follicle rupture and oocyte release. This mechanism involves metalloproteinases (MMPs), mainly MMP-2 and MMP-9, which degrade the ECM and allow the necessary structural changes. Other ECM-modulating proteases, such as ADAM and ADAMTS families, also contribute to this process. Their activity is tightly regulated by tissue inhibitors of metalloproteinases (TIMPs), ensuring that tissue remodeling occurs in a controlled manner. Disruption of the balance between MMPs and TIMPs increases the risk of infertility-related conditions such as polycystic ovary syndrome (PCOS), endometriosis, luteinizing hormone (LH) deficiency syndrome, and ovarian aging. In addition to the ECM, other factors, including intracellular signaling pathways, oxidative stress (OS), and mitochondrial function, contribute to ovarian physiology and directly affect oocyte quality and viability. This narrative review focuses on the molecular mechanisms governing ovarian function, with particular emphasis on the remodeling of the ECM by MMPs during ovulation, and examines how their disorders contribute to infertility. A deeper understanding of these mechanisms may lead to the identification of new therapeutic targets and the improvement of assisted reproduction outcomes. Full article

Cryptorchidism is the most common non-lethal congenital defect of the male reproductive system in sheep, with potential economic consequences for flock management. This study investigated the incidence, testicular morphology, ultrasonographic characteristics, semen quality, and sexual behavior of bilateral cryptorchid Sarda rams. Slaughterhouse inspections of 2360 lambs showed an incidence of 0.87% cryptorchidism. Cryptorchid testes were significantly rounder and lighter than intact testes, indicating impaired development in affected animals. Ultrasonography of 15 adult bilateral cryptorchid rams showed that retained testes were markedly undersized and that the left testis was less frequently visualized. No significant association with age was detected within the studied age range. All ejaculates recovered from bilateral cryptorchid rams were azoospermic. Nevertheless, behavioral trials suggested that bilateral cryptorchid males retained sexual interest and the ability to identify estrous ewes. These findings confirm the infertility of bilateral cryptorchid Sarda rams while highlighting their preserved sexual behavior, suggesting a potential zootechnical use as teaser rams for heat detection. Repurposing cryptorchid males in this way could represent a potential alternative to surgically modified teaser rams or the use of aprons on intact rams. Full article