1.  DHEA 治療顯著增加了子宮內膜厚度有助於提高臨床懷孕率
2. DHEA給藥也提高了卵子和胚胎的品質[包括獲卵數（MD = 0.73，95% CI：0.36至1.10；證據品質低）、受精卵數（MD = 0.48，95% CI：0.10至0.87；證據品質低）、移植物數（MD 0.65，95% CI：0.27至1.03；證據品質低）
3. DHEA對活產率/持續懷孕率、流產率和MII期卵母細胞數量的影響，現有證據尚不足以得出結論。 

Meta-Analysis

. 2025 Feb 20;18(1):35.

doi: 10.1186/s13048-024-01581-3.

Administration of dehydroepiandrosterone improves endometrial thickness in women undergoing IVF/ICSI: a systematic review and meta-analysis

Background: The positive effects of dehydroepiandrosterone (DHEA) on oocyte and embryo quality improvement are often concerned. While the results on DHEA-induced endometrial improvement are controversial.

Objective: To evaluate whether DHEA intervention improved endometrial function and reproductive outcomes during in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycles and to thus provide clinical recommendations.

Data sources: PubMed, Cochrane Library, EMBASE and Web of Science from database inception to 31 July 2024, without language restrictions. The references of conference proceedings and websites on clinical trials were manually checked.

Study design: Systematic review and meta-analysis.

Study eligibility criteria: Parallel-controlled randomized controlled trials (RCTs) design; women underwent IVF/ICSI, patients in the experimental group received adminstration with DHEA, whereas the control group received with or without placebo; and the outcomes included reproductive or endometrial function.

Study appraisal and synthesis methods: RCTs evaluating the effects of DHEA on IVF/ICSI outcomes were included. Risk of bias and quality of evidence (QoE) were assessed according to the Cochrane Collaboration's tool and the Grading of Recommendations Assessment, Development and Evaluation system. Odds ratios (ORs) and mean differences (MDs) with 95% confidence intervals (CIs) were assessed by random-effects or fixed-effects models. Subgroup and meta-regression analyses were used to find sources of heterogeneity. Trial sequential analysis was used to judge the stability of the outcomes. Trial sequential analysis was used in order to control for random errors.

Results: A total of 16 trials included 1973 women. DHEA treatment significantly increased endometrial thickness (MD = 0.93, CI: 0.27 to 1.60; low QoE), which helped improve clinical pregnancy rate (CPR) (OR = 1.34, 95% CI: 1.08 to 1.67; low QoE). DHEA administration also increased the quality of oocyte and embryo [including the number of oocytes retrieved (MD = 0.73, CI: 0.36 to 1.10; low QoE), oocytes fertilized (MD = 0.48, CI: 0.10 to 0.87; low QoE), transferred embryos (MD = 0.27, CI: 0.09 to 0.46; very low QoE), and high-quality embryos (MD = 0.65, CI: 0.27 to 1.03; low QoE)]. Subgroup and meta-regression analyses revealed that heterogeneity might be related to disease type, ovarian stimulation protocol, and addition time of DHEA treatment. There was insufficient evidence to reach a conclusion regarding the live birth rate/ongoing pregnancy rate, miscarriage rate, and MII oocyte number of DHEA. And no severe adverse effects were observed with DHEA administration. Due to the apparent improvemen in the CPR, women with thin endometrium might benefit from DHEA cotreament.

Conclusions: Due to the limited sample size and methodological problems, the QoE was low to very low; hence, the results should be interpreted with caution. The effectiveness of DHEA requires more research before it can be considered for clinical practice.

卵巢反應普通或不佳的病患----不適用黃體素抑制腦下垂體  &  GnRHa破卵

捐卵年輕病患應採用 GnRHa破卵  不適用GnRHa抑制腦下垂體 

為預測卵巢刺激反應建議使用竇狀卵泡計數 (AFC) 或抗苗勒氏管激素 (AMH)

不建議使用年齡、BMI、基礎 FSH、抑制素 B、基礎雌二醇、基礎孕酮和基礎 LH 來預測卵巢反應

卵巢刺激療程前 不建議使用賀爾蒙或避孕藥物

Practice Guideline

. 2026 Apr 1;41(4):498-514.

doi: 10.1093/humrep/deag018.

ESHRE guideline: ovarian stimulation for IVF/ICSI: an update in 2025†

 

單一案例顯示，妊娠早期(0-7週)接觸週纖達沒有導致胎兒不良後果

Review

. 2026 Apr;55(4):103133.

doi: 10.1016/j.jogoh.2026.103133. Epub 2026 Feb 5.

Semaglutide exposure in early pregnancy and pregnancy outcomes: A case report and review of literature

Background: Semaglutide, a glucagon-like peptide-1 receptor agonist, is increasingly used for the treatment of diabetes and weight loss, including in women of reproductive age. However, its impact on pregnancy outcomes remains largely unknown, with limited data available. The manufacturer advises against using semaglutide within two months prior to planned pregnancy, but some patients may unknowingly use it during early pregnancy.

Case presentation: We report the case of a 37-year-old woman with a pre-pregnancy Body Mass Index (BMI) of 27.73 kg/m². She received semaglutide 0.5 mg once weekly, initiated before conception and continued until approximately 7 weeks of gestation, and discontinued treatment immediately upon recognition of pregnancy. All prenatal screenings, including nuchal translucency and four-dimensional color Doppler ultrasound, were normal. She delivered a healthy male infant at nearly 40 weeks of gestation. The infant showed no adverse outcomes during follow-up assessments at 1 and 3 months of age.

Conclusions: This case suggests that semaglutide exposure during early pregnancy may not necessarily lead to adverse outcomes in obese women. However, larger studies are needed to confirm these findings and to better understand the impact of semaglutide on pregnancy outcomes. This case report contributes to the limited literature on this topic and may inform future clinical decision-making.

 驅動卵巢纖維化的關鍵分子路徑包括轉化生長因子-β (TGF-β)/Smad訊號路徑、Wnt/β-catenin路徑和PI3K/Akt通路，

這些路徑調控纖維母細胞活化、細胞外基質重塑和組織硬化。

纖維化卵巢間質的特徵是I型和III型膠原蛋白、纖維連接蛋白和透明質酸含量升高，從而破壞正常的卵泡發生和類固醇生成。卵巢纖維化也與多囊性卵巢症候群、卵巢早衰和子宮內膜異位症等生殖系統疾病相關，

目前治療策略集中在吡非尼酮等抗纖維化藥物、TGF-β抑制劑和氧化壓力調節，以及乾細胞療法等新興療法。

. 2026 Jan 7;32(1):gaaf058.

doi: 10.1093/molehr/gaaf058.

Molecular mechanisms of ovarian fibrosis

Ovarian fibrosis is increasingly recognized as a pivotal factor contributing to ovarian ageing, dysfunction, and female infertility. It results from chronic or repetitive ovarian injury, such as that caused by repeated ovulation, which induces inflammation and excessive extracellular matrix (ECM) deposition, predominantly by activated fibroblasts and myofibroblasts. The key molecular pathways driving ovarian fibrosis include transforming growth factor-beta (TGF-β)/Smad signalling, Wnt/β-catenin, and PI3K/Akt pathways, which orchestrate fibroblast activation, ECM remodelling, and tissue stiffening. Elevated collagen types I and III, fibronectin, and hyaluronan characterize the fibrotic ovarian stroma, disrupting normal folliculogenesis and steroidogenesis. Ovarian fibrosis is also implicated in reproductive pathologies such as polycystic ovary syndrome, premature ovarian insufficiency and endometriosis, and may contribute to an increased risk of ovarian cancer, although definitive causal links require further elucidation. Current therapeutic strategies remain largely experimental, focusing on antifibrotic agents such as pirfenidone, TGF-β inhibitors, and modulation of oxidative stress, alongside emerging interventions such as stem cell therapies, which are offer potential avenues for intervention in the ovary. This review synthesizes current insights into the cellular and molecular mechanisms driving ovarian fibrosis, its association with reproductive disorders, and emerging therapeutic strategies. It underscores key knowledge gaps and emphasizes the need for future research focused on fibroblast activation, inflammatory signalling, and immune-ECM interactions to facilitate the development of targeted, long-term interventions aimed at preventing or reversing ovarian fibrosis and preserving female fertility. 

 

1. 精索靜脈曲張影響15%的男性族群。
2. 精索靜脈曲張合併低睪固酮水平的患者在接受精索靜脈曲張修復術後，總睪固酮水平平均升高約80至100 ng/dL。
3. 精索靜脈曲張切除術可能在無需藥物的情況下顯著改善睪固酮水平

. 2026 Jul;126(1):3-8.

doi: 10.1016/j.fertnstert.2026.03.011.

Varicocele and low testosterone

Varicoceles are estimated to affect 15% of the general male population. The association between varicocele and infertility has been well established, as reflected by impaired spermatogenesis. However, it is also crucial to consider the role of testes in testosterone production and the effects of testosterone deficiency on overall male health. Patients with varicocele and low testosterone have been found to have an average increase of approximately 80 to 100 ng/dL in total testosterone levels after varicocele repair. In combination with other interventions, such as weight loss, varicocelectomy may provide sufficient improvements in testosterone levels without requiring medications. Further research is warranted to better define predictors of postvaricocelectomy improvements, such as age, baseline testosterone levels, and varicocele grade, and to clarify the clinical significance of postoperative testosterone increases.

1.  在OAT患者中，DGC法獲得的精子數量最多，速度、活力和SSFI也最佳。
2. AGF-2技術在正常精子症患者中是最有效的方法。 
3. DGC、AGF-2和上游處理後，精子DNA損傷顯著降低。
4. DGC對OAT患者最有益，
5. AGF-2和上游法更適合正常精子症患者。

. 2025 Nov 21;6(4):e250012.

doi: 10.1530/RAF-25-0012. Print 2025 Oct 1.

Sperm preparation techniques affect biological parameters, fertility indices, and DNA fragmentation in patients with oligo-astheno-teratozoospermia

Abstract: In normozoospermia, the albumin gradient filtration (AGF) and swim-up processing techniques are used to isolate spermatozoa with the highest biological parameters and specific sperm fertility indices (SSFI). In contrast, the highest number of sperm with the best motility rate, velocity, and SSFI, and the lowest DNA damage and nuclear fragmentation are isolated using the density gradient centrifugation (DGC) preparation technique in oligo-astheno-teratozoospermia (OAT) patients. The study aimed to evaluate the effect of DGC, AGF-1, AGF-2, and swim-up preparation techniques on biological parameters, including SSFI, chromatin integrity, and DNA fragmentation in patients with OAT and normozoospermia. One hundred men with normozoospermia and OAT participated in the study. Biological parameters (concentration, velocity, total motility, and normal morphology), SSFI (progressively motile sperm concentration-grade a (PMSCa), progressively motile sperm concentration-grade b (PMSCb), and sperm motility index, functional sperm concentration, motile sperm concentration), chromatin integrity, and DNA fragmentation were assessed before and after each processing method using SQA-V Gold sperm analyzer and specific staining, TUNEL, and COMET assays. In OAT patients, the highest number of sperm with the best velocity, motility, and SSFI was demonstrated in the DGC method. However, the AGF-2 technique was the most efficient method in normozoospermic patients. Sperm DNA damage significantly decreased following preparation with DGC, AGF-2, and swim-up techniques. Overall, the findings highlight that DGC is the most beneficial method for OAT patients, whereas AGF-2 and swim-up techniques are more suitable for normozoospermic individuals. These comparisons emphasize the need to tailor techniques according to patient-specific sperm profiles.

1.  菌叢失調——以乳酸桿菌屬減少和厭氧菌過度生長為特徵——與不良妊娠結局相關。
2. 慢性子宮內膜炎常伴隨乳桿菌屬減少和致病微生物（如加德納菌和埃希氏菌）定植，
3. 抗生素治療可能恢復菌叢平衡，並已被報告可提高胚胎著床率。
4. 反覆著床失敗通常與非乳酸桿菌主導的子宮內膜菌群有關，
5. 聯合使用抗生素和益生菌可部分恢復其正常狀態。
6. 多囊性卵巢症候群中，腸道菌叢失衡——以微生物多樣性低、短鏈脂肪酸產生菌減少和脂多醣產生革蘭氏陰性菌增加為特徵——與代謝和生殖功能障礙均相關。膳食纖維、益生菌和二甲雙胍可能有助於重建菌叢平衡。
7. 子宮內膜異位症和子宮肌腺症患者的生殖道菌叢多樣性往往較高，乳桿菌豐度降低，可能加劇發炎反應。
8. 妊娠期間，富含乳酸桿菌的陰道菌叢與較低的流產和早產風險有關。

Review

. 2026 Apr;125(4):574-582.

doi: 10.1016/j.fertnstert.2026.01.010. Epub 2026 Jan 21.

The reproductive tract microbiome and female fertility: dysbiosis, disease links, and emerging therapeutic strategies

The reproductive tract microbiome plays a pivotal role in female fertility, with Lactobacillus-dominated communities maintaining a protective, low-pH environment. Dysbiosis-characterized by a reduction in Lactobacillus species and overgrowth of anaerobes-is associated with adverse outcomes. Chronic endometritis frequently involves diminished Lactobacillus species and colonization by pathogenic microbes such as Gardnerella and Escherichia, and antibiotic treatment may restore eubiosis and has been reported to improve implantation rates. Recurrent implantation failure is often linked to non-Lactobacillus-dominated endometrial microbiota, which can be partially normalized through combined antibiotic and probiotic interventions. In polycystic ovary syndrome, gut dysbiosis-marked by low microbial diversity, reduced short-chain fatty acid-producing bacteria, and increased lipopolysaccharide-producing Gram-negative species-correlates with both metabolic and reproductive dysfunction. Dietary fiber, probiotics, and metformin may help reestablish microbial balance. Patients with endometriosis and adenomyosis tend to harbor high-diversity reproductive tract microbiota with decreased Lactobacillus abundance, potentially exacerbating inflammatory pathways. During pregnancy, a Lactobacillus-rich vaginal microbiota is associated with lower risks of miscarriage and preterm birth, whereas bacterial vaginosis-like, high-diversity communities are linked to increased risks. Emerging therapies-including antibiotics, vaginal probiotics, and vaginal microbiota transplantation-aim to restore eubiosis and improve reproductive outcomes. Collectively, this review highlights the impact of dysbiosis on fertility and summarizes emerging therapeutic strategies to optimize reproductive success.

 節段性嵌合體和染色體單體嵌合體胚胎的懷孕結局與整倍體胚胎的懷孕結局相當，

染色體三體嵌合體胚胎的懷孕結局則明顯較差

. 2026 May;125(5):786-796.

doi: 10.1016/j.fertnstert.2026.01.008. Epub 2026 Jan 21.

Impact of different types of embryonic mosaicism on pregnancy outcomes

Objective: Mosaic embryos can yield healthy live births, although pregnancy outcomes are inferior to those with euploid embryos. Pregnancy outcomes also vary significantly among mosaic embryos with different characteristics, yet current classifications lack sufficient granularity to reflect this heterogeneity. However, prevailing classification systems lack sufficient granularity to adequately reflect this heterogeneity. The objective of this study is to delineate pregnancy outcome differences among mosaic embryos categorized using a refined classification framework that provides greater resolution of mosaicism characteristics.

Subjects: A total of 434 cycles of mosaic embryo transfers and 868 cycles of euploid embryo transfers were included.

Exposure: The euploid or mosaic embryos transferred and the characteristics of mosaicism.

Main outcome measures: Clinical pregnancy rate, ongoing pregnancy rate, live birth rate, first-trimester pregnancy loss rate, incidence of maternal complications, and congenital anomalies.

Results: Generalized estimating equation (GEE) models were used to compare pregnancy outcomes between groups. Overall, mosaic embryos were associated with significantly inferior pregnancy outcomes than euploid embryos, driven primarily by high-level mosaic embryos. Compared with euploid embryos, the segmental mosaic embryos had similar pregnancy outcomes, whereas the chromosomal mosaic embryos had worse pregnancy outcomes, with lower clinical pregnancy rate (odds ratio [OR]=0.65; 95% confidence interval [CI]: 0.43-0.98), ongoing pregnancy rate (OR=0.56; 95%CI: 0.37-0.84), and live birth rate (OR=0.61; 95%CI: 0.41-0.92). Within chromosomal mosaic embryos, pregnancy outcomes did not differ significantly between monosomy mosaic and euploid embryos. In contrast, chromosomal trisomy mosaic embryos presented markedly worse outcomes than euploid embryos across all measures: biochemical pregnancy rate (OR=0.46; 95%CI: 0.25-0.83), clinical pregnancy rate (OR=0.48; 95%CI: 0.27-0.84), first-trimester pregnancy loss rate (OR=6.00; 95%CI: 1.99-18.11), ongoing pregnancy rate (OR=0.32; 95%CI: 0.18-0.58), and live birth rate (OR=0.35; 95%CI: 0.19-0.63). Finally, the incidence of maternal complications and congenital anomalies did not differ significantly between mosaic and euploid groups.

Conclusion: Segmental and chromosomal monosomy mosaic embryos have pregnancy outcomes comparable with those of euploid embryos, whereas chromosomal trisomy mosaic embryos are associated with significantly poorer outcomes.

 子宮內膜容受性分析 (ERA) 顯示，無論是一般不孕症族群或是有胚胎移植失敗史的患者，ERA 都無法優化 EET 週期中的生殖結果

. 2023 Oct 23:14:1251699.

doi: 10.3389/fendo.2023.1251699. eCollection 2023.

Does endometrial receptivity array improve reproductive outcomes in euploid embryo transfer cycles? a systematic review

Besides chromosomal normality, endometrial receptivity is an important factor in determining successful pregnancies. Endometrial receptivity array (ERA), a promising endometrial receptivity test, was speculated to improve the reproductive outcomes. However, its effectiveness is controversial in clinical practice. Therefore, we conducted this review to investigate its role in in vitro fertilization (IVF) treatment. To eliminate the interference of embryo quality, we only analyzed studies that originally reported the reproductive outcomes of patients who underwent ERA-guided euploid embryo transfer (EET). Unexpectedly, it revealed that ERA could not optimize the reproductive outcomes in EET cycles, no matter in general infertile population or in patients with a history of previous failed embryo transfers.

 endometrial receptivity analysis (ERA)子宮內膜容受性分析 

ERA接受性( receptivity)與否

----與年紀無明顯關聯

. 2026 Apr;43(4):1169-1177.

doi: 10.1007/s10815-026-03824-2. Epub 2026 Feb 9.

Endometrial aging and uterine receptivity: endometrial receptivity analysis (ERA) outcomes in female patients of diverse age groups

Purpose: To assess whether the endometrial receptivity analysis (ERA) captures receptivity changes attributed to endometrial aging and whether it may be useful for older patients undergoing fertility treatment.

Methods: Retrospective cohort study of patients who underwent ERA testing at an academic center (01/2019-05/2024). The ERA inferred transcriptomic levels of canonical receptivity markers from biopsies obtained at standard timing. Demographic and treatment-related variables were analyzed by age group. The proportion of non-receptive ERA results (pre- and post-receptive combined) was compared using Fisher's exact test. Univariable and multivariable logistic regression assessed associations between predictors and non-receptive ERA.

Results: Of 210 patients, 205 were included. Age distribution was < 35 (n = 35, 17%), 35-37 (n = 58, 28.3%), 38-40 (n = 53, 25.8%), and ≥ 41 (n = 59, 28.8%). Overall, 166 (81.0%) ERAs were receptive, 33 (16.1%) pre-receptive, and 6 (2.9%) post-receptive. BMI, infertility diagnosis, and prior implantation or miscarriage history did not differ by age. Non-receptive ERA proportions were 20% (< 35), 17.2% (35-37), 17.0% (38-40), and 22.0% (≥ 41) (p = 0.52). In multivariable analysis adjusting for BMI and number of prior failed euploid transfers, age was not associated with non-receptive ERA (aOR 0.98, 95% CI 0.34-2.30, p = 0.97).

Conclusion: Uterine age was not associated with increased odds of non-receptive ERA, suggesting that the test does not capture age-related changes in endometrial receptivity. Although endometrial aging is implicated in reduced embryo transfer success, the ERA should not be ordered solely on the basis of uterine age. The ERA may not reliably detect age-related endometrial differences in the window of implantation at a clinical level.

空卵泡症候群 (EFS) ------ 一種罕見的體外受精併發症，指在取卵過程中未取出卵子。

ZP3 基因中一種新的雜合突變 (p.Ser173Cys, c.518C > G)----與空卵泡綜合症相關

Empty follicle syndrome (EFS) ------ a rare IVF complication where no eggs are retrieved during an egg collection procedure,

Novel heterozygous mutation (p.Ser173Cys, c.518C > G) in the ZP3 gene

----associated with EFS

A novel mutation in ZP3 causes empty follicle syndrome and abnormal zona pellucida formation

• Genetics
• Published: 02 November 2020

• Volume 38, pages 251–259 (2021)
• Cite this article

Save article

Journal of Assisted Reproduction and GeneticsAims and scopeSubmit manuscript

Purpose

To identify disease-causing genes involved in female infertility.

Methods

Whole-exome sequencing and Sanger DNA sequencing were used to identify the mutations in disease-causing genes. We performed subcellular protein localization, western immunoblotting analysis, and co-immunoprecipitation analysis to evaluate the effects of the mutation.

Results

We investigated 17 families with female infertility. Whole-exome and Sanger DNA sequencing were used to characterize the disease gene in the patients, and we identified a novel heterozygous mutation (p.Ser173Cys, c.518C > G) in the ZP3 gene in a patient with empty follicle syndrome. When we performed co-immunoprecipitation analysis, we found that the S173C mutation affected interactions between ZP3 and ZP2.

Conclusions

We identified a novel mutation in the ZP3 gene in a Chinese family with female infertility. Our findings thus expand the mutational and phenotypical spectrum of the ZP3 gene, and they will be helpful in precisely diagnosing this aspect of female infertility.