Linlin Liang

Background: Current guidelines recommend laparoscopic cystectomy for ovarian endometrioma (OMA) ≥4 cm before fertility treatment, yet cystectomy inevitably damages ovarian reserve. While recent large-scale studies have confirmed that cystectomy reduces antimüllerian hormone (AMH) levels and oocyte yield, whether this translates into impaired cumulative live birth rate (CLBR)—the most clinically relevant IVF outcome—remains inadequately addressed. Methods: This retrospective cohort study included 394 infertile patients with OMA undergoing their first IVF cycle at a single tertiary center (January 2016–December 2022). Patients were stratified into Group A (non-surgical OMA <4 cm, n=116), Group B (non-surgical OMA ≥4 cm, n=47), and Group C (surgical OMA ≥4 cm, n=231). The primary outcome was CLBR. Multivariable logistic regression (primary analysis of CLBR), propensity score matching (PSM), and inverse probability of treatment weighting (IPTW) were employed. Multiple linear regression was used as an exploratory analysis of oocyte yield. Results: In non-surgically managed patients, OMA size did not independently predict CLBR (Group B vs. A: OR = 1.06, P = 0.882). Among patients with OMA ≥4 cm, prior cystectomy was associated with significantly lower AMH (1.98 vs. 3.16 ng/mL, P = 0.001), fewer retrieved oocytes (median 7 vs. 11, P = 0.001), and impaired embryological outcomes. However, CLBR did not differ significantly between surgical and non-surgical management (52.4% vs. 59.6%, P = 0.370; adjusted OR = 0.77, 95% CI: 0.38–1.56, P = 0.469). PSM (OR = 0.67, P = 0.374) and IPTW (OR = 0.77, P = 0.448) confirmed these findings. Patient age (OR = 0.92, P = 0.030) and number of transferred embryos (OR = 2.21, P = 0.014) were the only independent predictors of CLBR. Conclusions: Pre-IVF laparoscopic cystectomy for OMA ≥4 cm significantly compromises ovarian reserve and IVF efficiency and this study did not detect a significant improvement in CLBR, although the comparison was underpowered to exclude clinically meaningful differences. Direct IVF may warrant consideration as an alternative strategy for patients without absolute surgical indications. When surgery is planned, preoperative fertility preservation should be considered. These findings require validation in prospective randomized trials.

Background: Fertility preservation (FP) enables individuals to maintain future reproductive potential, yet population-level data on FP awareness and willingness remain limited in inland China. Previous studies have been largely descriptive without quantifying the population-level impact of modifiable determinants. This study identified independent predictors of FP awareness and willingness among college students and the general population in Henan Province, central China, and estimated the population attributable fraction (PAF) of key modifiable factors. Methods: A cross-sectional survey was conducted (May–October 2022) using stratified sampling among college students ( n = 765) and general population members ( n = 1,008). Two validated knowledge scoring systems (13-point and 11-point scales) were developed. Multivariable logistic regression and PAF analysis were performed. Results: Among college students, FP awareness was 21.1% and willingness 65.3%. Knowledge score was the sole independent predictor of FP awareness (aOR = 2.22, 95%CI: 1.92–2.56; PAF = 62.8%). FP willingness was independently associated with medical major (aOR = 1.62, p = 0.003), contraceptive use (aOR = 2.06, PAF = 48.2%), and gender (aOR for female = 0.68, p = 0.024). In the general population, knowledge score (aOR = 1.86, p < 0.001) and medical background (aOR = 1.83, p = 0.003) predicted FP awareness. FP willingness was independently associated with marital status (aOR = 2.10, PAF = 39.7%) and knowledge score (aOR = 1.16, p < 0.001). Educational attainment was not independently associated with FP willingness after adjustment (aOR = 1.09, p = 0.198). Sensitivity analyses using corrected risk ratios confirmed that OR-based PAFs represent upper-bound estimates for common outcomes. Conclusion: Knowledge is the primary modifiable predictor of FP awareness and willingness with substantial population-level impact. If confirmed in longitudinal studies, knowledge-centered educational strategies prioritizing non-medical populations, unmarried individuals, and rural residents may substantially reduce current awareness and willingness gaps.

Introduction: Polycystic ovary syndrome (PCOS) affects 5–20% of adolescent females worldwide, yet scalable non-pharmacological interventions remain scarce. Tai Chi, a traditional Chinese mind-body exercise, may address the complex metabolic, reproductive, and psychosocial dimensions of PCOS, but robust randomized controlled trial evidence is lacking. Methods: This 6-month, single-center, parallel-group randomized controlled trial (February–July 2025, Zhengzhou, China) enrolled 120 female college students (aged 18–22 years) meeting Rotterdam PCOS criteria, randomized 1:1 to dietary adjustment alone (control, n = 60) or dietary adjustment plus 24-style simplified Tai Chi (intervention, n = 60; 60 min, 5×/week). The primary outcome was the Health-Promoting Lifestyle Scale total score. Secondary outcomes included BMI, menstrual cycle length, and serum testosterone. Complete-case analysis (n = 86) used repeated-measures ANOVA, independent t-tests, and Cohen's d effect sizes. Intention-to-treat analysis with last observation carried forward (ITT-LOCF, n = 120) was performed as a sensitivity analysis. Results: The combined intervention produced a large between-group difference in the primary outcome (total lifestyle score improvement: 15.49 points, 95% CI: 13.00–17.98, P < 0.001; d = 2.62), with the exercise dimension showing the largest effect (d = 2.69). However, the exercise subscale effect size partly reflects measurement overlap between the Tai Chi intervention and the self-reported exercise items. Secondary outcomes showed modest improvements favoring the combined intervention: post-intervention BMI (21.35 ± 1.76 vs 22.51 ± 2.08 kg/m², P = 0.005), menstrual cycle duration (38.49 ± 6.37 vs 50.19 ± 12.04 days, P < 0.001), and testosterone reduction (16.7% vs 6.4%, between-group P = 0.033). Significant time × group interactions were observed for all indicators (partial η² = 0.066–0.494) except dietary nutrition. ITT-LOCF analysis confirmed the primary finding (MD = 10.90, P < 0.001, d = 0.64). Exploratory subgroup analyses suggested, but could not confirm, greater benefit in participants with severe menstrual irregularities (>60 days; interaction P = 0.028–0.042). Discussion: Tai Chi combined with dietary adjustment may serve as a useful adjunctive exercise modality within lifestyle-based management for young women with PCOS. The large behavioral effect sizes should be interpreted with caution, as they partly reflect structured participation and measurement overlap. The absence of an active exercise comparator precludes attribution of benefits specifically to Tai Chi. Multi-center trials with active exercise comparators, comprehensive metabolic profiling, and long-term follow-up are needed to confirm these preliminary findings.

Cryopreservation has important application in assisted reproductive technology (ART). The vitrification technique has been widely used in the cryopreservation of oocytes and embryos, as a large number of clinical results and experimental studies have shown that vitrification can achieve a higher cell survival rate and preimplantation development rate and better pregnancy outcomes. Ovarian tissue vitrification is an alternative method to slow freezing that causes comparatively less damage to the original follicular DNA. At present, sperm preservation mainly adopts slow freezing or rapid freezing (LN2 vapor method), although the vitrification method can achieve higher sperm motility after warming. However, due to the use of high-concentration cryoprotectants and ultra-rapid cooling, vitrification may cause strong stress to gametes, embryos and tissue cells, resulting in potentially adverse effects. Imprinted genes are regulated by epigenetic modifications, including DNA methylation, and show single allele expression. Their accurate regulation and correct expression are very important for the placenta, fetal development and offspring health. Considering that genome imprinting is very sensitive to changes in the external environment, we comprehensively summarized the effect of cryopreservation—especially the vitrification method in ART—on imprinted genes. Animal studies have found that the vitrification of oocytes and embryos can have a significant impact on some imprinted genes and DNA methylation, but the few studies in humans have reported almost no influence, which need to be further explored. This review provides useful information for the safety assessment and further optimization of the current cryopreservation techniques in ART.