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Rural women in India continue to face major geographical, financial, and sociocultural barriers to get timely maternal and reproductive healthcare, despite recent investments in primary care infrastructure and digital health initiatives. The West Bengal state telemedicine program, where patients are delivered healthcare through Health and Wellness Centres (HWCs), offers a hybrid model that combines on-site Community Health Officers (CHOs) with remote physicians, but its functionality for reproductive health remains underexplored. This descriptive qualitative study explored staff experiences of implementing and delivering a hybrid telemedicine model for maternal and reproductive healthcare at peripheral Health and Wellness Centers (HWCs) in two West Bengal districts selected for their differing health system capacities. In total, 23 in-depth interviews were conducted with CHOs, Medical Officers, IT staff, and program administrators involved in telemedicine systems at HWCs and linked facilities in the selected two districts (Nadia and Howrah). The collected interview data were analyzed using reflexive thematic and sentiment analysis. Participants described telemedicine as a bridge that connects rural women, especially older, low-income, and socially disadvantaged clients for getting specialist guidance while preserving free medications, reducing travel, and strengthening continuity of care for general and reproductive health needs. Across the reproductive continuum, teleconsultations supported safer family planning, triage and co‑management of high‑risk pregnancies, and follow‑up for minor post‑partum complications, anchored by CHOs' physical assessments. In the studied telemedicine system, recurrent barriers include doctor unavailability, pressure to meet daily case targets, incomplete clinical information, and weak digital infrastructure. These led to rushed consultations, generalized prescriptions, and limited suitability of telemedicine for emergencies or complex gynecological assessment. Hybrid telemedicine at HWCs can substantially narrow access gaps in maternal and reproductive healthcare in rural settings when CHOs are empowered as skilled on-site assessors and consistent remote clinical support is available. To realize its full potential, programs must rebalance quantity-driven targets with quality, invest in joint training for CHOs and physicians, and address persistent infrastructural bottlenecks so that telemedicine can function as a reliable screening and support system rather than a substitute for essential in‑person care.

The long-term psychosocial outcomes of reproductive genetic carrier screening (RGCS) have yet to be adequately quantified. We examined long-term psychosocial outcomes of RGCS within the Australian Reproductive Genetic Carrier Screening Project ('Mackenzie's Mission'), where 9107 reproductive couples had RGCS for ~1300 genes and 175 (1.9%) received a new increased chance result. We administered a survey at approximately three to five years (mean = 3.7) post-result, capturing attitudes toward the result, state anxiety (using the STAI-6) and decision regret for all participants, plus empowerment and decisional conflict for participants with an increased chance result. Using STAI-6 data from previous surveys, we used linear mixed models to examine change in state anxiety over time. Participants with a low chance result (n = 2512) had low state anxiety, minimal decision regret and felt reassured by their result. For participants with an increased chance result (n = 86), increased state anxiety after result disclosure gradually decreased, almost returning to baseline by 3-5 years post-result. This group also had high empowerment, minimal decision regret, low decisional conflict regarding reproductive choices and positive attitudes about the utility of their increased chance result. Predictors of clinically meaningful state anxiety at 3-5 years post-result were: having an increased chance result, higher trait anxiety and having a child with a medical condition/disability. Findings highlight that large-panel RGCS is valuable for reproductive planning. Elevated state anxiety after increased chance result disclosure aligns with other reproductive genetic screening and decreases over time. It is important that RGCS programmes provide appropriate, longitudinal psychosocial support to promote the reproductive empowerment of all who participate.

The objective of this retrospective cohort study was to evaluate the association between body weight (BW) at first calving and growth, health, and reproductive performance during the rearing period, as well as subsequent milk production, calving related events, transition cow health, and culling risk in the first and second lactation in dairy cows from a single commercial dairy herd in northern Germany. The final data set consisted of 3,891 primiparous cows that calved between 2017 and 2021 and 1,894 of which were followed until their second lactation. Data were extracted from a commercial dairy herd management software system including information from 1) the heifer rearing phase: growth, calfhood morbidity and reproductive performance as nulliparous heifers and from 2) first lactation and second lactation: including age at first calving, calving related events, transition cow health, milk yield, culling risk, and growth from lactation 1 until 2. The animals were categorized into 4 quartiles based on their BW at first calving Body weight quartile 1-4 (BW_Q1): 394 - 564 kg (n = 1,019), BW_Q2: 566 - 588 kg (n = 996), BW_Q3: 589 - 612 kg (n = 923), BW_Q4: 614 - 768 kg (n = 953). Mixed effect models were used for continuous outcomes, multiple logistic regression for binary risk outcomes and Cox-proportional hazard models were used for time to event outcomes. Cows in BW_Q1 were already lighter at birth by 1.5 kg compared with cows from BW_Q4 and experienced higher pre-weaning morbidity (BW_Q1: 40.5% vs. BW_Q3: 34.3%) without showing a difference in failed transfer of passive immunity. Although lighter heifers in BW_Q1 had reduced pre-weaning growth, and therefore lower BW at weaning and at d 360 they showed better reproductive performance as nulliparous heifers, resulting in an 18-d reduction in age at conception and a 19-d reduction in age at first calving compared with heavier heifers in BW_Q4. In the first and second lactation, lighter cows had an approximately 2 kg/d lower milk production during the first 8 weeks of each lactation than heavier cows. Average daily gain in lactation 1 was significantly higher in BW_Q1 (0.359 ± 0.006 kg/d) compared with BW_Q4 (0.253 ± 0.006 kg/d) suggesting some compensatory growth. Further, in lactation 1, lighter cows from BW_Q1 had an approximately 43% greater risk for culling within 300d in milk, compared with the heavier cows from all other quartiles. Overall, body weight at first calving was associated with subsequent performance, with lighter cows producing less milk but exhibiting greater post-calving growth, while reproductive performance differed during rearing but not after calving.

Conventional health education may not fully address the difficulty of translating GDM-related knowledge into sustained self-management behaviors. This study aimed to evaluate whether a PRECEDE-PROCEED Model-based GDM health education program was associated with improved self-management ability and pregnancy outcomes in patients with GDM. This single-center retrospective matched-cohort study was conducted at Huzhou Maternity & Child Health Care Hospital and included clinical data of pregnant women who underwent regular prenatal examinations in the obstetric outpatient department and were diagnosed with GDM from August 2024 to August 2025. Based on the nursing methods received, the participants were divided into an observation group (GDM health education intervention program based on the PRECEDE-PROCEED Model) and a control group (standard GDM health education intervention program). A total of 150 patients were enrolled. Patients were matched at a 1:1 ratio, with 75 cases in each group. Post-intervention, fasting and two-hour postprandial blood glucose levels were lower in the observation group than in the control group (p<0.05), and two-hour postprandial blood glucose decreased after intervention in both groups. Scores of GDM-related knowledge, management behaviors, attitudes, beliefs, and social support were significantly elevated in both groups, and considerably higher in the observation group (p<0.05). The incidence of postpartum hemorrhage and hypertensive disorders of pregnancy was notably lower in the observation group (p<0.05). Compared with conventional health education, the GDM health education intervention program based on the PRECEDE-PROCEED Model was associated with better blood glucose levels in GDM patients, improved self-management skills, and lower incidence rates of postpartum hemorrhage and hypertensive disorders of pregnancy.

Sexual violence in armed conflict contexts constitutes a serious violation of human rights and a persistent challenge for global public health. This article analyzes the differentiated impacts on the physical, mental, sexual, and reproductive health of women and girls, from a public health perspective with a gender approach. Through a narrative review of academic literature, institutional reports, and international legal frameworks, two main mechanisms of harm were identified: 1) the use of gender-based violence as a war tactic, and 2) the disruption of essential health and social protection services. The analysis reveals long-term psychosocial consequences, increased maternal morbidity and mortality, neglect of menstrual health, and the structural impact of forced displacement and the feminization of poverty. Institutional barriers are examined, such as the lack of disaggregated data, legal impunity, and the exclusion of women from decision-making spaces. Positive experiences in transitional justice mechanisms and women-led initiatives are also highlighted, offering effective pathways for prevention, care, and reparation. The article offers public policy recommendations for humanitarian actors and health systems: comprehensive implementation of sexual and reproductive health services in emergencies, gender-sensitive mental health support, information systems with an intersectional perspective, and active participation of women in all phases of post-conflict response and reconstruction.

Background and Objectives: Young women treated for breast cancer often face persistent sexual and reproductive challenges post-treatment, which frequently remain unaddressed during routine follow-up. This study evaluated health-related quality of life (HRQoL), sexual health, and fertility-related counselling in breast cancer survivors younger than 40 years. Materials and Methods: We performed a single-centre cross-sectional study including 65 women with non-metastatic breast cancer (at least 12 months post-primary treatment). Patients completed the EORTC QLQ-C30 and SHQ-22 questionnaires, along with a pilot-tested 7-item fertility preservation survey. Data were analyzed using descriptive statistics and non-parametric tests to compare treatment subgroups (e.g., endocrine therapy vs. others). Results: Overall quality-of-life scores were relatively preserved (median 66.67), with high functional scores. However, patients reported symptomatic distress, particularly fatigue and insomnia (both median 33.33). Sexual health was significantly impacted: communication with healthcare professionals was the most impaired domain (median score 100), followed by low libido (66.7) and vaginal dryness (66.7). Women receiving endocrine therapy reported significantly lower functional scores and a higher symptom burden compared to those not on endocrine treatment (p < 0.05). While 60% of patients received fertility information, only 16.9% underwent preservation procedures. Notably, a significant association was observed between reproductive health actions and sexual behaviour; women who had undergone fertility preservation procedures reported higher levels of sexual activity (p = 0.015). Conclusions: Despite relatively preserved functional status, young breast cancer survivors face significant symptomatic and sexual challenges. The profound lack of communication regarding sexual health and the gaps in fertility counselling highlight the need for a more integrative, multidisciplinary approach in survivorship care.

Crises like a pandemic can exacerbate maternal and child depressive symptoms. The relationship between a pre-existing maternal dangerous world belief (BDWPre) with subsequent maternal (DEPPost_Mat) and child depressive symptoms (DEPPost_Child) during the actual crisis, and related mechanisms, remain unclear. This study 1) examines associations between BDWPre, DEPPost_Mat and DEPPost_Child, and 2) explores moderating and mediating roles of COVID-19 stress and pre-pandemic maternal depressive symptoms (DEPPre_Mat), along with the mediating effect of household conflict (HCpost). This cohort data were from the Singapore PREconception Study of Long-Term Maternal and Child Outcomes, including 90 complete cases and 373 imputed cases. Multiple linear regression detected longitudinal associations between BDWPre, DEPPost_Mat, and DEPPost_Child, with COVID-19 stress and DEPPre_Mat as moderators. Structural equation modeling tested mediating roles of COVID-19 stress, DEPPre_Mat, and HCpost; insensitive maternal behavior was examined as an additional mediator. There were total associations of BDWPre with DEPPost_Mat (&#x3b2; = 0.172, 90 % CI [0.039, 0.306]) and DEPPost_Child (&#x3b2; = 0.161, 90 % CI [0.031,0.291]). DEPPre_Mat directly associated with an increase in DEPPost_Mat (&#x3b2; = 0.361, 90 % CI [0.248, 0.475]) and DEPPost_Child (&#x3b2; = 0.262, 90 % CI [0.121, 0.401]). COVID-19 stress and HCPost sequentially mediated the association between DEPPre_Mat and DEPPost_Mat, and this relationship could be independently mediated by the HCPost. Early interventions for pre-existing maternal depressive symptoms and BDW are critical to protect maternal and preschooler mental health during crises. Interventions prioritizing household conflict, alongside crises-related stress, livelihood impacts, and media exposure, may be beneficial for susceptible preschoolers and their mothers during crises.

Spermatogenesis is a highly coordinated biological process in which diploid spermatogonia undergo mitotic expansion, meiotic division, and terminal differentiation into haploid spermatozoa. This process is tightly regulated by intrinsic germ cell programs and extrinsic signals from Sertoli cells within the seminiferous epithelium. Among the signaling pathways governing male germ cell development, all-trans retinoic acid (RA), a bioactive metabolite of vitamin A, has emerged as a master regulator of meiotic initiation and spermatogonial differentiation in mammals. RA functions through nuclear retinoic acid receptors (RARs) and retinoid X receptors (RXRs), which regulate transcriptional networks essential for germ cell progression, including the activation of Stimulated by Retinoic Acid 8 (STRA8), a key determinant of meiotic entry. Intratesticular RA homeostasis is maintained by a balance between synthesis via aldehyde dehydrogenase (ALDH) enzymes and degradation by cytochrome P450 family 26 (CYP26) enzymes, ensuring precise temporal and spatial control of germ cell development. While rodent models have defined core mechanisms of RA signaling, the canine testis provides a valuable comparative and translational system due to its physiological similarity to human spermatogenesis and relevance to reproductive management. Recent studies highlight conserved RA signaling pathways in dogs, including receptor-mediated transcriptional regulation, feedback control of RA metabolism, and post-transcriptional modulation via microRNAs. Importantly, pharmacological manipulation of RA signaling can reversibly disrupt spermatogenesis, supporting its potential applications in non-hormonal male contraception. This review integrates molecular, developmental, pharmacological, and comparative evidence and presents RA signaling as a central regulatory axis of spermatogenesis with important translational applications.

Sex workers worldwide experience different forms of violence and stigma that increase the risk of adverse health outcomes. It is assumed that a discriminatory, criminalizing context as well as intersectional stigma increases the risk of sexual violence for sex workers. We aim to answer the following questions: (1) What types of sexual violence do sex workers experience and (2) how frequently do they encounter it? (3) To what extent are these types of sexual violence associated with mental and sexual health conditions? (4) Are these associations moderated by legislative models? In a preregistered systematic review (PROSPERO: CRD42024503922), scientific databases, references from meta-analyses, and publications from sex work organizations were searched. A total k&#x2009;=&#x2009;207 quantitative and qualitative studies (N&#x2009;=&#x2009;157,991) published since 2013 were summarized meta-analytically and narratively. Sex workers experience sexual violence across various contexts, with quantitative records identifying rape as the most prevalent form. Qualitative findings document varied forms of sexual violence including non-penetrative acts, sexual harassment, technology-facilitated sexual violence, and sexual neglect. The lifetime prevalence of sexual violence is 26.3% (95% Confidence Interval [CI] 22.0-31.0). Mental health conditions (depressive, post-traumatic stress symptoms, and suicidality) were associated with sexual violence: OR [95% CI]&#x2009;=&#x2009;1.85 [1.58-2.16], p < .001, as were alcohol and other recreational drugs: OR [95% CI]&#x2009;=&#x2009;1.95 [1.59-2.38], p <&#x2009;.001. Both sexually transmitted infections, including HIV (OR [95% CI]&#x2009;=&#x2009;1.36 [1.11-1.66], p = .003) and reproductive health related outcomes (OR [95% CI]&#x2009;=&#x2009;1.76 [1.18-2.63], p = .013) were significantly associated with sexual violence. Potential moderation by legislative model could not be detected due to insufficient data. This systematic review suggests sexual violence against sex workers as a critical human rights issue. However, the generalisability of these findings is constrained by substantial statistical heterogeneity and limited representativeness within the current literature, which remains focused predominantly on cisgender women in in-person sex work. This calls for redefining sexual violence with input by sex workers and addressing structural inequities to aid in destigmatizing sex work and reducing social inequities.

Evidence on violence against women predominantly focuses on those of reproductive age, leaving a gap regarding older women. This study aimed to evaluate the effectiveness of a Health Belief Model (HBM)-based training on enhancing violence-preventive behaviors among older women referring to rural health centers in Kharameh City in 2024. This quasi-experimental study was conducted on 140 older women allocated into experimental (n&#x2009;=&#x2009;70) and control (n&#x2009;=&#x2009;70) groups using a multi-stage cluster and simple random sampling method. Data were collected using a standard HBM-based questionnaire before and two months post-intervention. The experimental group received six face-to-face HBM-focused training sessions. Data were analyzed using SPSS-27 via paired t-test, independent t-test, and chi-square tests. Pre-intervention, no statistically significant differences were observed between the two groups across all HBM constructs and behaviors (P&#x2009;>&#x2009;0.05). Post-intervention, the experimental group showed statistically significant improvements in knowledge, attitude, perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, self-efficacy, and preventive behaviors compared to the control group (P&#x2009;<&#x2009;0.05). The HBM-based training intervention significantly enhanced violence-preventive behaviors among older women. Integrating such theory-driven educational programs into primary healthcare settings may empower older women by promoting their self-efficacy and adopting evidence-based preventive behaviors.

The 2022 Supreme Court ruling in Dobbs v. Jackson Women's Health Organization returned regulatory authority over abortion to the states and precipitated a wave of restrictive state-level legislation. This narrative review examines how these state responses have influenced medical residency applications, physician training, and maternal health equity. Existing research indicates that restrictive state laws have contributed to a decline in residency applications to programs in jurisdictions with near-total abortion bans. A growing body of evidence suggests that many medical students, particularly those seeking OBGYN training, prioritize programs in states with fewer restrictions to ensure comprehensive clinical education. These trends may exacerbate existing maternity care deserts by contributing to physician shortages, particularly in underserved and rural areas. The review further explores how the post-Dobbs regulatory environment impacts physician training. Many OBGYN residency programs in restrictive states struggle to provide abortion training, often requiring residents to travel out of state, which creates significant financial and logistical burdens. Additionally, a lack of transparency regarding training availability in these states complicates the ability of prospective residents to assess program offerings. Beyond residency applications, these state-level restrictions have affected practicing physicians, contributing to burnout, legal uncertainties, and ethical dilemmas. Many providers in restrictive jurisdictions report moral distress and legal risks when making clinical decisions, leading some to relocate to states with greater reproductive freedoms. The compounded effects of these laws may widen healthcare disparities, disproportionately affecting marginalized communities, particularly low-income individuals and people of color. Given the limited longitudinal evidence since Dobbs, continued monitoring of OBGYN residency applications, training availability, workforce distribution, and maternal health outcomes is needed to determine the persistence and magnitude of these effects.

Active duty Service Women (ADSW) face unique challenges in accessing reproductive care. To overcome these issues, the Defense Health Agency Procedural Instruction (DHA-PI) 6200.02 was introduced in May 2019 and Women and Infant Community Clinics (WICCs) were established to facilitate its implementation. This study examined the impact of WICCs on improving access to extended contraception and contraceptive counseling services. A retrospective observational cohort design was employed. ADSW 18 and 55 years, with TRICARE enrollment between January 1, 2016, and September 30, 2022, who were enrolled at or received care at a site at a WICC were included in the cohort. The primary outcome was the rate of extended contraception defined as 168+ days' supply and rate of family planning/contraception counseling. Separate calculations were conducted for ADSW with direct care encounters at family practice, family medicine, or OB/GYN clinics at WICC sites, defined as the "opportunity" perspective, and ADSW enrolled at WICC sites regardless of whether they had a direct care encounter, defined as the "responsibility" perspective. Interrupted time series (ITS) analysis was utilized to evaluate both immediate and sustained impact of WICCs on these outcomes. The study was granted exemption from the Defense Health Agency Institutional Review Board and informed consent was waived (DHQ-24-2011). Sixteen WICC sites were identified, where 114,768 ADSW received care and 75,399 were enrolled at those sites. Although there was a slight increase in the percentage of ADSW receiving extended contraception supply (short-acting reversible contraception [SARC], long-acting reversible contraception [LARC], or permanent contraception) post-implementation, this trend was not sustained. Among ADSW with direct care encounters, extended coverage rates declined over time. Additionally, measures assessing access to family planning and contraceptive counseling showed a significant downward trend compared with projected trends expected in the absence of WICC implementation. WICC sites did not lead to sustained improvements in extended contraceptive access or family planning/contraception counseling. These findings may be attributed to the early implementation phase of WICCs. Future research should assess the effectiveness of WICCs following the standardization of policies across the Military Health System.

Suboptimal reproductive performance following artificial insemination (AI) remains a primary constraint to the profitability of buffalo farming in Bangladesh. This study aimed to evaluate the efficacy of intravaginal bio-stimulation and clitoral massage (CM) in enhancing the post-AI conception rates in buffaloes. A total of 125 female buffaloes were randomly selected, and their age, parity, breed, body condition score, reproductive health (RH), and calving difficulty were recorded. The buffaloes were divided into five groups (n = 25 in each group): group A (natural mating), group B (AI during observed estrus), group C [AI followed by penis-like device (PLD) application], group D (AI with CM), and group E (AI followed by PLD and CM). Group B (only AI) served as the control for the intervention groups (C, D, and E). The overall conception rate was 46.4%, with group A having the highest rate (64.0%). The conception rate of group E (52.0%) was higher than that of groups C (44.0%), D (40.0%), and B (32.0%). Parity and previous calving difficulty significantly influenced the conception rates (p < 0.05). Buffaloes aged between 4.6 and 5.5 years were 4.3 times more likely to conceive compared with other age groups (p < 0.05). Correlation coefficient analysis revealed a significant positive correlation between age and parity (p < 0.01) and a significant negative correlation with the RH of cows. Intravaginal bio-stimulation using a PLD combined with CM post-AI significantly improves the conception rate in buffaloes.

Gynaecological cancers increasingly affect women of reproductive age, necessitating fertility-sparing treatments that balance oncological safety with reproductive potential. However, the long-term impact of these treatments on survivorship-specifically regarding sexual function, quality of life (QoL) and reproductive outcomes-remains understudied. LIFE-Repro is a prospective multicentre cohort study designed to evaluate these impacts in young female cancer survivors. Between 2023 and 2027, eleven tertiary referral hospitals in Korea will recruit 200 patients aged &#x2264;45 years with gynaecological cancers who have undergone fertility-sparing treatment. Participants will undergo baseline assessments followed by prospective follow-ups every 6 months. At each visit, patient-reported outcomes assessing sexual function, QoL and health status will be collected using a mobile application developed by the research team. The primary endpoint is the incidence of post-treatment sexual dysfunction measured by the Female Sexual Function Index-Korean version. Secondary endpoints include longitudinal changes in QoL, cancer recurrence, survival, pregnancy rates, live birth rates and premature menopause. The study protocol was approved by the Institutional Review Board of Korea University Guro Hospital (2024GR0484). Results will be disseminated through peer-reviewed journals and conference presentations. KCT0009578.

Extreme weather events, like drought and heat stress, make it harder to meet water needs in water-insecure settings, particularly vulnerable groups. This study examines how short-term (heat stress) and long-term (drought) water stress affects hydration status across reproductive states (pregnant, lactating, compared to non-pregnant/non-lactating) for Daasanach semi-nomadic pastoralist women in northern Kenya. Drawing on unbalanced panel data, we analyzed 565 observations from 303 women (aged &#x2265;&#x2009;16&#x2009;years) in 2019-2024. Hydration was assessed via urine specific gravity (USG) with dehydration classified as USG >&#x2009;1.020. Environmental heat stress was measured by ambient temperature and humidity, with sensitivity analyses using wet bulb globe temperature. Mixed effect logistic regression models indicated ambient temperature and humidity were significantly associated with greater odds of dehydration across all women. Holding heat stress constant, lactating but not pregnant women had higher odds of dehydration than non-pregnant/non-lactating women. A significant interaction between heat stress and reproductive status indicated that the probability of dehydration increased fastest for pregnant women as temperatures rose. Holding heat constant, dehydration probability increased during drought years compared to pre- and post-drought and was most pronounced among lactating women. Ambient heat stress increases dehydration risk among Daasanach women with effects compounded in pregnancy, though overall lactation was the period of greatest vulnerability to dehydration. Dehydration probability peaked during the drought illustrating how long-term periods of water scarcity also challenge water needs. Heat stress and droughts exacerbate maternal and infant health risks; thus, targeted hydration and cooling interventions are needed.

The targeted, substrate-specific degradation of paternal mitochondria inside the zygote, known as post-fertilization sperm mitophagy, is a crucial and evolutionarily conserved early embryonic event. It ensures the exclusive maternal inheritance of the mitochondrial genome. Post-fertilization sperm mitophagy was initially thought to only be achieved via the ubiquitin-proteasome system. Until pro-autophagic receptor proteins such as SQSTM1, GABARAP, as well as the proteasome-interacting ubiquitinated protein dislocase VCP, were identified as contributors to the degradation of the sperm mitochondria early after mammalian fertilization. This synergy of proteasomal and autophagic pathways ensures a timely degradation of sperm mitochondria shortly after fertilization. The discovery of these autophagic receptors lead researchers to believe there might be other autophagic receptors and determinants necessary for proper post-fertilization sperm mitophagy. Based on the established inventory of proteins from mass spectrometry trials of boar spermatozoa exposed to porcine oocyte extracts in an intra-specific porcine cell-free system (CFS), five candidate mitophagy determinants were further investigated in this study, namely LACTB, PRDX3, PSMA8, TOMM34, and FUNDC1. These proteins of interest were studied and validated by using in vitro fertilization (IVF) protocols, cell imaging of spermatids, spermatozoa, oocytes and zygotes, protein interactome analysis, and the porcine CFS. The proteins PSMA8 and TOMM34 behaved in accordance with our proteomic study predictions. The PSMA8 labeling increased after exposure to CFS; in agreement with the classification PSMA8 was given from the mass spectrometry findings. TOMM34 underwent a visible decrease in labeling after exposure to CFS, which also agreed with its proteomic classification; this labeling persisted in IVF zygotes. Except for LACTB, the examined proteins showed mutual interactions as well as interactions with previously identified sperm mitophagy factors in the STRING interactome analysis. Results from this study validate the novel porcine CFS as a valuable tool for the exploration of early fertilization events at a molecular level. Future phenotyping and functional studies using porcine CFS will advance the understanding of mitochondrial inheritance and zygotic development and potentially shed light on the origins of certain mitochondrial diseases arising from the failure of post-fertilization sperm mitophagy.

To assess the changes in the characteristics of women undergoing induced abortion and their contraceptive choices before and after the implementation of the "three-child" policy, and to inform strategies for improving reproductive health services in China. We conducted a retrospective comparative study at a tertiary maternity hospital in Fujian, China. Women who underwent induced abortion between 31 May 2019 and 30 May 2020 (pre-policy period) and those who underwent the procedure between 31 May 2023 and 30 May 2024 (post-policy period) were included. We used R software (version 4.3.2) to compare contraceptive use and method choices prior to the abortion, as well as the primary reasons for unintended pregnancy between pre- and post-policy periods. In the pre-policy period, non-use of contraception was the leading cause of unintended pregnancy (43.38%), primarily attributed to a perception of low pregnancy risk. Among contraceptive users, condoms were the most common method (26.47%). Post-policy, the rate of contraceptive non-use decreased to 32.19%. However, reliance on low-efficacy methods persisted, with condoms (43.49%) and withdrawal (23.51%) remaining predominant. Non-use of contraception and reliance on low-efficacy methods remained the primary contributors to unintended pregnancies among women undergoing induced abortion both before and after the three-child policy. Higher educational attainment was associated with lower contraceptive failure risk. These findings underscore the urgent need to improve access to effective contraceptive methods and strengthen reproductive health education to reduce unintended pregnancies and safeguard women's reproductive health.

Background: Hyperprolactinemia is a common endocrine disorder with significant reproductive and systemic implications. This study aimed to investigate the nationwide epidemiological trends, longitudinal shifts in pharmacological treatment, and the temporal associations of concurrent conditions and long-term sequelae in Korean women with claims-based hyperprolactinemia. Methods: A nationwide, population-based retrospective cohort study was conducted using data from the Health Insurance Review & Assessment Service (HIRA) of South Korea from 2009 to 2021. Female patients aged 10-59 years with hyperprolactinemia diagnostic claims were evaluated. We analyzed annual prevalence, incidence, diagnostic procedures, and dopamine agonist prescription patterns. Associated clinical conditions were classified into two categories based on the timing of their diagnosis relative to hyperprolactinemia: concurrent or underlying conditions present at baseline, and long-term complications that developed during the follow-up period. Results: A total of 95,616 female patients were identified after applying the selection criteria. The prevalence and incidence of hyperprolactinemia peaked among women in their early thirties, with an absolute peak at age 32. A significant pharmacological paradigm shift was observed: bromocriptine was the predominant therapy during the early study period, but cabergoline prescriptions surpassed bromocriptine in 2017. Regarding clinical work-ups, only 5.3% of the entire cohort underwent a sella magnetic resonance imaging (MRI). Regarding associated clinical conditions, reproductive disorders such as infertility (28.0%) and polycystic ovary syndrome (24.8%) showed high overall prevalence but low incidence of new diagnoses during the follow-up period. Conversely, among the patients affected by bone disorders, more than 60% of the total osteoporosis and osteopenia cases were diagnosed subsequent to the initial hyperprolactinemia diagnosis. Significant post-diagnosis incidence was also observed for metabolic disorders, including dyslipidemia and diabetes mellitus. Conclusions: Hyperprolactinemia in Korean women is highly concentrated in the peak reproductive years. The shift toward cabergoline reflects evolving clinical guidelines and improved drug accessibility. Our findings highlight that while reproductive issues often present concurrently, bone loss and metabolic complications frequently emerge as post-diagnosis sequelae. Therefore, clinical management should extend beyond prolactin normalization to include proactive, multidisciplinary screening for skeletal and metabolic health.

To explore the role of circulating human chorionic gonadotropin (hCG) in the pathophysiology of enhanced myometrial vascularity (EMV) postpregnancy and the usefulness of determining hCG level in the clinical evaluation and management of this condition. This was a retrospective observational case series of patients managed clinically at our centers who had postpregnancy EMV diagnosed using&#xa0;ultrasound by the observation of a dilated vascular web in the myometrium, with or without retained products of conception (RPOC), that persisted beyond 4-6&#x2009;weeks following a failed or terminated pregnancy. We retrieved serial maternal serum hCG measurements and noted the highest maternal serum hCG level measured, as well as the time for hCG to reach non-pregnancy levels, defined as hCG &#x2264;&#x2009;5&#x2009;mIU/mL. The time to resolution of the EMV was recorded; this was determined by normal ultrasound findings (when imaging was available), or assumed if a procedure had been performed to resolve the EMV or when hCG reached non-pregnancy levels. When available, we retrieved peak systolic velocity (PSV) values measured in the vascular web. A PSV of &#x2265;&#x2009;20&#x2009;cm/s was considered elevated. Representative ultrasound and color Doppler images were evaluated. Sixteen patients with sonographically diagnosed EMV that was still present over 4-6&#x2009;weeks after failure or termination of a pregnancy (i.e. persistent EMV) were included. The median duration from diagnosis of EMV until resolution was 113 (range, 58-293)&#x2009;days. Persistence of EMV was associated with prolonged detectable levels of hCG, with a time for hCG to reach non-pregnancy levels of 97 (range, 58-271)&#x2009;days. In the 13 cases in which this was measured, Doppler studies revealed elevated PSV, with a median highest PSV of 80.8 (range, 46.7-146.3)&#x2009;cm/s. One patient was managed expectantly from the outset of their presentation. Four additional patients were followed expectantly for the EMV after they underwent&#xa0;surgical procedures at presentation; seven patients required uterine artery embolization and four required dilatation and curettage to remove the residual placental tissue. Our findings suggest that pathological persistence of EMV is associated with the prolonged presence of circulating hCG, probably produced by residual trophoblastic tissue. Furthermore, we believe that persistent EMV is potentially maintained, in major part, by the vasodilatory and angiogenic effects of circulating hCG. Recognition of this association provides a physiological explanation for the natural history of EMV and supports expectant management in hemodynamically stable patients. Monitoring of maternal serum hCG and Doppler PSV may help to distinguish self-resolving EMV from cases requiring intervention, and high PSV levels can alert the practitioner to the potential for hemorrhage following intervention. These findings highlight the importance of differentiating EMV from congenital arteriovenous malformation and RPOC without EMV, and may inform more tailored, less invasive clinical management strategies. &#xa9; 2026 International Society of Ultrasound in Obstetrics and Gynecology.