Asian Pacific Journal of Reproduction
Issue 3,2026 Table of Contents
2026(3):91-109.
DOI: 10.4103/apjr.apjr_242_25
Abstract:
Objective: To identify barriers and future strategies for establishing fertility preservation in developing countries. Methods: A systematic literature search was conducted to identify studies/articles reporting in English on the barriers and strategies of fertility preservation in the developing countries. The literature search was conducted in PubMed, Cochrane Library, Scopus, and Google Scholar using search terms "challenges", "strategies", "fertility preservation", and "developing countries" to identify relevant sources from 2019 to 2024 applicable to current updates on fertility preservation. Results: A total of 34 studies were included in the analysis. Barriers were identified on healthcare providers and patients. Moreover, it could also be categorized as the backbone of an established fertility preservation center, which is an accessible assisted reproductive technology (ART) center. Without an established ART center, maintaining and utilizing the fertility preservation center would be challenging. Lack of awareness was another main barrier identified among healthcare providers. From the patient's perspective, the main barriers identified were the lack of financial support for fertility preservation programs and the awareness of fertility preservation programs. Policy, sociocultural, religious, knowledge, access to service, competency, and attitude were the other barriers identified. Few studies addressed strategies. Several strategies were identified, including improving access to ART facilities, enhancing financial support and policy for targeted patients undergoing fertility preservation, and increasing knowledge and awareness of healthcare providers and patients. However, further investigation is warranted. Conclusions: Several barriers have been identified for fertility preservation in developing countries. Therefore, corresponding strategies were proposed to specifically address them.
Objective: To identify barriers and future strategies for establishing fertility preservation in developing countries. Methods: A systematic literature search was conducted to identify studies/articles reporting in English on the barriers and strategies of fertility preservation in the developing countries. The literature search was conducted in PubMed, Cochrane Library, Scopus, and Google Scholar using search terms "challenges", "strategies", "fertility preservation", and "developing countries" to identify relevant sources from 2019 to 2024 applicable to current updates on fertility preservation. Results: A total of 34 studies were included in the analysis. Barriers were identified on healthcare providers and patients. Moreover, it could also be categorized as the backbone of an established fertility preservation center, which is an accessible assisted reproductive technology (ART) center. Without an established ART center, maintaining and utilizing the fertility preservation center would be challenging. Lack of awareness was another main barrier identified among healthcare providers. From the patient's perspective, the main barriers identified were the lack of financial support for fertility preservation programs and the awareness of fertility preservation programs. Policy, sociocultural, religious, knowledge, access to service, competency, and attitude were the other barriers identified. Few studies addressed strategies. Several strategies were identified, including improving access to ART facilities, enhancing financial support and policy for targeted patients undergoing fertility preservation, and increasing knowledge and awareness of healthcare providers and patients. However, further investigation is warranted. Conclusions: Several barriers have been identified for fertility preservation in developing countries. Therefore, corresponding strategies were proposed to specifically address them.
2026(3):110-123.
DOI: 10.4103/apjr.apjr_119_25
Abstract:
Objective: To identify the barriers and facilitators in the identification and management of high-risk pregnancies in India. Methods: A systematic search of PubMed and Google Scholar was conducted from the inception of database till 27 March 2024, using predefined keywords and search terms, including “high risk pregnancy,” “identification,” “management,” “barrier,” “challenge,” “facilitator,” “enabler,” and “India,” combined using Boolean operators (AND/OR). Only studies published in English were included. Screening was conducted using Rayyan software. Data were extracted into structured tables and synthesized using a qualitative thematic approach to identify key barriers and facilitators in the identification and management of high-risk pregnancies. Results: A total of 144 publications were identified. After screening based on eligibility criteria, 21 studies were finally included in the review. The included studies highlighted multiple barriers in the identification and management of high-risk pregnancies, including knowledge and awareness gaps among women and healthcare providers, inconsistent clinical management, and inadequate infrastructure. Financial constraints and cultural factors further added to the challenges. Women in tribal and rural areas faced additional barriers such as geographical isolation, lack of transportation, and limited access to specialized maternal healthcare. Facilitators identified in the literature included social support networks, the role of community health workers in bridging gaps between facilities and communities, and targeted education programs. Improved health literacy, standardized clinical protocols, and tailored management strategies were also reported as important facilitators. Conclusions: This review highlights the importance of strengthening healthcare infrastructure and addressing the identified barriers comprehensively to improve maternal and fetal outcomes. Enhancing awareness, empowering community health workers, and adopting standardized management protocols can contribute significantly to better identification and management of high-risk pregnancies in India.
Objective: To identify the barriers and facilitators in the identification and management of high-risk pregnancies in India. Methods: A systematic search of PubMed and Google Scholar was conducted from the inception of database till 27 March 2024, using predefined keywords and search terms, including “high risk pregnancy,” “identification,” “management,” “barrier,” “challenge,” “facilitator,” “enabler,” and “India,” combined using Boolean operators (AND/OR). Only studies published in English were included. Screening was conducted using Rayyan software. Data were extracted into structured tables and synthesized using a qualitative thematic approach to identify key barriers and facilitators in the identification and management of high-risk pregnancies. Results: A total of 144 publications were identified. After screening based on eligibility criteria, 21 studies were finally included in the review. The included studies highlighted multiple barriers in the identification and management of high-risk pregnancies, including knowledge and awareness gaps among women and healthcare providers, inconsistent clinical management, and inadequate infrastructure. Financial constraints and cultural factors further added to the challenges. Women in tribal and rural areas faced additional barriers such as geographical isolation, lack of transportation, and limited access to specialized maternal healthcare. Facilitators identified in the literature included social support networks, the role of community health workers in bridging gaps between facilities and communities, and targeted education programs. Improved health literacy, standardized clinical protocols, and tailored management strategies were also reported as important facilitators. Conclusions: This review highlights the importance of strengthening healthcare infrastructure and addressing the identified barriers comprehensively to improve maternal and fetal outcomes. Enhancing awareness, empowering community health workers, and adopting standardized management protocols can contribute significantly to better identification and management of high-risk pregnancies in India.
2026, 15(3):124-131.
DOI: 10.4103/apjr.apjr_66_25
Abstract:
Objective: To estimate the pooled prevalence rate of different types of abortion and the most important related factors of abortion in Iran based on a systematic review and meta-analysis. Methods: This systematic review and meta-analysis was conducted on the Iranian studies during the February 1, 2012 to December 31, 2024. Abortion prevalence and its influencing factors were evaluated. Relevant keywords were used to find eligible studies in Web of Science, PubMed, Google Scholar, Scopus, Science-Direct and SID databases. Due to high heterogeneity in included studies, random-effects model was utilized to estimate the pooled estimated of abortion and its subgroups. Results: Out of 231 reviewed articles, only 11 articles on 24 429 women were finally included. The pooled prevalence of induced abortion, spontaneous abortion, legal abortion and overall abortion was estimated as 7.65% (95% CI 4.24 to 11.95), 5.92% (95% CI 0.24 to 18.32), 1.66% (95% CI 0.83 to 2.76) and 7.23% (95% CI 1.07 to 18.22), respectively. Conclusions: Abortion is a worldwide major public health problem even in Iran and related to different socioeconomic and psychosocial factors. Its prevalence in Iran is high and it remains as reproductive health concern in Iran due to low fertility rate and oncoming up down population growth.
Objective: To estimate the pooled prevalence rate of different types of abortion and the most important related factors of abortion in Iran based on a systematic review and meta-analysis. Methods: This systematic review and meta-analysis was conducted on the Iranian studies during the February 1, 2012 to December 31, 2024. Abortion prevalence and its influencing factors were evaluated. Relevant keywords were used to find eligible studies in Web of Science, PubMed, Google Scholar, Scopus, Science-Direct and SID databases. Due to high heterogeneity in included studies, random-effects model was utilized to estimate the pooled estimated of abortion and its subgroups. Results: Out of 231 reviewed articles, only 11 articles on 24 429 women were finally included. The pooled prevalence of induced abortion, spontaneous abortion, legal abortion and overall abortion was estimated as 7.65% (95% CI 4.24 to 11.95), 5.92% (95% CI 0.24 to 18.32), 1.66% (95% CI 0.83 to 2.76) and 7.23% (95% CI 1.07 to 18.22), respectively. Conclusions: Abortion is a worldwide major public health problem even in Iran and related to different socioeconomic and psychosocial factors. Its prevalence in Iran is high and it remains as reproductive health concern in Iran due to low fertility rate and oncoming up down population growth.
Binarwan Halim
,
Ivana G Nababan
,
Carine A Widjaja
,
Jesselyn Angellee
,
Diana Novia
,
Yose E Hasibuan
2026(3):132-139.
DOI: 10.4103/apjr.apjr_158_25
Abstract:
Objective:To evaluate the efficacy of platelet-rich plasma (PRP) incubation on embryo developmental outcomes in intracytoplasmic sperm injection (ICSI) cycles involving low-quality sperm. Methods: Sixty-six couples undergoing ICSI were enrolled in a prospective randomised study conducted at Halim Fertility Center, Indonesia between January and August 2023. Male with severe oligoasthenoteratozoospermia were randomised into two groups. Following density gradient centrifugation, samples in the PRP group were incubated with autologous PRP for one hour prior to ICSI, whereas the non-PRP group underwent standard processing without PRP exposure. Baseline characteristics and assisted reproductive technology outcomes between two groups were compared. The primary outcome was the blastocyst formation rate, while secondary outcomes included fertilisation rate, cleavage rate, and blastocyst quality. Results: A total of 66 couples were included, with 33 couples in each group. Participants' demographics and semen parameters did not differ significantly between the two groups. The PRP group demonstrated a higher fertilisation rate than the non-PRP group (84.1% vs. 78.2%), but the difference was not statistically significant (P=0.38). The PRP group showed significantly higher cleavage rates (98.9% vs.95.0%; P=0.03) and blastocyst formation rates (56.7% vs. 46.6%; P=0.006) compared to the non-PRP group. Additionally, the PRP group exhibited a higher proportion of good-quality blastocysts (44.8% vs. 41.2%; P=0.01) and a lower proportion of poor-quality blastocysts (22.1% vs. 27.8%; P=0.03). Conclusions: PRP incubation prior to ICSI in severe oligoasthenoteratozoospermia cases improves cleavage rates, blastocyst formation, and embryo quality. PRP may be a promising adjunct to optimise ICSI outcomes in male factor infertility. Study registration: This study was registered at ClinicalTrials.gov with the registration number NCT07579858.
Objective:To evaluate the efficacy of platelet-rich plasma (PRP) incubation on embryo developmental outcomes in intracytoplasmic sperm injection (ICSI) cycles involving low-quality sperm. Methods: Sixty-six couples undergoing ICSI were enrolled in a prospective randomised study conducted at Halim Fertility Center, Indonesia between January and August 2023. Male with severe oligoasthenoteratozoospermia were randomised into two groups. Following density gradient centrifugation, samples in the PRP group were incubated with autologous PRP for one hour prior to ICSI, whereas the non-PRP group underwent standard processing without PRP exposure. Baseline characteristics and assisted reproductive technology outcomes between two groups were compared. The primary outcome was the blastocyst formation rate, while secondary outcomes included fertilisation rate, cleavage rate, and blastocyst quality. Results: A total of 66 couples were included, with 33 couples in each group. Participants' demographics and semen parameters did not differ significantly between the two groups. The PRP group demonstrated a higher fertilisation rate than the non-PRP group (84.1% vs. 78.2%), but the difference was not statistically significant (P=0.38). The PRP group showed significantly higher cleavage rates (98.9% vs.95.0%; P=0.03) and blastocyst formation rates (56.7% vs. 46.6%; P=0.006) compared to the non-PRP group. Additionally, the PRP group exhibited a higher proportion of good-quality blastocysts (44.8% vs. 41.2%; P=0.01) and a lower proportion of poor-quality blastocysts (22.1% vs. 27.8%; P=0.03). Conclusions: PRP incubation prior to ICSI in severe oligoasthenoteratozoospermia cases improves cleavage rates, blastocyst formation, and embryo quality. PRP may be a promising adjunct to optimise ICSI outcomes in male factor infertility. Study registration: This study was registered at ClinicalTrials.gov with the registration number NCT07579858.
Huy Phuong Tran
,
Ngoc Thanh Truong
,
Tuyet Thi-Diem Hoang
,
Ha Le-Bao Tran
,
Vy Nguyen-Thao Do
,
Quan Van Pham
,
Trang Nguyen-Khanh Huynh
2026(3):140-146.
DOI: 10.4103/apjr.apjr_273_25
Abstract:
Objective: To compare pregnancy outcomes between a hyaluronic acid (HA)-enriched transfer medium and a conventional HA-free transfer medium in frozen embryo transfer cycles. Methods: We conducted a retrospective cohort study at Hung Vuong Hospital including frozen embryo transfer (FET) cycles performed between May 2023 and February 2025. Cycles were classified according to the transfer medium used: HA-enriched EmbryoGlue (EG) versus Continuous Single Culture-NX Complete (CSCM-NXC). Outcomes included positive human chorionic gonadotropin (hCG), clinical pregnancy, ongoing pregnancy, live birth, and pregnancy loss. Results: A total of 840 FET cycles were analyzed (EG, n=445; CSCM-NXC, n=395). Pregnancy outcomes were comparable between groups. Use of EG was not associated with higher rates of positive hCG (40.67% vs. 41.77%) or live birth (27.87% vs. 28.86%). Adjusted analyses similarly showed that transfer medium type was not associated with positive hCG [adjusted odds ratios (aOR) 0.92, 95% CI 0.69-1.22] or live birth (aOR 0.92, 95% CI 0.67-1.25). Conclusions: In this retrospective cohort, use of an HA-enriched transfer medium was not associated with improved pregnancy outcomes in FET cycles.
Objective: To compare pregnancy outcomes between a hyaluronic acid (HA)-enriched transfer medium and a conventional HA-free transfer medium in frozen embryo transfer cycles. Methods: We conducted a retrospective cohort study at Hung Vuong Hospital including frozen embryo transfer (FET) cycles performed between May 2023 and February 2025. Cycles were classified according to the transfer medium used: HA-enriched EmbryoGlue (EG) versus Continuous Single Culture-NX Complete (CSCM-NXC). Outcomes included positive human chorionic gonadotropin (hCG), clinical pregnancy, ongoing pregnancy, live birth, and pregnancy loss. Results: A total of 840 FET cycles were analyzed (EG, n=445; CSCM-NXC, n=395). Pregnancy outcomes were comparable between groups. Use of EG was not associated with higher rates of positive hCG (40.67% vs. 41.77%) or live birth (27.87% vs. 28.86%). Adjusted analyses similarly showed that transfer medium type was not associated with positive hCG [adjusted odds ratios (aOR) 0.92, 95% CI 0.69-1.22] or live birth (aOR 0.92, 95% CI 0.67-1.25). Conclusions: In this retrospective cohort, use of an HA-enriched transfer medium was not associated with improved pregnancy outcomes in FET cycles.
2026(3):147-148.
DOI: 10.4103/apjr.apjr_159_25
Abstract:
Tumour necrosis factor alpha (TNF-α), a pleiotropic pro- inflammatory cytokine, plays a crucial role in orchestrating immune responses at the maternal-foetal interface. Excessive TNF-α expression can result in compromised implantation, defective placentation, and ultimately miscarriage. Moreover, TNF-α stimulates the release of other inflammatory mediators, creating a feedback loop that exacerbates tissue damage. Despite these insights, limited studies have evaluated TNF-α levels in early pregnancy as a predictive marker in Indonesian populations, particularly in Aceh. Thus, this research aims to explore the relationship between first- trimester TNF-α levels and miscarriage, offering potential clinical utility in early pregnancy risk assessment. We conclude that elevated serum TNF-α levels in the first trimester are significantly associated with miscarriage. TNF-α may serve as a potential biomarker for predicting adverse pregnancy outcomes and could inform preventive strategies in antenatal care. Larger, multi- centre studies incorporating broader immunological markers are recommended to confirm these findings.
Tumour necrosis factor alpha (TNF-α), a pleiotropic pro- inflammatory cytokine, plays a crucial role in orchestrating immune responses at the maternal-foetal interface. Excessive TNF-α expression can result in compromised implantation, defective placentation, and ultimately miscarriage. Moreover, TNF-α stimulates the release of other inflammatory mediators, creating a feedback loop that exacerbates tissue damage. Despite these insights, limited studies have evaluated TNF-α levels in early pregnancy as a predictive marker in Indonesian populations, particularly in Aceh. Thus, this research aims to explore the relationship between first- trimester TNF-α levels and miscarriage, offering potential clinical utility in early pregnancy risk assessment. We conclude that elevated serum TNF-α levels in the first trimester are significantly associated with miscarriage. TNF-α may serve as a potential biomarker for predicting adverse pregnancy outcomes and could inform preventive strategies in antenatal care. Larger, multi- centre studies incorporating broader immunological markers are recommended to confirm these findings.
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