Background: Infertility represents a major global public health challenge. Identifying modifiable factors to optimize the outcomes of assisted reproductive technology (ART) is therefore crucial. Seasonal exposure has been reported to be correlated with natural conception rates, birth patterns, and adverse pregnancy outcomes. However, the potential associations between seasonal exposure and pregnancy outcomes among women undergoing fresh embryo transfer cycles remain controversial. This study aims to determine whether an association exists between seasonal exposure and pregnancy outcomes following fresh embryo transfer cycles, thereby providing evidence-based guidance on whether seasonal considerations should be integrated into ART treatment planning. Methods: This review adhered to the PRISMA guidelines. Literature searches were conducted across seven major electronic databases. Data synthesis employed either fixed-effects models. Subgroup analyses were performed according to the Köppen climate classification. The risk of bias in the included studies was assessed using the Newcastle-Ottawa Scale (NOS). Associations are reported as odds ratios (ORs) with corresponding 95% confidence intervals (CIs), and heterogeneity was quantified using the I ² statistic. Results: A total of 19 retrospective studies encompassing 159,696 fresh embryo transfer cycles were included. Overall, no significant associations were found between season and clinical pregnancy or live birth. Subgroup analyses, however, revealed climate-specific variations: In Cwa (humid subtropical) climates, live birth rates were significantly higher in summer than in winter (OR = 1.05; 95% CI, 1.01–1.10; I ² = 0%, P heterogeneity < 0.05). In Dfb (warm–summer humid continental) climates, live birth rates were significantly higher in spring than in summer (OR = 1.07; 95% CI, 1.01–1.14). Conclusion: Seasonal variation exhibits no significant association with pregnancy outcomes following fresh embryo transfer cycles. The observed variations within specific climate subgroups may result from multifactorial influences and require further research for validation. Clinicians and patients can prioritize medical indications and personal readiness without concern that seasonal timing may adversely impact pregnancy outcomes. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251077751 , Identifier: CRD420251077751.

A good clinical guideline for integrated traditional Chinese and Western medicine (ITCWM) should be established by multi-subject specialists, including clinical expert of ITCWM, traditional Chinese medicine and Western medicine, and medical staff from different levels of health care organization, clinical and preclinical medicine researcher, statistician, clinical epidemiologist and economist, medical decision-maker and administrative expert. Establishment of guideline should be abided by the following scientific procedure: association of ITCWM (AITCWM) or the branch of AITCWM decides the subject of clinical guideline, set up a team of special subject of clinical guideline (or decided by research project), evaluate literature systematically, prepare a draft manuscript, consult and appraise it in the same occupation, announce the content in the academic circle, collect feedback opinions and proposals and then make analysis, modify the clinical guideline, publish the clinical guideline, apply the clinical guideline, collect and appraise feedback opinions and proposals, modify and consummate the clinical guideline. In order to supply and consummate original guideline, scientific and renewed evidence should be emphasized on the basis of evidence-based medicine. The author also suggested insistence on the combination of disease and syndrome, syndrome being governed by disease, standardization of syndrome type, establishment of reasonable amount of syndrome types, standard and method of modifying the treatment. The user of guideline should pay attention to both the principle and flexibility, and the author stressed that guideline was just a diagnosis and treatment reference to clinician, which should be used flexibly and not be imitated mechanically in practical application. The practicability of guideline should be pay attention to so that the clinician can apply and manipulate the guideline easily. Meanwhile, the group of guideline establishment has an obligation to train medical staff and to promote the practice of clinical guideline. Only in this way, the authority, standardization and applicability of clinical guideline on ITCWM can be ensured, and then the expected purpose of clinical guideline establishment can be attained.

Background: Endocrine factors are one of the main causes of miscarriage, and estrogen and progesterone are hormones necessary for pregnancy and act in multiple settings of pregnancy, while clinical attention to estrogen levels is insufficient. This study was conducted to investigate the effect of estrogen supplementation on pregnancy outcomes in patients with low estrogen levels in early pregnancy .Methods: 279 pregnant women whose estrogen was below the optimal cut-off value for the diagnosis of adverse outcome corresponding to 4-6 weeks weeks were screened among those who underwent pregnancy monitoring at Hubei Provincial Maternal and Child Health Hospital from January 2021 to January 2022, and randomly divided into experimental group (149 cases) and control group (130 cases), and the experimental group was given progesterone + estrogen preparation + proprietary Chinese medicine to preserve fetus. The control group was given progesterone + proprietary Chinese medicine for fetal preservation.Results: In the study of estrogen supplementation on pregnancy outcome, the experimental group had a higher The success rate of fetal preservation was higher than that of the control group and was statistically significant (P<0.05).Conclusion: Dynamic monitoring of blood E2 values in early pregnancy ，before the placenta is fully formed, combined with a comprehensive analysis of their weekly optimal cut-off values, is important for clinical diagnosis and clinical intervention. Estrogen supplementation in pregnant women with low hormone levels may be beneficial to embryonic development and has implications for improving pregnancy outcomes. Estrogen acts in several aspects of pregnancy, and more in-depth studies on estrogen are necessary.