Research
National Institute for Health and Care Excellence, 2026 · National Institute for Health and Care Excellence
Second draft guidance (consultation 15 September to 5 October 2026; expected publication 21 January 2027). Recommendation 1.1: Endotest (Ziwig, saliva 109-microRNA signature, CE IVDR class C, ages 18 to 43, GBP 1,381 per test) can be used in the NHS during a 4-year evidence generation period as an option to diagnose endometriosis in primary care, only when clinical examination is normal and ultrasound is negative, inconclusive, declined or not suitable. Recommendation 1.5: more research is needed on DotEndo (DotLab blood microRNA, GBP 400), Endomkit (Camlab/apDia serum BDNF plus CA-125, GBP 28 to 199) and EndoSure (gastrointestinal myoelectrical activity, GBP 350) before NHS funding. Committee noted all peer-reviewed accuracy evidence came from secondary or tertiary care where prevalence is higher than in primary care; the developmental Endotest cohort was judged at high risk of bias and the external validation studies at unclear risk; DotEndo, Endomkit and EndoSure had no external validation studies; no study reported clinical outcomes; the technologies cannot distinguish types of endometriosis or determine severity; clinical experts stated a negative result should not be a reason to deny referral if endometriosis is still suspected; imaging does not identify all types, particularly superficial peritoneal endometriosis. Average time to diagnosis in the UK cited as 9 years 4 months.
Research
Ormos M et al., 2026 · European journal of obstetrics, gynecology, and reproductive biology
Endometriosis is challenging to diagnose due to its nonspecific symptoms and the lack of reliable non-invasive methods. This study evaluates the diagnostic accuracy of Endotest©, a salivary microRNA test, by comparing its performance to laparoscopy. Additionally, it examines its ability to detect deep infiltrating endometriosis. In an exploratory attempt, we also conducted postoperative Endotest© to evaluate the consistency of results after surgery.
A prospective study was carried out in women undergoing laparoscopy for suspected endometriosis. Preoperative saliva samples were collected and analyzed using Endotest©. A second Endotest© was performed postoperatively in patients with confirmed endometriosis. Accuracy, sensitivity, specificity, positive predictive value, and negative predictive value were calculated in this off-label setting and compared to radiologic methods in case of deep infiltrating endometriosis. Misclassification factors and potential changes in microRNA expression after surgery were also analyzed.
Among 134 participants, 120 had endometriosis confirmed by laparoscopy. Compared to laparoscopy, preoperative Endotest© showed an accuracy of 73%, with sensitivity of 78% and specificity of 33% in this highly preselected patient cohort. For deep infiltrating endometriosis, the diagnostic accuracy of 49% for Endotest© was inferior to radiologic methods. Postoperative Endotest results were inconsistent, with 18 of 84 cases showing discordant findings between pre- and post-surgical testing.
Endotest demonstrated high sensitivity but low specificity in this off-label analysis, limiting its use as a standalone diagnostic tool in this highly preselected patient cohort. The variability in postoperative Endotest© results suggests that microRNA expression may change after surgery. Further studies are needed to determine its role in clinical practice.
Research
Lifshitz K et al., 2026 · International urology and nephrology
Paternity rates among testicular cancer survivors are reduced. The patient journey, from fertility preservation at diagnosis to attempted paternity or use of assisted reproductive technologies (ART), contains two key gaps in the literature. While baseline semen impairment is well recognized, the relationship between disease stage, tumor pathology, and semen quality remains inconsistent. In addition, prior studies have largely excluded sex-cord stromal tumors, lacked healthy comparators, and rarely performed pathology-specific analyses within the same clinical stage. Reported paternity rates vary widely (6-21%), yet real-world data on ART utilization and live-birth outcomes remain limited. We conducted a retrospective cohort study (2017-2023) at a single tertiary academic referral center within a healthcare system that provided full coverage for sperm cryopreservation for 5 years and ART for up to 2 live births. Primary outcomes included baseline semen parameters by tumor histology and clinical stage, pathology-specific comparisons within each stage, and post-treatment utilization of cryopreserved sperm. Secondary outcomes were ART pregnancy and live-birth rates. The semen parameters were compared with those of healthy sperm donor candidates. The cohort included 126 men (mean age 36.6 ± 10.9 years; 83 seminoma, 35 non-seminoma, 8 sex-cord stromal tumors). Compared with 100 healthy donor candidates, testicular cancer patients demonstrated significantly impaired baseline semen quality across all parameters except volume (all p ≤ 0.01). Post-thaw semen quality was further reduced, with lower motility rates (17.5% vs 44.1%) and total motile counts (1.1 vs 7.8 million), highlighting greater motility and total motile count loss following cryopreservation. Sex-cord stromal tumors exhibited the poorest semen parameters. Semen quality did not differ by stage overall; pathology-specific differences were observed only in stage II disease, favoring non-seminoma tumors (p ≤ 0.05). Overall, 69% (n = 91) elected sperm cryopreservation. Among those, the median number of vials initially frozen was 15 (IQR 10-18), with a mean of 11.6 ± 4.3 vials per patient (range 1-18). During a median follow-up of 5.3 years (IQR: 3.9-6.8), only 8% (n = 7) used their vials for ART, undergoing a median (IQR) of 2.5 (1-4) cycles per couple (15 cycles recorded among 6 of 7 couples; cycle count missing for one couple), resulting in 12 pregnancies and an overall live-birth rate of 67%: 2/2, 100%, 6/10, 60%. Testicular cancer significantly impairs semen quality, with important variation by tumor pathology rather than stage. These findings underscore the fertility preservation often enables future use primarily through IVF and supports banking multiple vials to mitigate freeze-thaw losses.
Research
Lynch I et al., 2026 · Integrated Environmental Assessment and Management
The pervasive use of lip cosmetics results in chronic, low-dose exposure to complex mixtures of chemicals via multiple routes, yet current cosmetic safety regulations treat lip products as conventional topical applications to skin. While the EU safety assessment framework acknowledges ingestion as an exposure route for lip products, standardised lip-specific testing models do not currently exist. The US requires no mandatory pre-market safety review for cosmetic ingredients and systemic exposure consideration is confined to voluntary industry assessment (except for colour additives). In both jurisdictions, exposure estimates are based on usage data from 2005 that do not reflect current real-world usage patterns of lip cosmetics, including frequent reapplication, product layering, and marketing based on food characteristics. The unique physiology of the lips, which represent a transitional tissue between external skin and oral mucosa provides the vermilion and labial mucosa are characterized by a markedly thinner and incompletely keratinised epithelium, reduced lipid barrier components, high vascularisation, and constant moisture-collectively conferring substantially higher permeability than facial skin. Evidence from pharmacology demonstrates that oral mucosal tissues are deliberately exploited for rapid systemic drug delivery. By comparing how the oral mucosal exposure route is evaluated across cosmetic, food, and pharmaceutical regulatory regimes, this review identifies a chemicals applied to the lips are assessed under frameworks designed for low-permeability skin, despite a biological reality more consistent with mucosal exposure. This mismatch undermines the accuracy of current risk assessments and may lead to systematic underestimation of internal dose for certain lip cosmetic ingredients including microplastics. Addressing this gap will require lip-specific exposure models, physiologically relevant in vitro systems, and updated regulatory guidance to ensure that cosmetic safety assessment accurately reflects the unique exposure profile of lip products.
Research
DiGirolamo L et al., 2026 · Integrated Environmental Assessment and Management
Lip products occupy a regulatory blind spot. Classified as cosmetics for external application across all major jurisdictions, there are two distinct cutaneous absorption via lip tissue with significantly diminished barrier function, and oral ingestion documented at levels reaching half a kilogram annually for high-frequency users. We present a comparative analysis of how the United States, European Union (EU), United Kingdom (UK), Canada, China, and South Korea regulate lip products, revealing a systemic gap in how regulations address their actual exposure profile. Three critical gaps are definitional miscategorization of the exposure profile; absence of appropriate safety assessment for either ingestion or lip-tissue absorption pathways; and testing duration requirements that are absent in the majority of frameworks and, where they exist, capped at subchronic endpoints that do not reflect continuous real-world use extending far beyond 90 days. Baseline exposure data underpinning global safety assessments were collected in 2003-2005 and predate contemporary lip product categories; contemporary studies document 95th-percentile lip balm consumption at 1,270 mg/day, a 14.6-fold increase over regulatory baselines. Two regulatory paradoxes within the EU crystallize titanium dioxide, banned as a food additive over oral ingestion genotoxicity concerns, remains unrestricted in lip cosmetics with an identical ingestion pathway; and microplastics are restricted in lip products under EU chemicals regulation because of environmental release through human ingestion, while the Cosmetics Regulation assesses them under dermal parameters. This demonstrates that regulatory sophistication cannot overcome classificatory error, and that meaningful reform requires updated, population-specific exposure studies reflecting contemporary usage patterns, product categories, and consumer demographics. We recommend development of lip-appropriate assessment methodology via validated non-animal methods (within existing cosmetic regulatory frameworks, without product reclassification) and the potential extension of the food-grade ingredient safety principles accepted in industry voluntary guidance to all lip product ingredient categories.
Research
Becker AS et al., 2026 · JBRA assisted reproduction
GLP-1 receptor agonists (GLP-1RAs) have gained attention as a potential adjunct in preconception care for women with polycystic ovary syndrome (PCOS) and infertility. This narrative literature review (June 2025) searched PubMed, SciELO, and LILACS using the descriptors "weight loss medication," "GLP-1 receptor agonists," "liraglutide," "semaglutide," "fertility," "PCOS," and "reproductive outcomes," including studies published between 2014 and 2025, yielding 47 relevant articles. Overall, GLP-1RAs show consistent metabolic benefits and emerging evidence of improved reproductive outcomes in PCOS, with clinical trials reporting increased menstrual regularity, ovulation, and pregnancy rates-particularly when combined with metformin. Liraglutide (1.2-3.0 mg/day) and exenatide (10 µg twice daily) have been associated with improved follicular development and endometrial receptivity. Mechanistically, GLP-1 receptors are expressed in reproductive tissues, and these agents may exert anti-inflammatory, antifibrotic, and androgen-lowering effects; liraglutide has also been reported to restore granulosa-oocyte communication via suppression of CXCL10. In one randomized trial, pregnancy rates were higher with liraglutide plus metformin (69.2%) than with metformin alone (35.4%; p<0.05). Ovulation rates up to 86% have been described with exenatide plus metformin, exceeding those observed with monotherapy. Despite these signals of benefit, GLP-1RAs remain contraindicated during pregnancy due to limited human data and fetal risks observed in animal studies; semaglutide and tirzepatide require an 8-10 week washout period prior to conception, and tirzepatide may reduce oral contraceptive effectiveness because of delayed gastric emptying. In summary, GLP-1RAs are a promising strategy for preconception management in women with PCOS and obesity-related infertility, especially in combination with metformin, but they should be avoided during pregnancy and lactation, and individualized counseling is essential to align therapy with reproductive goals.