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Objective Methods Results Conclusion This study sought to estimate population level prevalence of infertility and explored whether time to pregnancy is related to selected factors.This study's analysis was based on data collected from 2081 women who were sampled from participants of the 2016 Ethiopia Demographic and Health Survey based on risk of pregnancy criteria: age between 15 and 49 years, currently married or cohabitating, sexually active, not used contraception method during the 5 years before interview, not menopausal, and not pregnant. We used a current duration (CD) approach in which for each woman we calculated the length of time‐at‐risk of pregnancy (CD value) in months. A parametric survival model was fitted to CD values from which the median time to pregnancy (TTP) and prevalence of infertility were estimated. To explore variables associated with a longer TTP accelerated failure time, regression models were built to estimate time ratios.The median TTP was 4 months (95% confidence interval [CI] 3.9–4.1). The 12‐month prevalence of overall, primary, and secondary infertility were 29.5% (95% CI 27.50–31.47), 31.1% (95% CI 27.85–34.48), and 27.7% (95% CI 25.30–30.23), respectively. A longer TTP was observed for women aged 35 to 49 (P = 0.001), nulliparous (P = 0.00), when the usual residence of the husband is outside the home (P = 0.001), for women who want to give birth soon (P = 0.00), for cigarette smokers (P = 0.027), for rich women (P = 0.002), and for tertiary (P = 0.00) and primary educated women (P = 0.00).This study suggests reproductive‐age women, which indicates that large numbers of Ethiopian women need fertility services. [ABSTRACT FROM AUTHOR]

Objective: To compare the effectiveness and cost of in‐vitro fertilization (IVF) with or without preimplantation genetic testing for aneuploidy (PGT‐A) when only one or two blastocysts are obtained. Methods: A dataset was gathered from 1829 patients including 368 non‐PGT‐A and 1461 PGT‐A cycles with one or two blastocysts obtained, between April 2013 and July 2022. Patients were matched 1:1 by propensity‐score matching for maternal age, number of metaphase‐II oocytes inseminated and number of blastocysts obtained, achieving a database of 242 patients per group. The non‐PGT‐A and PGT‐A groups were compared for differences in live birth rate (LBR) per embryo transfer (ET), cumulative LBR per patient, miscarriage rate (MR) per clinical pregnancy, number of days between oocyte retrieval and conclusion of the IVF cycle (primary outcome), mean expenses incurred at the clinic and incremental cost‐effectiveness ratio (ICER). Results: More than twice as many ETs were conducted in the non‐PGT‐A group compared with the PGT‐A group, yet the cumulative LBR per patient was similar between groups (23.6% (95% CI, 18.5–29.5%) vs 27.3% (95% CI, 21.9–33.4%)). This outcome was achieved with a higher LBR per ET (16.2% (95% CI, 12.6–20.5%) vs 41.5% (95% CI, 33.9–49.4%)) and lower MR per clinical pregnancy (30.1% (95% CI, 21.8–42.6%) vs 13.9% (95% CI, 7.5–24.0%)) in the PGT‐A group. The MR per patient was also lower in the PGT‐A group (9.5% (95% CI, 6.2–14.1%) vs 4.5% (95% CI, 2.4–8.2%)). The mean duration between oocyte retrieval and IVF cycle conclusion was 131 (95% CI, 113–150) days in the non‐PGT‐A group vs 74 (95% CI, 61–87) days in the PGT‐A group (P < 0.001; power = 99.8%). The ICER of PGT‐A for the months saved between oocyte retrieval and conclusion of the IVF cycle was €499 overall, ranging between €170 and €2065 according to the number of blastocysts obtained and/or maternal age. The ICER of PGT‐A for prevented miscarriages was €18 968, decreasing to €3525 when calculated among patients aged ≥ 35 years with two blastocysts obtained. Conclusions: When conducted in expert IVF clinics for patients indicated for the procedure, PGT‐A is clinically valuable even when only one or two blastocysts are obtained. PGT‐A reduces the number of ETs and miscarriages while the cumulative LBR per patient remains unaffected, and allows these outcomes to be achieved in a shorter timeframe. The ICER of PGT‐A vs non PGT‐A decreased as maternal age increased. © 2024 International Society of Ultrasound in Obstetrics and Gynecology. [ABSTRACT FROM AUTHOR]

Background Methods Results Conclusions Over the past few decades, several studies have found that semen quality parameters have steadily declined over time. Many hypotheses have been made to explain this finding, among which a sedentary lifestyle has been investigated. To synthesize the current evidence, we performed a systematic review of published papers reporting on the relationship between sedentary habits and semen parameters.Embase and PubMed were systematically searched for papers published in English up to May 2023. We included all full‐text observational papers that reported the relationship between sedentariness and semen parameters. Article selection adhered to the Preferred Reporting Items for Systematic Reviews and Meta‐Analysis (PRISMA) guidelines.Sixteen observational studies were ultimately included, six in healthy men and ten in men from Fertility Clinics. They encompassed a total of 13,509 men, with 9877 being healthy men and 3632 presenting at Fertility Clinics for initial assessment. In terms of semen volume, no association emerged in the six studies involving healthy men: however, results in men referring to fertility clinics mainly showed no association, with one indicating a decline and one higher volume. Twelve studies did not report differences in sperm concentration, while one study in men from Fertility Clinics and two in healthy men observed a decline in this parameter with increasing time spent on TV watching or sedentary posture in spare time. Total sperm count was found to be similar across groups of inactivity, except for one study that showed a significant decrease when men from Fertility Clinics spent more time watching TV. No significant differences were reported in sperm motility across all studies, with only one study, among those addressing sperm morphology, indicating a lower percentage of normal forms in men watching TV more than 3 h per day. Finally, three studies conducted in men referring to Fertility Clinics analyzed the sperm DNA fragmentation index. Two of these studies found a higher DNA fragmentation index in men spending more time per day in a sitting posture.This review suggests a weak association between time spent sitting during spare time and sperm concentration, but the findings are inconsistent, highlighting the need for further research. [ABSTRACT FROM AUTHOR]

As is the case around the globe, South African fertility clinics face an ever‐expanding problem: what to do with the growing number of surplus cryopreserved embryos. Fertility clinics remain hesitant to destroy these abandoned embryos, partly because of concerns about the legal ramifications. This article clarifies the legal position in South Africa and offers practical recommendations to assist fertility clinics in managing abandoned embryos. In sum, fertility clinics cannot deem embryos as abandoned and discard them if fertility patients fail to respond to a notice that the embryo storage agreement is about to expire. However, if there is non‐payment for embryo storage by fertility patients and the fertility clinic has informed the fertility patients of other options available to them with respect to their embryos, and there is still no response, the fertility clinic is legally entitled – and legally obliged – to discard the embryos. [ABSTRACT FROM AUTHOR]

To explore the relationships among fertility stress, dyadic coping and marital quality in couples undergoing in vitro fertilization‐embryo transfer (IVF‐ET). Couples receiving IVF‐ET treatment at the clinic of the reproductive medicine centre of a hospital in China from February 2023 to October 2023 were selected by convenience sampling. A general information questionnaire, the Infertility Fertility Stress Scale (COMP‐FPSS‐SF), the dyadic coping inventory, and the marital adjustment test were used to evaluate the results. AMOS24.0 software was used to construct an actor‐partner interdependence model that extended to mediation to analyze the relationships among couples' fertility stress, dyadic coping, and marital quality. The fertility stress level of IVF‐ET wives was significantly higher than that of their husbands (p < 0.05). Wives' levels of dyadic coping and marital quality were significantly lower than those of husbands (p < 0.05). Fertility stress, dyadic coping, and marital quality were positively correlated between IVF‐ET couples (p < 0.01). In terms of the actor effect, the fertility stress of IVF‐ET couples had a significant impact on their marital quality through their dyadic coping (β = −0.188, p < 0.05; β = −0.109, p < 0.05). In terms of partner effects, wives' fertility stress significantly affected their husbands' marital quality through their own or their husbands' dyadic coping (β = −0.055, p < 0.01; β = 0.157, p < 0.01). Dyadic coping mediates the relationship between fertility stress and marital quality in IVF‐ET couples. Nurses can use husbands and wives as central individuals and dyadic coping as the starting point to formulate intervention measures to reduce fertility stress and improve marital quality. [ABSTRACT FROM AUTHOR]

Background Aims Methods Results Conclusion Treatment‐related premature ovarian insufficiency (POI) can result in early‐onset menopause and infertility.To assess the prevalence of goserelin use for POI prevention in women with cancer since it was listed by the Australian Pharmaceutical Benefits Scheme in 2018 for this indication.This retrospective study included women aged 18–45 years who received curative‐intent alkylating chemotherapy for a malignancy between August 2020 and December 2022 at the Peter MacCallum Cancer Centre. The co‐primary end‐points were (i) documentation of a discussion with the patient regarding goserelin for POI prevention and (ii) prescription of goserelin for POI prevention prior to chemotherapy commencement.Sixty‐six patients were eligible. Fifty patients (76%) had a documented discussion regarding goserelin for POI prevention and 53 patients (80%) were prescribed goserelin for POI prevention. Nulliparous women were more likely to have a discussion regarding goserelin (P = 0.004). Younger women, nulliparous women and those referred to a fertility service were more likely to have been prescribed goserelin for POI prevention (P = 0.003, P = 0.001 and P = 0.002 respectively). Twenty‐one of 53 patients (40%) who received goserelin had the first dose administered ≥7 days before chemotherapy commencement.One‐quarter of eligible patients did not have a documented discussion regarding goserelin, despite the negative consequences of POI. Efforts are needed to increase the discussion and use of goserelin in all premenopausal women regardless of their fertility interests and to ensure timely administration in those who choose to receive it. [ABSTRACT FROM AUTHOR]

It is not controversial to state that parental age is increasing in several countries. But how to deal with this increase might be. Some Nordic countries have set an upper age limit for females seeking assisted reproduction in their national legislation, but none have done so for males. There are also recommendations in place that restrict access to publicly funded assisted reproduction for both females and males of advanced age in some Nordic countries. As recent data now show somatic and psychiatric health risks related to advanced paternal age, we ask if the time has come for countries to set an upper age limit for males seeking assisted reproduction like there already is for females, and summarize some of the risks and rewards involved in treating couples with advanced age in fertility clinics. [ABSTRACT FROM AUTHOR]

As a growing number of embryos collect in fertility clinics, it is imperative to evaluate the permissibility of available options for genetic parents and fertility institutions. Much of the discussion on appropriate treatment of embryos has focused on the circumstances under which it is permissible to destroy embryos for instrumental purposes, and thus has little application to the fertility context. I aim to develop a new account of the value of embryos whereby embryos have final value in virtue of their relationship to persons that could exist. I call this symbolic value. To establish this value, I first show that corpses have this same symbolic value in virtue of their relationship to prior persons, and then show that the cases of corpses and embryos are relevantly similar. Because of this value, we ought to treat embryos in particular respectful ways. It is currently common practice in the United States to simply discard extra embryos that exist as a result of in vitro fertilization. I argue it is generally impermissible to simply discard embryos because it is an act of disrespect and does not treat them in accordance with their value. [ABSTRACT FROM AUTHOR]

Introduction: Intrauterine insemination (IUI) is one of the most widespread fertility treatments. However, IUI protocols vary significantly amongst fertility clinics. Various add‐on interventions have been proposed to boost success rates. These are mostly chosen arbitrarily or empirically. The aim of this systematic review and meta‐analysis is to assess the effectiveness and safety of add‐on interventions to the standard IUI protocol and to provide evidence‐based recommendations on techniques used to optimize the clinical outcomes of IUI treatment. Material and Methods: Systematic review and meta‐analyses were performed in accordance with PRISMA guidelines. A computerized literature search was performed from database inception to May 2023. Randomized controlled trials (RCTs) were included reporting on couples/single women undergoing IUI with any protocol for any indication using partner's or donor sperm. A meta‐analysis based on random effects was performed for each outcome and add‐on. Three authors independently assessed the trials for quality and risk of bias and overall certainty of evidence. Uncertainties were resolved through consensus. Primary outcomes were ongoing pregnancy rate (OPR) or live birth rate (LBR) per cycle/per woman randomized. Registration number PROSPERO: CRD42022300857. Results: Sixty‐six RCTs were included in the analysis (16 305 participants across 20 countries). Vaginal progesterone as luteal phase support in stimulated cycles was found to significantly increase LBR/OPR (RR 1.37, 95% CI 1.09–1.72, I2 = 4.9%) (moderate/low certainty of the evidence). Endometrial scratch prior/during stimulated IUI cycles may increase LBR/OPR (RR 1.44, 95% CI 1.03–2.01, I2 = 1.8%), but evidence is very uncertain. Results from two studies suggest that follicular phase ovarian stimulation increases LBR/OPR (RR 1.39, 95% CI 1.00–1.94, I2 = 0%) (low certainty of evidence). No significant difference was seen for the primary outcome for the other studied interventions. Conclusions: The findings of this systematic review and meta‐analysis suggest that vaginal luteal phase progesterone support probably improves LBR/OPR in stimulated IUI treatments. In view of moderate/low certainty of the evidence more research is needed for solid conclusions. Further research is also recommended for the use of endometrial scratch and ovarian stimulation. Future studies should report on results according to subfertility background as it is possible that different add‐ons could benefit specific patient groups. [ABSTRACT FROM AUTHOR]

Background Objectives Materials and Methods Results Discussion and Conclusion Fertility preservation and subsequent third‐party reproduction represents a principal pathway by which gay and bisexual cisgender men may have biologically related children. Previous studies of a similar design have commented on the availability of fertility services for sexually and gender diverse communities, but none have investigated access to the aforementioned services for this specific population.To assess the availability of fertility preservation and third‐party reproduction services for gay and bisexual cisgender men across US fertility clinics and sperm banks.A content analysis was performed on a sample of fertility clinic and sperm bank websites compiled from three online sources. Sample construction and analysis were completed in 2023. Each website was systematically examined by two separate coders with a third coder deciding any discrepancies. Website coding followed a pre‐constructed standardized questionnaire. Logistic regression analysis was used to identify statistically significant differences.A total of 675 clinic and sperm bank websites (136 academic and 539 private) were analyzed. Five hundred and two (74.4%) offered third‐party reproduction and 326 (48.3%) offered fertility preservation for gay and bisexual cisgender men. Furthermore, 248 websites (36.7%) featured some form of disqualifying language either directly communicating or implying exclusion of gay and bisexual cisgender men from these services. Private facilities were more likely to offer third‐party reproduction (odds ratio [OR] = 1.88, p < 0.01) but less likely to offer fertility preservation (OR = 0.68, p < 0.05) compared with academic affiliated facilities. Lastly, states in the highest Human Rights Campaign Equality Index tier were significantly more likely to offer third‐party reproduction (OR = 2.50, p < 0.01) than the lowest tier.These findings demonstrate great variability in access to fertility preservation and third‐party reproduction services. Geography and ambiguity in facility‐specific policies represent persistent barriers to family building for gay and bisexual cisgender men. [ABSTRACT FROM AUTHOR]

The Phylum Cressdnaviricota consists of a large number of circular Rep‐encoding single‐stranded (CRESS)‐DNA viruses. Recently, metagenomic analyzes revealed their ubiquitous distribution in a diverse range of eukaryotes. Data relating to CRESS‐DNA viruses in humans remains scarce. Our study investigated the presence and genetic diversity of CRESS‐DNA viruses in human vaginal secretions. Vaginal swabs were collected from 28 women between 29 and 43 years old attending a fertility clinic in New York City. An exploratory metagenomic analysis was performed and detection of CRESS‐DNA viruses was confirmed through analysis of near full‐length sequences of the viral isolates. A phylogenetic tree was based on the REP open reading frame sequences of the CRESS‐DNA virus genome. Eleven nearly complete CRESS‐DNA viral genomes were identified in 16 (57.1%) women. There were no associations between the presence of these viruses and any demographic or clinical parameters. Phylogenetic analysis indicated that one of the sequences belonged to the genus Gemycircularvirus within the Genomoviridae family, while ten sequences represented previously unclassified species of CRESS‐DNA viruses. Novel species of CRESS‐DNA viruses are present in the vaginal tract of adult women. Although they be transient commensal agents, the potential clinical implications for their presence at this site cannot be dismissed. [ABSTRACT FROM AUTHOR]

Objective: This research was conducted to assess access to assisted reproductive technologies (ART) and the current status of the in vitro fertilization (IVF) program that have been implemented in Indonesia over the last 10 years. Methods: We established a retrospective cohort study and descriptive analysis of the current state of access to infertility care in Indonesia. The data were collected from all IVF centers, clinics, and hospitals in Indonesia from 2011 to 2020, including the number of IVF clinics, total ART cycles, retrieved fresh and frozen embryos, average age of IVF patients, IVF pregnancy rate, and causes of infertility. Results: The number of reported fertility clinics in Indonesia has increased from 14 clinics in 2011 to 41 clinics by 2020. As many as 69 569 ART cycles were conducted over the past 10 years, of which 51 892 cycles used fresh embryos and 17 677 cycles used frozen embryos. The leading cause of consecutive infertility diagnosis was male infertility. Nearly half of the women who underwent IVF procedures (48.9%) were under 35 years old. The pregnancy rate outcome of women who underwent IVF ranged from 24.6% to 37.3%. Conclusion: Developments in ART in Indonesia have led to improvements in the ART cycles performed throughout the 10 year period. The identification of key areas that require improvement can provide an opportunity to enhance access to infertility care. Synopsis: The ART developments in Indonesia throughout the last 10 years have led to a total of 69 569 ART cycles with pregnancy rate ranging from 24.6% to 37.3%. [ABSTRACT FROM AUTHOR]

Artificial insemination (AI) centres select bulls as calves according to their genetic breeding values and raise them until the first semen collection; yet, a high dropout rate of reared bulls is a problem for AI centres. Potential hormonal indicators of bull sexual maturation (cortisol, dehydroepiandrosterone (DHEA), testosterone, oestradiol, insulin‐like growth factor 1 (IGF‐1)) were observed and evaluated in relation to the performance parameters to perhaps identify candidate biomarkers allowing an early selection of bulls as suitable sires. Blood samples from 102 German Holstein calves at 4 ± 1, 8 ± 1 and 12 ± 2 months of age from six AI centres were analysed using validated immunoassays for cortisol, DHEA, testosterone, oestradiol and IGF‐1. Semen analyses included native and thawed diluted semen. Bulls were classified at the first semen collection into groups with good versus poor performance (GP vs. LP). After 2 years, the subsequent differentiation was done in high (HPP), medium (MPP) and low performance persistency (LPP). Age at first semen collection was an important factor for sperm quality. Cortisol concentrations decreased with age, but the cortisol/DHEA ratio decreased with age only in GP bulls (p <.05). Oestradiol and testosterone concentrations both correlated with libido behaviour (p <.05). Testosterone and IGF‐1 concentrations were higher at the time of first semen collection in GP bulls and increased with age (p <.05). In conclusion, testosterone and IGF‐1 concentrations at first semen collection are associated with performance at first semen collection and future performance persistency, and might be useful early biomarkers for consistent sperm producing bulls on AI centres. [ABSTRACT FROM AUTHOR]

Background. Currently, there are few studies on the effects of hyperlipidemia on semen parameters and serum hormones in men. In this study, we divided the study subjects into two groups of normal and hyperlipidemia according to the criteria, and observed the differences between semen parameters and serum reproductive hormones in hyperlipidaemic men and normal men, to explore the potential associations between the indicators. Materials and Methods. Eight hundred eighty five men attending infertility clinics in six hospitals from September 2016 to June 2017 were selected. Their lipid levels, semen parameters, and serum reproductive hormone levels were tested, and a total of 480 men with normal lipids and 405 men with hyperlipidemia were selected according to the criteria, and the relationship between semen quality, serum reproductive hormones, lipids and semen parameters, and serum hormones was statistically analyzed. Results. There was no significant difference in semen parameters between hyperlipidaemic men and normal men (P >0:05), serum testosterone levels were significantly lower in hyperlipidaemic men (P <0:05), and there was a negative correlation between triglycerides (TG) and testosterone in the blood (P <0:05).Conclusion. Hyperlipidemia does not affect male semen parameters, and changes in testosterone in hyperlipidaemic men may be related to triglycerides. [ABSTRACT FROM AUTHOR]

Summary: Tropical forest root characteristics and resource acquisition strategies are underrepresented in vegetation and global models, hampering the prediction of forest–climate feedbacks for these carbon‐rich ecosystems. Lowland tropical forests often have globally unique combinations of high taxonomic and functional biodiversity, rainfall seasonality, and strongly weathered infertile soils, giving rise to distinct patterns in root traits and functions compared with higher latitude ecosystems. We provide a roadmap for integrating recent advances in our understanding of tropical forest belowground function into vegetation models, focusing on water and nutrient acquisition. We offer comparisons of recent advances in empirical and model understanding of root characteristics that represent important functional processes in tropical forests. We focus on: (1) fine‐root strategies for soil resource exploration, (2) coupling and trade‐offs in fine‐root water vs nutrient acquisition, and (3) aboveground–belowground linkages in plant resource acquisition and use. We suggest avenues for representing these extremely diverse plant communities in computationally manageable and ecologically meaningful groups in models for linked aboveground–belowground hydro‐nutrient functions. Tropical forests are undergoing warming, shifting rainfall regimes, and exacerbation of soil nutrient scarcity caused by elevated atmospheric CO2. The accurate model representation of tropical forest functions is crucial for understanding the interactions of this biome with the climate. [ABSTRACT FROM AUTHOR]

Background: The use of ultrasound to guide placement of the embryo during in vitro fertilisation (IVF) is important, but there are times where a good image cannot be obtained. Having a trained sonographer perform the ultrasound may therefore improve the success of embryo transfer. Aim: To determine whether the routine use of a sonographer to guide embryo transfer is superior to standard care. Materials and Methods: Randomised, controlled, prospective clinical study in a private infertility clinic. There were 113 women aged <38 years undergoing frozen embryo transfer (donor egg/embryo excluded) who were randomised to sonographer‐guided embryo transfer or standard care (the doctor performs an ultrasound prior to embryo transfer and the patient holds the ultrasound probe). The primary outcome was visualisation of the air bubble, and secondary outcomes were distance of the air bubble from the fundal endometrium, pregnancy rate (gestational sac on ultrasound at seven weeks) and live birth rate. Results: The bubble was visualised in 100% of embryo transfers with a sonographer compared to 83% in the ultrasound‐assisted group, and this was statistically significant (P < 0.01). No statistically significant differences were found in terms of distance from the fundal endometrium or in pregnancy rate and live birth rate. Conclusion: Sonographer‐guided embryo transfer leads to statistically higher rates of visualisation of the air bubble compared to ultrasound‐assisted transfer. [ABSTRACT FROM AUTHOR]

Background: Treatment‐related gonadal dysfunction leading to fertility problems is a frequently encountered late effect in childhood cancer survivors (CCSs). This study evaluated reproductive outcomes and reproductive health care utilization among male CCSs compared with male siblings. Methods: A nationwide cohort study was conducted as part of the Dutch Childhood Cancer Survivor LATER study part 1, a questionnaire and linkage study. A questionnaire addressing reproductive outcomes and reproductive health care was completed by 1317 male CCSs and 407 male siblings. A total of 491 CCSs and 185 siblings had a previous or current desire for children and were included in this study. Results: Fewer CCSs had biological children compared with siblings (65% vs. 88%; p <.001). The type of conception by men who fathered a child was comparable between CCSs and siblings (spontaneous conception of 90% of both groups; p =.86). The percentage of men who had consulted a reproductive specialist because of not siring a pregnancy was higher in CCSs compared with siblings (34% vs. 12%; p <.001). Following consultation, fewer CCSs underwent assisted reproductive techniques (ART) compared with siblings (41% vs. 77%; p =.001). After ART, fewer CCSs fathered a child compared with siblings (49% vs. 94%; p =.001). Conclusions: More male survivors consult a reproductive specialist, but fewer survivors undergo ART and father a child after ART compared with siblings. This insight is important for understanding potential problems faced by survivors regarding family planning and emphasizes the importance of collaboration between oncologists and reproductive specialists. This study showed that two‐thirds of male survivors of childhood cancer who had a desire for children fathered a biological child and that children of 90% of male survivors were conceived spontaneously. Compared with male siblings, more male survivors consulted a reproductive specialist because of not siring a pregnancy; however, both the application of and birth rates after assisted reproductive techniques in survivors were lower. [ABSTRACT FROM AUTHOR]

Across Pacific Island countries, women and men are disproportionately affected by several risk factors for infertility, including sexually transmissible infections, complications from unsafe abortions, postpartum sepsis, obesity, diabetes, tobacco smoking and excessive alcohol consumption. Despite this, little is known about community awareness of infertility, behavioural risk factors, the lived experiences of infertile couples or the contexts in which they access fertility care. In this opinion piece we discuss the current evidence and gaps in evidence regarding infertility in Pacific Island countries and the importance of locally tailored approaches to preventing infertility and the provision of fertility care. [ABSTRACT FROM AUTHOR]

Background: Children conceived with assisted reproductive technologies (ART) or after a long waiting time have a higher prevalence of congenital malformations, but few studies have examined the contribution of type of infertility. Objectives: To quantify the association between causes of infertility and prevalence of malformations. Methods: We compared the prevalence at birth of all and severe malformations diagnosed up to age 2 between 6656 children born in 1996–2017 to parents who had previously been assessed for infertility a an academic fertility clinic ("exposed") and 10,382 children born in the same period to parents with no recent medical history of infertility ("reference"). We estimated prevalence ratios (PR) and prevalence differences (PD), by infertility status, type of treatment (non‐ART, ART), and infertility diagnosis, in all children and among singletons. Results: Compared with children of parents with no infertility, children of parents with infertility had a higher prevalence of malformations (both definitions), particularly following ART conceptions. After accounting for treatment, ovulatory disorders were associated with a higher prevalence of both all (PR 1.49, 95% confidence interval (CI) 1.15, 1.93; PD 3.8, 95% CI 1.0, 6.6) and severe (PR 1.53, 95% CI 1.02, 2.29; PD 1.8, 95% CI −0.2, 3.7) malformations (the estimates refer to exposed children conceived without treatment). Unexplained and male factor infertility were associated with all and severe malformations, respectively. Estimates among singletons were similar. A diagnosis of ovulatory disorders was associated with all malformations also in analyses restricted to exposed children, regardless of treatment (we did not examine severe malformations, due to limited power). Conclusions: In this study, ovulatory disorders were consistently associated with a higher prevalence of congenital malformations (including severe malformations) among live births, regardless of mode of conception. [ABSTRACT FROM AUTHOR]

Background: Endometriosis is an estrogen‐dependent, chronic inflammatory disease that affects 10% of women during the reproductive ages. Despite the estimated 50% heritability for the condition, only 26% was associated with common genetic variants. Thus, necessity of identifying rare variants for the missing heritability is implicated in the literature. Therefore, our study aimed to identify novel rare genetic variants involved in the pathogenesis of endometriosis utilizing a family of multiple affected members. Methods: A family composed of four affected women along with their two unaffected mothers were recruited at a single gynecology and infertility clinic specialized in endometriosis. All patients presented with endometriomas, which was visualized by transvaginal ultrasonography. Two affected individuals had received laparoscopic endometrioma excision and therefore were diagnosed with recurrent disease. One mother had a history of endometrial serous adenocarcinoma (ESC) for which she underwent hysterectomy with bilateral oophorectomy. Three endometriosis cases were whole exome sequenced on Illumina NextSeq 550 platform with an average of 90% coverage. Candidate genes were confirmed by Sanger sequencing and followed‐up with family segregation. Results: Novel rare variants were identified in TNFRSF1B (NM_001066.3: c.1072G>A, p.(Ala358Thr)) and GEN1 (NM_001130009.3: c.1574C>T, p.(Ser525Leu)) as possible genetic causes of endometriosis. A third novel rare variant was identified in CRABP1 (NM_004378.3:c.54G>C, p.(Glu18Asp)) only on the mother with ESC history and her daughters. Conclusion: Novel candidate genetic variants that might contribute to endometriosis were suggested that need replication through independent cohorts or validation by functional studies. The family has also received genetic counseling and that the affected daughters are on clinical follow‐up, accordingly. [ABSTRACT FROM AUTHOR]

Purpose: Spermatogenesis requires a large amount of energy, which is primarily produced by the mitochondrial electron transfer chain. Mitochondrial dysfunction affects male infertility, suggesting a relationship between the electron transfer chain and male infertility. COXFA4L3 (C15ORF48) is an emerging subunit protein of cytochrome oxidase specifically expressed in germ cells during spermatogenesis, and it may be involved in male infertility. Therefore, to investigate whether COXFA4L3 could be a marker of mitochondrial dysfunction in the sperm, this study examined the protein expression and localization profile of COXFA4L3 in the sperm of male patients with infertility. Methods: Twenty‐seven semen samples from a male infertility clinic at the Reproductive Center of Yokohama City University Medical Center were used to analyze sperm quality parameters and the expression and localization of energy production‐related proteins. These data were compared with the outcomes of infertility treatment. Results: The expression levels of COXFA4L3 varied significantly between samples. Furthermore, COXFA4L3 was ectopically localized to the acrosome. Conclusions: Ectopic expression of COXFA4L3 and PNA‐stained acrosomes may be useful parameters for fertility treatment selection. Assessing the acrosomal localization of COXFA4L3 will expedite pregnancy treatment planning. [ABSTRACT FROM AUTHOR]

Objective: This study aims to explore the status and influencing factors of fertility intention in women of childbearing age with systemic lupus erythematosus (SLE). Methods: A total of 158 SLE patients admitted to the Affiliated Hospital of Nantong University from February 2021 to February 2022 were selected for a cross‐sectional study. The dependent variable in this study was the fertility intention of lupus women of childbearing age, so the questionnaire was selected: "In view of your disease, do you plan to have children? Yes/no" as the measurement statement. Lupus patients were divided into fertility intention groups and non‐fertility intention groups. The questionnaire survey comprises following scales: Hospital Anxiety and Depression Scale (HADS), Multidimensional Fatigue Inventory (MFI‐20), Female Sexual Distress Scale‐Revised (FSDS‐R), and others. Independent t‐test, one‐way ANOVA, Mann–Whitney U test, and binary logistic regression were used for analysis. Results: The results showed that 20.9% of lupus patients in this study had a fertility intention. The fertility intention was associated with age, reproductive history, reproductive concerns, sexual distress, fatigue, family function, social support, depression, and sleep. Binary logistic regression showed that physical fatigue (OR 3.56, 95% CI 1.048–12.07) and personal health (OR 2.50, 95% CI 1.065–5.853) had significant predictors of fertility intention. Conclusion: Our study identified a lower fertility intention in SLE patients who had reproductive concerns, sexual distress, family dysfunction, and fatigue. We encourage healthcare institutions to provide counseling services to all the SLE patients who have fertility intention and focus more on those who have requirements for fertility. [ABSTRACT FROM AUTHOR]

The article discusses the prevalence of infertility in Sub-Saharan Africa and the role of qualitative research in advancing fertility treatment services in the region. It highlights the importance of understanding the psychosocial effects of infertility, especially in a cultural context where high fertility is expected. The research aims to explore the experiences of women living with infertility in Africa to improve service delivery and address gender disparities in care provision. [Extracted from the article]

Ordinary differential equation models used in mathematical epidemiology assume explicitly or implicitly large populations. For the study of infections in a hospital, this is an extremely restrictive assumption as typically a hospital ward has a few dozen, or even fewer, patients. This work reframes a well‐known model used in the study of the spread of antibiotic‐resistant bacteria in hospitals, to consider the pathogen transmission dynamics in small populations. In this vein, this paper proposes a Markov chain model to describe the spread of a single bacterial species in a hospital ward where patients may be free of bacteria or may carry bacterial strains that are either sensitive or resistant to antimicrobial agents. We determine the probability law of the exact reproduction number Rexact,0${\cal R}_{exact,0}$, which is here defined as the random number of secondary infections generated by those patients who are accommodated in a predetermined bed before a patient who is free of bacteria is accommodated in this bed for the first time. Specifically, we decompose the exact reproduction number Rexact,0${\cal R}_{exact,0}$ into two contributions allowing us to distinguish between infections due to the sensitive and the resistant bacterial strains. Our methodology is mainly based on structured Markov chains and the use of related matrix‐analytic methods. This guarantees the compatibility of the new, finite‐population model, with large population models present in the literature and takes full advantage, in its mathematical analysis, of the intrinsic stochasticity. [ABSTRACT FROM AUTHOR]

Ovarian reserve (OR) and fertility are critical in women's healthcare. Clinical methods for encoding OR and fertility rely on the combination of tests, which cannot serve as a multi‐functional platform with limited information from specific biofluids. Herein, metabolic fingerprinting of follicular fluid (MFFF) from follicles is performed, using particle‐assisted laser desorption/ionization mass spectrometry (PALDI‐MS) to encode OR and fertility. PALDI‐MS allows efficient MFFF, showing fast speed (≈30 s), high sensitivity (≈60 fmol), and desirable reproducibility (coefficients of variation <15%). Further, machine learning of MFFF is applied to diagnose diminished OR (area under the curve of 0.929) and identify high‐quality oocytes/embryos (p < 0.05) by a single PALDI‐MS test. Meanwhile, metabolic biomarkers from MFFF are identified, which also determine oocyte/embryo quality (p < 0.05) from the sampling follicles toward fertility prediction in clinics. This approach offers a powerful platform in women's healthcare, not limited to OR and fertility. [ABSTRACT FROM AUTHOR]

Tehran's actual prevalence of Chlamydia trachomatis (CT) and its genotypes are still unclear. Molecular typing of CT strains can provide essential epidemiological knowledge and contribute to improved control measures. In this study, we aimed to determine the prevalence of CT and its genotypes in the endocervical infections of females who attended the gynecology and infertility clinics in Tehran. A total of 291 women were tested for chlamydial infection by in-house PCR using specific primers for the CT cryptic plasmid. Nested PCR for amplification of the ompA gene in positive samples was carried out, genotyping was performed by sequencing this gene, and further phylogenetic analysis was conducted. Sexual infection by CT was observed in 10.3% (30/291) of the subjects, and the mean age of patients was 30.4. The ompA gene was sequenced in 27 samples, revealing E genotypes 40.7%, (n = 11), F 25.9%, (n = 7), G 18.5%, (n = 5), D 11.1%, (n = 3), and K 3.7%, (n = 1). This study emphasizes the importance of the diversity among CT genotypes in our studied population and the need for wide-screening the neglected bacterial infection among women in Tehran. [ABSTRACT FROM AUTHOR]

In April 2023, the World Health Organization (WHO) issued new estimates affirming that one in six individuals experience infertility globally. Yet, many states are unclear on their responsibility to prevent infertility, ensure access to treatment, and to end the harm suffered by individuals who are considered infertile. Responding to this uncertainty, in June 2023, the United Nations Office of the High Commissioner on Human Rights (OHCHR) issued a new research paper explaining states' legal obligations regarding infertility. Importantly, OHCHR underscores that states must take steps to prevent infertility by addressing its root causes and ensure access to treatment. Further, states must address the negative consequences of infertility, including stigma and violence, as well as the discriminatory stereotypes that lead to certain groups facing disproportionate harm from infertility. This article provides an overview of the OHCHR report and explains what this means for healthcare providers, who have a critical role to play in providing care and advocating for legal and policy reform necessary to prevent, diagnose, and treat infertility. Synopsis: This article provides an overview of OHCHR's new 2023 research paper on human rights obligations to address the preventable causes and consequences of infertility, and highlights healthcare providers' role in advancing human rights and preventing harm to patients through infertility prevention, diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Introduction: This study aims to assess the motivations and treatment experiences of women undergoing social egg freezing and to understand the impact of the Covid-19 pandemic. Material and methods: Between January 2011 to December 2021, 191 social egg freezing patients were recruited from the Lister Fertility Clinic, London UK. Participants completed a validated questionnaire investigating patients' perspectives of social egg freezing. A response rate of 46.6% was achieved. Results: In all, 93.9% of women expressed concern regarding age-related fertility decline which influenced their decision to undergo social egg freezing. The majority (89.5%) of women were not in a relationship at the time of social egg freezing and considered this a motivating factor. Also, 39.0% of participants had side effects related to treatment which affected work and social life. Participants were significantly more likely to experience side effects if they underwent multiple egg freezing cycles (χ², p < 0.01) or if they cryopreserved oocytes during the COVID-19 pandemic (χ², p < 0.05). Of the women, 64.0% wished to have cryopreserved oocytes at a younger age, a view significantly more likely if older than 37 years at first social egg freezing cycle (χ², p < 0.001). Also, 82.3% of women reported their decision to undergo social egg freezing was not delayed due to concerns regarding COVID-19 exposure during treatment; 44.1% considered the pandemic made them more willing to undergo social egg freezing. Conclusions: Most participants did not regret their decision to undergo social egg freezing but the majority wished they had cryopreserved oocytes at a younger age. This highlights the importance of early education to optimize outcomes and patient choice. The egg freezing process can be stressful, women may have concerns around social egg freezing and unprecedented situations such as the COVID-19 pandemic may alter treatment experience. [ABSTRACT FROM AUTHOR]

Climate change is becoming increasingly more pronounced every day while the amount of greenhouse gases in the atmosphere continues to rise. CO2 reduction to valuable chemicals is an approach that has gathered substantial attention as a means to recycle these gases. Herein, some of the tandem catalysis approaches that can be used to achieve the transformation of CO2 to CC coupled products are explored, focusing especially on tandem catalytic schemes where there is a big opportunity to improve performance by designing effective catalytic nanoreactors. Recent reviews have highlighted the technical challenges and opportunities for advancing tandem catalysis, especially highlighting the need for elucidating structure‐activity relationships and mechanisms of reaction through theoretical and in situ/operando characterization techniques. In this review, the focus is on nanoreactor synthesis strategies as a critical research direction, and discusses these in the context of two main tandem pathways (CO‐mediated pathway and Methanol‐mediated pathway) to CC coupled products. [ABSTRACT FROM AUTHOR]

This study is aimed at establishing the effects of varying sperm quality on IVF-ICSI/IMSI outcomes in unexpected poor ovarian responder subjects of POSEIDON groups 1 and 2. In the present study, 1,263 couples with female partners who fulfilled the POSEIDON group 1 and 2 criteria were recruited. All couples underwent ICSI or IMSI at Morula IVF Jakarta Clinic, Indonesia. Patients were subsequently classified into six groups, according to semen conditions of the respective male partners: (1) normozoospermic, (2) teratozoospermia, (3) oligoasthenoteratozoospermia (OAT), (4) asthenozoospermia, (5) severe OAT, and (6) cryptozoospermia. Laboratory and clinical outcomes of the IVF-ICSI/IMSI program were then evaluated. Early and late embryonic development parameters including the number of fertilization, cleavage and blastocyst stages, and blastocyst quality differed significantly among the different sperm quality groups (p < 0.05). No difference was observed in the number of embryo transfers and clinical pregnancy among the studied groups (p > 0.05). Our study has demonstrated the effect of sperm quality on embryo development at the early and later stages; however, the clinical pregnancy was not impaired in the unexpected poor responders of POSEIDON groups 1 and 2. [ABSTRACT FROM AUTHOR]

Introduction. Medications such as antioxidants and recombinant FSH are prescribed to improve sperm DFI (DNA fragmentation index) and treat infertility. Due to the high cost and duration of medications, in this study, we decided to investigate the effectiveness of combining these two medications with lower doses and in less time, compared to previous studies prescribing them individually, to reduce sperm DFI in infertile men. Methods. This study, a retrospective observational before and after trial, included a group (n = 94) of men aged 18-50 years with DFI > 20 % suffering from male factor infertility in an andrology clinic in Tehran, Iran, from 2019 to 2020. Patients received the combination of two medications, recombinant FSH every 5 days (75 IU subcutaneously) and an antioxidant every day (selenium, vitamin E, CoQ10, and folic acid) for 2 months. The patient's sperm DFI and sperm parameters have been measured before and after the medication and were reported in patient's files. In all patients, we compare the sperm DFI and sperm parameters before and after the treatment to evaluate the effect of the combination therapy. Results. The sperm DFI was significantly reduced (p value ≤0.001) in the patients treated by the combined medication. The sperm DFI improvement was 50.16% in the total population. However, there were no significant changes in other sperm parameters such as sperm concentration, total motility, progressive motility, immotile sperms, and abnormal morphology. Total sperm count and nonprogressive motility had significant changes statistically. Conclusion. Sperm DFI is an important indicator for evaluating the quality of semen. In this study, we demonstrate that the combination of recombinant FSH and antioxidants in a shorter time and with lower doses is effective in reducing DFI significantly. But in terms of other sperm parameters, it does not make a significant difference. [ABSTRACT FROM AUTHOR]

Nurse‐led clinics are known to positively impact and benefit patients; however, there is little understanding of the role of the nurse in a nurse‐led male Lower Urinary Tract Symptoms (LUTS) clinic. LUTS affect up to 30% of males over 65 in the United Kingdom and can significantly impact the quality of life of the person experiencing them. LUTS can be managed with conservative changes, as well as with medication and surgical intervention. The aim of this scoping review is to map what is known about the role of the nurse in a nurse‐led male LUTS clinic and what research tells us regarding, the barriers and enablers in nurses leading a male LUTS clinic. This scoping review follows the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses extension for Scoping Reviews (PRISMA‐SCR) checklist and the methodological guidelines set out by the Joanna Briggs institute. A literature search was carried out over three databases (CINAHL, Medline Ovid, ProQuest health and medical collection) and systematically searched from 2000 to 2021. Grey literature was also searched, and citation chaining was undertaken. Following a systematic review of the literature, four papers met the inclusion criteria for this scoping review. The emergent themes across the four papers consisted of structure, assessment and resources, and effectiveness of the nurse‐led male LUTS clinic. There was clear agreement across the literature regarding the investigations and assessment the nurse should carry out. Ongoing practical, theoretical, and observational training and education is required to ensure the nurse is competent in running a male LUTS clinic. The papers reviewed showed the nurse provided a supportive role to the consultant. However, there is evidence indicating there is a move towards autonomous practice. There is a dearth of the current research relating to the role of the nurse in nurse‐led male LUTS clinics and the enablers and barriers in nurses leading male LUTS clinics. Further research should be considered to gain a better understanding of where nurse‐led male LUTS clinics currently take place, what the role of the nurse is in leading a LUTS clinic and what enablers and barriers exist. [ABSTRACT FROM AUTHOR]

The article discusses a study on fertility outcomes among female adolescents and young adults with cancer, focusing on racial disparities. It highlights the need to consider socioeconomic factors, cultural and psychological influences, and regional differences in future research. The authors recommend regular studies to track the impact of treatment advances on fertility outcomes. The study's limitations include a lack of consideration for socioeconomic factors and cultural influences, as well as its reliance on Texas data, which may limit generalizability. [Extracted from the article]

Background: Clinical practice guidelines recommend to inform female cancer patients about their infertility risks due to cancer treatment. Unfortunately, it seems that guideline adherence is suboptimal. In order to improve quality of integrated female oncofertility care, a systematic assessment of current practice is necessary. Methods: A multicenter cross‐sectional survey study in which a set of systematically developed quality indicators was processed, was conducted among female cancer patients (diagnosed in 2016/2017). These indicators represented all domains in oncofertility care; risk communication, referral, counseling, and decision‐making. Indicator scores were calculated, and determinants were assessed by multilevel multivariate analyses. Results: One hundred twenty‐one out of 344 female cancer patients participated. Eight out of 11 indicators scored below 90% adherence. Of all patients, 72.7% was informed about their infertility, 51.2% was offered a referral, with 18.8% all aspects were discussed in counseling, and 35.5% received written and/or digital information. Patient's age, strength of wish to conceive, time before cancer treatment, and type of healthcare provider significantly influenced the scores of three indicators. Conclusions: Current quality of female oncofertility care is far from optimal. Therefore, improvement is needed. To achieve this, improvement strategies that are tailored to the identified determinants and to guideline‐specific barriers should be developed. [ABSTRACT FROM AUTHOR]

Purpose: Infertility is a critical late toxicity that impacts adolescent and young adult (AYA, ages 15–39 years) cancer survivors. International oncology societies recommend discussing fertility preservation (FP) for all AYA patients, regardless of stage or prognosis. We aim to understand Canadian medical oncologists' perceptions, attitudes, and knowledge toward FP and pregnancy in patients with cancer, including advanced stages and high risk for recurrence. Methods: An anonymous electronic survey utilizing hypothetical scenarios was sent to medical oncologists in the province of Ontario, Canada. Descriptive statistics were used to summarize all data. Logistic regression models were constructed to identify factors that predicted FP discussions and referrals. Results: The survey was received by 91 medical oncologists, and the response rate was 44%. Fifty‐eight percent of respondents offer FP for all patients. Physicians are more likely to refer patients for FP before curative intent therapy than before palliative chemotherapy (95% vs. 39.5%, p < 0.001). Most respondents (86%) are comfortable discussing FP; however, only 31% self‐reported feeling up‐to‐date on knowledge of current FP methods. Female physicians were more likely to report up‐to‐date knowledge and confidence discussing FP with patients. Forty percent of respondents identified that concerns about the welfare of the resulting offspring should not be a cause for denying patients assistance in reproduction. Conclusion: There is a significant difference in physician attitude toward offering FP based on the cancer stage. Increased awareness of standard of care guidelines and resources for difficult situations may improve the frequency of discussions about FP in motivated cancer patients. [ABSTRACT FROM AUTHOR]

Purpose: To investigate whether progestin‐primed ovarian stimulation (PPOS) with chlormadinone acetate (CMA) adversely affects clinical results and neonatal outcomes, or causes congenital deformities. Methods: This retrospective study was conducted at private IVF clinic from November 2018 to November 2021. Women underwent oocyte retrieval using gonadotropin‐releasing hormone (GnRH) antagonist protocol (n = 835) or PPOS protocol (n = 57) were included. Eligible patients were normal ovarian responders (aged <40, AMH ≧1.0 ng/mL) with freeze‐all cycle. Embryo developments, clinical results, or neonatal outcomes of singletons derived from transfer of frozen single blastocysts were compared within each group. Results: Patient characteristics were similar in both groups. The median LH level (mIU/mL) at trigger in the GnRH antagonist group [2.0 (1.2–3.7)] was significantly higher than in the PPOS group [0.9 (0.3–1.7)]. There was no cycle with premature LH surge in the PPOS group. Fertilization and blastocyst formation rates did not differ significantly between groups. Furthermore, clinical outcomes were also similar in the two groups. Congenital abnormality rates did not differ significantly [0.9% (3/329), 0.0% (0/17)]. Conclusions: CMA using ovarian stimulation did not negatively affect clinical results. Our data suggest that PPOS with CMA is an appropriate ovarian stimulation method for normal ovarian responders. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate clinical outcomes after endometrial receptivity analysis (ERA). Methods: This was a multicenter, retrospective cohort study involving 861 women who underwent ERA testing at certified fertility clinics in Japan, and who received subsequent personalized blastocyst embryo transfers (ET) between 2018 and 2020. Clinical outcomes, including pregnancies, miscarriages, and live births, were evaluated according to receptivity status for ERA. Results: Mean patient age was 37.7 years (SD = 4.0), and the median number of previous ETs was 2 (interquartile range, 2–3). 41.0% (353/861) of patients were non‐receptive for ERA testing. Clinical pregnancy, miscarriage, and live birth rates for personalized blastocyst ET were 44.5% (226/508), 26.1% (59/226), and 26.8% (136/508) for receptive patients, and 43.1% (152/353), 28.3% (43/152), and 28.9% (102/353) for non‐receptive patients, all statistically nonsignificant. Multiple logistic regression demonstrated similar nonsignificant associations between receptivity and clinical outcomes. Greater patient age, smoking, and longer duration of infertility were significantly and negatively associated with receptivity, whereas a history of delivery was positively associated and statistically significant. Conclusions: Clinical outcomes after ERA testing were similar between receptive and non‐receptive patients. Further prospective study including an appropriate comparison group are warranted to evaluate the efficacy of ERA testing. [ABSTRACT FROM AUTHOR]

Objective: To determine the implications of an incidentally noted subchorionic hematoma on pregnancy outcomes in the infertile population. Methods: Retrospective cohort study at a tertiary care, university‐based facility. All patients with intrauterine pregnancy on initial obstetric ultrasound presenting to an infertility clinic between January 2015 and March 2018 (n = 1210), regardless of treatment cycle, were included. Nonviable pregnancies were excluded. The main outcome measured was association between subchorionic hematoma and first trimester miscarriage. Results: The prevalence of subchorionic hematoma was 12.5% (n = 151) and did not differ by type of fertility treatment. There was no association between subchorionic hematoma and first trimester miscarriage; however, among patients with subchorionic hematoma, those who reported both bleeding and cramping had an increased probability of miscarriage compared to those without symptoms (0.62 vs. 0.12, P <0.001). The live birth rate in this sample was 81.3% and there were no statistically significant differences in pregnancy outcomes between those with and without subchorionic hematoma. Conclusion: Among an infertile population, there was no increased risk of miscarriage when subchorionic hematoma was seen on early ultrasound; however, when patients noted both vaginal bleeding and cramping, their probability of miscarriage was significantly increased. Subchorionic hematomas noted incidentally are not associated with an increased miscarriage risk in the infertile population unless patients present with both bleeding and cramping. [ABSTRACT FROM AUTHOR]

The objective of this review study is to evaluate the therapeutic role of PDE5 inhibitors (PDE5is) in the amelioration of oligoasthenospermia in infertile males. PDE5is have a beneficial influence on the secretory function of the Leydig and Sertoli cells, the biochemical environment within the seminiferous tubule, the contractility of the testicular tunica albuginea, and the prostatic secretory function. In several studies, the overall effect of sildenafil and vardenafil increased quantitative and qualitative sperm motility. Furthermore, some studies indicate that PDE5is influence positively the sperm capacity to undergo capacitation under biochemical conditions that are known to induce the sperm capacitation process. Additional research efforts are necessary in order to recommend unequivocally the usage of sildenafil, vardenafil, or avanafil for the alleviation of male infertility. [ABSTRACT FROM AUTHOR]

Mature oocyte cryopreservation provides a realistic opportunity for future pregnancy for female patients with cancer.[18] The age of the patient and the number of oocytes retrieved will influence the number of opportunities for pregnancy. Fertility preservation treatment is often urgent to prevent a delay in commencing cancer treatments. It is advisable that patients with cancer be offered pre-pregnancy counsellingIII-2C ht Effective contraception is required during chemotherapy for women undergoing cancer treatment and immediately after treatment. Women who receive cancer treatment may be more likely to have reduced ovarian reserve than those who have not undergone cancer treatment.[8] Furthermore, sperm quality is reduced in men previously treated for cancer compared with the general population.[9] Azoospermia may occur after cancer treatment including chemotherapy and radiation. [Extracted from the article]

Obesity causes many health problems as well as has negative effects on fertility. However, little is known about the association between obesity‐related markers (hip circumference (HC), waist circumference (WC), waist to hip ratio (WHR), waist to height ratio (WHtR), body fat mass (BFM), skeletal muscle (SM), resting metabolism (RM), visceral fat (VF), and visceral adiposity index (VAI)) and sperm parameters. This cross‐sectional study was conducted on 98 men in three groups: normal‐weight (Nw; body mass index: BMI < 25 kg/m2), overweight (Ow; BMI: 25–29 kg/m2), and obese (Ob; BMI: 30–35 kg/m2) to investigate this issue. The mean WC, HC, WHtR, BFM, SM, RM, and VF were remarkably higher (p < 0.001) for subjects in the Ob group than in Ow and Nw. In Nw, positive correlations were observed between BFM (r = 0.402) and VAI (r = 0.353) and sperm progressive motility (p < 0.05). In Ob males, there was a positive correlation (r = 0.430) between sperm progressive motility and height and a negative relation (r = −0.447) between sperm progressive motility and WHtR. We found the association between serum testosterone (T) levels, T/estradiol ratios, and semen parameters being dependent on obesity‐related markers which confirms the negative effects of obesity on male hormones. In conclusion, WHtR is a valuable parameter in infertility clinics that warrants further studies. [ABSTRACT FROM AUTHOR]

Background: : Postpartum endometritis can cause subfertility in cows and reduce the reproductive performance of dairy herds. Thus, there is a critical need to improve the accuracy of the diagnosis of this disease, particularly in dairy cows. Objectives: : This study confirmed the effects of the combined use of two non‐laboratory methods: Metricheck device (MT) and ultrasonography (UT) to detect signs of endometritis and therefore predict the likelihood of pregnancy. Methods: : The reproductive tract of 67 lactating Holstein cows (25 primiparous and 42 multiparous) was observed at 4 and 6 weeks postpartum using the MT and UT. The cows with flecks and more purulent material in the vaginal discharge were defined as MT‐positive, and the cows with uterine echogenic contents were defined as UT‐positive. The combined definition was also used; both the UT and MT results or either the UT or MT result had to be positive for the final decision to be positive. The true‐negative cows were determined as both MT‐UT‐negative. Results and discussion: When comparing the diagnostic results obtained by MT and UT, 37.3% and 32.8% of the total cows showed conflicting results at 4 and 6 weeks postpartum. The proportion of non‐pregnant cows until 200 days postpartum was significantly greater in both MT‐UT‐positive cows than in the true negative cows. The hazard ratios of pregnancy rate were 0.37 for both MT‐UT‐positives relative to the true negatives at 4 weeks postpartum. Similar significant differences were not detected using the MT or UT alone. These results indicate that a more severe effect on the chance of pregnancy could be detected in cows that are both MT‐UT‐positive compared with those positive for MT or UT alone. Conclusions: : The combined use of MT and UT could support veterinary practitioners in diagnosing endometritis, potentially improving the accuracy of predicting subsequent reproductive performance. [ABSTRACT FROM AUTHOR]

Background: Infertility affects 15% of couples in Italy and approximately 10%–12% of couples worldwide. Focusing on female fertility, there are multiple causes, among which diet has a great influence. Methods: We investigated whether the consumption of certain fatty acids affects four outcomes of the assisted reproduction techniques. From September 2014 to December 2016, women referring to our Italian fertility unit, eligible for assisted reproduction techniques, were invited to participate. Information on diet was recorded through a validated food frequency questionnaire. Results: Four hundred and ninety‐four women were included, of whom 95% achieved good quality oocytes, 87% achieved embryo transfer, 32.0% achieved clinical pregnancies and 24.5% achieved pregnancy at term. The fourth quartile of saturated fatty acids consumption, compared to the first one, showed an association with clinical pregnancy (adjusted relative risk 0.67, 95% confidence interval 0.45–1.00, p = 0.0491). Some associations emerge accounting for confounders. Age was associated with clinical pregnancy and pregnancy at term in the models considering all fatty intakes and food groups variables but was not associated with oocytes quality and embryo transfer. Physical activity was associated with clinical pregnancy. Conclusions: There is biological plausibility for the effect of omega‐3 and omega‐6 polyunsaturated fatty acids on oocyte development via synthesis of eicosanoids, even if only limited associations are shown in the present study. Future research should aim to measure the serum levels of fatty acids and investigate the outcomes of assisted reproduction techniques. Research highlights: There is biological plausibility for the effect of omega‐3 and omega‐6 polyunsaturated fatty acids on oocyte development via synthesis of eicosanoids.We investigated the relationship between fatty acids intake in a population of women undergoing assisted reproduction techniques (ART) and four outcomes: good quality oocytes, embryo transfer, clinical pregnancy and pregnancy at term.No associations emerged between fatty acids intake and ART outcomes, except for the fourth quartile of saturated fatty acids consumption. [ABSTRACT FROM AUTHOR]

Key content: Fertility treatment using donated gametes and embryos is increasingly common. Indications for the use of donated sperm and oocytes include azoospermia, single women and women in same‐sex relationships, inherited conditions, poor quality embryos or failed fertilisation in previous cycles of assisted reproductive technology, and ovarian insufficiency.Causes of azoospermia and ovarian insufficiency include congenital and genetic disorders, infectious and traumatic conditions, iatrogenic causes and age‐related decline.These treatment cycles have ethical and legal implications and require appropriate pre‐conception counselling and completion of Human Fertilisation and Embryology Authority (HFEA)‐mandated forms to ensure the safety of donors, recipients and any children born as a result of treatment.All donors are screened for infectious diseases and can also be screened for genetic conditions. Sperm donation can be organised outside of recognised fertility clinic settings, which increases the possibility of infection transmission.Compared with cycles using autologous gametes and embryos, treatment outcomes can increase live birth rates and reduce incidence of low birthweight, but may increase hypertensive disorders of pregnancy. Learning objectives: To understand the clinical indications for the use of gamete and embryo donation, including potential risks to donors and recipients, and success rates.To learn the practical considerations of donation and procurement processes, screening, quarantine, legal and regulatory aspects in the UK and international comparison.To appreciate special issues, including psychological assessment and support requirements, ethical considerations, intrafamilial donation, commercial DNA testing and family tracing implications. Ethical issues: Donors must be made fully aware of the implications of donation and the lack of anonymity once resulting children reach the age of 18, according to UK law.Recipients must be thoroughly counselled regarding the implications and psychological impact of treatment. The HFEA obliges all clinics to offer implications counselling to those undergoing treatment in terms of the impact of treatment on them and how to broach the subject with future children. [ABSTRACT FROM AUTHOR]

Introduction: Although a trustworthy connection between doctor and patient is crucial in clinical practice, it could be hindered by different cultural and linguistic backgrounds. Moreover, an effective doctor–patient interaction could be even more challenging in andrological fields, in which psychological and social components are predominant. Aim: To analyse the doctor–patient relationship in the andrological field, applying both qualitative and quantitative analyses. Methods: monocentric, cross‐sectional, observational study was performed between May and December 2018. During the study, all patients aged >18 years attending the Modena Andrology Unit for couple infertility or erectile dysfunction were enrolled and the doctor–patients interaction recorded. Patients were divided into two groups depending on their medical seeking and were further divided between native and non‐native speakers of Italian. All patients underwent a routine andrological examination. Every first medical consultation was audio‐recorded and transcribed using "ELAN" software for socio‐linguistic analysis. Transcriptions underwent qualitative analysis through conversation analysis. Then, quantitative analyses were performed, and interaction parameters underwent correlation analyses. Results: Twenty‐five patients were enrolled. The analysis of the andrological interview allowed to recognise five consecutive phases, following a semi‐standardized pattern. Patients without linguistic barriers and with infertility problems showed more autonomous contribution during the consultation. No difference arose in the sexual dysfunctions group. Doctor's explanations were frequent, but when linguistic barrier was present or Italian patients seemed less talkative, explanations were shorter, and doctors tried to use other conversational mechanisms to promote understanding. Patient's variables were significantly lower compared to the doctor, considering the number of turns (p = 0.025) and their minimum (p = 0.032), maximum (p < 0.001), and average durations (p < 0.001). Only patient's latency was significantly higher than the doctor's (p = 0.001). Conclusion: This is the first attempt to analyse the doctor–patient relationship in andrology using authentic audio‐recorded consultations. The results confirmed that a patient‐centred communication must be applied also in andrological consultations. However, the topics discussed may require more "medical formulation" to be acceptable to the participants in this context. [ABSTRACT FROM AUTHOR]

Globozoospermia (GZ) is a rare disorder found in less than 0.1% of infertile men in which spermatozoa lack acrosomes necessary for penetration of an oocyte. While methods have been demonstrated to allow globozoospermic men to achieve a viable pregnancy with their partner, the Wold Health Organization considers identifying and reporting GZ on semen analysis to be 'important'. Our study aims to determine if and to what extent in vitro fertilization (IVF) laboratories nationwide recognize and report GZ on semen analysis reports. We constructed an IRB‐approved survey sent nationwide to IVF and andrology clinic laboratory directors listed by the Society for Assisted Reproductive Technology and/or the American Society for Reproductive Medicine. Results from the survey were de‐identified for analysis. A total of 490 surveys were sent with a response rate of 10% (n = 51). Most respondents (66%) practiced in a private, rather than academic, setting. A majority of respondents were confident in their technicians' knowledge of GZ (86%) and ability to identify it on a sample (94%). However, only half of respondents noted a space to report the concern for GZ to the ordering physician, and 25% of respondents did not feel their clinic was able to identify patients where there is a concern for GZ. Similarly, 84% of respondents did not report a percent of acrosome‐deficient sperm. Less than half of respondents reported that their clinic has previously diagnosed GZ. Though the majority of respondents felt that their laboratory technicians would be able to identify GZ, a significant minority felt that their clinic did not have means to be able to report concern for GZ. This may be due to the absence of a proper channel to report a concern for GZ, a lack of knowledge about the condition, or failure to distinguish GZ from a broader reported percentage of morphologically abnormal sperm. Given evidence that the diagnosis of GZ may be under‐reported in the United States, there should be a national standard for laboratory technicians to be trained to recognize GZ and be able to report their suspicion to the ordering clinician. [ABSTRACT FROM AUTHOR]

Introduction: This study addressed deficient information on the provision of infertility care in obstetrics and gynecology clinics. We additionally evaluated the availability of these services based on clinic affiliations or stated sexual orientation. Methodology: We performed a national cross‐sectional "mystery caller" survey of 293 general obstetrics and gynecology clinics in 2017–2018. We matched clinics identified by web‐based search engine in a 1:1 ratio by Catholic hospital affiliation, after determining number of clinics based on state‐population densities. A standard call script included questions regarding provision of infertility services, ovulation induction methods, and information about the caller's sexual orientation. We performed descriptive frequencies and compared responses based on hospital affiliations. Results: Of the 293 clinics included, 49% were affiliated with Catholic and 17% with academic hospitals. The majority offered infertility care (85%, 248/293), and of these 97% (240/248) offered ovulation induction. Only 3% (6/240) reported they would not provide to women in same‐sex relationships. Most clinics not offering infertility evaluations (43/45, 96%) cited it was outside of their scope of care and of these 33% (15/45) did not provide information for self‐referral. Clinics affiliated with academic (aOR 0.23) or Catholic (aOR 0.34) hospitals were less likely to provide evaluations. Those with academic affiliation were more likely to provide information for self‐referral (aOR 19.2). Discussion: Most general obstetrics and gynecology practices offered appointments for infertility evaluation and ovulation induction. Clinics rarely denied services to women reporting a same‐sex partnership, regardless of hospital affiliation. These findings provide reassurance to same‐sex couples seeking fertility care. [ABSTRACT FROM AUTHOR]

Background: Cancer patients face multiple challenges, such as infertility caused by exposure to gonadotoxic agents and gonadal irradiation during cancer treatment. Little is known about the health practitioners' knowledge and practice regarding fertility preservation and its available options in Saudi Arabia. Thus, this study is designed to evaluate the level of knowledge, attitude, and practice (KAP) towards fertility preservation in cancer patients among health practitioners in an environmental region in Saudi Arabia.Methods: The cross-sectional study was carried out between September 2020 and January 2021. A self-administered questionnaire was distributed among health practitioners from a variety of specialties who work closely with cancer patients.Results: Out of 100 participants, 90% need more knowledge about fertility preservation. The lack of fertility preservation clinics in the patient's area and its unaffordable expenses significantly influenced the health practitioners' attitude towards fertility preservation discussion with cancer patients. The results revealed that 92% of the participants agreed that the Saudi Ministry of Health should establish practice guidelines and provide fertility preservation services for cancer patients.Conclusions: The present study showed that clinical practitioners' knowledge remains insufficient. Education of health practitioners and the establishment of practice guidelines and fertility preservation clinics for cancer patients are required. [ABSTRACT FROM AUTHOR]