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Prevalence of testosterone deficiency is increasing in the adolescent and young adult male population. As the average paternal age rises, there is a significant population of men with hypogonadism seeking testosterone therapy wishing to achieve or maintain fertility potential. Identification of potential lifestyle modifications that may improve the testosterone deficiency is one of the initial interventions of the holistic strategy in treatment. This is followed by drug therapy; however, traditional testosterone therapy acts as a contraceptive by suppressing the hypothalamus-pituitary-gonadal (HPG) axis and therefore cannot be used as a treatment strategy. A solution has been the off-label use of selective estrogen receptor modulators, human chorionic gonadotropin (hCG), and anastrozole inhibitors to treat hypogonadal symptoms while increasing intratesticular testosterone, a necessity for spermatogenesis. Recently, a novel therapy, Natesto intranasal testosterone gel, has been shown to increase serum testosterone levels while maintaining semen parameters. This is hypothesized to be because of its short-acting properties having lesser effect on the HPG axis, in contrast to the long-acting properties of traditional testosterone therapy. It is important to differentiate hypogonadal men between those seeking to achieve or maintain fertility status because the drug therapy of choice differs. This can be accomplished by determining the levels of 17-hydroxyprogesterone (17-OHP), because it is a biomarker for intratesticular testosterone. Those with low 17-OHP may wish to initiate treatment with alternative therapies, whereas those with high 17-OHP may trial short-acting testosterone therapies. As the urologist's armamentarium continues to increase, better strategies to increase testosterone levels in men seeking fertility can be achieved.

As an ethnic religion, the Amish are of interest to population health researchers due to a distinctive health profile arising from ethnic attributes, including a closed genetic pool and shared culture that shapes lifestyle practices. Amish-focused health research both furthers our knowledge of health conditions by comparing Amish with non-Amish and assists health practitioners in serving this rapidly growing population. Amish health research, now representing approximately a quarter of all Amish-focused publications, is in need of review, to the end of strengthening this knowledge body's coherence, clarifying research directions, and identifying knowledge gaps, lapses, and stagnations. Herein, we synthesize and discuss Amish physical health conditions research, both the population's distinctive health profile and mechanisms shaping this profile. Specifically, we summarize research addressing BMI, physical activity, and body image; diet and supplements; cancer; cardiovascular conditions; communicable diseases; immunity; sleep; genetic disorders; tobacco and alcohol use; periodontal conditions; traumatic injuries; natural treatments for burns; fertility; and sexually transmitted diseases. In reflection, we raise questions about the nature of intervening mechanisms shaping the Amish health profile, the strange omission of several common independent variables commonly used when studying other ethnic groups' health, several recurring methodological complications, and public health policy considerations.

One of the key life history assumptions is that mortality rates are positively associated with fast life history dynamics. Since the COVID-19 pandemic has elevated mortality rates throughout the world, we tested this assumption using reproductive motivation (desired number of children and desired age of first reproduction) as a key output measure using a repeated cross-sectional design. We assessed reproductive motivation in Serbian young adults before the pandemic started (N = 362), during the pandemic-caused state of emergency (the peak of the epidemic's first wave: N = 389) and after the state of emergency (i.e., after the first wave: N = 430). Furthermore, in the third time-point we measured experiences during the state of emergency and additional measures of reproductive motivation (reasons for and against parenthood). Subsamples were matched by sex, education, and the sampling procedure. We found the between-group differences which are congruent with life history theory: the desired age of first reproduction was lowest after the state of emergency compared to the 2 previous time-points. However, there were no differences in the desired number of children. Furthermore, the analysis of the links between experiences during the epidemic and reproductive motivation yielded the results which are incongruent with life history theory-adverse experiences during the state of emergency were negatively related to the reproductive motivation. Since the findings were only partially in accordance with life history theory, we discuss possible reasons which may explain the heterogeneity of results. (PsycInfo Database Record (c) 2021 APA, all rights reserved) Impact Statement One of the key assumptions of life history theory is that elevated mortality rates should produce faster life history dynamics which should reflect in higher fertility. This hypothesis is important not only for understanding evolutionary processes in an ecological context but also for predicting demographic trends as well. This assumption was tested by examining the links between COVID-19 epidemic and reproductive motivation (desired number of children and desired age of first reproduction) in young adults. The results showed mixed support for the life history predictions and provide useful guidelines for future studies in this topic. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

The increased survival achieved with surgery and cancer treatments for breast cancer has led to a growing concern about fertility in young women, adversely affecting quality of life outcomes. Th e potential loss of fertility not only has a psychological but can also affect patients' treatment adherence or decisions, such as selection of treatments associated with a lower risk of infertility despite inferior outcomes. Our objective is to provide an overview of current knowledge about how systemic cancer treatments could impact the future fertility of breast cancer survivors The main hypothesis of how chemotherapy produce damage to the ovaries is a direct damage to the DNA of the oocytes, resulting in the activation of apoptosis and / or autophagy-related pathways. Alkylating agents as cyclophosphamide are the chemotherapeutic agents that are associated with the highest risk of gonadotoxicity; however, breast cancer patients are usually given combinations of chemotherapy drugs. Conversely, endocrine therapy, such as tamoxifen, does not appear to have a permanent effect on fertility but long-term use could lower oocyte quality due to patient aging. There is still not enough evidence about the effect on ovarian reserve for many biological therapies and for new drugs being used in the non-metastatic setting, and further research in this area is needed. Members of multidisciplinary teams in breast cancer should understand the impact on fertility of cancer treatments and the importance of an early referral of premenopausal patients to specialists in reproductive medicine to discuss all possible fertility preservation strategies.

The combined effects of declining fertility and increased longevity have accelerated population aging in different parts of the world. Unlike other countries, Puerto Rico is also experiencing unprecedented levels of working-age out-migration. The full impact of high out-migration on Puerto Rican demography is not fully understood. Placing Puerto Rico’s aging process in an international context is useful in identifying the role out-migration is having on the accelerated aging of the Puerto Rican society. Using the World Population Prospects 2019 estimates, we compared the pattern of rapid aging found for Puerto Rico with the trajectories of six other countries with the highest population of 65+ in the World, Europe, and the Caribbean from 1960 to 2020. Prior to 2010, the aging process in Puerto Rico was comparable to the other countries. After 2010, the percent of the population over 65 years in Puerto Rico nearly doubled from 13.1% to 21%. The nearly doubling of the percent of older adults is not observed in any of the comparison countries. We find that the rapid aging of Puerto Rico, changing from a linear trend to an exponential one, is a result of accelerating levels of out-migration, which is concentrated in the working-age population.

Background: Female fertility refers to the capacity to produce oocytes and achieve fertilization and pregnancy, and it is impaired by age, disease, environment and social pressure. However, no effective therapy that restores female reproductive ability has been established. Mesenchymal Stromal Cells (MSCs) exhibit multilineage differentiation potential and have attracted considerable attention as a tool for restoring female fertility. Methods: This study used human umbilical cord-MSCs (Huc-MSCs) to restore fertility in aging female mice and mice with chemotherapy-induced damage through the rescue of ovarian function and reconstruction of the fallopian tubes and uterus. In our study, two mouse models were generated: aging mice (35 weeks of age) and mice with chemotherapy-induced damage. Results: The effect of MSCs on the ovaries, fallopian tubes and uterus was evaluated by analyzing gonadal hormone levels and by performing morphological and statistical analyses. The levels of estradiol (E2) and follicle-stimulating hormone (FSH) exhibited significant recovery after Huc-MSC transplantation in both aging mice and chemotherapy-treated mice. Huc-MSC treatment also increased the number of primordial, developing and preovulatory follicles in the ovaries of mice. Moreover, MSCs were shown to rescue the morphology of the fallopian tubes and uterus through mechanisms such as cilia regeneration in the fallopian tubes and reformation of glands and endometrial tissue in the uterus. Conclusion: Huc-MSCs may represent an effective treatment for restoring female fertility through recovery from chemotherapy-induced damage and rescue of female reproductive organs from the effects of aging.

Objective: Anticancer treatment may be associated with damage to the reproductive organs and risk of infertility in children with cancer. The collectivist cultural norms of Asian societies may lead...

International audience; Purpose: Infertility in adolescents and young adult (AYA) survivors of malignant disease remains a major long-term adverse effect, but semen collection for fertility preservation in fertility centers is not always feasible and makes AYAs uncomfortable. We evaluated the feasibility of collecting sperm samples on the ward versus in fertility centers. Methods: Consecutive hospitalized AYA-aged male patients in the Hematology AYA unit (Saint-Louis Hospital, France) between August 2010 and June 2016 with hematological disease and indication of semen collection (n = 95) were included in this retrospective study. Semen quality was analyzed according to World Health Organization guidelines and was compared according to semen collection place: on the ward (n = 46) or in fertility center (n = 49). Results: The median age was median age 19.1 years (range: 13.7-33.3; interquartile range: 17.1-22.8) and 85 patients successfully collected semen. Sperm collection failure was ∼11% and was comparable between the two modalities as were main sperm quality characteristics (semen volume, sperm concentration, total sperm count, progressive motility and vitality, sperm morphology, and multiple anomalies index). Oligospermia was significantly higher in the samples obtained in fertility center (47.7%) than on the ward (26.8%), p = 0.047. Average frozen straws were comparable, 12.2 ± 6.4 on the ward versus 11.9 ± 6.3 in fertility center. Conclusion: Semen collection on the ward is feasible and would be particularly interesting for AYA male patients without altering semen quality characteristics.

Do the long work hours required by many high-paying professions inhibit the entry of women? I investigate this question by studying a 2003 policy that capped the average workweek for medical residents at 80 hours. Using data on the universe of US medical school graduates, I find that when a specialty reduces its weekly hours, more women enter the specialty, whereas there is little change in men’s entry. I provide evidence that the increase in women is due to changes in labour supply, rather than labour demand. At the residency program level, I document that baseline female representation predicts female entry after the reform. A back-of-the-envelope calculation suggests that the reallocation of women among medical specialties due to the hours reduction can close the physician gender wage gap by 11$\%$.

This paper examines the role of social and cultural norms regarding fertility in women's HIV risk in Sub-Saharan Africa. Fertility is highly valued in most African societies, and premarital fertility is often encouraged to facilitate marriage. This incentivizes unprotected premarital sex and escalates HIV risk. I build a rich lifecycle model linking women's decisions concerning sex, fertility and education to HIV infection and calibrate it to match Kenyan data. Quantitative results show that premarital fertility motives account for 13 percent of HIV prevalence among young Kenyan women and that a combination of fertility motives and contraception cost accounts for nearly one-third of this prevalence. Various policies are evaluated. While an HIV treatment subsidy would reduce HIV prevalence to the greatest extent, its effectiveness would be severely mitigated by increased risky sex.

Cryptorchism is a congenital anomaly of male genitalia, and is defined as a disorder of lowering testicles into the scrotum. In our study, the quality of sperm and fertility of men who were operated from unilateral or bilateral cryptorchism in childhood were analyzed. According to the age in which they were operated, patients were classified into different time groups, subjected to clinical examination and sperm analysis. A normal sperm count was found: 36.9% of the total number of patients operated from unilateral to bilateral cryptorchism. The highest percentage of normal sperm counts was 73.97%: the data which was found in the group that was operated from one-sided cryptorchism to the end of the second year of life. Regardless of the age of the cryptorchism operation, it is possible to expect a disorder of spermatogenesis.

Objective: Telehealth is used in various healthcare settings with patient satisfaction and reduced patient cost. [1, 2] However, fertility care is a uniquely personal journey and patient attitudes towards telehealth are relatively unknown. We evaluated attitudes of fertility patients across the United States towards telehealth using a validated telehealth satisfaction and usefulness questionnaire. Materials and Methods: We conducted a cross-sectional survey study. An anonymous, web-based survey was distributed to national infertility groups between Feb-April 2021.The survey gathered demographic information and included the Telehealth Usability Questionnaire (TUQ), which assesses aspects of telehealth usability with a 7-point Likert scale (strongly disagree to strongly agree). We solicited general comments regarding telehealth for fertility care. The primary outcome was overall satisfaction using telehealth. We computed descriptive statistics to compare satisfied vs unsatisfied participants. Results: 104 respondents initiated and 74 completed the survey. Participants represented 24 different states and all regions of the United States. Most respondents were white (81.1%) with a median age of 35 years old. Most participants (80%) were satisfied using telehealth. Given low frequency of patient dissatisfaction, we were unable to perform statistical tests to compare demographic differences between satisfied and unsatisfied participants. Most (86.5%) respondents would use telehealth again. When given an option, 63.5% prefer in person for new patient visits. For follow up visits, 47.3% prefer telehealth and 27% had no preference. Only 25.7% preferred a follow up visit in person. Conclusions: Telehealth can improve access to care with high rates of patient satisfaction. Most fertility patients still prefer new visits be conducted in person. Impact Statement: Our findings suggest fertility clinics should continue to offer telehealth visits even after the end of the COVID-19 pandemic. References: 1. Alex Zhu, D., et al., TELEHEALTH FOR MALE-INFERTILITY IS FEASIBLE AND SAVES PATIENTS’ TIME AND MONEY. ASRM 2020 2. Tenforde, A.S., et al., Outpatient Physical, Occupational, and Speech Therapy Synchronous Telemedicine: A Survey Study of Patient Satisfaction with Virtual Visits During the COVID-19 Pandemic. Am J Phys Med Rehabil, 2020.

Despite the sizeable impact of migration on childbearing, less is known about how it shapes contraceptive use undergirding fertility. We utilize binational survey data collected in 2006/7 by the Migration, Gender, and Health among Immigrant Latinos in Durham, NC study to assess how selection, disruption, and adaptation shape contraceptive use among Mexican migrant women. We address selectivity with respect to both socio-demographic and formative sexual initiation characteristics, comparing migrants to non-migrants in Mexico. We examine the disruptive effect of migration on contraception among migrant women sexually initiated in Mexico. Finally, we compare current methods between Mexican migrants and non-migrants to assess adaptation to U.S. contraceptive practices. We find migrant selectivity is less important than context in shaping immigrant women’s contraceptive practices, though migrant women sexually initiated in the United States exhibit earlier and higher levels of contraceptive use than their migrant peers initiated in Mexico. Migration also disrupts contraceptive trajectories. Many migrants discontinue contraceptive use pre-migration in response to their husbands’ solo migration. Partner separation also reduces contraceptive use immediately after migration. Finally, migrants show numerous signs of adaptation to the U.S. context, mainly via the adoption of oral contraception. The main obstacle for contraceptive use in Durham is lack of information about where to obtain it. Efforts to improve immigrants’ reproductive health should recognize the deleterious effect of policies encouraging family separation. Health care must reach immigrant women soon after arrival, be attuned to pre-migration contraceptive practices, and recognize the unique vulnerabilities of women migrating at older ages.

Objective To assess the priorities and decisions of gay and bisexual men (GBM) pursuing fatherhood. Design Cross-sectional study. Setting Internet-based survey. Patients GBM who were interested in pursuing or had previously pursued family building options. Interventions None. Main Outcome Measures This study aimed to assess the attitudes of respondents regarding: 1) mode of achieving parenthood and the relative importance of a genetic link to offspring; 2) the relative importance of factors considered when selecting an oocyte donor (OD); and 3) the relative importance of factors associated with selecting a gestational carrier (GC). Access to care and financial considerations were also analyzed. Results The majority (68.2%) of the 110 respondents desired parenthood via OD and GC. This was consistent with 53.2% of respondents reporting that a genetic link to a child was ‘extremely important’ or ‘important.’ Most couples (86.6%) desired to use sperm from both partners. 40.5% of respondents reported that a twin gestation would be the most ideal pregnancy outcome. Medical history was considered the most important factor when selecting an OD (83.5%) while pregnancy history was considered the most important selection criterion for a GC (86.2%). 89.1% of respondents reported the fertility services they desired were available to them, although 33.0% reported they would have to travel to another state for care. Conclusion Understanding the circumstances of GBM pursuing fatherhood allows for individualized care. Since many respondents desired twin pregnancies, it is important to counsel patients regarding risks of multiple gestation and to determine the motivations for this preference.

The natural lifespan of the ovary is occasionally interrupted by pathological processes; some are known, but many are unknown. Premature ovarian insufficiency (POI) can be a devastating diagnosis for an adolescent or for someone who has yet to start a family. Common causes of POI include genetic and chromosomal defects, autoimmune damage, and cancer treatments. Knowledge of the pathogenesis of this condition and an awareness of contemporary hormone replacement and fertility options are required to design a multidisciplinary therapeutic approach comprising reproductive medicine, endocrinology, clinical psychology, and assisted fertility expertise.

Introduction Vaccination is a key global strategy to mitigate the clinical impact of the COVID-19 virus. As part of local efforts to manage the outbreak, the government of Ghana announced its intention to vaccinate its population starting with essential and high-risk workers including radiographers. However, there were reports of hesitance to receiving the vaccine among the radiography workforce. This study was undertaken prior to the intended vaccination exercise to assess the willingness and concerns of radiographers to undergo the COVID-19 vaccination and to suggest recommendations to improve the vaccine uptake. Methods An ethically-approved online survey strategy was employed for this cross-sectional study conducted between 24th-28th February 2021. The survey employed quantitative questions and open text response options. Quantitative and open text responses were analysed using statistical and thematic analyses, respectively. Results There were 108 responses (response rate of 46.3%). The majority (n = 64, 59.3%) were willing to have the vaccine, however, some (n = 44, 40.7%) were not. The main reason behind their willingness to have the vaccine was its ability to reduce the spread of infections and lower mortality (n = 35, 54.7%). However, doubts about the vaccine's efficacy and side effects (n = 26, 56.8%), conspiracy theory concerns about its effects on the Ghanaian race (n = 4, 9.1%), and fertility concerns (n = 2, 4.5%) were some reasons for their hesitance to receive the vaccine. The open text commentary further revealed that the vaccine was thought of as a lifesaving medication, however, clinical safety concerns, lack of education/information and religious beliefs were affecting peoples' willingness to be vaccinated. Conclusion Our findings demonstrate the need for an urgent public health educational intervention to address the COVID-19 vaccine hesitancy concerns raised by radiographers to help increase the vaccine uptake. Implication for practice The study provides pertinent information to improve COVID-19 vaccine uptake among radiographers to limit the spread of infections.

BACKGROUND: Approximately half of all pregnancies in the United States are unintended. However, women who are diagnosed with cancer in their reproductive years may be a unique population. This study examines the prevalence of and identifies factors associated with unplanned pregnancy among cancer survivors. MATERIALS AND METHODS: Female cancer survivors aged 22–45 years, diagnosed between ages 20–35 years and at least 2 years postdiagnosis, and women with no history of cancer were interviewed about their reproductive histories, including pregnancy intention. Using a random matching process, comparison women were assigned an artificial age at cancer diagnosis equal to that of her cancer survivor match. An adjusted Cox model was fit examining time to unintended pregnancy after cancer for each of 1,000 matches. Cox proportional hazards models were also fit to assess associations between participant characteristics and unplanned pregnancy after cancer among survivors. RESULTS: Cancer survivors (n = 1,282) and comparison women (n = 1,073) reported a similar likelihood of having an unplanned pregnancy in models adjusted for race, income, history of sexually-transmitted infection, and history of unplanned pregnancy before diagnosis (adjusted hazard ratio [aHR] 1.06, 95% simulation interval 0.85–1.36). After adjusting for confounders, unplanned pregnancy among survivors was associated with age

Background: No dairy breed or crossbreed has superior overall performance in all environments; therefore, it is necessary to determine which crossbreed is the most suitable for the Mexican tropic and what proportion of European breed is optimum for reproduction. Objective: To assess the effect of the proportion of Bos taurus (Bt) genes on reproductive performance of Holstein×Zebu (HZ) and Brown Swiss×Zebu (BZ) cows, and compare reproductive performance of these genotypes in a dual-purpose production system. Methods: Cows were maintained in a rotational grazing system on African star grass (Cynodon plectostachyus) in Veracruz, Mexico. Cows were milked twice daily. Calves were kept tied to the side of their dams while the cows were milked. Results: The percentage of Bt genes did not affect (p>0.05) fertility traits (age at first calving, days to first service after calving, services per conception, conception rate at first service, days open until conception, gestation length, and calving interval) of BZ cows. In contrast, HZ cows with less than 75% Holstein (H) genes were 0.3 years younger (p

A set of 45 diverse Asian and African origin/bred populations of pearl millet were investigated multi-locationally for morphological traits including grain yield and assessed for their fertility restoration ability on three cytoplasmic male sterility (CMS) systems in two contrasting seasons. Significant genetic variation was found for all the yield linked traits. Multivariate analysis for grain yield and its component traits grouped these populations into five clusters. Most of the Asian origin populations grouped into single cluster (Cluster III) and separated from the rest of the African origin populations indicating the presence of correspondence between clustering pattern and geographical origin of the populations. Clusters dominated with Asian populations (As-As) had linkages with early flowering, short plant height, more number of tillers, small and thin panicles, small seeded and low grain yield compared to the clusters dominated by African populations (Af-Af) or African origin and Asian bred (Af-As) populations. Genetically related populations having common parentage were found grouped in same clusters. Fertility restoration/maintainer frequency of 45 populations on three diverse CMS systems revealed that overall fertility restoration frequency was highest for A1 (86%) followed by A4 (37%) and for A5 (7%) CMS system. Five populations were identified as potential sources for developing maintainer lines for all three CMS systems and eight populations were identified specifically for A4 and A5 CMS systems. A set of 11 and four populations were identified for restorer line development exclusively for A1 and A5 CMS system, respectively. Six populations were identified for the development of dual restorers for both A1 and A4 CMS system.

Objective: To elucidate the impact of the COVID-19 pandemic on access to fertility services. Methods: A retrospective quality improvement study was conducted at a university-affiliated fertility practice in southwestern Ontario. Annual procedural volumes for intrauterine and donor inseminations (IUI/DI), in vitro fertilization and intracytoplasmic sperm injections (IVF/ICSI), and frozen embryo transfers (FET) during the COVID-19–affected year were compared with mean annual volumes from the 2 preceding years. In addition, volumes for the same procedures were compared between the first quarter of 2021 and mean first quarter volumes from 2018 to 2019. Piecewise linear regressions were conducted to evaluate whether any changes in monthly procedural volume were attributable to the COVID-19 pandemic. Results: In 2020, our fertility practice attained the mean annual volumes of 89.7% for IUI/DI, 69.0% for IVF/ICSI, and 60.6% for FET. In contrast, in 2021, we performed mean first quarter volumes of 130.1% for IUI/DI, 164.3% for IVF/ICSI, and 126.8% for FET. The slopes of the pre- and post–COVID-19 segments of the piecewise linear regressions were significantly different for IUI/DI (P < 0.001) and IVF/ICSI (P = 0.001), but not for FET (P = 0.133). Conclusion: The COVID-19 pandemic resulted in decreased annual volumes of medically assisted reproductive procedures at a university-affiliated fertility practice in southwestern Ontario. Impact on monthly procedural volume was confirmed for IUI/DI and IVF/ICSI by linear regression. Local adaptations helped compensate and exceed expected volumes in 2021. As a result, the COVID-19 pandemic resulted in a short-lived limitation in access to fertility care.

This paper examines the impact of male casualties due to World War II on fertility and female employment in the United States. We rely on the number of casualties at the county-level and use a difference-in-differences strategy. While most counties in the U.S. experienced a Baby Boom following the war, we find that the in- crease in fertility was lower in high-casualty rate counties than in low-casualty rate counties. Analyzing the channels through which male casualties could have decreased fertility, we provide evidence that county male casualties are positively related to 1950s female employment and household income.

The 2021 Women's Preventive Services Initiative Well-Woman Chart outlines a framework for incorporating preventive health services recommended by the Women's Preventive Services Initiative, the US Preventive Services Task Force, and Bright Futures based on age, health status, and risk factors. Following the previous guidelines for preventive care, this document failed to offer recommendations or guidelines for infertility screening and fertility counseling in the course of well-woman care. Healthcare providers may be less likely to address fertility with their patients in the absence of clear, evidence-based recommendations, potentially resulting in underinformed reproductive choices and compromised reproductive potential. Given the devastating consequences of infertility and unintended childlessness, we, herein, propose that infertility screening and fertility counseling should become an integral part of well-woman care and that organizations, such as the Women's Preventive Services Initiative, put forth guidelines to assist providers in addressing fertility throughout a woman's reproductive lifespan.

There is some evidence that access to schooling reduces fertility along the intensive margin in developing countries, but the transmission channels are not well understood; most education interventions impact financial costs, access, and school quality. We isolate the specific effect of child school fees on maternal fertility by studying a 1997 schooling reform in Uganda, in which the government abolished elementary school fees for up to four children per household. Families with more school-aged children were required to pay fees for the additional ones. We demonstrate that eligibility limits reduced births: women with more than four children in 1997 were 4.2 percentage points less likely to give birth to an additional child in the subsequent two years. We provide evidence that this result is driven by UPE eligibility limits, not by other factors associated with the policy or other secular changes. Fertility effects are persistent over time and survive the lifting of the eligibility limit in 2003. The policy is also associated with a temporary reduction in the desired fertility, with mothers preferring having four children or fewer during the policy period than before.

Introduction Increased fiber intake has been associated with decreased breast cancer risk, while increased animal protein intake with increased risk. The objective of this study is to examine the relationship of dietary fiber and protein intake to estrogen and sex hormone–binding globulin (SHBG) concentrations at puberty onset. Methods These analyses were conducted using the Cincinnati puberty cohort of the Breast Cancer and the Environment Research Program, with girls followed every 6 months from ages 6 and 7. The analyses included serum measurements at 6-month intervals for estrogen and SHBG concentrations, from 18 months prior to breast stage 2 (onset of puberty). Dietary intake was documented via 24-hour dietary recalls every 3 months. Dietary factors of interest included total energy intake; total and animal protein; total, soluble, and insoluble fiber; and lignan and flavanol intake. Results This study included 260 participants who generated 871 serum specimens and 3,000 days of diet intake. In longitudinal models, estradiol was associated inversely with insoluble fiber intake; estrone positively with animal protein intake; SHBG with greater insoluble fiber and lower total protein intake; and ratio of estrone to SHBG, a measure of bioavailable estrogen, positively with animal protein. Conclusions Greater protein intake, especially animal protein, led to greater estrogen concentrations and lower SHBG; greater animal protein and greater caloric intake led to increased bioavailable estrogen. This relationship may have served an evolutionary advantage in the past for greater fertility with adequate high-quality protein; in contemporary women, a modest decrease in animal protein may be beneficial in reducing breast cancer risk.

The agricultural soils of the Happy Valley-Goose Bay (HV-GB) region of Newfoundland and Labrador, Canada are Podzols that are converted from boreal forest and have limited productivity due to their sandy texture, acidity, low soil organic matter (SOM), cation-exchange capacity (CEC), and water and nutrient retention capacity. Although numerous studies advocate biochar for mitigating soil quality problems and enhancing agronomic productivity, there is limited information on managing biochar for boosting the productivity of Podzols under newly converted agricultural lands. A 5 year experiment evaluated the impact of eight biochar rates (0–80 Mg C·ha−1) on soil properties including SOM, CEC, and availability of plant nutrients and metals in agricultural soils of HV-GB. Both immediate and long-term impacts were thus assessed. Biochar generally improved soil fertility indicators. Although the largest rates (40 and 80 Mg C·ha−1) led to the greatest changes, significant changes were also found with rates as low as 10 Mg C·ha−1. Increasing biochar rates had diminishing returns for quality parameters of soil. The impact of biochar decreased with time after application, but the largest rate led to longer lasting effects. Although biochar was incorporated in topsoil, its effects were also measurable in the subsoil, albeit with a temporal delay, usually of 1 year. Thus, given the diminishing returns of increasing biochar rates, and that beneficial effects diminish over years, it is advisable that biochar be added in smaller amounts immediately after conversion, as little as 10 Mg C·ha−1, with regular supplementation as needed.

Like other assisted reproductive technology (ART) procedures, the cost of egg freezing (EF) is significant, presenting a potential barrier to access. Given recent technological advancements and rising demand for EF, it is timely to reassess how EF is funded. An online cross-sectional survey was conducted in Victoria, Australia and was completed by 656 female individuals. Participants were asked their views on funding for both medical and non-medical EF. The median age of participants was 28 years (interquartile range 23–37 years) and most participants were employed (44% full-time, 28% part-time, 33% students). There was very high support for public funding for medical EF (n = 574, 87%), with 302 (46%) participants indicating support for the complete funding of medical EF through the public system. Views about funding for non-medical EF were more divided; 43 (6%) participants supported full public funding, 235 (36%) supported partial public funding, 150 (23%) supported coverage through private health insurance, and 204 (31%) indicated that non-medical EF should be self-funded. If faced with the decision of what to do with surplus eggs, a high proportion of participants indicated that they would consider donation (71% to research, 59% to a known recipient, 52% to a donor programme), indicating that eggs surplus to requirements could be a potential source of donor eggs. This study provides insights that could inform policy review, and suggests revisiting whether the medical/non-medical distinction is a fair criterion to allocate funding to ART.

Borderline ovarian tumor is a tumor with pathomorphological characteristics, biological behavior and prognosis between benign and malignant tumors. Preoperative diagnosis of ovarian cancer is usually based on imaging and tumor markers. Because of the early diagnosis and good prognosis of borderline ovarian tumors, fertility preserving surgery can be selected for patients with borderline ovarian tumors who have not completed fertility. Compared with radical surgery, fertility preserving surgery has a higher recurrence rate, but most of them are not malignant, which will not affect the overall survival rate, and the postoperative fertility rate is also very good. Patients with borderline ovarian tumors, especially those with BOT stage II or above, should get pregnant as soon as possible and be followed up closely for a long time.

Communication in social insect colonies depends on signals accurately reflecting the identity and physiological state of the individuals. Such information is coded by the products of multiple exocrine glands, and the resulting blends reflect the species, sex, caste, age, task, reproductive status, and health of an individual, and may also contain caste-specific pheromones regulating the behavior and physiology of other individuals. Here we examined the composition of labial gland secretions in females of the bumble bee Bombus impatiens, of different castes, social condition, age, mating status, and ovarian activation. We show that active queens, gynes, and workers each produce caste-specific compounds that may serve different communicative functions. The composition and amounts of wax esters, mostly octyl esters produced by active queens, differed significantly between castes, mating, and social conditions, suggesting a social signaling role. Farnesyl esters were predominant in gynes and peaked at optimal mating age (6-10 days), suggesting their possible roles as sex pheromone components. Reproductive status of females and age across castes was reflected by the ratio between short- and long-chain hydrocarbons, suggesting that these compounds may serve as fertility signals. Our findings overall suggest that the labial gland composition in B. impatiens reflects different facets of female bee physiology. While further bioassays are required to determine the function of these compounds, they are likely to have an important role in the communication between individuals and to the cohesion of the social structure.

Study objective Women with adenomyosis may show a lower pregnancy rate and a higher miscarriage rate than healthy women. There is also a general agreement that leiomyomas, either submucosal or intramural, negatively affect fertility, when compared with women without fibroids. Some of these women may benefit from adenomyomectomy, however this cytoreductive procedure is considered invasive and technically challenging especially in severe diffuse cases. The study aimed to compare the clinical and reproductive outcomes of patients who underwent adenomyomectomy with those of patients who underwent intramural myomectomy. Design Retrospective study. Setting Department of Obstetrics & Gynecology, Center of Gynecological Endoscopy and Minimally Invasive surgery, 1st Faculty of Medicine, General University Hospital in Prague. Patients A total of 55 women who underwent surgical resection of uterine adenomyosis and 55 patients who underwent myomectomy for intramural uterine fibroid/s were included in this study. All study participants wished to retain and possibly improve their reproductive potential. Interventions Between 2004 and 2019, 110 women underwent laparoscopic or open uterus-sparing surgery for clinically significant uterine adenomyosis (group A) or fibroids (group B), respectively. Measurements and main results Two groups of women who underwent different fertility-saving procedures were compared. Although all women entering the study had declared their wish to conceive, only 28 patients in group A (group A1) and 24 women in group B (group B1) finally aimed toward pregnancy. The mean age and follow-up period was 35.0 years and 76.81 months, respectively, in group A and 34.8 years and 72.5 months, respectively, in group B. The pregnancy and delivery rates were 75.0% and 46.4%, respectively, in group A1 versus 96.0% and 70.8%, respectively, in group B1, with no significant differences between the two groups. The open surgical approach was significantly more frequently employed in group A (47.3% versus 16.4%; p Conclusions In this study, women who underwent surgery on the uterine muscularity, including myomectomy or adenomyomectomy, had comparable reproductive outcomes, with no significant differences.

Conceptualizations of the ‘biological clock’ in popular imaginary in the USA centre on the temporal limits of fertility, with assisted reproductive technology (ART) an increasingly proposed answer to these constraints (at least in the public imaginary). In this study, I analyse how surrogates in the USA understand their own bioavailability for others’ reproductive needs in the commercial ART market vis-a-vis their own reproductive trajectories. Based on interview data with gestational surrogates, I propose a new concept of the ‘ART clock’ to capture how time shapes the experiences of reproductive workers in the US fertility clinic. My findings point to four important ART time-related issues: (i) women desiring to extend their own ‘biological clocks’ via surrogacy; (ii) significant time being needed to achieve and sustain third-party pregnancy; (iii) women extending their total reproductive time via repeat surrogacy ‘journeys’; and (iv) temporal constraints to surrogacy reproduction regarding time of year, the day-to-day time effort, the number of surrogacy journeys, the total number of pregnancies, and surrogates’ age and the ages of their children. Each of these aspects point to important ways that reproductive desire and time shape the labour of reproductive workers, highlighting temporal constraints to assisted reproduction and limits to ART as a solution to delayed reproduction and the biological clock.

Objective To develop an efficient clinical-grade freezing protocol towards experimental clinical cryopreservation of testicular tissues in prepubertal boys suffering from cancer. Design Experimental cryopreservation of testicular tissue. Setting Hadassah Hebrew University Medical Center, Jerusalem, Israel. Patients Adult patients undergoing orchiectomy for various tumors, and prepubertal boys scheduled for gonadotoxic treatment. Intervention: None Main outcome measure(s) Histopathological analysis of tissue architecture, structural integrity, and cellular morphology, was performed for control and frozen-thawed cryopreserved tissues. The number of seminiferous tubules per testicular section was calculated. The survival of spermatogonial stem cells (SSCs) and Sertoli cells of control and frozen-thawed cryopreserved tissues was analyzed by immunofluoresence staining. Results Uncontrolled Slow-Freezing (USF), Controlled Slow-Freezing (CSF), and vitrification similarly preserved the integrity of the adult testicular tissues, and the survival of SSCs and Sertoli cells. CSF of prepubertal testicular tissues effectively preserved their architecture, the number of tubules, SSCs and Sertoli cells. In addition, we observed SSC loss following chemotherapy in prepubertal boys, reemphasizing the importance of fertility preservation prior to gonadotoxic treatment. Conclusion Future fertility restoration for male survivors of pediatric cancers depends on the development of an optimal prepubertal testicular tissue cryopreservation method. Our findings demonstrate the effectiveness of CSF for cryopreservation of human prepubertal testicular tissues, and may contribute to more effective banking of these tissues, and potential fertility restoration.

New Zealand and Australia are countries which currently prohibit donor payment and require open-identity forms of donation. This study explored the concerns of fertility stakeholders regarding payment which would constitute financial reward for gamete donation, and factors predicting such concerns. A total of 434 participants from across New Zealand and Australia completed an online survey anonymously. Participants included those with infertility and treatment experience, donors, recipients, donor-conceived people and clinic professionals. Results indicated that participants' concerns related to their assumptions about the type of donor motivated by financial reward, and the possibility that, if paid, donors might conceal information relevant to treatment and the donor-conceived person. Furthermore, participants were concerned about increasing recipient costs. Participants with personal experience of infertility held stronger concerns overall. Professionals expressed concerns of clinical relevance, such as the withholding of donor information relevant to treatment outcomes. The lowest levels of concern were expressed in relation to payment devaluing the meaning of human life. Qualitatively, themes highlighted concerns regarding payment enticing the 'wrong' type of donor, increased cost to recipients, and concern about the wellbeing of donor-offspring. Collectively, such concerns must be understood against the New Zealand and Australia open-identity donation context which enables the possibility of contact between donors and offspring. These findings indicate that donor recruitment campaigns need to account for different stakeholder concerns, and consider ways to address donor shortages effectively while remaining compliant with legislative requirements.

Few studies explore in-depth accounts of women’s and men’s experiences with, and transitions between, obstetrician/gynaecologists (OB/GYNs) and reproductive endocrinologists during infertility diagnostic and treatment processes. This study examined this subject matter with data from qualitative, in-depth, semi-structured interviews. Between April 2007 and March 2008, the first author interviewed 20 women and eight men from a large midwestern metropolitan area in the USA who had used, or were in the process of using, any fertility treatment in the 5 years preceding the interview. Six couples and 16 individuals were interviewed, resulting in narratives of 22 distinct infertility journeys. The main complaints made by respondents about OB/GYNs were that they were insufficiently concerned with providing timely treatment and that they paid insufficient attention to male partners. Women felt that their concerns were taken more seriously by reproductive endocrinologists, but complained of insensitivity, depersonalization and misinformation, and were suspicious of a profit orientation.

Objective: To enumerate pregnancy outcomes for a representative sample of women in Australia surveyed in 2012–2013 (primary aim) and compare these with women surveyed in 2001–2002 (secondary aim).\ud \ud Methods: Computer-assisted telephone interviews with over 10,000 women aged 16–69 years (participation rate 68.4%). Results are weighted for chance of selection and to reflect the population as a whole.\ud \ud Results: Of women with experience of vaginal intercourse, 75.1% had ever been pregnant, 18.4% reported difficulties getting pregnant and 10.0% had had fertility treatment. Of those who had been pregnant, 91.3% had ever had a live birth, 34.3% a miscarriage, 22.8% an abortion and 2.3% a stillbirth; 0.9% had relinquished a child for adoption. The proportion first pregnant in their 30s was 11% among women aged 60–69 and 26% among those aged 40–49. Fewer older women reported difficulties getting pregnant. Of the 21,882 pregnancies reported, 70% led to live births and 10% were terminated. Compared with our 2001–2002 survey, fewer women reported ever having been pregnant. Giving up newborns for adoption has become very rare.\ud \ud Conclusions: Falling fertility since the 1960s reflects greater access to contraception and abortion and higher opportunity costs of childbearing.\ud \ud Implications for public health: These findings on women's lifetime reproductive experiences complement routine annual data collections.

The declining birth rate in China highlights the need for a better understanding of the relationship between fertility decisions, maternal labor supply, and grandparenting. Drawing on the China Migrants Dynamic Survey, our analysis finds that grandparental childcare of the first child has a positive and significant effect on the second birth, regardless of whether the mother participates in the labor market. Notably, a mediation analysis demonstrates the mediating effect of maternal labor force participation, which negatively impacts having a second child. Grandparenting for the first child indirectly restrains the second birth through promoting maternal employment. However, childcare by grandparents can significantly alleviate the incompatibility of the mothers’ time allocation and thus shows a more substantial positive, direct impact on the second birth. Given the insufficient supply of affordable and quality childcare services in China, our findings indicate that grandparental childcare is a practical way to boost fertility and maternal labor supply.

Objective To estimate the annual cost associated with obstetric events in women of reproductive age with immune-mediated inflammatory diseases, from the perspective of the National Healthcare System. Methods A cost-analysis was developed to estimate the impact associated with obstetric events in women of reproductive age with psoriasis (PSO), psoriatic arthritis (PsA), rheumatoid arthritis (RA) and axial spondyloarthritis (axSpA). The analysis considered complications during fertility and conception, in pregnancy and in the postpartum. All parameters were validated and agreed by a multidisciplinary expert panel. Unitary costs (€, 2019) were obtained from national, local databases. Results During fertility and conception, an annual cost per patient of €229 was estimated for a preconception consultation in a patient with PSO, of €3,642 for a preconception consultation in patients with PsA, RA and axSpA and €4,339 for assisted reproduction. Women with complications in pregnancy had an annual cost per patient of €1,214 for a miscarriage in the first trimester, €4,419 for a late miscarriage in the second trimester, €11,260 for preeclampsia €3,188 for restricted intrauterine growth and €12,131 for threat of premature delivery. In the postpartum, an annual cost per patient of €120,364, €44,709, and €5,507 were estimated associated with admissions to neonatology of premature infants of Conclusions This analysis provides insight on the economic burden of complications associated with women of reproductive age for immune-mediated diseases (PSO, PsA, RA, axSpA). Individualization of treatment, additional and close monitoring may reduce the risk and burden of these complications.

Background We conducted a questionnaire-based study of pouch function, quality of life, sexual function, and fertility among patients who had undergone ileal pouch anal anastomosis (IPAA) in childhood and who are now over 18 years old. Methods A consecutive series of patients were asked to complete the following questionnaires: Pouch Function Score (PFS), Short Form 36 (SF-36), International Index of Erectile Function (IIEF) (males), and Female Sexual Function Index (FSFI) (females). Fertility in females was also assessed. Data are quoted as a median (SD). Results Of 144 patients who had IPAA, 101 were eligible, and 70 responded. Mean age at surgery was 14 years, and mean current age is 26 years. Most patients had either ulcerative colitis or familial adenomatous polyposis. The questionnaire was completed by 38/70 (54%). Median PFS score was 6 (5). SF-36 were lower than previous reports. Median FSFI was 30 (7.6), 84% of possible maximum. Median IIEF was 69, 92% of possible maximum. Successful conception was reported in 5/7 women who had tried. However, there were several miscarriages and two surgical emergencies during pregnancies. Conclusions IPAA can be performed in childhood with similar pouch function to reported adult series. Quality of life appears poorer, but sexual function is maintained. There may be an association with adverse events in pregnancy.

Population projections rely on one-sex renewal models. Consequently, changing the projection of male mortality does not affect the projection of birth, contradicting commonsense. A two-sex renewal model is presented in this paper to provide a better description of reproduction and more reasonable population projections. This model is nonlinear and includes the one-sex renewal models as special cases. In this model, age-specific birth rates are defined for two sexes jointly; total fertility, net reproduction rate, and intrinsic growth rate are also derived for two sexes jointly; and age-specific populations approach or converge to stable status. Applying the two-sex renewal model to Australia, it indicates that one-sex models underestimated the intrinsic growth rate by 14 percent. Compared to the results of one-sex models, the two-sex model would provide higher growth rate for low-fertility countries, and lower growth rate for high-fertility countries. In other words, the one-sex models are commonly biased. If the two-sex model is applied to all the countries, it would project smaller populations for the world in the future.

This observational study aimed to determine the effect of genetic merit for fertility traits on estrous expression and estrous cycle duration in grazing dairy cows, as measured by an activity monitoring device. A secondary aim was to describe changes in expression of estrus that occur during successive estrous cycles postpartum. Neck-mounted, activity-monitoring devices (Heatime, SCR Engineers Ltd.) were fitted to nulliparous Holstein-Friesian heifers with positive (POS FertBV) or negative genetic merit for fertility traits (NEG FertBV) to capture activity data during their first and second lactations (POS FertBV: n = 242, n = 188; NEG FertBV: n = 159, n = 87 in lactation 1 and 2, respectively). An estrous event was identified when the activity change index exceeded 26 activity units (AU) for 4 h. A total of 1,254 and 892 estrous events were identified in lactation 1 and 2, respectively. Estrous duration was defined as the interval between when the threshold was first exceeded and when activity dropped below the threshold, with no new event starting within 24 h of the end of the previous event. This definition of estrus included cows in which activity crossed the threshold multiple times in a day and were classified as a single estrous event. A second measure, high activity duration, was defined as the total hours that activity exceeded the threshold. To characterize estrous activity, peak activity (above baseline) and total activity (area under the curve of activity above baseline) were measured. Compared with NEG FertBV cows, POS FertBV cows had more active, longer estrous events. In lactation 1, the POS FertBV group had a mean estrous duration and a high activity duration of 12.5 and 12.4 h compared with 11.4 and 11.3 h for the NEG FertBV group [standard error of the difference (SED) = 0.5 and 0.4 h, respectively]. This significant difference also occurred in lactation 2, with a mean estrous duration of 13.1 versus 11.8 h (SED = 0.5 h) and a high activity duration of 13.0 versus 11.8 h (SED = 0.4 h) in the POS and NEG FertBV groups, respectively. Total activity and peak activity were greater in the POS compared with the NEG FertBV group in lactation 1 (peak activity: 65.5 vs. 55.8 AU, SED = 2.4 AU; total activity: 588 vs. 494 AU, SED = 25 AU) and lactation 2 (peak activity: 72.5 vs. 61.2 AU, SED = 2.9 AU; total activity: 648 vs. 541 AU, SED = 30 AU). Estrous cycle duration did not differ between the POS and NEG FertBV groups (lactation 1: 20.4 vs. 20.6 d, SED = 0.25; lactation 2: 20.8 vs. 21.0 d, SED = 0.28). Less estrous activity of the cow was associated with the first postpartum estrus. In contrast, the number of previous estrous events did not consistently affect the duration of the subsequent estrous cycle. The outcomes of this study provide evidence that positive genetic merit for fertility traits is associated with more overt estrous expression. Selection for these traits may improve estrous expression and thus estrous detection in commercial herds.

Résumé Le contexte actuel de pandémie conduit à s’interroger sur les conséquences de la COVID-19 en Assistance médicale à la procréation (AMP). En effet, suite aux premières recommandations de l’Agence de la Biomédecine en Mars 2020, les centres d’AMP ont suspendu leurs activités. La reprise progressive des tentatives en Mai 2020 s’est accompagnée de nombreux questionnements, concernant les effets directs et indirects du SARS-CoV-2 sur la qualité des gamètes, la gamétogenèse, la fertilité, la grossesse et la santé néonatale. L’objectif de cette revue de la littérature, est de synthétiser les données disponibles, pour informer les patient(e)s pris(es) en charge et adapter les pratiques d’AMP en cette période de la COVID-19. La plupart des études récentes, se basent sur l’évaluation des effets du syndrome infectieux, sur l’analyse des facteurs hormonaux, et sur l’expression des protéines d’entrée virale (ACE2 et TMPRSS2) au niveau des cellules impliquées dans la gamétogenèse pour évaluer les répercussions de la COVID-19. La transmission materno-fœtale du SARS-CoV-2 n’a pas pu être démontrée à ce jour, mais l’infection néonatale reste possible. Néanmoins, les hommes seraient plus à risque d’être infectés par le SARS-CoV-2, d’être symptomatiques et la spermatogenèse est vraisemblablement affectée. La présence du virus dans le sperme est un évènement rare, mais l’ensemble de ces paramètres sont à prendre en compte dans la prise en charge des couples en AMP. Cependant, aucune conséquence sur la qualité des gamètes féminins n’a été mise en évidence jusqu’à présent.

Objective To comprehensively characterize the DNA virome in semen samples collected for in vitro fertilization. Design A descriptive clinical study. Setting Single academic fertility center. Patients 24 male partners from couples undergoing in vitro fertilization (IVF). Interventions Couples were randomized to receive 1 g of azithromycin (standard of care) or no azithromycin at the time of baseline IVF assessment. Semen samples were collected at the time of the female partners’ egg retrieval, and 100 μL of sample was used for virome analysis. Main Outcome Measures Detection of viruses by ViroCap enrichment of viral nucleic acid and sequencing. Association between the virome, semen parameters, and pregnancy outcomes. Results We detected viruses in 58% of the subjects. Viruses included polyomaviruses, papillomaviruses, herpesviruses, and anelloviruses. Viromes detected in semen had little overlap with the viromes detected in vaginal samples from their female partners collected at time of embryo transfer, which were analyzed in a previous study. Lower viral diversity in semen samples was positively associated with pregnancy (P=0.03, Hodges-Lehmann estimate of difference 1; 95% CI 2 to 0.00003). There was no association between viral diversity and sperm concentration, motility or fertilization rates. Conclusion This comprehensive characterization of the DNA virome in semen reveals an association between virome diversity and pregnancy in couples undergoing IVF. However, no association was found with specific semen parameters or fertilization rates, suggesting viral exposure may negatively affect pregnancy after fertilization. Future studies should be undertaken to evaluate associations between the semen virome with IVF outcomes in larger cohort.

Study Objective To compare the recurrence rate, post-treatment American Fertility Society (AFS) score, ongoing pregnancy rate, and endometrial thickness of 3 secondary prevention therapies in preventing recurrent intrauterine adhesions (IUAs) and increasing pregnancy rates in infertile women after hysteroscopic adhesiolysis. Design A retrospective study. Setting A private fertility hospital. Patients A total of 200 consecutive infertile women, with the desire to have a baby and were diagnosed as having IUAs detected by hysterosalpingogram, who underwent hysteroscopic adhesiolysis for IUAs from January, 2018 to May, 2020. Interventions Women who underwent hysteroscopic adhesiolysis received hormone therapy, and one of the 3 secondary preventions: hyaluronic acid (HA) gel alone, intrauterine devices (IUDs) alone, or HA gel + IUD. Measurements and Main Results Of the 200 women included in the final analysis, 121 received HA alone, 59 were treated with IUD alone, and 20 received HA gel + IUD combination. The mean post-treatment AFS score for IUAs was significantly lower in the HA gel + IUD group than the HA alone or the IUD alone groups (adjusted p = .01 and p = .02, respectively). Multivariable analysis revealed a significantly lower recurrence rate in the women after treatment with HA gel + IUD than HA alone (adjusted odds ratio, 0.19; 95% credible interval [CreI], 0.03–0.88). Women treated with HA gel + IUD also had reduced post-treatment AFS scores compared with HA alone (β coefficients, −0.83; 95% CreI, −1.64 to −0.01). For ongoing pregnancy rates after in vitro fertilization, the adjusted odds ratio for HA gel + IUD vs HA alone was 2.03 (95% CreI, 0.44–11.00) and for IUD alone vs HA alone was 1.13 (95% CreI, 0.41–3.29), indicating nonsignificant differences. There were no differences observed in endometrial thickness on the day of embryo transfer among the 3 groups. Conclusion The investigation of the primary outcome in reducing the recurrence rate IUA after treatment demonstrated that a combination of HA gel + IUD provides greater prevention of recurrent IUAs and may decrease post-treatment AFS scores for infertile women undergoing hysteroscopic adhesiolysis. However, for the secondary outcome of increasing pregnancy rates, there was no improvement in the ongoing pregnancy rates after in vitro fertilization.

The preservation of fertility in women of childbearing age with breast cancer is challenging because the time for ovarian stimulation is restricted and only a limited number of oocytes can be retrieved before gonadotoxic therapies. The aim of this meta-analysis was to evaluate the fertility preservation outcomes after ovarian stimulation with various protocols in women with breast cancer. PubMed, Embase and the Cochrane Library were searched. Twenty-two studies comparing the outcomes of women with breast cancer receiving random-start ovarian stimulation or conventional protocol; single or double ovarian stimulation cycles; and coadministration of aromatase inhibitors or tamoxifen were included. Random-start ovarian stimulation resulted in a comparable number of retrieved oocytes to the conventional protocol. Two ovarian stimulation cycles had significantly higher numbers of total retrieved oocytes than one cycle (mean difference 7.91, 95% confidence interval [CI] 3.42 to 12.40). Coadministration of letrozole and tamoxifen showed similar results for retrieved oocytes to those without. A significantly lower peak serum oestradiol concentration was observed in letrozole-based groups than in letrozole-free groups (mean difference -1.22; 95% CI -1.42 to -1.02). In conclusion, this study indicated that implementing random-start protocols to shorten the duration of waiting for ovarian stimulation, applying two ovarian stimulation cycles, and coadministration of letrozole can lead to more desirable outcomes.

Peripartum metabolism and subsequent reproductive performance of dairy cows are linked, with maladaptation over the transition period associated with poor reproductive success. A herd of seasonal calving, grazing dairy cows was established that differed in their genetic merit for fertility traits. The heifers were produced by a customized mating program to achieve a 10-percentage point divergence in the New Zealand fertility breeding value (FertBV) as follows: +5 FertBV (POS) versus −5% FertBV (NEG), while also limiting divergence in other breeding values, including body weight, body condition score, and milk production. In this study, we aimed to characterize differences in metabolic, mineral, and metabolic stress marker profiles during their first postpartum transition period as primiparous heifers and to examine if animals with longer postpartum anestrous intervals (PPAI; more than 66 d compared with less than 35 d) had greater metabolic dysfunction. Blood was sampled at −21, −14, −7, 0, 4, 7, 10, 14, 17, 21, 28, and 35 d relative to calving in 455 primiparous cows and plasma analyzed. The NEG cows had lower concentrations of both plasma nonesterified fatty acids and β-hydroxybutyrate at d 7 compared with POS cows. Detailed temporal profiling of various metabolic, mineral, and metabolic stress markers was undertaken in a subset of cows (n = 70). Cows were selected retrospectively to create 4 groups in a 2 × 2 factorial design with either a POS or NEG FertBV and either a short (19–35 d) or long (66–131 d) PPAI. The NEG cows tended, on average, to have lower nonesterified fatty acids and β-hydroxybutyrate concentrations compared with POS cows across the transition period. Mean body weight and body condition score was greatest in NEG cows when compared with the POS cows and an interaction with day demonstrated this only occurred precalving. They also had indications of improved liver health precalving, with higher albumin-to-globulin ratios and lower bilirubin concentrations. Concentrations of aspartate aminotransferase were lower, and the Na-to-Cl ratio was greater in cows with a long versus a short PPAI at d 28 and d 35 after calving, potentially because of cows with a short PPAI (19–35 d) returning to estrous during this time. Magnesium concentrations were lower in NEG cows with a short PPAI from d 21 onwards, indicating NEG cows may metabolically respond to estrous differently than POS cows. The NEG-long PPAI cows had greater gamma-glutamyl transferase concentrations from calving until d 28 and lower bilirubin concentrations throughout the transition period. Together, the results demonstrate significant effects of FertBV on peripartum metabolic status. However, most of the markers tested returned to reference intervals within 4 d after calving or remained within those intervals for the whole transition period, indicating relatively minor biological effects of FertBV on transition period adaptation. The profound differences in reproductive performance among the groups was not explained by underlying differences in metabolic responses during the transition period.

Targeted cancer therapy is rapidly evolving the landscape of personalized health care. Novel approaches to selectively impeding tumour growth carry significant potential to improve survival outcomes, particularly for reproductive-aged patients harbouring treatment refractory disease. Current agents fall within two classes: immunotherapy and small molecule inhibitors. These are collectively divided into the following subclasses: monoclonal antibodies; immunomodulators; adoptive cell therapy; treatment vaccines; kinase inhibitors; proteasome inhibitors; metalloproteinase and heat shock protein inhibitors; and promoters of apoptosis. The short- and long-term effects of these treatments on the female reproductive system are not well understood. As a result, clinicians are rendered unable to appropriately counsel women on downstream effects to their fertility. Data-driven consensus recommendations are desperately needed. This review aims to characterize the effect of targeted cancer therapy on the female hypothalamic-pituitary-ovary axis, direct ovarian function and conception.

Research question: To evaluate the correlation between clinical and hormonal parameters and comorbidity burden in Caucasian women presenting for fertility treatment. Design: Monocentric cross-sectional study including a cohort of 3163 Caucasian women seeking medical care for fertility treatment. All patients underwent centralized laboratory testing for hormonal assessment. Complete clinical and laboratory data from the entire cohort were retrospectively analysed. Comorbidity burden score was assessed by the Charlson Comorbidity Index (CCI; categorized as 0 versus 1 versus ≥2). Results: Descriptive statistics and regression models tested the associations between clinical and laboratory parameters and CCI. Among the entire cohort of patients, a CCI = 0 was found in 2977 women (94.1%), and CCI = 1 and CCI ≥2 were found in 113 (3.6%) and 73 (2.3%) patients, respectively. Age (P = 0.009), gravidity (P = 0.001), anti-Müllerian hormone (AMH, P < 0.001) and TSH (P = 0.003) values were significantly different among CCI groups. In regression models, age at presentation and AMH emerged as independent indicators of CCI ≥ 1. Age at presentation

Objective To evaluate long-term reproductive outcomes in couples who were enrolled in a large randomized controlled trial that studied optimal treatment for unexplained infertility. Design Telephone survey, administered between March 2019 and February 2020. Setting Large urban university-affiliated fertility center. Patient(s) Couples who enrolled in the Fast Track and Standard Treatment Trial (FASTT). Intervention(s) None. Main Outcomes Measure(s) Number of live births, methods of conception, adoption, and satisfaction regarding family size. Result(s) Of the 503 couples enrolled in FASTT, 311 (61.8%) were contacted and 286 (56.9%) consented to participate. The mean age and follicle-stimulating hormone level at the time of enrollment in FASTT were 33.1 ± 3.2 years and 6.8 ± 2.2 mIU/mL, respectively, for those who participated in this study. The mean age at follow-up was 49.5 ± 3.4 years. Of the 286 women, 194 (67.8%) had a live birth during the trial and 225 (78.7%) continued to try to conceive after FASTT. Of those who tried to conceive without treatment, 101 of 157 (64.3%) had a successful live birth, whereas 12 (5.3%) women had a live birth via intrauterine insemination and 82 (36.4%) via autologous oocyte in vitro fertilization. Overall, 182 (80.9%) women achieved a live birth after FASTT. Conclusion(s) The majority of couples were able to achieve a live birth after FASTT. Only 19 (6.6%) never achieved a live birth during their reproductive years. Moving to treatment sooner allows the opportunity to achieve >1 live birth, which is associated with increased satisfaction regarding family size. This further supports access to care and insurance coverage for infertility treatment.

Study Objective Myomectomy is the gold standard treatment for patients with symptomatic fibroids who desire fertility preservation. Given the relatively recent application of robotic surgery in the field of gynecology, there is only a small amount of data describing fertility outcomes after robotic-assisted laparoscopic myomectomy (RALM). The objective of this study was to determine the pregnancy rate in patients trying to conceive after RALM. Design A single-center, retrospective case series. Setting Department of Obstetrics and Gynecology, St. Michael's Hospital, Toronto, Ontario, Canada. Patients All patients who underwent RALM between October 2008 and September 2015 and who consented to a telephone interview were included. Intervention None. The primary outcome was pregnancy rate after RALM. Secondary outcomes included whether patients underwent fertility treatment, rate of live births after RALM, rate of spontaneous abortion mode of delivery in pregnancies following RALM, obstetric complications, and symptoms experienced postoperatively. Measurements and Main Results A total of 123 patients underwent RALM between 2008 and 2015. Of them, 101 consented to be interviewed. Average age ± standard deviation was 34.4 ± 4.4 years. Average myoma size was 8.9 ± 2.2 cm. Of all myomas, 64 (63.4%) were intramural, 35 (34.7%) were subserosal, and 2 (2%) were submucosal according to preoperative imaging. The pregnancy rate after RALM was 42/60 (70.0%). Three additional patients became pregnant who were not trying to conceive. Of the 45 patients who became pregnant, 38 (84.4%) successfully delivered or were pregnant at the time of data collection. Conclusion The pregnancy rate after RALM was 70.0%, which is similar to that reported in previous studies. Future research should aim to conduct larger, prospective studies investigating fertility outcomes after RALM and should aim to identify variables that predict pregnancy.

To compare the reproductive outcome after early miscarriage between women managed expectantly and those treated with vaginal misoprostol.This study was a planned secondary analysis of data collected prospectively in a randomized controlled trial comparing expectant management with vaginal misoprostol treatment (single dose of 800 µg) in women with early embryonic or anembryonic miscarriage and vaginal bleeding. The outcome measures were the number of women with a clinical pregnancy conceived within 14 months after complete miscarriage and the outcome of these pregnancies in terms of live birth, miscarriage, ectopic pregnancy and legal termination of pregnancy. The participants replied to a questionnaire sent by post covering their reproductive history ≤ 14 months after the index miscarriage was complete. Supplementary information and data for women who did not return their questionnaire were retrieved from medical records.Of 94 women randomized to misoprostol treatment and 95 allocated to expectant management, 94 and 90 women, respectively, were included for analysis. Information on reproductive outcome was available for 89/94 (95%) and 83/90 (92%) women, respectively. Complete miscarriage without surgical evacuation was achieved within 31 days in 85% (76/89) of the women in the misoprostol group and in 65% (54/83) of those managed expectantly. The proportion of women treated with surgical evacuation was 33% (27/83) in the expectant-management group vs 12% (11/89) in the misoprostol group. At 14 months after the index miscarriage was complete, 75% (67/89) of women treated with misoprostol and 75% (62/83) of those managed expectantly had achieved at least one clinical pregnancy, while 40% (36/89) and 35% (29/83), respectively, had had at least one live birth (mean difference, 5.5% (95% CI, -9.7 to 20.3%)). When considering the outcome of all pregnancies conceived within 14 months after the index miscarriage was complete, 63% (56/89) of women in the misoprostol group and 55% (46/83) of those in the expectant-management group delivered a live baby after a pregnancy (mean difference, 7.5% (95% CI, -7.9 to 22.4%)).Women with early miscarriage can be reassured that fertility is similar after misoprostol treatment and expectant management. © 2021 The Authors. Ultrasound in ObstetricsGynecology published by John WileySons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.