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Abstract Background Domestic violence is a leading cause of poor health outcomes during pregnancy and the postpartum period. Therefore, there is a need for integrated domestic violence interventions in reproductive health care settings. India has one of the highest maternal and child mortality rates. This review aimed to identify characteristics of existing evidence-based integrated domestic violence and reproductive healthcare interventions in India to identify gaps and components of interventions that demonstrate effectiveness for addressing domestic violence. Methods A systematic review of intervention studies was conducted using Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Three research team members performed independent screening of title, abstracts and full-texts. Results The search resulted in 633 articles, of which 13 articles met inclusion criteria for full text screening and analysis. Common components of integrated violence and reproductive health interventions that were effective in addressing domestic violence included: psychoeducation/education (n = 5), skill building (n = 5), counseling (n = 5), engaging stakeholders with use of trained lay peer facilitators (n = 3), and engaging male spouses (n = 3). Conclusions Interventions in India for domestic violence that are integrated with reproductive health care remain few, and there are fewer with effective outcomes for domestic violence. Of those with effective outcomes, all of the interventions utilized psychoeducation/education, skill building, and counseling as part of the intervention.

Abstract Background Despite the importance of health literacy and the self-care skills in improving individual and social health and health costs reduction, scientific evidence indicates women’s poor awareness of self-care needs and low health literacy concerning reproductive and sexual health in most societies. The present study was conducted to specify the effect of health awareness promotion on self-care needs and reproductive and sexual health literacy of newly married women. Methods This randomized controlled clinical trial was conducted on 64 newly married women aged 15–45 in Tehran, Iran from August 2021 to the end of December 2021. The participants were randomly assigned into the intervention (n = 32) and control (n = 32) groups. The intervention group received four individual health awareness-promotion education sessions. The reproductive and sexual self-care needs, and sexual health literacy questionnaires, were completed before and 4-week after the intervention through interview. The data were analyzed using SPSS26 software. The independent t-tests and ANCOVA were used to comparison the mean scores and a significance level of P

Abstract Background Existing estimates of adolescent sexual and reproductive health (ASRH) behaviors may be a gross undercount given the sensitivity of this behavior in Indian culture. The objective of this study was to estimate ASRH behaviors in Rajasthan, India using direct questions and the best friend approach that seeks to reduce social desirability bias. Methods We used population-based data of adolescents aged 15–19 in Rajasthan collected between September and December 2022. Data include whether the respondent and her closest female friend ever had a partner, ever had sex, ever used contraception, and were currently using contraception. We estimated respondent and best friend ASRH outcomes separately, overall and among unmarried adolescents for whom we anticipate social desirability bias is greatest. Results The best friend approach performed well, with method assumptions largely met even before adjustments. Respondent and best friend estimates were similar among all adolescents except for current contraceptive use, which was higher for friends (though not significantly so). However, we observed large differences in ASRH behaviors between unmarried respondents and friends, with a significantly higher percentage of friends who ever had a partner (4.3% respondents, 11.6% friends), and a slightly higher percentage who ever had sex (2.4%, 3.8%) and who were currently using contraception (17.0%, 19.7% among those in need of contraception). Conclusions We observed potential benefits of using the best friend methodology in estimating premarital sexual activity, but further work is needed to refine social network-based measures of sensitive adolescent behaviors in larger study samples to better understand ASRH needs.

Abdirizak Mohamud Yusuf,1 Mohamed Omar Warsame,2 Saido Gedi,3 Naima Abdulkarim Abdullahi,4 Daud Ibrahim Ahmed5 1Department of Family Health, Federal Ministry of Health, Mogadishu, Somalia; 2School of Public Health and Research, Somali National University, Mogadishu, Somalia; 3Public Health Department, Erciyes University, Kayseri, Turkey; 4World Health Organization Emergency Program, WHO, Mogadishu, Somalia; 5Department of Training and Development, National Institute of Health, Mogadishu, SomaliaCorrespondence: Abdirizak Mohamud Yusuf, Email abdirizak.moh20@gmail.comBackground: Depression is a global health concern with significant consequences, especially for women. Hormonal changes and gender disparities contribute to its prevalence. Hormonal contraceptives are widely used among women of reproductive age, but some users report mood-related side effects.Purpose: This study aims to investigate the relationship between hormonal contraceptive use and depression among women in Mogadishu, Somalia.Methods: An analytical cross-sectional study was conducted at two hospitals in Mogadishu, targeting married women aged 15– 49 using hormonal contraceptives. A sample size of 227 participants was determined, and data was collected using semi-structured questionnaires, including the Patient Health Questionnaire-9 (PHQ-9) to assess depression. The data were analyzed using SPSS version 25, including multivariate logistic regression.Results: The prevalence of depression among participants was 33.5%, with significant associations observed between depression and occupation, income level, type of hormonal contraceptive used, and duration of contraceptive use. Housewives, individuals with lower income, users of oral pills and implant methods, as well as those with shorter durations of contraceptive use, constituted the high-risk groups for depression.Conclusion: Depression poses a concern among women using hormonal contraceptives in Mogadishu, Somalia. Healthcare providers should educate women about potential side effects and consider individualized contraceptive recommendations. Mental health support initiatives and awareness campaigns should be introduced. Future research is recommended to further understand and address depression in this context.Keywords: hormonal contraceptives, HC, reproductive health, depression, Somali women, cross-sectional study

Nigeria has the largest population in Africa, a high fertility rate, and unmet needs for family planning. Family planning is a key strategy for sustainable development. A good knowledge of factors that determine contraceptive uptake is imperative for policy formulation. A nationally representative secondary dataset of 41,821 women aged 15–49 years who participated in the 2018 Nigeria Demographic and Health Survey was analyzed. Multivariate logistic regression was used to examine the association between various factors and the current use of modern contraceptives. The respondents’ average age was 35.9 ± 7.9 years. Overall, contraceptive prevalence was 16.6% for traditional methods and 12.2% for modern methods. Predictors of an increase in modern contraception use were age 40–44 (aOR = 1.07, 95% CI: 0.75–1.53); being a working-class woman (aOR = 1.15, 95% CI: 0.99–1.33); living in an urban area (aOR = 1.14, 95% CI: 0.97–1.33); living in the South West (aOR = 1.36, 95% CI: 1.03–1.79); increasing wealth (aOR = 0.78, 95% CI: 0.66–0.93); and health insurance (aOR = 1.22, 95% CI: 0.89–1.68). Couple dynamics influencing modern contraceptive use were joint decision (aOR = 2.16, 95% CI: 1.81–2.59), self-decision on health care (aOR = 1.34, 95% CI: 1.06–1.70), and earning more than a partner (aOR = 1.14, 95% CI: 0.78–1.66). There are significant variations in contraceptive uptake attributable to socioeconomic and political inequalities, requiring a holistic approach to mitigate barriers and improve contraceptive uptake.

Objective. To assess changes in reproductive, maternal, newborn, child, and adolescent health (RMNCAH) in Haiti from August 2018 to September 2021, before and during the COVID-19 pandemic. Methods. A retrospective study using surveillance data from the Haitian Unique Health Information System, examining two periods: pre- and peri-COVID-19 pandemic. Health indicators at the national level in the two periods were compared using two-sample t-tests for proportions, and average absolute monthly changes were calculated using variance-weighted regression. Results. There was a statistically significant decline in the proportion of most of the indicators assessed from the pre- to the peri-COVID-19 pandemic period. However, the most affected indicators were the proportions of pregnant women with four antenatal care visits, with five antenatal care visits or more, and those who received a second dose of tetanus vaccine, which decreased by over 4 percentage points during the two periods. Likewise, the proportions of children who received diphtheria, tetanus, and pertussis (DTaP), BCG, polio, pentavalent, and rotavirus vaccines also all declined by over 8 percentage points. In contrast, pneumococcal conjugate vaccine increased by over 4 percentage points. A statistically significant decrease was also observed in the average absolute monthly changes of several reproductive and child health indicators assessed. Conclusions. The COVID-19 pandemic may have contributed to the decline observed in several RMNCAH indicators in Haiti. However, the role played by the sociopolitical crisis and control exercised by armed groups over the population in the last three years cannot be ruled out.

With a keen awareness of the size and health needs of the global adolescent population, governments, nongovernment organizations and the technical and funding agencies that support them continue to seek innovative answers to persistent programming challenges to increasing contraceptive use among sexually active adolescents. Adolescents 360 (A360) is a project implemented by Population Services International (PSI) and partners with funding from the Bill and Melinda Gates Foundation (BMGF) and the Children's Investment Fund Foundation (CIFF). The first phase of the project was implemented from 2016 – 2020 in Ethiopia, Nigeria, and Tanzania. A360 hypothesized that human centered design (HCD) could catalyze new insights into identifying and solving problems that limit adolescents' use of contraception. Despite initial promising results, A360 demonstrated very limited impact on modern contraceptive uptake among adolescents. The authors of this commentary were members of a technical advisory group to A360 and are uniquely positioned to provide insights on this project to complement those of A360's staff and evaluators, which are already in the public arena. Our analysis suggests that all stakeholders should take steps to rebalance their programs and investments to not only seek new solutions (i.e. game changers), but to also invest in the institutionalization of the solutions that have been generated over the past 40 years, prioritizing those that have shown evidence of effectiveness (i.e. adolescent responsive health service delivery) and those that demonstrate significant promise (i.e. social norm change). [ABSTRACT FROM AUTHOR]

Ensuring proper menstrual hygiene management remains a significant challenge for young women in India. The term "exclusive use of hygienic period products during menstruation" refers to relying solely on period products like sanitary pads, tampons, or menstrual cups. Poor menstrual hygiene practices not only increase the risk of reproductive tract infections but also lead to various negative health outcomes, including discomfort and potential complications. This study explores factors associated with the exclusive use of period products during menstruation aged 15–24, investigates geographic disparities, examines rural–urban gaps, and assesses inequality in India. Utilizing data from the fifth National Family Health Survey (NFHS-5), responses from 2,41,180 women aged 15 to 24 were analysed using logistic regression and multivariate decomposition analyses to explore socioeconomic predictors. Moran's I statistics also assessed spatial dependency, while Lorenz curves and Gini coefficients measured inequality. Quintile and LISA maps visualized regional disparities. The study found that 76.15% of women in India reported exclusive use of hygienic period products during menstruation. Rural areas reported a lower percentage of exclusive use of hygienic period products (72.32%) during menstruation compared to urban areas (89.37%). Key factors associated with the exclusive use of hygienic period products among 15–24-year-old women in India include age, education, place of residence, wealth, access to media, and healthcare discussions. Geographically, central districts exhibited the lowest coverage (< 65%), while the Southern region reported the highest (> 85). The GINI coefficient of 0.39 highlighted moderate inequality in distribution. Decomposition analysis revealed that household wealth contributed 49.25% to rural–urban differences, followed by education (13.41%), media access (7.97%), and region (4.97%). This study highlights significant regional disparities and low utilization of hygienic period products among young women in India, particularly in central districts. Policymakers should prioritize interventions targeting these regions, addressing socio-economic disparities. Strategies to promote education, improve media access, and enhance household wealth can facilitate menstrual hygiene adoption. Initiatives to reduce sanitary napkin costs and increase accessibility, particularly in rural areas, are crucial to mitigating geographical disparities nationwide. [ABSTRACT FROM AUTHOR]

There are persistent and profound racialised inequalities in maternal and reproductive health in the UK. Yet in multiple settings, these disparities have been blamed on class or ethnicity, individuals and communities rather than the structures within which they live. In this study, we draw on narratives told within a ‘slow‐stitch’ craft workshop, organised in southern England for racialised women with reproductive trauma, to show how processes of racialisation and racism shape experiences of maternal and reproductive healthcare. Experiences of reproductive trauma were multiple and cumulative. The burden of knowledge of racialised disparities was carried into health‐care spaces, with plans made in advance to self‐manage in risky spaces. The constant management of racialised stereotypes and subsequent strategies of bodily and emotional containment ultimately was not protective and there was little agency over levels of care received in health‐care spaces. Perceptions surrounding racialised bodies shaped treatment, whilst proximities to whiteness afforded alternative realities. Taking a phenomenological approach we analyse race as a sensory, spatial and relational constellation haunted by long‐standing histories of fraught inequality. Bringing together in the crafting circle a group of women racialised in different ways enabled the sharing of “unspeakable” stories surrounding racism and reproductive trauma, and allowed race to be brought into being as a form of solidarity and connection. [ABSTRACT FROM AUTHOR]

We have undertaken a systematic review and meta-analysis to investigate the association between maternal exposure to air pollutants and outcomes of in vitro fertilization (IVF). Studies were identified through a comprehensive online search. After standardizing all air pollution concentrations to 10 μg/m3, we analyzed the levels of six air pollutants (PM2.5, PM10, O3, NO2, CO, and SO2) by applying a random effects model. A total of five articles met inclusion criteria upon final reviewing. Exposure to PM10, NO2, and CO was linked to the risk of ectopic pregnancy, while exposure to O3 was found to have a reverse association with biochemical pregnancy. Additionally, our analysis indicated a negative association between exposure to PM10, NO2, CO, and SO2 and live birth rates, as well as between NO2 exposure and intrauterine pregnancy. Our study emphasized the relationship between exposure to ambient air pollution and negative effects on pregnancy outcomes for women undergoing IVF. [ABSTRACT FROM AUTHOR]

Background: Persistent human papillomavirus (HPV) infection is considered the primary etiological factor for invasive cervical cancer. Understanding the epidemiology of circulating potential high-risk (HR) and HR HPV strains is essential in updating epidemiological knowledge and recommendations on genotype-specific vaccination development. This study determined the prevalence and factors associated with Potential HR/HR HPV among women attending selected reproductive health clinics in Lake Victoria Basin. Methods: A cross-sectional facility-based survey made up of 434 women aged 16–68 years was carried out in two selected facilities. Structured questionnaires were administered to collect participant clinical and social characteristics. Cervical specimens were collected and HPV genotyping was carried out using RIATOL HPV genotyping qPCR assay. Descriptive statistics followed by logistic binary regression was done using R version 4.3.2. Results: The overall prevalence of potential HR/HR HPV among women attending the selected reproductive health clinics was reported at 36.5% (158/434). Specifically, in the rural setting, Gobei Health Center, the prevalence was 41.4% (41/99) while in the urban setting-JOOTRH, it was 34.6% (117/335). The most prevalent potential HR/HR HPV are 52, 67, 16, 31, 39, 45, and 31 among women. Age was the main factor associated with HPV infection with women between the age of 30–39 having the highest risk (AOR = 0.3, CI:0.2–0.7, p < 0.001). Conclusion: In both rural and urban regions, potential HR/HR HPV infection among women attending reproductive health clinics at the selected facilities remains common. The study identifies the need for effective implementation and clinical follow-up process of cervical cancer control program in the LVB. [ABSTRACT FROM AUTHOR]

People are inundated with popular press reports about medical research concerning what is healthy, get advice from doctors, and hear personal anecdotes. How do people integrate conflicting anecdotal and statistical information when making medical decisions? In four experiments (N = 4126), we tested how people use conflicting information to judge the efficacy of artificial and real medical treatments. Participants read an anecdote from someone in a clinical trial, or who had undergone a medical treatment previously, for whom the medical treatment was ineffective. We found that reading anecdotes for either artificial or real medical treatments shifted participants' beliefs about the efficacy of a medical treatment. We observed this result even when the anecdote was uninformative, was paired with an icon array, or when participants were provided with thorough medical decision aids about reproductive health procedures. Our findings highlight the pervasive effect of anecdotes on medical decision making. [ABSTRACT FROM AUTHOR]

An interdisciplinary fetal-neonatal neurology (FNN) program over the first 1,000 days teaches perspectives of the neural exposome that are applicable across the life span. This curriculum strengthens neonatal neurocritical care, pediatric, and adult neurology training objectives. Teaching at maternal-pediatric hospital centers optimally merges reproductive, pregnancy, and pediatric approaches to healthcare. Phenotype--genotype expressions of health or disease pathways represent a dynamic neural exposome over developmental time. The science of uncertainty applied to FNN training re-enforces the importance of shared clinical decisions that minimize bias and reduce cognitive errors. Trainees select mentoring committee participants that will maximize their learning experiences. Standardized questions and oral presentations monitor educational progress. Master or doctoral defense preparation and competitive research funding can be goals for specific individuals. FNN principles applied to practice offer an understanding of gene--environment interactions that recognizes the effects of reproductive health on the maternal-placental-fetal triad, neonate, child, and adult. Pre-conception and prenatal adversities potentially diminish life-course brain health. Endogenous and exogenous toxic stressor interplay (TSI) alters the neural exposome through maladaptive developmental neuroplasticity. Developmental disorders and epilepsy are primarily expressed during the first 1,000 days. Communicable and noncommunicable illnesses continue to interact with the neural exposome to express diverse neurologic disorders across the lifespan, particularly during the critical/sensitive time periods of adolescence and reproductive senescence. Anomalous or destructive fetal neuropathologic lesions change clinical expressions across this developmental-aging continuum. An integrated understanding of reproductive, pregnancy, placental, neonatal, childhood, and adult exposome effects offers a life-course perspective of the neural exposome. Exosome research promises improved disease monitoring and drug delivery starting during pregnancy. Developmental origins of health and disease principles applied to FNN practice anticipate neurologic diagnoses with interventions that can benefit successive generations. Addressing health care disparities in the Global South and high-income country medical deserts require constructive dialogue among stakeholders to achieve medical equity. Population health policies require a brain capital strategy that reduces the global burden of neurologic diseases by applying FNN principles and practice. This integrative neurologic care approach will prolong survival with an improved quality of life for persons across the lifespan confronted with neurological disorders. [ABSTRACT FROM AUTHOR]

Background: There are 1.2 billion adolescents in the world today, more than ever before, making up 16% of the world's population and nearly one-fourth of the total population in Sub-Saharan Africa. Adolescents are facing life-threatening health challenges attributed to sexual and reproductive health issues such as unwanted pregnancies, unsafe abortions, and sexually transmitted infections, including the human immunodeficiency virus, and acquired immunodeficiency syndrome. The aim of this research is to explore the individual and relational levels of factors that drive adolescents to engage in risky sexual behaviour. Methods: A qualitative phenomenological study design was used from February to June 2020. Adolescents and health professionals were selected purposefully. A total of 12 individual in-depth interviews, five focus group discussions with adolescents, and eight key informant interviews with health professionals were conducted using a semi-structured guide. Data analysis was performed using thematic analysis with ATLAS Ti version 7 software. Credibility, dependability, transferability, and confirmability were used to ensure the trustworthiness of the data. Results: In this study, two themes were identified; individual level factors such as sexual desire and emotion driven sex, limited knowledge of sexual and reproductive health, and a permissive attitude towards sexual activities drive adolescents to engage in risky sexual behaviour; and relational level factors such as, limited family support and involvement, negative peer pressure and influence, male partner dominance during the partnership, and pressuring females to engage in sexual intercourse were perceived factors influencing adolescents to engage in risky sexual behaviour. Conclusion: Various individual-level and relational-level factors are influencing adolescents to engage in risky sexual behaviour. Socially and culturally acceptable, comprehensive sexual education should be provided for in-school and out-school adolescents to enhance their knowledge, attitude, and skill about sexual and reproductive health. Interventions at the peer and partner level should be considered to enhance the life skills that enable them to resist pressure from peers and their partners. Child-parent communication on sexual and reproductive health matters should be promoted. [ABSTRACT FROM AUTHOR]

Normal reproductive function and fertility is considered a "sixth vital sign" because disruptions to this sensitive physiological system can forewarn other health issues, including exposure to environmental toxicants. We found that female mice exhibited profound loss of embryos during pre-implantation and fetal development coincident with a change to the source of their drinking water. When female mice were provided with tap water from the building in which they were housed (Water 2), instead of tap water from a neighboring building which was their previous supply (Water 1), ovulated oocytes were degenerated or had impaired meiotic maturation, and failed to form embryos. The harmful effects of Water 2 exposure were not reversible even following a recovery period; however, carbon-filtration of Water 2 removed the toxic contaminant. Water composition analysis to identify the responsible toxicant(s) found that trace elements were present at expected levels and phthalates were undetectable. Per- and Poly-fluoroalkyl Substances (PFAS), a family of persistent organic pollutants were detected at ~4 ng/L. To investigate further, female mice were given drinking water categorized by level of PFAS contamination (0.6 ng/L, 2.8 ng/L, or 4.4 ng/L) for 9 weeks. Compared to mice consuming purified MilliQ water, mice consuming PFAS-contaminated water had decreased oocyte quality, impaired embryogenesis and reduced cell numbers in blastocysts. PFAS concentration in the drinking water was negatively correlated with oocyte viability. Importantly, the levels of PFAS detected in the tap water are within current "safe level" guidelines, and further research is needed to determine whether PFAS are responsible for the observed reproductive toxicity. However, this research demonstrating that water deemed suitable for human consumption has detrimental effects on mammalian embryo development has important implications for public health and water quality policies. [ABSTRACT FROM AUTHOR]

Introduction: Despite substantial investment in improving healthcare among adolescents in low- and middle-income countries, barriers to access and utilization of services persist, especially to sexual and reproductive health (SRH) services. In response to adolescents' health service needs due to their vulnerability, interventions aimed at improving access and utilization of sexual and reproductive health services have been implemented in specific regions of Zambia. To highlight progress in the access and the overall delivery of services in Zambia, in the wake of a system-level funding mechanism, this paper aims to understand the accessibility, availability, acceptability and quality (AAAQ) of health services provided to young people. Materials and methods: In a qualitative case study, 48 discussions-32 individual interviews with stakeholders and 16 focus group discussions, consisting of 128 male and female adolescents were conducted in six districts from Eastern, Southern and Muchinga provinces of Zambia. Interviews were audio-recorded, recordings transcribed verbatim, and transcripts were analysed using deductive thematic analysis, using the AAAQ framework and Atun's framework on integration, as a guide to reporting the findings. Results: We found that adolescents knew of and had access to common commodities and services-male condoms, health education and HIV counselling and testing. However, availability was affected by access-related barriers such as frequent stock-outs and insufficiently trained healthcare providers. In addition, accessibility was more restricted during the COVID-19 pandemic lockdown and compounded by the low acceptability of SRH service among adolescents across all contexts. This led to the use of alternatives such as herbal medicine and maintained common myths and misconceptions. The overall quality was marred by the lack of dedicated spaces for adolescent health services and the lack of information, education and communication (IEC) materials in some spaces. Conclusion: While it was noted that some services were available for adolescents in all the study sites, numerous barriers inhibited access to these services and had an impact on the quality-of-service provision. With the added restriction to SRH service asses for young people, due to the low acceptability of adolescent SRH service use, the overall integration of adolescent SRH interventions into routine service provision was low and can be improved by targeting contextual barriers and maintaining best practices. [ABSTRACT FROM AUTHOR]

Background. Despite global efforts to promote contraceptive use and ensure reproductive health, Somalia continues to face significant challenges in this regard. This study aims to explore the prevalence of contraceptive use in Somalia and identify the determinants influencing its use. Methods. A total of 8,162 reproductive‐aged women's data were analyzed extracted from 2020 Somali Health and Demographic Survey. The outcome variable was contraception use, classified as any contraception use (yes vs. no), any modern contraception use (yes vs. no), and any traditional contraception use (yes vs. no). The explanatory variables were factors at the individual, household, and community level. The multivariate binary logistic regression model was used to explore associations of outcome variables with explanatory variables. Results. The findings revealed low prevalence of contraceptive use among Somalia women, with only 7% reporting its use. Among them, less than 1% utilized modern contraceptive methods. Several determinants of contraception use were identified, including younger age, higher educational attainment (primary and secondary education), higher parity, exposure to family planning messages through mass media, urban place of residence, and residing in the northwest and northeast regions of Somalia. Conclusion. The results underscore the urgent need for substantial efforts to improve contraceptive use in Somalia. Strengthening healthcare facilities to provide comprehensive sexual and reproductive health services, with a particular focus on promoting contraception uptake, is crucial. Public awareness campaigns and educational programs should also be prioritized to enhance knowledge and understanding of contraception among Somali women. [ABSTRACT FROM AUTHOR]

Adenomyosis is a benign gynecologic disorder that had previously not been well studied or understood. However, it is now become a more common diagnosis with long-standing implications especially for fertility. In this literature review, the pathophysiology and diagnosis along with management options for uterine preservation and fertility along with more definitive options are reviewed. While there is a better understanding of adenomyosis, there is still more research that is needed to fully elucidate the best ways of management for patients especially in those seeking fertility. [ABSTRACT FROM AUTHOR]

Background: Social problems related to infertility are associated with a significant psychological burden for the involved couple. Previous studies have shown the positive effects of couple interactions on the psychological health of these couples; however, the specific conditions of participating in assisted reproductive treatments (ART) might influence the effect of couple collaboration. Therefore, the present study aimed to evaluate the relationship between couple collaboration, well-being during infertility, and the psychological indicators of infertile couples undergoing fertility treatment. Methods: This cross-sectional study was conducted on 200 ART volunteer couples. Couple collaboration and well-being during infertility were evaluated using a validated researcher-made questionnaire, and the level of depression, anxiety, and stress was evaluated using the DASS-21 questionnaire in both couples. Statistical analysis was performed using the plug-in application PROCESS macro for SPSS and AMOS software. Results: The results showed that couple collaboration was correlated with the level of depression, anxiety, and stress. Moreover, depression, anxiety, and stress levels were correlated with well-being during infertility. The direct and indirect effect of couple collaboration on the depression level was significant; however, the direct effect of couple collaboration on the level of anxiety and stress was not significant, and the effect of couple collaboration on these indicators was mediated by well-being during infertility. The fit index of the equation modelling showed a good fit of the relationship path between the variables of couple collaboration, well-being during infertility, and psychological indicators (CMIN = 4.196, p = 0.260). Conclusion: The results of this study show that the specific conditions of participating in ART may affect the direct effects of couple interaction on an infertile couple's levels of anxiety and stress. These results suggest that in order to develop mental health programs for infertile couples, strategies based on couple collaboration that are associated with higher well-being during infertility should be developed and presented. Plain English Summary: Social problems related to infertility are associated with a significant psychological burden for the involved men and women. Previous studies have shown the positive effects of couple interactions on the psychological health of these couples. However, the specific conditions of participating in assisted reproductive treatments (ART) might influence the effect of couple collaboration. Therefore, the present study aimed to evaluate the relationship between couple collaboration, well-being during infertility, and the psychological indicators of infertile couples undergoing fertility treatment. This cross-sectional study was conducted on 200 ART volunteer couples. Couple collaboration, well-being during infertility and the level of depression, anxiety, and stress were evaluated using validated questionnaires. The results showed that the direct and indirect effect of couple collaboration on the depression level was significant; however, the direct effect of couple collaboration on the level of anxiety and stress was not significant, and the effect of couple collaboration on these indicators was mediated by well-being during infertility. The results of this study show that the specific conditions of participating in ART may affect the direct effects of couple interaction on an infertile couple's levels of anxiety and stress. These results suggest that in order to develop mental health programs for infertile couples, strategies based on couple collaboration that are associated with higher well-being during infertility should be developed and presented. [ABSTRACT FROM AUTHOR]

Rheumatoid arthritis (RA) is a chronic immune-mediated inflammatory disease which can induce progressive disability if not properly treated early. Over the last 20 years, the improvement of knowledge on the pathogenesis of the disease has made available several drugs targeting key elements of the pathogenetic process, which now represent the preferred treatment option after the failure of first-line therapy with conventional drugs such as methotrexate (MTX). To this category of targeted drugs belong anti-cytokine or cell-targeted biological agents and more recently also Janus kinase inhibitors (JAKis). In the absence to date of specific biomarkers to guide the therapeutic choice in the context of true precision medicine, the choice of the first targeted drug after MTX failure is guided by treatment cost (especially after the marketing of biosimilar products) and by the clinical characteristics of the patient (age, sex, comorbidities and compliance) and the disease (presence or absence of autoantibodies and systemic or extra-articular manifestations), which may influence the efficacy and safety profile of the available products. This viewpoint focuses on the decision-making process underlying the personalized approach to RA therapy and will analyse the evidence in the literature supporting the choice of individual products and in particular the differential choice between biological drugs and JAKis. [ABSTRACT FROM AUTHOR]

Simple Summary: This article explores the impact of chemotherapy on ovarian function in female cancer survivors, emphasizing the importance of preserving fertility alongside cancer treatment. Chemotherapy-induced ovarian failure (CIOF) poses a significant concern, affecting patients' quality of life. The study aims to identify genetic markers predictive of CIOF through a systematic review of existing literature. The review identifies four relevant studies focusing on genetic factors associated with CIOF. Findings suggest potential associations between genetic variations, like CYP3A4*1B and GSTA1, and CIOF risk. Moreover, BRCA mutations may influence ovarian reserve recovery post-chemotherapy. While current assessment methods rely on biochemical tests and ultrasound imaging, genetic testing holds promise for personalized fertility preservation strategies. Integrating genetic markers into clinical practice could revolutionize decision making in fertility preservation for female cancer survivors, enhancing reproductive potential preservation. Background: Recent advances in cancer diagnosis and treatment have significantly improved survival rates among women of reproductive age facing cancer. However, the potential iatrogenic loss of fertility caused by chemotherapeutic agents underscores the need to understand and predict chemotherapy-induced ovarian damage. This study addresses this gap by systematically reviewing the literature to investigate genetic markers associated with chemotherapy-induced ovarian failure (CIOF). Objective: The primary objective is to identify genetic markers linked to CIOF, contributing to a comprehensive understanding of the factors influencing fertility preservation in female cancer survivors. Methods: A systematic review was conducted using PubMed, EMBASE, Web of Science, Scopus, and OVID electronic databases from inception through December 2023. Studies were included if they featured genomic assessments of genes or polymorphisms related to CIOF in women with histologically confirmed tumors. Exclusion criteria comprised in vitro and animal studies, reviews, and pilot studies. The resulting four human-based studies were scrutinized for insights into genetic influences on CIOF. Results: Of the 5179 articles initially identified, four studies met the inclusion criteria, focusing on alkylating agents, particularly cyclophosphamide, and anthracyclines. Su et al. explored CYP3A41B variants, revealing modified associations with CIOF based on age. Charo et al. investigated GSTA1 and CYP2C19 polymorphisms, emphasizing the need to consider age and tamoxifen therapy in assessing associations. Oktay et al. delved into the impact of BRCA mutations on anti-Müllerian hormone (AMH) levels post-chemotherapy, supported by in vitro assays. Van der Perk et al. focused on childhood cancer survivors and revealed significant associations of CYP3A43 and CYP2B6*2 SNPs with AMH levels. Conclusions: This systematic review analyzes evidence regarding genetic markers influencing CIOF, emphasizing the complex interplay of age, specific genetic variants, and chemotherapy regimens. The findings underscore the need for a personalized approach in assessing CIOF risk, integrating genetic markers with traditional ovarian reserve testing. The implications of this study extend to potential advancements in fertility preservation strategies, offering clinicians a comprehensive baseline assessment for tailored interventions based on each patient's unique genetic profile. Further research is essential to validate these findings and establish a robust framework for integrating genetic markers into clinical practice. [ABSTRACT FROM AUTHOR]

Background: The composition of the vaginal microbiota during the menstrual cycle is dynamic, with some women remaining eu- or dysbiotic and others transitioning between these states. What defines these dynamics, and whether these differences are microbiome-intrinsic or mostly driven by the host is unknown. To address this, we characterized 49 healthy, young women by metagenomic sequencing of daily vaginal swabs during a menstrual cycle. We classified the dynamics of the vaginal microbiome and assessed the impact of host behavior as well as microbiome differences at the species, strain, gene, and phage levels. Results: Based on the daily shifts in community state types (CSTs) during a menstrual cycle, the vaginal microbiome was classified into four Vaginal Community Dynamics (VCDs) and reported in a classification tool, named VALODY: constant eubiotic, constant dysbiotic, menses-related, and unstable dysbiotic. The abundance of bacteria, phages, and bacterial gene content was compared between the four VCDs. Women with different VCDs showed significant differences in relative phage abundance and bacterial composition even when assigned to the same CST. Women with unstable VCDs had higher phage counts and were more likely dominated by L. iners. Their Gardnerella spp. strains were also more likely to harbor bacteriocin-coding genes. Conclusions: The VCDs present a novel time series classification that highlights the complexity of varying degrees of vaginal dysbiosis. Knowing the differences in phage gene abundances and the genomic strains present allows a deeper understanding of the initiation and maintenance of permanent dysbiosis. Applying the VCDs to further characterize the different types of microbiome dynamics qualifies the investigation of disease and enables comparisons at individual and population levels. Based on our data, to be able to classify a dysbiotic sample into the accurate VCD, clinicians would need two to three mid-cycle samples and two samples during menses. In the future, it will be important to address whether transient VCDs pose a similar risk profile to persistent dysbiosis with similar clinical outcomes. This framework may aid interdisciplinary translational teams in deciphering the role of the vaginal microbiome in women's health and reproduction. 9k3PVfrRnyX1V_8jfg2U5D Video Abstract [ABSTRACT FROM AUTHOR]

Objective: To provide a brief summary of the high incidence, symptomatology, different types, and diagnosis of adenomyosis and to explore various aspects of the disease, with the primary aim of raising awareness among gynecologists for appropriate and early detection. Background: Adenomyosis, a benign gynecological condition characterized by the infiltration of endometrial tissue into the myometrium, poses significant challenges to women's reproductive health. Methods: A narrative review was conducted by searching PubMed, Scopus, and Cochrane databases and offering a non-systematic summary and critical analysis of current knowledge on the impact of adenomyosis on women's health. Articles published in the English language up to May 2023, including original scientific papers, clinical trials, meta-analyses, and reviews focusing on various aspects of adenomyosis, were included in the synthesis of this review. Conclusions: Approximately 20% of women are affected by adenomyosis, which manifests with various subtypes, distinct epidemiological profiles, symptomatology, and treatment responses. Despite its clinical significance, adenomyosis remains understudied, resulting in a significant disparity in research and the literature compared to other gynecological conditions. The severity of adenomyosis is compounded when coexisting with endometriosis, particularly deep-infiltrating endometriosis (DIE), leading to exacerbated fertility issues and severe symptomatology. The wide range of symptoms, including adverse pregnancy outcomes such as pre-eclampsia, highlights its wider impact and emphasizes the need for increased awareness of the condition. Adenomyosis is frequently associated with treatment failure in endometriosis, contributing to dienogest resistance, elevated discontinuation rates, and persistent pain post-endometriosis surgery. Additionally, the lack of specific treatments tailored to adenomyosis poses a considerable challenge in clinical management. [ABSTRACT FROM AUTHOR]

Introduction: Spain is a multicultural society and has been defined by several authors as an immigrant-receiving country. Moroccan women of childbearing age constitute 28.20% of Moroccan immigrants. Objectives: describe the interaction processes that occur between health professionals and Moroccan immigrant women in reproductive healthcare. Methods: Qualitative descriptive study based on Grounded Theory. Thirty immigrant women from Morocco and thirty-five health professionals participated in the study. Specific dimensions of analysis were defined and used to design the interview guide and focus groups. Results: In the healthcare encounter, the construction of an effective communicative space between the people involved in it is essential; however, the language barrier and the interpersonal relationships characterized by silence in the encounter make a meaningful healthcare relationship difficult for those who participate in it. Conclusions: There are communication and relationship problems that alter healthcare and the professional–patient relationship which require the use of translation programs, the incorporation of intercultural meters, and the development of cultural competence in health professionals. [ABSTRACT FROM AUTHOR]

Background: Colombia has high numbers of internally displaced people, forced to migrate due to the conflict. 1 in 3 displaced women undergo pregnancy during adolescence, compared to around 1 in 5 in the non-displaced population, alongside health and resource inequalities between these groups. There is limited qualitative information available from the perspectives of displaced women experiencing adolescent pregnancy. This research explores how structural violence may feature in their experiences. Methods: Qualitative methods were used. Participants were recruited with purposive sampling, using key informants and snowball sampling technique. 14 semi-structured interviews were conducted in Ciudad Bolívar, Bogotá, involving 11 displaced women who began childbearing age 15–19 in the past 10 years, and 4 participants' mothers. Data was analysed using the theoretical framework of structural violence, and emergent themes categorised using thematic analysis. Results: Pregnancy was considered advantageous in many ways, but this was contradicted by resulting disadvantages that ensued. Structural violence was embedded in life stories, manifesting in poverty and difficulties accessing reliable income, poor access to healthcare and education following pregnancy. Institutional and interpersonal discrimination confounded these challenges. Conclusions: Pregnancy during adolescence was a contradictory experience, representing both a safety net and a trap due to a complex interplay of structural and cultural violence in everyday survival. Policymakers must consider the importance of the context surrounding adolescent pregnancy and address systematic disadvantages affecting women in these positions. Plain language summary: The violent conflict in Colombia has left many people forced to leave their homes and become 'internally displaced'. Internally displaced women are more likely to become pregnant during their adolescence than non-displaced women. This work tries to understand more about the everyday lives of displaced women who experience adolescent pregnancy, through interviews. The interviews were analysed and results interpreted using the theory of 'structural violence'. Structural violence describes how social structures such as racism, sexism, war and poverty determine life choices, leading to suffering and inequality. The work found that pregnancy and motherhood in adolescence for displaced women was positive in many ways by bringing purpose, status and companionship. However, these women also experienced many challenges after pregnancy, such as exclusion from education and secure employment and difficulty accessing healthcare. This demonstrated that structural violence features in multiple interconnected forms in the daily lives of displaced adolescent mothers. The work urges policymakers to appreciate the complexity of context surrounding adolescent pregnancy and motherhood, and to address the structural disadvantages facing women in these situations. [ABSTRACT FROM AUTHOR]

Background: Botswana is one of the countries severely impacted by the HIV/AIDS pandemic. Despite an extensive HIV prevention campaign, the incidence of HIV, particularly among women, remains high. Condoms play a significant role in preventing new HIV infections, although men and women do not consistently use them. Objective: The study assessed the individual, relationship and community factors associated with consistent condom use among women in Botswana. Design: A cross-sectional study using secondary data drawn from a national survey on Gender-Based Violence Indicators in 2012. Methods: The primary survey sampled 639 women, aged 18 years and older, using a multistage procedure. The final sample size for the secondary analysis included a total of 480 women who were sexually experienced and had reported using condoms with their male partners. Multivariate logistic regression analysis was employed to assess the association between consistent condom use and the explanatory variables. The multivariate logistic regression adjusted for cluster/community random effects. Results: About 43% of the women used condoms consistently in the past year. Consistent condom use was more likely among women who were employed in the past year (adjusted odds ratio = 1.77; 95% confidence interval = 1.25-2.50). While, women who lived with their partners (adjusted odds ratio = 0.46; 95% confidence interval = 0.28–0.74), had non-Christian beliefs (adjusted odds ratio = 0.52; 95% confidence interval = 0.29–0.92), perceived that their partners would be angry if they ask to use a condom (adjusted odds ratio = 0.19; 95% confidence interval = 0.06–0.58) and perceived that their community says women need their husband's permission to do paid work (adjusted odds ratio = 0.56; 95% confidence interval = 0.38–0.83) were less likely to use condoms consistently. Conclusion: Consistent condom use among Botswana's female population is suboptimal. Consistent condom use was higher among women with employment, and lower among women who lived with their partners, had non-Christian beliefs, feared their partners' reaction upon asking for condom use and held inequitable community gender beliefs. To enhance women's consistent use of condoms, friendly condom use information, female economic empowerment strategies and programmes that involve religious leaders and promote progressive and healthy masculine practices in Sexual Reproductive Health/HIV interventions should be considered. [ABSTRACT FROM AUTHOR]

Background: An essential aspect of human well-being is positive sexual health outcomes. However, the issue of adverse sexual health outcomes continues to be a major public health concern, particularly for women with disabilities in sub-Saharan Africa (SSA). Therefore, this current scoping review mapped studies conducted in the last twenty-nine years on the sexual health of women with disabilities from these five dimensions: sexual activity, contraceptive use, sexual autonomy, sexual violence and risky sexual behaviour, whilst seeking to identify the current state of knowledge and address the study gaps in SSA. Methods: This current scoping review was informed by the methodological framework proposed by Arksey and O'Malley. Exploratory searches were conducted in PubMed, Web of Science, African Journals Online, etc., to identify studies conducted in SSA that focus on sexual activity, contraceptive use, sexual autonomy, sexual violence and risky sexual behaviour among women with disabilities in SSA since the inception of the International Conference on Population and Development in 1994 to 30th of March 2024. This process resulted in the inclusion of seventeen (17) studies. Results: Of the 1362 identified through various databases, 34 studies were included for the full-text retrieval and screening; only 17 studies met the inclusion criteria. The eligible studies were conducted across six countries in SSA and published between 2008 and 2023. Eight studies used quantitative study type, six utilised qualitative approach, and three employed mixed-methods analysis. Two studies were conducted on sexual activity, ten were conducted on contraceptive use, four were conducted on sexual violence, and one study was conducted on risky sexual behaviour, whilst no study on sexual autonomy met the inclusion criteria. Conclusion: This review showed that there were few or scarce studies on sexual activity, contraceptive use, sexual autonomy, sexual violence and risky sexual behaviour among women with disabilities in SSA and even where the studies were substantial (contraceptive use), the majority of the studies were conducted in a country. Future studies should consider examining dimensions of sexual health, such as sexual autonomy, sexual activity and risky sexual behaviour of women with disabilities that were not available or were scarce in the literature. Plain language summary: Sexual health is really important for people's overall well-being, and it includes aspects like how we feel socially, mentally, emotionally, and physically. In sub-Saharan Africa, especially for women with disabilities, sexual health is a big concern. So, this review looked at studies done over the last 29 years about the sexual health of women with disabilities in sub-Saharan Africa. It focused on five areas: sexual activity, contraceptive use, sexual autonomy, sexual violence, and risky sexual behaviour. Databases were searched for relevant studies and found 17 that fit the set criteria. These studies were from six countries in sub-Saharan Africa and were published between 2008 and 2023. Most of the studies were about contraceptive use, with fewer focusing on sexual activity, sexual violence, and risky behaviour. There weren't any eligible studies on sexual autonomy. The review concluded that there's not enough research on these sexual health dimensions among women with disabilities in sub-Saharan Africa, especially on sexual autonomy, and future studies should explore this further. [ABSTRACT FROM AUTHOR]

AbstractBackgroundMethodsResultsConclusionThe contraception and reproductive health of adolescents and youth is critical to their development and global public health. In order to provide useful references for choosing and optimizing adolescent contraception and reproductive health measurement instruments, the objective of this review is to summarize existing relevant measurement instruments and analyze them in terms of application characteristics, comparison of traditional and newly developed instruments, and psychometric properties.A literature search was conducted of three databases (PubMed, Web of Science, and Embase Database) on articles published between database creation and March 2023, involving contraception and reproductive health measurement instruments for adolescents and youth. After critical appraisal, inductive content analysis was conducted.Eventually 14 measuring instruments that met the criteria were included. Most of these instruments have been developed for adolescents and youth and are reliable. Five of the instruments were developed specifically for females and none for male adolescents. In contrast to traditional instruments measuring adolescents’ contraceptive knowledge and contraceptive self-efficacy, newly developed instruments in recent years have focused on including the community and the family in their measurement.This review systematically summarizes existing measurement instruments for contraception and reproductive health among adolescents and youth. It provides a solid basis for promoting the use of existing instruments and the development of new ones. [ABSTRACT FROM AUTHOR]

AbstractThe overturning of Roe v. Wade dramatically altered the landscape of reproductive health care in the United States, yet the extent to which OBGYN influencers on TikTok (i.e., board-certified doctors who specialize in obstetrics and gynecology and have a large following on the social media platform TikTok) used their public platform during this time remains unexplored. This study conducted a content analysis of 441 TikTok videos to identify the most common health concerns raised by OBGYN influencers, their overall responses to the U.S. Supreme Court’s decision, and the strategies they used to combat stigma and misinformation surrounding women’s sexual and reproductive health. Results indicate that a rapidly changing legal landscape has created a complicated terrain for OBGYNs to navigate, where uncertainty and perhaps fear dictate how and to what extent OBGYNs openly discuss abortion and the overturning of Roe v. Wade on public platforms such as TikTok. The OBGYNs in the sample worked around these legal confines to share vital reproductive health information, combat stigma, and express their concerns over the U.S. Supreme Court’s decision. Surprisingly, OBGYNs in the sample rarely addressed sexual and reproductive health misinformation. Implications for these findings are discussed. [ABSTRACT FROM AUTHOR]

This research has suggested a link between major depressive disorder (MDD) and infertility, with interleukin‐18 (IL‐18) being proposed as a potential mediator due to its connections to both conditions. A Mendelian randomization (MR) approach was utilized in this study, which drew on genetic data from 500,199 European participants studied for MDD, along with additional IL‐18 and reproductive health data from the FinnGen consortium and GWAS datasets. Single nucleotide polymorphisms were employed as instrumental variables to examine the causal relationships between MDD, genetically predicted IL‐18 levels, and infertility. In our study, bidirectional MR analysis revealed a significant inverse causal relationship between MDD and genetically predicted IL‐18 levels, with a higher genetic predisposition to MDD, correlating with reduced IL‐18 levels (β: −0.40; 95% confidence interval (CI): −0.69 to −0.11; P = 7.09 × 10−3). Additionally, MDD is found to significantly increase the risk of female infertility. Notably, genetically predicted IL‐18 levels demonstrated a protective effect against female infertility (odds ratio (OR): 0.92; 95% CI: 0.86–0.98; P = 1.17 × 10−2). Mediation analysis indicated that genetically predicted IL‐18 levels partially mediated the impact of MDD on female infertility associated with cervical, vaginal, other or unspecified origin, accounting for up to 14.61% of this effect. No evidence of pleiotropy or heterogeneity was detected. The role of genetic predispositions to MDD in influencing genetically predicted IL‐18 levels, and subsequently, female infertility, was highlighted by our study, offering insights into the complex interplay between mental health and reproductive biology. These findings contribute to a deeper understanding of the genetic and molecular pathways influencing these conditions, suggesting new directions for research and potential therapeutic interventions. [ABSTRACT FROM AUTHOR]

Issue Addressed Methods Results Conclusions So What? Sexual and reproductive health (SRH) knowledge influences health literacy and promotes positive health behaviours. This scoping review explores the SRH knowledge of women in Australia and reports on knowledge assessment, ways of learning, enablers and barriers, and interventions to improve knowledge.Seven databases were searched for eligible articles published in English between 2012 and 2022.Eighty‐five sources were included for analysis. Data were mapped by knowledge topic and population group and charted against four review objectives. Assessment of knowledge was the primary focus in 59% of sources. Two sources used a validated knowledge assessment tool. Knowledge was assessed using self‐assessment, a measurement of correctness, or both. Women learnt about SRH through a range of sources, including healthcare providers, peers, family, internet, and school. Enablers and barriers spanned information content, delivery, timing, accessibility, interactions with those providing information, cultural and gendered norms, pre‐migration experiences, and functional health literacy. Nine sources reported on interventions to facilitate SRH knowledge.This review identified topics, population groups, and gaps in assessment of SRH knowledge of women in Australia. Overall, the measurement of women's SRH knowledge is largely conducted using unvalidated tools focusing on specific topics.It is recommended a validated tool be developed to comprehensively assess the SRH knowledge of women in Australia allowing for intersectional population analysis and exploration of knowledge conceptualisation. This would enable assessment of interventions aiming to improve SRH knowledge thereby facilitating improved health literacy and outcomes. [ABSTRACT FROM AUTHOR]

Background: Women in Himachal Pradesh encounter various restrictions impacting their reproductive health practices, including menstrual hygiene, breastfeeding, and complementary feeding. This qualitative survey aimed to explore these practices, beliefs, and challenges to inform targeted interventions. Methods: A qualitative survey was conducted from March 2021 to August 2022 across 20 selected blocks in 11 districts of Himachal Pradesh. Focus group discussions (FGDs) included a diverse range of participants, such as women of reproductive age, lactating mothers, Anganwadi workers, ASHAs, and other stakeholders. Thematic analysis identified common themes and patterns related to menstrual hygiene, breastfeeding, and complementary feeding. Results: Thematic analysis revealed key findings in each area. Menstrual hygiene practices included the continued use of cloth instead of sanitary pads, improper disposal of menstrual products, and prevalent social and religious taboos and myths. Despite awareness of breastfeeding benefits, misconceptions about alternative feeding methods persisted. Complementary feeding practices were generally well understood, but certain communities held beliefs against nonvegetarian foods and relied on commercially prepared products. Conclusion: The study underscores the need to address cultural beliefs, provide accurate information, and promote evidence-based practices to enhance reproductive health in Himachal Pradesh. Targeted interventions, education programs, and community-based awareness campaigns are essential to dispel myths, promote positive practices, and empower women to make informed decisions. [ABSTRACT FROM AUTHOR]

Background: Current guidance on the selection of appropriate contraception for people with multiple sclerosis (PwMS) is lacking. Objective: To address this gap, an expert-led consensus program developed recommendations to support clinicians in discussing family planning and contraception with women and men with multiple sclerosis (MS). Methods: A multidisciplinary steering committee (SC) of 13 international clinical experts led the program, supported by an extended faculty of 32 experts representing 18 countries. A modified Delphi methodology was used for decision-making and consensus-building. The SC drafted 15 clinical questions focused on patient-centered care, selection of contraception, and timing of stopping/starting contraception and disease-modifying therapies (DMTs). Statements addressing each question were drafted based on evaluation of published evidence and the experts' clinical experience. Consensus was reached if ⩾75% of respondents agreed (scoring 7–9 on a 9-point scale) with each recommendation. Results: Consensus was reached on 24 of 25 proposed recommendations, including how and when to discuss contraception, types and safety of contraceptives, and how to evaluate the most appropriate contraceptive options for specific patient groups, including those with significant disability or being treated with DMTs. Conclusion: These expert recommendations provide the first practical, relevant, and comprehensive guidance for clinicians on the selection of contraception in PwMS. [ABSTRACT FROM AUTHOR]

Fertility treatment, including assisted reproductive technology (ART), is increasingly used. Sex hormones influence seizure control as well as interacting with antiseizure medications, and so the hormonal manipulation involved in fertility treatments has direct implications for people with epilepsy. Here, we summarise the various fertility treatments and consider their important influences on epilepsy care. While early observations raised concerns about seizure exacerbation associated with ART, there are limited data to guide best practice in people with epilepsy, and further research is needed. [ABSTRACT FROM AUTHOR]

Introduction: A state of healthy physical, mental, and social welfare that is linked to reproductive processes and functions is known as reproductive health. Prospective brides require regular updates on initiatives to improve reproductive health and prevent reproductive health issues through the use of the appropriate media. The purpose of this research was to evaluate the effect of booklets on adolescents’ knowledge and attitudes about reproductive health services for prospective brides at the Denpasar City Health Center. Materials and methods: Pre-experimental design with one group pretest-posttest is used in this kind of research. The sample is 65 teenagers using simple random sampling technique. Knowledge and attitude data before and after the intervention were collected by questionnaire. The form of intervention is the use of booklets in reproductive health education and screening of prospective brides. Data were analyzed by Wiloxon test. Results: The analysis’s findings revealed a significant difference in the average knowledge before and after receiving education using booklet media (p=0.000), as well as a significant difference in the average attitude before and after receiving education using booklet media (p=0.000). Conclusion: Booklets are effective to increases adocescents’ knowledge and attitudes about reproductive health services and screening of prospective brides. [ABSTRACT FROM AUTHOR]

Introduction: Mobile applications have the potential to enhance the effective dissemination of precise information pertaining to HIV and sexual and reproductive health. The purpose of the study is a descriptive investigation aimed at assessing the validity of video-based learning media using a procedural development model. Materials and methods: The evaluation of validity was conducted by a group of specialists in the field of material and media using a product development assessment tool in the format of video-based learning materials. Results: Based on the analysis of seventeen expert evaluations, the average score obtained for the format, language, and content components was 3.53, and for four expert media evaluations, the average score obtained for the use of learning videos was 3.42. Conclusion: The mobile health education application program for mental health, HIV voluntary counseling, and testing among the deaf community is valid and can be used in the next research. [ABSTRACT FROM AUTHOR]

Introduction: The research regarding the effect of hookah smoking on health is still deficient, even though it has been proven to jeopardize human health by raising the hazard of different types of cancers, infections, and cardiovascular disease. We aimed to study the effect of dual tobacco smoking (hookah and cigarettes) on semen parameters of infertile men. Methods: In this cross-sectional study, we studied the effect of different types of smoking patterns on human semen parameters among men who visited IVF laboratories to do a seminal fluid analysis (SFA). A total number of 761 participants were included, divided into the following: 108 dual smokers, 219 hookah smokers, 222 cigarette smokers, and 212 non-smokers. To analyze the effect of dual smoking on normal morphology, an interaction term between the cigarette index and hookah index was used. Results: Multivariable regression analysis after adjustment for age, BMI, education level, children, chronic diseases, varicocele, testicular surgery history, infertility duration, and cause revealed no significant difference in the sperm concentration and the percentage of progressive motility between non-smokers, cigarette smokers, or hookah smokers. However, there was a significant difference in the log of normal morphology percentage between the three groups. Cigarette and hookah smoking were significantly associated with having lower percentages of normal morphology. There was a significant difference in the log-normal morphology %, where light and heavy dual smokers had the least exponential beta of log-normal morphology %, 0.43 (95% CI: 0.33–0.55) and 0.36 (95% CI: 0.24–0.53), respectively. Conclusions: Dual tobacco smoking can adversely affect sperm morphology. [ABSTRACT FROM AUTHOR]

BACKGROUND: Phenols and parabens are two classes of high production volume chemicals that are used widely in consumer and personal care products and have been associated with reproductive harm and pregnancy complications, such as preeclampsia and gestational diabetes. However, studies examining their influence on maternal blood pressure and gestational hypertension are limited. OBJECTIVES: We investigated associations between individual phenols, parabens, and their mixture on maternal blood pressure measurements, including systolic and diastolic blood pressure (SBP and DBP) and hypertension during pregnancy (defined as stage 1 or 2 hypertension), among 푁 = 1,433 Puerto Rico PROTECT study participants. METHODS: We examined these relationships cross-sectionally at two time points during pregnancy (16–20 and 24–28 wks gestation) and longitudinally using linear mixed models (LMMs). Finally, we used quantile g-computation to examine the mixture effect on continuous (SBP, DBP) and binary (hypertension during pregnancy) blood pressure outcomes. RESULTS: We observed a trend of higher odds of hypertension during pregnancy with exposure to multiple analytes and the overall mixture [including bisphenol A (BPA), bisphenol S (BPS), triclocarbon (TCC), triclosan (TCS), benzophenone-3 (BP-3), 2,4-dichlorophenol (2,4-DCP), 2,5-dichlorophenol (2,5-DCP), methyl paraben (M-PB), propyl paraben (P-PB), butyl paraben (B-PB), and ethyl paraben (E-PB)], especially at 24-28 wk gestation, with an adjusted mixture odds?ratio(OR)=1.57 (95% CI: 1.03, 2.38). Lower SBP and higher DBP were also associated with individual analytes, with results from LMMs most consistent for methyl paraben (M-PB) or propyl paraben (P-PB) and increased DBP across pregnancy [adjusted M-PB β=0.78 (95% CI: 0.17, 1.38) and adjusted P-PB β=0.85 (95% CI: 0.19, 1.51)] and for BPA, which was associated with decreased SBP (adjusted β=-0.57; 95% CI: -1.09, -0.05). Consistent with other literature, we also found evidence of effect modification by fetal sex, with a strong inverse association observed between the overall exposure mixture and SBP at visit 1 among participants carrying female fetuses only. CONCLUSIONS: Our findings indicate that phenol and paraben exposure may collectively increase the risk of stage 1 or 2 hypertension during pregnancy, which has important implications for fetal and maternal health. [ABSTRACT FROM AUTHOR]

Objective The aim of the study is to map the shared genetic component and relationships between thyroid and reproductive health traits to improve the understanding of the interplay between those domains. Design A large-scale genetic analysis of thyroid traits (hyper- and hypothyroidism, and thyroid-stimulating hormone levels) was conducted in up to 743 088 individuals of European ancestry from various cohorts. Methods We evaluated genetic associations using genome-wide association study (GWAS) meta-analysis, GWAS Catalog lookup, gene prioritization, mouse phenotype lookup, and genetic correlation analysis. Results GWAS meta-analysis results for thyroid phenotypes showed that 50 lead variants out of 253 (including 5/52 of the novel hits) were linked to reproductive health in previous literature. Genetic correlation analyses revealed significant correlations between hypothyroidism and reproductive phenotypes. The results showed that 31.9% of thyroid-associated genes also had an impact on reproductive phenotypes, with the most affected functions being related to genitourinary tract issues. Conclusions The study discovers novel genetic loci linked to thyroid phenotypes and highlights the shared genetic determinants between thyroid function and reproductive health, providing evidence for the genetic pleiotropy and shared biological mechanisms between these traits in both sexes. [ABSTRACT FROM AUTHOR]

A T-shaped uterus is a rare uterine malformation that is classically associated with diethylstilbesterol (DES) exposure. Surprisingly, the prevalence of T- and Y-shaped uterus has increased in recent years despite the absence of a diagnostic consensus and a correlation with the reproductive outcomes has been observed. A systematic electronic database search for all English-language studies published on reproductive outcomes associated with dysmorphic uteri over the past 10 years using PubMed, Google Scholar, and Scopus was performed. This uterine malformation is associated with impaired reproductive outcomes, including primary infertility, miscarriage, ectopic pregnancy, and preterm birth. Hysteroscopic metroplasty is a simple surgical procedure that could potentially improve outcomes in subfertile women, but the data are not robust. Studies reported significant improvements in implantation and pregnancy rates after corrective metroplasty in women undergoing in vitro fertilization. However, multicenter, prospective, randomized, and controlled trials are needed to validate these findings and to help define clear diagnostic criteria, surgical indications, and appropriate follow-up of reproductive outcomes after the procedure. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the usability and feasibility of incorporating a cardiovascular risk assessment tool into adolescent reproductive health and primary care visits. We recruited 60 young women ages 13-21 years to complete the HerHeart web-tool in 2 adolescent clinics in Atlanta, GA. Main Outcome Measures: Participants rated the tool's usability via the Website Analysis and Measurement Inventory (WAMMI, range 0-95) and their perceived 10-year and lifetime risk of cardiovascular disease (CVD) on a visual analog scale (range 0-10). Participants' perceived risk, blood pressure, and body mass index were measured at baseline and 3 months after enrollment. Health care providers (HCP, n = 5) completed the WAMMI to determine the usability and feasibility of incorporating the HerHeart tool into clinical practice. Adolescent participants and HCPs rated the tool's usability highly on the WAMMI with a median of 79 (interquartile range [IQR] 65, 84) and 76 (IQR 71, 84). At the baseline visit, participants' median perceived 10-year risk of a heart attack was 1 (IQR 0, 3), and perceived lifetime risk was 2 (IQR 0, 4). Immediately after engaging with the tool, participants' median perceived 10-year risk was 2 (IQR 1, 4.3), and perceived lifetime risk was 3 (IQR 1.8, 6). Thirty-one participants chose to set a behavior change goal, and 12 participants returned for follow-up. Clinical metrics were similar at the baseline and follow-up visits. HerHeart is acceptable to young women and demonstrates potential for changing risk perception and improving health habits to reduce risk of CVD. Future research should focus on improving retention in studies to promote cardiovascular health within reproductive health clinics. [ABSTRACT FROM AUTHOR]

There is limited research examining the sexual and reproductive health (SRH) care needs and experiences of Black adolescents who are assigned female at birth (AFAB). This study aimed to understand the perspectives of Black AFAB adolescents in their receipt of SRH counseling in primary care and elicit preferences for SRH-related communication with clinicians. We interviewed English-speaking Black AFAB adolescents, ages 13-17, living in North Carolina between February and June 2022 about their SRH care experiences. The interviews were conducted via video conferencing, audio-recorded, professionally transcribed, and analyzed using a thematic approach. We interviewed 23 adolescents (mean age 15.8 years) across 10 geographically diverse counties in North Carolina. Most conveyed positive perceptions of clinicians regarding trust and comfort. However, many expressed concerns about clinicians not doing enough to ensure patient confidentiality, provide them with enough information to make informed and autonomous decisions, and destigmatize discussing SRH issues during the clinical encounter. Suggested improvements include sociodemographic congruence between patients and clinicians (eg, younger Black women), ensuring time alone with clinicians across adolescence, and proactively sharing information to promote respect and autonomy. Although Black AFAB adolescents had positive perceptions of their health care providers regarding relational components of care, many participants shared significant gaps and areas for improvement in the quality of care received to better align services with their preferences for SRH care. These findings can inform the development of SRH counseling best practices and clinician education to support respect and autonomy, which are routinely denied to Black AFAB adolescents. [ABSTRACT FROM AUTHOR]

To discuss the use of hormonal contraception (HC) in elite women's competitive sports from an anti-doping perspective because 1) it changes the natural female hormonal milieu; 2) is used to manipulate the menstrual cycle with performance enhancement intent; 3) even though lowering endogenous testosterone levels, some HCs contain testosterone-like androgenic compounds with potential performance-enhancing effects. A complex interaction between rapidly advancing sports-relevant biomedical scientific discoveries, societal changes concerning sex and gender, and a zero-tolerance anti-doping ideology, leads to contentious results, jeopardizing the premises defining and protecting contemporary elite sport in general and that of women in particular. This is in part because of the two out of three criteria for inclusion on the World Anti-Doping Agency's List of forbidden substances and methods: i) actual or potential for performance enhancement, ii) actual or potential for health risk, and iii) counter to the Spirit of Sport concept. These criteria would suffice for the inclusion of HC on the List, especially in their androgenic form. The fact that they are not is good for women's reproductive rights but also illustrates the arbitrariness of the administration of WADA's Prohibited List of substances and methods in elite sports. [ABSTRACT FROM AUTHOR]

Purpose: This study aimed to investigate the changes in serum Anti-Müllerian Hormone (AMH) levels, sex hormone levels, follicle-stimulating hormone (FSH)/luteinizing hormone (LH) ratio in patients with celiac disease (CeD), and their correlation with clinical characteristics and nutrient levels. Methods: This cross-sectional study collected clinical and biochemical data from a total of 67 females diagnosed with CeD and 67 healthy females within the reproductive age range of 18–44 years. The study was conducted at a tertiary hospital between September 2016 and January 2024. Both groups underwent comprehensive clinical and laboratory assessments. Serum levels of AMH and sex hormones were quantified using chemiluminescence immunoassay, and their associations with CeD clinical features and nutrient levels were thoroughly analyzed. Results: The study included 67 patients and 67 controls with a mean age of 36.7±7.6 years. No statistically significant differences were found between the two groups in mean age, BMI, FSH, LH, E2, P levels, FSH/LH, menstrual irregularities, abortions history, parity, and gravidity (all P>0.05). However, AMH, T, FER, FA, Zn, and Se levels were significantly lower, and PRL levels were higher in the CeD group (all P<0.05). Spearman's correlation analysis showed that AMH levels were negatively correlated with age, tTG level, disease duration, and Marsh grading (P<0.05). Conclusions: This study highlights the association between impaired ovarian function in CeD patients and disease severity and nutrient levels. Early detection and intervention for ovarian function abnormalities are imperative to enhance fertility potential in CeD patients. [ABSTRACT FROM AUTHOR]

Background: Non‐obstructive azoospermia (NOA) diagnosis poses challenges for couples seeking parenthood. Microdissection testicular sperm extraction (MD‐TESE) excels in retrieving testicular sperm cells for NOA cases. However, limited live birth data in Australian NOA patients hinders accurate counselling. Aims: This study aimed to determine the likelihood of infertile couples with a male partner diagnosed with NOA conceiving biological children using MD‐TESE / intracytoplasmic sperm injection (ICSI). Materials and methods: A retrospective cohort study included 108 NOA men treated at a public fertility unit and a private fertility centre (May 2009–May 2022). Primary outcome: live birth rate (LBR); secondary outcomes: sperm retrieval rate, pregnancy rate, and neonatal outcomes. Results: Among 108 patients undergoing MD‐TESE, the positive sperm retrieval rate (PSRR) was 64.8% (70/108). Histology best predicted sperm retrieval success, with hypo‐spermatogenesis yielding a 94.1% PSRR. Age, testicular volume, and hormonal parameters had no significant impact. Mean male age: 35.4 years; mean partner age: 32.7 years. Fertilisation rate: 50.7%. LBR per initiated cycle: 58.7% (37/63); per embryo transfer: 63.8% (37/58); per initially diagnosed NOA man: 34.3% (37/108). Cumulative LBR: 74.1% (43/58); twin rate: 10.8% (4/37). No neonatal deaths or defects were observed among 47 live offspring. Conclusion: This study provides valuable data for counselling NOA couples on the probability of conceiving biological offspring. MD‐TESE and ICSI yielded favourable PSRR (64.8%) and LBR (63.8%). However, couples should be aware that once NOA is confirmed, the chance of taking home a baby is 34%. [ABSTRACT FROM AUTHOR]

Background: Systematic reviews and meta‐analyses are instrumental in shaping clinical practice. However, their findings can sometimes be marred by discrepancies and potential biases, thereby diluting the strength of the evidence presented. Umbrella reviews serve to comprehensively assess and synthesise these reviews, offering a clearer insight into the quality of the evidence presented. In the context of the relationship between sperm DNA fragmentation (SDF) and assisted conception outcomes, there is a divergence in the literature. Some reviews suggest a clear cause‐and‐effect linkage, whereas others present conflicting or inconclusive results. Objectives: In this umbrella review we aimed to synthesise the evidence collated in systematic reviews and meta‐analyses summarising the association of SDF with assisted reproductive technology (ART) outcomes. Search strategy: After preregistration (https://doi.org/10.17605/OSF.IO/6JHDP), we performed a comprehensive search of the PubMed, Scopus, Cochrane Library, Web of Science and Embase databases. We conducted a search for systematic reviews on the association between SDF and ART without any restrictions on language or publication date. Selection criteria: Systematic reviews and meta‐analyses assessing the association between SDF and ART outcomes were eligible. Data collection and analysis: We assessed the quality of the included reviews using AMSTAR 2 and ROBIS, and determined the degree of overlap of primary studies between reviews estimating the corrected covered area (CCA), adjusted for structural missingness. We evaluated the most recent reviews assessing the association of SDF with live birth, pregnancy, miscarriage, implantation, blastulation and fertilisation. The synthesis of evidence was harmonised across all included quantitative syntheses, re‐estimating the odds ratio (eOR) in random‐effects meta‐analyses with 95% confidence intervals (95% CIs) and 95% prediction intervals (95% PIs). We categorised the evidence strength into convincing, highly suggestive, suggestive, weak or nonsignificant, according to the meta‐analysis re‐estimated P‐value, total sample size, I2 statistic for heterogeneity, small study effect, excess significance bias and the largest study significance. Main results: We initially captured and screened 49 332 records. After excluding duplicate and ineligible articles, 22 systematic reviews, 15 of which were meta‐analyses, were selected. The 22 reviews showed a moderate degree of overlap (adjusted CCA 9.2%) in their included studies (overall n = 428, with 180 unique studies). The 15 meta‐analyses exhibited a high degree of overlap (adjusted CCA = 13.6%) in their included studies (overall n = 274, with 118 unique studies). AMSTAR 2 categorised the quality of evidence in 18 reviews as critically low and the quality of evidence in four reviews as low. ROBIS categorised all the reviews as having a high risk of bias. The re‐estimated results showed that the association of SDF with live birth was weak in one and nonsignificant in four meta‐analyses. Similarly, the association of SDF with pregnancy, miscarriage, implantation, blastulation and fertilisation was also weak or nonsignificant. The association of high SDF with different ART outcomes was also weak or nonsignificant for different interventions (IVF, ICSI and IUI) and tests. Conclusions: This umbrella review did not find convincing or suggestive evidence linking SDF with ART outcomes. Caution should be exercised in making any claims, policies or recommendations concerning SDF. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the role of formal reproductive endocrinology and infertility (REI) consultation in fertility preservation counseling in a pediatric/adolescent oncology patient population. Methods: Retrospective chart review was performed at an academic adult hospital from 2021 to 2022. Pre- and postpubertal patients admitted to the pediatric/adolescent oncology service with cancer diagnoses and imminent gonadotoxic chemotherapy plans were included. Baseline characteristics were collected, including patient age, sex, race, language, insurance, and cancer diagnosis. Primary outcomes were formal REI consultation and fertility preservation election. Results: Nineteen of 58 eligible patients received a formal REI consultation. Patients were more likely to elect fertility preservation if they received a consult. Females were more likely to receive a consult than males and more likely to elect fertility preservation. Patients of age ≥16 years were more likely to receive consultation than younger patients. However, all patients of age <16 years who received a consult elected fertility preservation. There was no difference in consultation based on race, language, or insurance. Thirteen of 19 patients who received an REI consultation elected fertility preservation. Ten of 11 female elections were ovarian suppression, an unproven method of fertility preservation. The two male elections were semen cryopreservation. Conclusion: Underutilization of formal REI consults and a relative lack of proven fertility preservation elections may shed light on a need for increased fertility preservation awareness among young oncology patients and the providers who care for them. A streamlined process that automates formal REI consultation for all eligible patients may maximize the potential for comprehensive counseling and improve patient participation in fertility preservation. [ABSTRACT FROM AUTHOR]

Purpose: Reproductive health (RH) is a critical issue among cancer survivors worldwide. However, in developing countries where RH services for patients with cancer are often lacking, reproductive concerns among adolescent and young adult (AYA) survivors remain uncertain. In this study, we assessed the reproductive concerns of AYA cancer survivors in a resource-limited context of Uganda. Methods: We collected data from AYA cancer survivors at two facilities in Uganda using an interviewer-administered questionnaire. Descriptive statistics were calculated, one-way analysis of variance was used for intergroup comparisons, and multiple regressions were used to test for predictors of reproductive concerns. Results: A total of 110 AYA cancer survivors, with a median age of 20 years (interquartile range [IQR], 18–22), were interviewed. More than half (53.6%) of the respondents were males. The median time since cancer diagnosis was 19 months (IQR, 13.0–35.0). Almost all (91.8%) respondents had a future desire to have children, but only 15.5% received reproductive counseling. The mean total score for the reproductive concern subscales was highest for the fertility concern, followed by the information-seeking and health-related concerns. Reproductive counseling, desire to have children, and respondents' age were the factors influencing reproductive concern. Conclusions: The study shows a strong desire for biological parenthood with very low reproductive counseling among AYA cancer survivors, who remain concerned about their fertility, information needs, and health. This outcome underscores the need to integrate RH services into resource-limited cancer care settings. [ABSTRACT FROM AUTHOR]

Purpose: We sought to evaluate physicians' baseline knowledge of fertility preservation services available to patients with a cancer diagnosis within the military health system (MHS). Methods: Data on current cancer prevalence of over 31,000 unique cancer diagnoses were obtained from a comprehensive nationwide MHS dataset. Additionally, a 22-item survey was distributed to physicians practicing within the MHS assessing knowledge of reproductive health benefits, oncofertility counseling practices, and subspecialist referral patterns. Results: From 2020 to 2022, there were 31,103 individuals of reproductive age with cancer receiving care at a military treatment facility. One hundred fourteen physicians completed our survey, 76 obstetrician gynecologists (OB/GYNs), 18 oncologists, and 20 primary care physicians (PCPs). Ninety-three percent of respondents felt conversations about fertility preservation for reproductive-aged patients with cancer were very important. A total of 66.7% of oncologists, 35.5% of OB/GYNs, and 0% of PCPs felt comfortable counseling patients on coverage. A total of 33.3% of oncologists, 29.3% of OB/GYNs, and 0% of PCPs were familiar with oncofertility Defense Health Agency guidelines. Conclusion: Primary care, OB/GYN, and oncology practitioners are well situated to provide fertility preservation counseling to all individuals with a cancer diagnosis, but differences in counseling and referral patterns and a lack of knowledge of current agency policies may impair a patient's timely access to these resources. We propose implementation of an electronic patient navigator to address gaps in oncofertility care and standardize patient counseling in the MHS. This patient-focused guide would serve as a valuable model in all types of health care settings. [ABSTRACT FROM AUTHOR]

The United States faces troubling fertility trends that include high percentages of unintended pregnancies, as well as record-low fertility rates and individuals having fewer offspring than they desire. To address these problems, scholars and public health advocates have argued for the implementation of fertility information into existing sex-education curricula. In this study, we draw from 32 semi-structured interviews with secondary school sex educators to gain insight into their experiences on this front. They contended that one of the greatest barriers to their successfully teaching fertility related material was that students do not find fertility information relevant. Participants described three appeals that they employ to communicate fertility information as persistently relevant to the adolescents in their classes. Our interviews revealed that all three of these relevance appeals employ targeted invitations for students to tailor fertility information in ways that fit them personally. These findings suggest a need to re-conceptualize targeting and tailoring research in ways that connect with the goals of in situ, relevance-oriented communication, and they indicate how a focus on teaching health educators to establish fertility as relevant would help to situate future generations for better sexual and reproductive health over a lifetime. [ABSTRACT FROM AUTHOR]