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Background: Before pregnancy is recognized, ovulation, fertilization, and implantation must all occur. Physical activity and sedentary behavior may impact pregnancy success by altering each or all of these processes. The aim of this review was to review the association between physical activity and sedentary behavior with spontaneous female and male fertility. Method: PubMed/MEDLINE, Web of Science, CINAHL, SPORTDiscus, and Embase were searched from inception to August 9, 2021. Eligible studies included randomized controlled trials or observational studies, published in English, describing an association between physical activity or sedentary behavior (exposures) and spontaneous fertility (outcome) among women or men. Results: Thirty-four studies from 31 unique populations were included in this review (12 cross-sectional studies, 10 cohort studies, 6 case–control studies, 5 randomized controlled trials, and one case–cohort study). Of the 25 studies among women, the majority identified mixed results (n = 11) or no association (n = 9) between physical activity and female fertility. Seven studies reported on female fertility and sedentary behavior, and 2 found sedentary behavior was associated with decreased female fertility. Of the 11 studies among men, most of the studies (n = 6) found that physical activity was associated with increased male fertility. Two of the studies reported on male fertility and sedentary behavior, and neither identified an association. Conclusions: The association between spontaneous fertility and physical activity in both men and women remains unclear, and the association with sedentary behavior remains largely unexplored. [ABSTRACT FROM AUTHOR]

Fundamental fertility changes in developed countries and persistently low fertility rates are increasingly being interpreted using concepts of gender equality, gender equity, and gender revolution. This article analyzes links between gender role attitudes and fertility in Lithuania between 1990–2017 from a comparative perspective. Lithuania is compared to Sweden and Estonia, as well as Austria, France, and Italy. Based on seven data sets, the analysis is done using cluster analysis and binary logistic regression approaches. The findings reveal country-specific differences and similarities. First, in most countries, those who support the most traditional attitudes toward gender roles are the likeliest to have children. Second, Lithuania is the most traditional society; it is the slowest of the countries analyzed to transition to egalitarianism, and its gender role attitudes that significantly affect fertility are changing. Finally, in some cases, in the most traditional society, Lithuania, and the most egalitarian, Sweden, a new trend is emerging, whereby those who have supported non-traditional attitudes toward gender roles are more likely to have children. [ABSTRACT FROM AUTHOR]

The study's primary purpose was to recognise the effects of determinants on the level of fertility and thereby explain the differences in trends in the regions of Slovakia. At the turn of the century, the differences in fertility in regions increased, but the total fertility rate decreased. Multivariate statistical methods clarified the regional effects of the level and nature of fertility. Initial regression surveys indicated weak effects between regions, which led to applying factor and cluster analysis to establish regional types. Comprehensive regression analysis was then applied. The strength and nature of regional relationships differed at the inter- and intra-regional levels. Research has demonstrated significant differences in fertility rates dependent on the socioeconomic environment, as regional types uniquely link to determinants. Moreover, each determinant has specific spatial patterns with unequal regression coefficients at different regional levels, which cannot be evaluated constantly. Knowing how spatial variation in fecundity occurs will enable future studies to elucidate the processes involved. Finally, fertility is vital for social assessment and policy formulation, the study’s findings could inform local decision-makers and planners in identifying the socioeconomic conditions underlying fertility at the regional level and planning appropriate intervention strategies. [ABSTRACT FROM AUTHOR]

Objective: Multiple sclerosis (MS) is an autoimmune disease of the central nervous system, and previous observational epidemiological studies have suggested an association between MS and male infertility; male infertility due to sperm abnormalities may result from a number of aetiological factors, such as genetics, autoimmune factors, etc., and there are currently no studies to assess whether MS is associated with sperm abnormalities in men. Therefore, we performed a Mendelian randomization (MR) analysis to assess the causal relationship between MS and abnormal spermatozoa. Methods: In this study, independent single nucleotide polymorphisms (SNPs) strongly associated with multiple sclerosis (MS) were identified by mining public genome-wide association study repositories and used as instrumental variables to explore causality. The causal effect of MS on sperm abnormalities was systematically assessed using two-sample Mendelian randomization (MR) techniques, and various analytical models such as inverse variance weighting (IVW), MR-Egger and MR-PRESSO were implemented to dissect the association. In addition, a wide range of sensitivity tests, including Cochran's Q test to detect heterogeneity, MR-Egger intercept analysis to assess bias, leave-one-out to test model robustness, and funnel plot analysis to detect potential publication bias, were implemented to ensure the robustness and reliability of the causal inference results. Results: There was a significant causal relationship between MS and abnormal sperm (OR 1.090, 95% CI [1.017–1.168], p = 0.014); The accuracy and robustness of the results were confirmed by sensitivity analysis. Conclusion: Here we show that there appears to be a causal relationship between multiple sclerosis and abnormal spermatozoa. MS as a chronic disease has a higher risk of concomitant sperm abnormalities in its male patients, and reproductive and fertility issues in men with MS should receive special attention from clinicians. [ABSTRACT FROM AUTHOR]

ABSTRACT Objectives Methods Results Conclusions Human childrearing is cooperative, with women often able to achieve relatively high fertility through help from many individuals. Previous work has documented tremendous socioecological variation in who supports women in childrearing, but less is known about the intracultural correlates of variation in allomaternal support. In the highly religious, high‐fertility setting of The Gambia, we studied whether religious mothers have more children and receive more support with their children.We randomly sampled 395 mothers and 745 focal children enrolled in the Kiang West (The Gambia) Longitudinal Population Study cohort. Structured interviews asked mothers who and how often people invest in their children, and about their religious practices. Data were collected at participants' homes on electronic tablet‐based long‐form surveys and analyzed using the Bayesian hierarchical models.Religiosity was weakly associated with women's higher age‐adjusted fertility. Maternal religiosity was negatively related to maternal investment in focal children, but positively associated with total allomaternal support. Specifically, a woman's religiosity was positively associated with allomaternal support from matrilineal kin, other offspring, and affinal kin, but unrelated to paternal, patrilineal, and non‐kin investment.These results suggest that higher fertility among religious mothers may be supported by high levels of investment from biological and affinal kin. Matrilineal kin, other siblings, and affinal kin seem to be the most responsive to a woman's religiosity. Our findings cast doubt on interpretations of women's religious behaviors as signals of fidelity, and instead suggest they may be part of strategies to enable collective allomaternal resources and higher relative fertility. [ABSTRACT FROM AUTHOR]

Background Objective Methods Results Conclusion The use of fertility indicators to predict ovulation has largely been studied for contraceptive purposes, while less so as fertility‐promoting tools.To investigate the association between fertility indicators and fecundability in Danish women trying to conceive.Web‐based preconception cohort study. We analysed data from 11,328 females aged 18–49 years trying to conceive without fertility treatment for ≤6 menstrual cycles, from the Danish SnartGravid.dk and SnartForældre.dk cohorts (2007–2023). Participants reported the use of fertility indicators (counting days since the last menstrual period, cervical fluid monitoring, urinary ovulation testing, feeling ovulation, using a smartphone fertility app and measuring basal body temperature [BBT]). Time to pregnancy was measured in menstrual cycles ascertained by self‐reported pregnancy status. We estimated fecundability ratios (FR) and 95% confidence intervals (CIs) using proportional probabilities regression models adjusted for age, socio‐economic position, health indicators, reproductive history and gynaecological factors.Fertility indicators were used by 63.3% of participants at study entry. Counting days was the most common (46.9%), while measuring BBT was the least (3.0%). Other indicators ranged from 17.0% to 23.6%, with 69.7% using more than one indicator. Compared with non‐use, use of any fertility indicator was associated with greater fecundability (adjusted FR 1.14, 95% CI 1.08, 1.19). Cervical fluid monitoring showed the strongest association (aFR 1.46, 95% CI 1.03, 2.07), followed by urinary ovulation testing (aFR 1.35, 95% CI 1.16, 1.58) and counting days (aFR 1.18, 95% CI 1.09, 1.29). Feeling ovulation and fertility apps were modestly associated with fecundability, while measuring BBT was not associated. Sensitivity analysis restricting to ≤2 cycles of attempt time and two cycles of follow‐up showed an aFR for any indicator use of 1.21 (95% CI 1.13, 1.31).In this Danish preconception cohort, use of fertility indicators was associated with a higher fecundability, varying by type of indicator. [ABSTRACT FROM AUTHOR]

To assess the association between ethnicity and fertility outcomes for men in a statewide cohort. We linked data from the Utah Population Database and Subfertility Health Assisted Reproduction and Environment database, to comprise a cohort of sub-fertile men who underwent semen analysis between 1998 and 2017 in Utah. A multivariable Cox proportional hazard model was constructed to understand the impact of ethnicity on fertility outcomes in our cohort. A total of 11,363 men were included. 1039 (9.1%) were Hispanic. 39.7% of men in the lowest socioeconomic status group were Hispanic (P <.001). When controlling for demographic and clinical factors, the number of live births was reduced for Hispanic men (hazard ratios [HR] = 0.62 [0.57-0.67], P <.001). Though fertility treatment had a positive effect (HR 1.242 [1.085-1.421], P <.001), in competing risks models, Hispanic men were less likely to use fertility treatment (HR = 0.633 [0.526-0.762], P <.001). Hispanic ethnicity is significantly associated with a lower likelihood of successful fertility outcomes in Utah. Hispanic men had nearly a 40% reduced likelihood of live births when controlling for sociodemographic factors. Our results indicate that, depending on age, Hispanic men have up to approximately 14 fewer live births per 100 men per year, pointing to a significant disparity in fertility outcomes in the state of Utah. Given 15.1% of Utah's population identifies as Hispanic and 18.7% of the United States population identifies as Hispanic on the 2020 Census, a better understanding of the association of ethnicity and fertility outcomes is imperative. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To evaluate fertility outcomes based on size and number of intramural leiomyomas and outcomes after removal. DATA SOURCES: Online searches: MEDLINE, Clinical-Trials.gov, PubMed, Cochrane Library, and PROSPERO Library from 1994 to 2023. METHODS OF STUDY SELECTION: A total of 5,143 studies were identified, with inclusion of 13 study groups. TABULATION, INTEGRATION AND RESULTS: Outcomes for size and number of leiomyomas were reported with clinical pregnancy rates and ongoing pregnancy or live-birth rates. In data sets with maximum leiomyoma diameters of less than 6 cm for study inclusion, women with leiomyomas smaller than 3 cm had lower clinical pregnancy rates than women without leiomyomas, with an odds ratio (OR) of 0.53 (95% CI, 0.38-0.76) and, for ongoing pregnancy or live-birth rates, an OR of 0.59 (95% CI, 0.41-0.86). The ORs for clinical pregnancy rates in women with intermediately-sized leiomyomas (those between 3 cm and 6 cm) were lower than in women without leiomyomas, with an OR at 0.43 (95% CI, 0.29-0.63) and, for ongoing pregnancy or livebirth rates, an OR at 0.38 (95% CI, 0.24-0.59). In data sets without exclusion for women with larger-sized leiomyomas, clinical pregnancy rates were lower for those with leiomyomas smaller than 5 cm compared with those without leiomyomas, with an OR of 0.75 (95% CI, 0.58-0.96). Women with leiomyomas larger than 5 cm showed no differences in clinical pregnancy rate compared with women without leiomyomas, with an OR of 0.71 (95% CI, 0.32-1.58). Although women with a single leiomyoma in any location had no differences in outcomes, those with more than one leiomyoma had lower clinical pregnancy rates and ongoing pregnancy or livebirth rates, with an OR of 0.62 (95% CI, 0.44-0.86) and 0.57 (95% CI, 0.36-0.88), respectively. The clinical pregnancy rate for women undergoing myomectomy for intramural leiomyomas was no different than those with intramural leiomyomas in situ, with an OR of 1.10 (95% CI, 0.77-1.59). CONCLUSION: Even small intramural leiomyomas are associated with lower fertility; removal does not confer benefit. Women with more than one leiomyoma in any location have reduced fertility. [ABSTRACT FROM AUTHOR]

Weight loss before conception is recommended for women with overweight or obesity to improve fertility outcomes, but evidence supporting this recommendation is mixed. To examine the effectiveness of weight loss interventions using lifestyle modification and/or medication in women with overweight or obesity on pregnancy, live birth, and miscarriage. An electronic search of MEDLINE, Embase, Cochrane Library, including Cochrane Database of Systematic Reviews and Cochrane Central Register of Controlled Trials, and Cumulative Index to Nursing and Allied Health Literature was conducted through July 6, 2022, via Wiley. Randomized controlled trials examining weight loss interventions through lifestyle and/or medication in women with overweight or obesity planning pregnancy were included. Random-effects meta-analysis was conducted, reporting the risk ratio (RR) for each outcome. Subgroup analyses were conducted by intervention type, type of control group, fertility treatment, intervention length, and body mass index (BMI). Clinical pregnancy, live birth, and miscarriage events. A narrative review and meta-analysis were possible for 16 studies for pregnancy (n = 3,588), 13 for live birth (n = 3,329), and 11 for miscarriage (n = 3,248). Women randomized and exposed to a weight loss intervention were more likely to become pregnant (RR = 1.24, 95% CI 1.07–1.44; I2 = 59%) but not to have live birth (RR = 1.19, 95% CI 0.97–1.45; I2 = 69%) or miscarriage (RR = 1.17, 95% CI 0.79–1.74; I2 = 31%) compared with women in control groups. Subgroup analyses revealed women randomized to weight loss interventions lasting 12 weeks or fewer (n = 9, RR = 1.43; 95% CI 1.13–1.83) and women with a BMI ≥ 35 kg/m2 (n = 7, RR = 1.54; 95% CI, 1.18–2.02) were more likely to become pregnant compared with women in the control groups. Miscarriage was higher in intervention groups who underwent fertility treatment (n = 8, RR 1.45; 95% CI 1.07–1.96). Pregnancy rates were higher in women undergoing preconception weight loss interventions with no impact on live birth or miscarriage rates. Findings do not support one-size-fits-all recommendation for weight loss through lifestyle modification and/or medication in women with overweight or obesity immediately before conception to improve live birth or miscarriage outcomes. [ABSTRACT FROM AUTHOR]

This article inspects the relationship between fertility and employment, providing an explanatory mixed-method analysis to gauge their nexus for rural and urban Albania over the 2000s. We instrument reproductive decisions with having two first-born daughters in a 2SLS model of employment. We show that having an additional child negatively influences employment probability for rural mothers, but not for women in urban areas. Heterogeneous analyses show that rural women who lack education or wealth are more dependent on their fertility decisions, whilst there are no relevant differences by occupation types. We further show that the fertility effect is reinforced by the characteristics of the rural household, such as the presence of seniors in the household or if the partner is working. We then examine qualitatively how structural and contextual settings influence women in their decisions. We inspect the experience of rural women and employers from three distinct rural municipalities. Interviews reveal several obstacles that create a gap between employer and employee expectations, resulting in females refusing job offers. The qualitative findings suggest that targeted policies on transport, childcare, and employment services are essential aspects of policy-making to favour rural and distant women's integration. [ABSTRACT FROM AUTHOR]

Advancements in the management of patients with chronic myeloid leukemia (CML) allowed them to achieve survival comparable with their healthy counterparts. Consequently, their care has widened with growing focus on quality of life, including parenting children. Although tyrosine kinase inhibitors (TKI) are contraindicated in pregnancy given their teratogenic effect, their effect on male fertility is less clear with contradictory results from animal studies and case reports/series. We compared the sperm analysis parameters, as the gold-standard assessment for male fertility, of 11 patients with CP- CML before and after TKI therapy. Median therapy duration was 5.1 years (range: 2.5–16.5). The sperm concentration, % progressive, and total motility before and after therapy were not significantly different (p = 0.376, 0.569, and 0.595, respectively). Our results suggest no impairment in fertility potential in male patients after TKI therapy. A larger sample size is crucial to support/refute our findings. [ABSTRACT FROM AUTHOR]

Objective: This study examines the association between political identity and young adults' fertility desires from 1989 to 2019. Background: Understanding the factors that shape fertility preferences is important because these preferences are the critical bridge between social forces and fertility. Identity is a theorized, but understudied, predictor of fertility desires. The increasing salience of political identity suggests that the association between political identity and fertility desires has strengthened over time. Method: Data come from the 1989–2019 waves of Monitoring the Future, a nationally representative study of 12th graders (N = 67,557). Regression models examined how political identity (measured by Republican or Democrat preference) predicts the desired number of children, measured both continuously and categorically. Results: Regardless of the period, Republicans desired more children than Democrats—a difference that grew over time, from 0.07 in 1989–1993 to 0.29 in 2014–2019. Differences in religiosity and attitudes toward gender and childbearing explained pre‐2004 partisan gaps. From 2004 and onward, these factors attenuated, but did not fully explain, Republican–Democrat gaps. In later periods, relative to Democrats, Republicans still wanted more children on average, had a higher probability of wanting four or more children in 2004–2013 and a lower probability of eschewing parenthood in 2014–2019. Conclusion: Political identity has become increasingly salient for fertility desires, suggesting that identity might shape fertility intentions and future fertility behavior. [ABSTRACT FROM AUTHOR]

Summary: Obesity has emerged as a prevalent global health concern, with its detrimental effects on the reproductive system and sexual function garnering increasing attention. Both men and women affected by obesity face a heightened risk of fertility challenges and sexual dysfunction. Although fertility and sexual function are distinct topics, they are intricately linked and mutually influential in both medical and societal contexts. Bariatric surgery (BS) has generated promising results in alleviating sexual dysfunction and enhancing fertility, results which are often gender specific. In men, improvements in sexual function can often be attributed to weight loss and subsequent optimizations in sex hormone levels. However, improving female sexual function may be related to a range of factors beyond weight loss. Bariatric procedures have shown limited benefits for male fertility; in fact, in some situations it can even be detrimental, leading to a decrease in sperm count and quality. Conversely, BS may positively impact female fertility, improving pregnancy and neonatal outcomes. Nevertheless, it is essential to consider the potential risks related to the adverse effects of malnutrition and rapid weight loss following BS, making it advisable to wait for 12–18 months before attempting pregnancy. [ABSTRACT FROM AUTHOR]

Some high‐income countries have total fertility rates as low as one child. Using Spanish administrative data, we document that temporary contracts correlate with lower first birth rates. Also, women with children are less likely to work split‐shift jobs with long breaks in the middle of the day. We build a life‐cycle model where women decide on labor supply and fertility. We show that reforms eliminating duality or split‐shift jobs raise women's labor participation, narrow the employment gap between mothers and nonmothers, and boost fertility for working women. These reforms, together with childcare subsidies, increase married women's fertility to 1.8 children. [ABSTRACT FROM AUTHOR]

The number of transgender and gender diverse (TGD) youth seeking care continues to increase, necessitating comprehensive counseling about potential long-term effects of gender-affirming medical interventions on fertility. The objective of this narrative review was to examine fertility-related knowledge, attitudes, and decision-making (including factors influencing decisions, decision regret, and decision tools) among TGD youth. We searched PubMed, PsycInfo, and Google Scholar for original, peer-reviewed research investigating TGD youth attitudes and knowledge of fertility and fertility preservation, perspectives on fertility counseling and fertility preservation decision-making, as well as fertility-related decision tools. We reviewed 106 studies; eight were included in this narrative review. Four studies assessed TGD youth knowledge and attitudes of fertility and fertility preservation, three examined perspectives on fertility counseling and fertility preservation decision-making, and three discussed development of decision tools. Key findings were that: (1) many TGD youth are aware of potential fertility-related impacts of gender-affirming treatments, but there are still unmet informational needs, (2) some TGD youth report an interest in future biological parenthood, and of those who are not currently interested in biological parenthood, many acknowledge their desires may change over time, (3) ongoing discussions about fertility and fertility preservation are critical, and (4) decision tools are in development. In conclusion, TGD youth and their caregivers should receive ongoing, comprehensive fertility counseling and decision tools may be helpful to facilitate these discussions and decisions in each youth's gender-affirming care journey. [ABSTRACT FROM AUTHOR]

Background: Male factor infertility affect up to 50% of couples unable to conceive spontaneously. Several non-hormonal pharmacological treatments have been proposed to boost spermatogenesis and increase chances of conception in men with infertility. Still, no clear evidence exists on the most effective treatment strategy. Objective: We aimed to compare the effectiveness of non-hormonal pharmacological treatment options for men with infertility using a systematic review and network meta-analysis. Methods: We searched MEDLINE, EMBASE, and CENTRAL until October 2023 for randomised/quasi-randomised trials that evaluated any non-hormonal pharmacological treatment options for men with idiopathic semen abnormalities or those with hypogonadism. We performed pairwise and network meta-analyses using a random effect model. We assessed risk of bias, heterogeneity, and network inconsistency. We calculated the mean rank and the surface under the cumulative ranking curve (SUCRA) for each intervention the maximum likelihood to achieve each of reported outcomes. We reported primarily on sperm concentration and other important semen and biochemical outcomes using standardised mean difference (SMD) and 95% confidence-intervals(CI). Results: We included 14 randomised trials evaluating four treatments (Clomiphene citrate, Tamoxifen, Aromatase inhibitors, anti-oxidants) and their combinations in 1342 men. The overall quality of included trials was low. Sperm concentration improved with clomiphene compared to anti-oxidants (SMD 2.15, 95%CI 0.78–3.52), aromatase inhibitor (SMD 2.93, 95%CI 1.23–4.62), tamoxifen (SMD − 1.96, 95%CI -3.57; -0.36) but not compared to placebo (SMD − 1.53, 95%CI -3.52- 0.47). Clomiphene had the highest likelihood to achieve the maximum change in sperm concentration (SUCRA 97.4). All treatments showed similar effect for sperm motility, semen volume, and normal sperm morphology. FSH levels showed significant improvement with clomiphene vs.anti-oxidant (SMD 1.48, 95%CI 0.44–2.51) but not compared to placebo. The evidence networks for LH and testosterone suffered from significant inconsistency (p = 0.01) with similar trend of improvement with clomiphene compared to other treatments but not compared to placebo. Conclusion: There is insufficient evidence to support the routine use of Clomiphene, tamoxifen, and aromatase inhibitors to optimise semen parameters in men with infertility. Future randomised trials are needed to confirm the efficacy of clomiphene in improving fertility outcomes in men. PROSPERO: CRD42023430179. [ABSTRACT FROM AUTHOR]

This study examines the effect of the COVID‐19 pandemic on fertility in Norway at the individual level. Studies using data at the macrolevel have found a positive short‐term effect of the pandemic on the fertility level in Norway, but women's fertility response to the pandemic may differ depending on their life situation. We use the first lockdown on March 12, 2020, as a marker of the pandemic and apply a regression discontinuity design to compare births of women that were conceived before the pandemic started with those conceived during the first eight months of the pandemic. The positive effect on women's fertility in Norway was mainly driven by women in life phases that have generally high fertility rates (women aged 28–35 years and women who already have children). These groups are likely to be in an economically and socially secure and stable situation in which the restrictions due to the pandemic had limited influence. Besides two exceptions, we do not find differences in the effect of the pandemic on childbearing by women's work situation. This is most likely related to the strong welfare state and the generous additional pandemic‐related measures taken by the Norwegian government. [ABSTRACT FROM AUTHOR]

Intermarriage between immigrants and native individuals highlights the need to study childbearing as a joint decision of couples, because fertility preferences are likely to differ for the two partners involved. This study focuses on Sweden, where the majority population holds a relative preference for daughters but many immigrants come from countries with son preferences. Using longitudinal registers for the period 1990–2009, I analyse third-birth risks according to the sex composition of previous children and type of union. Doing so allows the study of preferences from behavioural data: couples with a daughter preference, for example, are more likely to have another child if their two previous children were boys. Results show that third-birth risks tend to be higher in unions between Swedish women and immigrant men, whereas unions between Swedish men and immigrant women tend to exhibit lower third-birth risks. Son preferences are rarely realized in intermarriages. [ABSTRACT FROM AUTHOR]

In the European Union, the consequences of population aging are generally visible, including the negative impact of dynamically rising aging index and old-age dependency ratio. Besides the growing number of elders, the basis of the problem spiral can be identified with the excessively low population of child cohorts (aged 0--14 years) entering the working-age group (aged 15--64 years). The focus of the study is on childbearing behavior, i.e. fertility, in a geographical based approach, at the level of NUTS 2 regions. According to the results, it can be concluded that the total fertility rate exchanged significantly regionally in the European Union between 2010 and 2020. The previously outstanding values of Western and Northern Europe have decreased significantly, the Central and Eastern European regions, which were in an unfavorable situation at the beginning of the decade, have made a significant progress, while the low values of 2010 of the southern regions decreased even further. The average age of women at childbirth shows smaller differences than the total fertility rate, as births were brought forward in only one percent of the regions; on the other hand, the average age of having children has shifted later at different paces in certain parts of the European Union. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the abortion views and reproductive concerns of current in vitro fertilization patients after the US Supreme Court Dobbs v. Jackson decision, which overturned the Roe v. Wade decision guaranteeing abortion access. Methods: This is a cross-sectional survey of English-speaking patients undergoing in vitro fertilization from January to November 2022 at a large academic institution in a state with restricted abortion care. Participants completed a 43-question electronic survey which measured feelings about abortion, future fertility treatments, and embryo disposition both quantitatively and qualitatively. Results: Of 543 eligible patients, 267 (49%) consented to participate when called and were sent the survey. Of those, 180 (67%) completed it, resulting in a total completion rate of 33%. The majority believe abortion should be legal in the case of birth defects (90.8%) or rape or incest (90.3%). A significant proportion (91.4%) expressed concerns about abortion being illegal in the state that they receive infertility care. They reported some concern about making embryos (89.6%), controlling what happens to them (95.4%), and discarding them (94.4%). Patients wrote about their concerns with pursuing fertility treatments, fear of not having access to needed medical care, and the desire to remain close to states with less restrictive abortion laws. Conclusions: The evolving political landscape surrounding access to reproductive care has created significant concerns regarding legal regulation of these treatments and the disposition of embryos. By understanding patients' concerns, health care providers can more effectively advocate for the protection of fertility treatments and patients' autonomy in embryo disposition. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate the ability of ChatGPT-4 to generate a biomedical review article on fertility preservation. Methods: ChatGPT-4 was prompted to create an outline for a review on fertility preservation in men and prepubertal boys. The outline provided by ChatGPT-4 was subsequently used to prompt ChatGPT-4 to write the different parts of the review and provide five references for each section. The different parts of the article and the references provided were combined to create a single scientific review that was evaluated by the authors, who are experts in fertility preservation. The experts assessed the article and the references for accuracy and checked for plagiarism using online tools. In addition, both experts independently scored the relevance, depth, and currentness of the ChatGPT-4's article using a scoring matrix ranging from 0 to 5 where higher scores indicate higher quality. Results: ChatGPT-4 successfully generated a relevant scientific article with references. Among 27 statements needing citations, four were inaccurate. Of 25 references, 36% were accurate, 48% had correct titles but other errors, and 16% were completely fabricated. Plagiarism was minimal (mean = 3%). Experts rated the article's relevance highly (5/5) but gave lower scores for depth (2–3/5) and currentness (3/5). Conclusion: ChatGPT-4 can produce a scientific review on fertility preservation with minimal plagiarism. While precise in content, it showed factual and contextual inaccuracies and inconsistent reference reliability. These issues limit ChatGPT-4 as a sole tool for scientific writing but suggest its potential as an aid in the writing process. [ABSTRACT FROM AUTHOR]

To investigate whether gynecologic and radiation oncologists document discussions of chemoradiation treatment's gonadotoxicity for patients with cervical cancer and what patient and physician factors make discussions more likely. Women with LACC treated with definitive CRT between 2009 and 2022 were included. Visit notes with gynecologic and radiation oncologists were reviewed for sexual health discussions. Fertility and premature menopause discussions were only evaluated among premenopausal patients. Variables of interest including demographics and staging were collected. Univariate and multivariate analyses were conducted using Rv4.2.1. A total of 93 women were included (22–91 years old). Most were Stage IIB (32%) or IIIB (34%). Sexual health discussions occurred among 74.2% of patients and did not have a significant relationship with any patient factors. Fertility discussions occurred with 17.5% of the 57 premenopausal patients and were more likely among younger patients (≤31.9, p < 0.001) with fewer children (≤1, p < 0.001). Premature menopause discussions occurred among 73.7% of premenopausal patients and were more likely among younger patients (≤39.0, p = 0.015). It is promising to see that oncologists are discussing sexual health and premature menopause with most patients. The limited fertility discussions suggest that oncologists are less likely to discuss fertility as women approach the age of menopause or already have children. Involvement of reproductive endocrinologists and psychologists may provide patients with a more comprehensive understanding of long-term quality of life. [ABSTRACT FROM AUTHOR]

In the United States, access to contraception and abortion care is limited by policy makers aligned with conservative religious positions, which are often specifically Catholic or Evangelical Christian. In this post- Roe political climate, activists, policy makers, voters, and everyday individuals are responding to the loss of legal authority over one's body. This article analyzes fertility awareness methods, contraceptive practices also known as "natural family planning." I explore the feminist health history of fertility awareness methods to enhance body knowledge and how these methods differ from the Catholic Church's antiabortion position promoting natural family planning. This study is based on materials collected from the 1960s to the present on fertility awareness methods and natural family planning from feminist, Catholic, and global public health perspectives. I selected the 1960s due to the confluence of social changes: the organizing of a feminist health movement, the marketing of the contraceptive pill, and shifts in Catholic teachings. By charting the multiple meanings of fertility awareness methods, I highlight their potential as a full-body health strategy that can withstand multiple challenges to sexual and reproductive care. In line with reproductive justice goals, fertility awareness methods assist both those who are trying not to conceive and those who are trying to conceive, and unlike mainstream contraceptive technologies, they build networks of people practicing fertility awareness. Although fertility awareness methods are controversial because some feminist health advocates interpret them as undermining support for all contraceptives and aligning with an antiabortion agenda, I advocate for a visible, dynamic, inclusive feminist framing of these methods. [ABSTRACT FROM AUTHOR]

This study examined attachment insecurities, infertility-specific coping strategies, and quality of life (QoL) in 87 couples seeking fertility treatment. Partners completed self-report measures. Path analyses showed that women's and men's attachment anxiety were associated with their own lower QoL, whereas attachment avoidance was associated with their own and their partner's lower QoL. Adaptive coping in men and women were associated with women's higher QoL. Non-adaptive coping was associated with men and women's lower QoL. Coping strategies explained the associations between attachment and QoL. This highlights the importance of individual and dyadic factors for understanding QoL in couples seeking fertility treatment. [ABSTRACT FROM AUTHOR]

Objective: Many women with Turner syndrome (TS) will consider fertility options and pregnancy. We wished to examine the fertility and pregnancy outcomes in women with TS undergoing oocyte donation (OD) treatment or spontaneous pregnancy in a large single‐centre cohort. General population reference data or data from those with idiopathic premature ovarian insufficiency were used as comparators. Design: A retrospective single‐centre cross‐sectional study. Patients and Measurements: Seventy‐four women with TS underwent OD treatment with a total of 105 pregnancies, and 31 women with TS had 71 spontaneous conceptions. Fertility outcomes included clinical pregnancy and live birth rate. Pregnancy outcomes included miscarriage rate, prevalence of hypertension, gestational diabetes, lower segment caesarean section (LSCS), small for gestational age (SGA), prematurity and vertical transmission of TS. Results: In those with TS, OD pregnancies were associated with increased rates of LSCS and SGA compared to spontaneous pregnancies; LSCS (OR: 4.19, 95% CI: 1.6−10.8, p =.003) and SGA (OR: 2.92, 95% CI: 1.02−8.38, p =.04). There were no recorded cardiac events but 5 (17.2%) cases of vertical transmissions of TS in daughters were identified. OD in those with TS was associated with a lower live birth rate per cycle started (OR: 0.53, 95% CI: 0.34−0.84, p =.008) and a higher rate of miscarriage compared to women with POI (40% vs. 26.2%, p =.04). Conclusions: We show that pregnancy in women with TS, whether OD or spontaneously conceived, carries obstetric risks, and therefore, women with TS, considering pregnancy, should receive comprehensive pre‐pregnancy counselling and optimal obstetric care. [ABSTRACT FROM AUTHOR]

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Background: Currently, awareness about platelet count (PC) and its consequences for perinatal outcome have increased, but there is little reliable evidence on fecundability. Methods: Based on the National Free Pre-conception Check-up Projects supported by the Chinese government, 5,524,886 couples met the inclusion criteria and were included in this cohort study. Cox regression models were adopted to estimate fecundability ratios (FRs) and their 95% confidence intervals (CIs) for pre-pregnancy PC quintiles. Restricted cubic splines were used to flexibly model and visualize the relationship of PC with FRs. Microsoft SQL server and R software were used for data management and analysis. Results: The median of pre-pregnancy PC among women was 221.00 x 109/L. The first (<177.00 x 109/L) and second quintile (177.00-207.99 x 109/L) of PC showed slightly increased fecundability (Q1: adjusted FR 1.05; 95% CI, 1.04-1.06; Q2: adjusted FR 1.04; 95% CI, 1.03-1.05), while higher quintals (Q4: 236.00-271.99 x 109/L; Q5: ≥272.00 x 109/L) were related to reduction of fecundability, when compared with the third quintile of PC (208.00-235.99 x 109/L) (Q4: adjusted FR 0.96; 95% CI, 0.95-0.97; Q5: adjusted FR 0.88; 95% CI, 0.87-0.89). In the first quintiles (<177.00 x 109/L), only 20.93% women had PC below 129.94 x 109/L. An inverse-U-shaped association was consistently observed among women such that the lower PC within the normal range (<118.03 x 109/L) and higher PC (>223.06 x 109/L) were associated with the risk of reduced female fecundability (P for non-linearity < 0.01). Conclusion: PC is associated with female fecundability. Further classification of PC levels may deepen our understanding of the early warnings and significance of female fecundability. [ABSTRACT FROM AUTHOR]

Purpose: This retrospective cohort study assessed semen and testicular tissue quality from adult and adolescent cancer patients who had samples cryopreserved in the Cryobank of Charité-Universitätsmedizin before and/or after cancer treatment. Methods and Materials: Medical and cryopreservation data for all samples stored between 03/2004 and 05/2019 were collected retrospectively. Results: We included information on 601 samples cryopreserved from 506 cancer patients for whom oncologic treatment data were available. The majority of the samples were cryopreserved prior to cancer treatment (460/600, 77%, median 5 days before treatment). Semen quality had a predisposed reduction in those collected from adolescents with testicular and/or hematological malignancies. Analyses of the 140 (23%) samples cryopreserved after treatment initiation (median of 84 days) revealed decreased median concentration and motility following high gonadotoxic-risk treatment. Rate of oligoasthenozoospermia was comparable in samples collected prior to treatment with those provided during follow-up spermiograms within 1 year after treatment initiation (45.5% vs 45.5%). However, an increase was seen in samples collected 1– 2 (9.1% to 90.9%) and 2– 3 (50.0% to 100.0%) years after treatment initiation. Conclusion: Cancer diagnosis and treatment may impair spermatogenesis; therefore, patient counseling prior to cancer treatment by an oncologist and/or fertility specialist is crucial. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusions To evaluate whether extending embryo culture to day 5 (D5) affects pregnancy rates in women older than 38 years undergoing in vitro fertilization (IVF).This retrospective, observational cohort study included data from fresh IVF cycles of women over 38 years, during 2011–2021. The cohort was divided according to day 3 (D3) versus D5 embryo transfer (ET).A total of 346 patients (ages 38–45 years) who underwent 496 IVF cycles were included, each yielding one to six embryos. A total of 374 (75%) fresh D3 ETs were compared with 122 (25%) D5 ETs. Demographically, there were more nulliparas in the D3 group (189 [50.9%] vs 47 [38.8%], P = 0.021). Higher gonadotropin dosage was used (3512 ± 1346 vs 3233 ± 1212 IU, P = 0.045) and lower maximum estradiol levels were reached in the D3 group (1129 ± 685 vs 1432 ± 708 pg/mL, P = 0.002). Thirty‐three (27%) of the D5 cycles resulted in transfer cancelation due to failure of blastocyst formation (P = 0.001). However, clinical pregnancy rates (P = 0.958), live birth rates (P = 0.988), and miscarriage rates (P = 0.710) did not differ between D3 and D5 ETs. Multivariable logistic regression for clinical pregnancy rate showed that day of transfer did not have a significant effect on the odds (P = 0.376), but maternal age (P = 0.001) and number of retrieved oocytes (P = 0.009) were significant variables.In older women, culturing embryos to blastocyst stage can decrease invalid ETs without reducing pregnancy rates. Cancelation rates are higher but it may avoid interventions and conserve valuable time. [ABSTRACT FROM AUTHOR]

The topic of fertility in women with spondyloarthritis (SpA) has been scarcely investigated to date. Recent systematic reviews and registry studies have brought renewed attention to the plight of women of childbearing age with rheumatic diseases, in particular SpA. Fertility may be impacted by physical impairment, hormonal imbalances and psychological distress. Several studies observed a reduction in anti-Müllerian hormone in women with SpA, reflecting a reduced ovarian reserve (OR). Furthermore, disease activity and the use of certain therapies can alter fertility, and this is reflected in a prolonged time-topregnancy (TTP), a validated outcome measure that can evaluate the status of subfertility. The employment of glucocorticoids or non-steroidal antiinflammatory drugs has also been linked to reduced fertility, whereas the use of biologics, especially tumour necrosis factor inhibitors (TNFi), is not associated with a prolonged TTP. In all women of childbearing age with rheumatic diseases, preconception counselling is paramount, and a referral to a reproductive specialist should be considered in the presence of multiple factors that may influence fertility. A comprehensive evaluation involving a multidisciplinary team of rheumatologists, gynaecologists, and often psychologists is warranted. In this narrative review, we collected the currently available literature focusing on fertility issues in women affected by SpA, providing data on fertility outcomes, hormonal imbalance, and therapeutic concerns. [ABSTRACT FROM AUTHOR]

Preimplantation embryo culture, pivotal in assisted reproductive technology (ART), has lagged in innovation compared to embryo selection advancements. This review examines the persisting gap between in vivo and in vitro embryo development, emphasizing the need for improved culture conditions. While in humans this gap is hardly estimated, animal models, particularly bovines, reveal clear disparities in developmental competence, cryotolerance, pregnancy and live birth rates between in vitro-produced (IVP) and in vivo-derived (IVD) embryos. Molecular analyses unveil distinct differences in morphology, metabolism, and genomic stability, underscoring the need for refining culture conditions for better ART outcomes. To this end, a deeper comprehension of oviduct physiology and embryo transport is crucial for grasping embryo–maternal interactions' mechanisms. Research on autocrine and paracrine factors, and extracellular vesicles in embryo–maternal tract interactions, elucidates vital communication networks for successful implantation and pregnancy. In vitro, confinement, and embryo density are key factors to boost embryo development. Advanced dynamic culture systems mimicking fluid mechanical stimulation in the oviduct, through vibration, tilting, and microfluidic methods, and the use of innovative softer substrates, hold promise for optimizing in vitro embryo development. [ABSTRACT FROM AUTHOR]

We explore, using a unique survey dataset containing retrospective information on immigrants' legal status, the relationship between previous irregular experience—from arrival up to the first residence permit achievement—and fertility patterns among non-EU immigrant women in Italy. While competing hypotheses explaining migrants' fertility behaviour have been recurrently offered, there is a substantial lack of knowledge on the role of undocumented experience as a contextual barrier in shaping international migrants' family formation processes. We adopt a life-course approach, employing event history analysis and Poisson regression modelling, to investigate how irregularity among immigrant women intertwines with the timing of the first childbirth and the total number of births occurred in Italy. We find that irregular experience—as a time-dependent process—delays the transition to childbirth post-migration. Furthermore, having experienced irregular status reduces completed fertility, offering few possibilities to catch-up over the life-course with fertility levels of women continuously having the legal status. Findings suggest long-lasting effects of irregular status and the potential disruption of migrant's fertility induced by migration policies, admission systems, and regulation factors. The reduced possibility of legal entry channels and lack of migration policies for planning and managing migration into Italy may thus have an impact on family formation trajectories among international immigrant women. [ABSTRACT FROM AUTHOR]

Background: Evidence supports the benefits of hydroxyurea (HU) in adults with sickle cell disease (SCD), but reservations remain due to long-term concerns of fertility. Retrospective analysis of clinical records of SCD patients (haemoglobin SS genotype) have identified gender-related differences in disease progression. This could inform risk stratification during SCD at diagnosis with the possibility to guide therapeutic decisions. Methods: This systemic review and meta-analysis evaluated fertility parameters in both children (aged ≥ 6 years) and adults with SCD receiving HU therapy. Studies were sourced from PubMed and EMBASE from inception to July 2023. A total of 160 potentially relevant articles were identified. Results: Four studies were included that evaluated the effects of HU on sperm parameters in males. A further 4 studies assessed anti-mullerian hormone (AMH) levels and ovarian reserves in females. Differences from baseline values were used to identify compromised fertility. Amongst males, HU treatment negatively impacted the concentration of spermatozoa (MD = -15.48 million/mL; 95% CI: [-20.69, -10.26]; p< 0.001), which continued following treatment cessation (MD = -20.09 million/mL; 95% CI: [-38.78, -1.40]; P = 0.04). HU treatment also led to lower total sperm counts (MD = -105.87 million; 95% CI: [-140.61, -71.13]; P< 0.001) which persisted after treatment (MD = -53.05 million; 95% CI: [-104.96, -1.14]; P = 0.05). Sperm volume, initial forward motility and morphology were unaffected by HU treatment. In females, HU treatment decreased the mean AMH levels 1.83 (95% CI [1.42, 2.56]. A total of 18.2.% patients treated with HU showed reduced ovarian reserves. Interpretation & conclusions: This systemic review and meta-analysis suggest that the use of HU for SCD impacts seminal fluid parameters in males and can diminish AMH levels and ovarian reserves in females. [ABSTRACT FROM AUTHOR]

Introduction: TNF-α, LT-α, and sCD40L belong to the TNF superfamily and play a pivotal role in chronic inflammatory disease. Yet, these soluble molecules are largely unexplored in endometriosis cases with infertility. The present study aimed to evaluate serum and peritoneal fluid levels of these molecules and correlate its level to the endometriosis severity. Methods: Peripheral blood and peritoneal fluid samples were obtained from 87 infertility cases who underwent laparoscopy, consisting of 44 endometriotic women and 43 non-endometriotic women. The levels of TNF-α, LT-α, and sCD40L were determined using ELISA. Results: Serum and peritoneal TNF-α levels were significantly elevated in the endometriosis group compared to the control group (p = 0.028; p = 0.027), but not the sCD40L and LT-α level. Serum and peritoneal TNF-α levels were significantly different between late-endometriosis (stage III or IV) compared to the control group (p = 0.026, p = 0.041, respectively). Moreover, the serum LT-α level was significantly higher in late-endometriosis cases compared to the early-endometriosis (stage I or II) cases (p = 0.03) and showed a positive correlation with endometriosis rASRM score (p = 0.001). ROC curve analysis showed a significant diagnostic value of serum LT-α in differentiating the late cases to the early endometriosis patients (AUC = 0.751, p = 0.007). A negative correlation between LT-α and total Endometriosis Fertility Index (EFI) score was also observed (p = 0.012). Conclusion: Severe endometriosis and lower EFI score are associated with higher serum LT-α level. Serum LT-α is a potential staging biomarker among endometriosis cases. Serum and peritoneal TNF-α levels were elevated in women with severe endometriosis among infertility cases. Further study should address the role and predictive value of LT-α in endometriosis-related infertility. [ABSTRACT FROM AUTHOR]

The current study shows how the traditional feminine clothing functions as a system of signs in Rupea (Romania). For this purpose, several photos taken on the occasion of various community events, and commented in interviews with local people, were capitalized through photo elicitation. The differences in the outfits worn by girls and women underline the importance given by the community to its female members' nubility and fertility. The clothing is a sign showing marital status. The community uses it as a means to guide males' connubial choices. Moreover, it indicates each woman's place in the community and in her kin. [ABSTRACT FROM AUTHOR]

Ovarian transposition (OT) has been proposed as a protective measure against radiation-induced damage to ovarian function and fertility. Despite its historical use, limited research has focused on evaluating endocrine and exocrine ovarian function after OT performed in adolescents and young adults (AYAs) before or during puberty. The purpose of our study was to investigate the fertility, pubertal development, and ovarian function of women with a previous history of OT during childhood, adolescence or young adulthood. In an observational bicentric retrospective study, we included 32 young female cancer patients who underwent OT before the age of 26 between 1990 and 2015 at Lyon Léon Bérard Cancer Center or Nancy University Hospital. The mean age at the time of OT was 15.6 years with a cancer diagnosis at 15 ± 4.8 years. Among the 10 women attempting pregnancy post-treatment, 60% achieved successful pregnancies. After a mean follow-up of 9.6 ± 7 years, 74% (17 out of 23) of women recovered spontaneous menstrual cycles (seven out of eight evaluable women with OT before or during puberty). Notably, 35% of women who did not attempt pregnancy demonstrated adequate ovarian reserve. Ovarian reserve and function recovery were influenced by the specific chemotherapy received. Importantly, our findings suggest that OT's effectiveness on ovarian activity resumption does not significantly differ when performed before or during puberty compared to pubertal stages. This study contributes valuable insights into the long-term reproductive outcomes of young women undergoing OT, emphasizing its potential efficacy in preserving ovarian function and fertility across different developmental stages. [ABSTRACT FROM AUTHOR]

Key Clinical Message: Endometriosis may contribute to Mullerian adenosarcoma development but makes diagnosis challenging given similar symptoms. Survival benefit has not been definitively shown for chemotherapy, hormonal therapy, or radiotherapy, consolidating surgery as the mainstay treatment. Local excision may be a treatment option for patients with confined tumors wishing to preserve their fertility. [ABSTRACT FROM AUTHOR]

Background: Postpartum hemorrhage (PPH) and post-abortion hemorrhage (PAH) are life-threatening conditions. Purpose: To evaluate the efficacy and safety of uterine arterial embolization (UAE) for PPH and PAH and to investigate future fertility after UAE. Material and Methods: This study included 57 consecutive patients (mean age = 34 years) who underwent UAE for PPH (n = 46) and PAH (n = 11) at our institution between January 2011 and December 2022. Technical success, non-visualization of the peripheral portion of bilateral uterine arteries on angiography, and clinical success, complete hemostasis after UAE, were assessed. UAE-associated complications and factors related to clinical success were analyzed. Pregnancy outcomes after UAE and complications during subsequent pregnancy were investigated in 16 patients who desired fertility and were followed up for >1 year. Results: The technical and clinical success rates were 100% and 84.2%, respectively. Sepsis (n = 1) and uterine empyema (n = 1) were observed as severe complications. Placental disorder, bleeding within 24 h after delivery or abortion, ≥1.5 shock index, ≥6 units of transfusion erythrocytes, and ≥8 obstetrical disseminated intravascular coagulation score were significantly associated with unfavorable clinical outcomes. In total, 16 pregnancies were observed in 12 patients after UAE, three of which were miscarriages and 13 were successful live births. During pregnancy, uterine rupture (n = 1) and accreta (n = 1) were observed. Conclusion: UAE is an effective treatment for PPH and PAH. Although UAE could preserve future fertility, careful attention should be paid to perinatal management for unusual complications. [ABSTRACT FROM AUTHOR]

Objective: To translate and culturally adapt the COMPI Fertility Problem Stress Scale–Short form (COMPI‐FPSS‐SF) and to test its reliability and validity in China. Methods: The cross‐sectional study adopted Brislin's translation model to translate, synthesize, back‐translate, and cross‐culturally adapt the COMPI‐FPSS‐SF for the Chinese setting. A total of 279 infertile women were invited to participate in the study to test the reliability and validity of the scale between March and June 2021. Results: It was verified that the Chinese version of the COMPI‐FPSS‐SF has three domains with nine items. The Cronbach's α coefficient of the total scale was 0.907, and the coefficient for each dimension ranged from 0.760 to 0.855. The test–retest validity was 0.891. The exploratory factor analysis extracted three common factors with eigenvalues of 4.499, 1.124, and 1.011 and a cumulative variance contribution of 73.706. The validity factor analysis showed good results for the three‐factor structure fit. The criterion‐related validity with the Fertility Inventory Short‐Form Scale was 0.649. The above analysis revealed statistically significant differences (P < 0.001). Conclusions: The Chinese version of the COMPI‐FPSS‐SF can be used for the assessment of fertility‐related stress in infertility patients in China with good reliability and validity. Synopsis: The Chinese version of the COMPI‐FPSS‐SF can be used for the assessment of fertility‐related stress in infertility patients in China with good reliability and validity. [ABSTRACT FROM AUTHOR]

For generations, women have relied on fertility awareness methods to plan and prevent pregnancy, for over a decade, many have been aided by digital tools to do so. New contraceptive fertility tracking apps (CFTAs)—that are backed by clinical efficacy trials to support their effectiveness as contraception—have the potential to enhance method choice and offer users a unique contraceptive option, but there is little evidence to inform the decisions around expanding access, particularly in low‐and middle‐income countries. We conducted a mixed methods study with quantitative online surveys (n = 1600) and qualitative interviews (n = 36) to explore the potential appeal of and demand for a hypothetical CFTA in one such market, the Philippines. Interest in using a CFTA was high among our Internet‐engaged, urban study population, with 83.9% "definitely" or "probably" interested in using it. Across demographic profiles, respondents perceived the appeal of the method as "natural" and "convenient." A majority were willing to pay for the method, though notably at a price (5.20 USD) below that of currently available CFTAs. We discuss various important factors to be considered before bringing a method like this to new markets, including the potential implications of equity constraints in reaching a wider market and the unexpected prevalence of other period‐tracking apps not intended as contraception being used in this market that could complicate any future roll‐out. These issues could be explored further with additional research. [ABSTRACT FROM AUTHOR]

In recent years, the awareness that pesticides can have other effects apart from generic toxicity is growing. In particular, several pieces of evidence highlight their influence on human fertility. In this study, we investigated, by a virtual screening approach, the binding between pesticides and proteins present in human gametes or associated with reproduction, in order to identify new interactions that could affect human fertility. To this aim, we prepared ligand (pesticides) and receptor (proteins) 3D structure datasets from online structural databases (such as PubChem and RCSB), and performed a virtual screening analysis using Autodock Vina. In the comparison of the predicted interactions, we found that famoxadone was predicted to bind Cellular Retinol Binding Protein-III in the retinol-binding site with a better minimum energy value of −10.4 Kcal/mol and an RMSD of 3.77 with respect to retinol (−7.1 Kcal/mol). In addition to a similar network of interactions, famoxadone binding is more stabilized by additional hydrophobic patches including L20, V29, A33, F57, L117, and L118 amino acid residues and hydrogen bonds with Y19 and K40. These results support a possible competitive effect of famoxadone on retinol binding with impacts on the ability of developing the cardiac tissue, in accordance with the literature data on zebrafish embryos. Moreover, famoxadone binds, with a minimum energy value between −8.3 and −8.0 Kcal/mol, to the IZUMO Sperm–Egg Fusion Protein, interacting with a network of polar and hydrophobic amino acid residues in the cavity between the 4HB and Ig-like domains. This binding is more stabilized by a predicted hydrogen bond with the N185 residue of the protein. A hindrance in this position can probably affect the conformational change for JUNO binding, avoiding the gamete membrane fusion to form the zygote. This work opens new interesting perspectives of study on the effects of pesticides on fertility, extending the knowledge to other typologies of interaction which can affect different steps of the reproductive process. [ABSTRACT FROM AUTHOR]

Results from previous studies examining the association between fertility treatment and borderline ovarian tumors are inconsistent. The aim of this study was to investigate the association between fertility treatment and borderline ovarian tumors in a cohort of infertile women. This cohort study was based on the Danish Infertility Cohort and included all infertile women aged 20–45 years living in Denmark between 1 January 1995 and 31 December 2017 (n = 146,891). Information on use of fertility drugs, borderline ovarian tumors and cancer diagnoses, covariates, emigration, and vital status was obtained by linkage to national registers. Cox proportional hazard models were used to estimate hazard ratios (HR) and 95% confidence intervals (CI) with adjustment for potential confounders for overall borderline ovarian tumors and for serous- and mucinous borderline ovarian tumors separately. During a median 11.3 years of follow-up, 144 women developed a borderline ovarian tumor. No marked associations between ever use of clomiphene citrate, gonadotropins, gonadotropin-releasing hormone receptor modulators, human chorionic gonadotropin or progesterone and borderline ovarian tumors were observed, neither overall nor for serous and mucinous borderline ovarian tumors analysed separately. Further, no clear associations with borderline ovarian tumors were found according to cumulative dose, time since first use or parity status for any fertility drugs. No marked associations between use of fertility drugs and borderline ovarian tumors were observed. However, the cohort's relatively young age at end of follow-up emphasizes the importance of extending the follow-up period for women who have used fertility drugs. • Ever use of specific types of fertility drugs was not markedly associated with risk of borderline ovarian tumors. • Further, time since first use and cumulative dose of fertility drugs did not affect the risk of borderline ovarian tumors. • During 11 years of follow-up, no associations between use of fertility drugs and borderline ovarian tumors were observed. • Further studies with longer follow-up are needed to determine the true long-term association. [ABSTRACT FROM AUTHOR]

STUDY QUESTION What are the costs and effects of tubal patency testing by hysterosalpingo-foam sonography (HyFoSy) compared to hysterosalpingography (HSG) in infertile women during the fertility work-up? SUMMARY ANSWER During the fertility work-up, clinical management based on the test results of HyFoSy leads to slightly lower, though not statistically significant, live birth rates, at lower costs, compared to management based on HSG results. WHAT IS KNOWN ALREADY Traditionally, tubal patency testing during the fertility work-up is performed by HSG. The FOAM trial, formally a non-inferiority study, showed that management decisions based on the results of HyFoSy resulted in a comparable live birth rate at 12 months compared to HSG (46% versus 47%; difference −1.2%, 95% CI: −3.4% to 1.5%; P  = 0.27). Compared to HSG, HyFoSy is associated with significantly less pain, it lacks ionizing radiation and exposure to iodinated contrast medium. Moreover, HyFoSy can be performed by a gynaecologist during a one-stop fertility work-up. To our knowledge, the costs of both strategies have never been compared. STUDY DESIGN, SIZE, DURATION We performed an economic evaluation alongside the FOAM trial, a randomized multicenter study conducted in the Netherlands. Participating infertile women underwent, both HyFoSy and HSG, in a randomized order. The results of both tests were compared and women with discordant test results were randomly allocated to management based on the results of one of the tests. The follow-up period was twelve months. PARTICIPANTS/MATERIALS, SETTING, METHODS We studied 1160 infertile women (18–41 years) scheduled for tubal patency testing. The primary outcome was ongoing pregnancy leading to live birth. The economic evaluation compared costs and effects of management based on either test within 12 months. We calculated incremental cost-effectiveness ratios (ICERs): the difference in total costs and chance of live birth. Data were analyzed using the intention to treat principle. MAIN RESULTS AND THE ROLE OF CHANCE Between May 2015 and January 2019, 1026 of the 1160 women underwent both tubal tests and had data available: 747 women with concordant results (48% live births), 136 with inconclusive results (40% live births), and 143 with discordant results (41% had a live birth after management based on HyFoSy results versus 49% with live birth after management based on HSG results). When comparing the two strategies—management based on HyfoSy results versus HSG results—the estimated chance of live birth was 46% after HyFoSy versus 47% after HSG (difference −1.2%; 95% CI: −3.4% to 1.5%). For the procedures itself, HyFoSy cost €136 and HSG €280. When costs of additional fertility treatments were incorporated, the mean total costs per couple were €3307 for the HyFoSy strategy and €3427 for the HSG strategy (mean difference €−119; 95% CI: €−125 to €−114). So, while HyFoSy led to lower costs per couple, live birth rates were also slightly lower. The ICER was €10 042, meaning that by using HyFoSy instead of HSG we would save €10 042 per each additional live birth lost. LIMITATIONS, REASONS FOR CAUTION When interpreting the results of this study, it needs to be considered that there was a considerable uncertainty around the ICER, and that the direct fertility enhancing effect of both tubal patency tests was not incorporated as women underwent both tubal patency tests in this study. WIDER IMPLICATION OF THE FINDINGS Compared to clinical management based on HSG results, management guided by HyFoSy leads to slightly lower live birth rates (though not statistically significant) at lower costs, less pain, without ionizing radiation and iodinated contrast exposure. Further research on the comparison of the direct fertility-enhancing effect of both tubal patency tests is needed. STUDY FUNDING/COMPETING INTEREST(S) FOAM trial was an investigator-initiated study, funded by ZonMw, a Dutch organization for Health Research and Development (project number 837001504). IQ Medical Ventures provided the ExEm®-FOAM kits free of charge. The funders had no role in study design, collection, analysis, and interpretation of the data. K.D. reports travel-and speakers fees from Guerbet and her department received research grants from Guerbet outside the submitted work. H.R.V. received consulting—and travel fee from Ferring. A.M.v.P. reports received consulting fee from DEKRA and fee for an expert meeting from Ferring, both outside the submitted work. C.H.d.K. received travel fee from Merck. F.J.M.B. received a grant from Merck and speakers fee from Besins Healthcare. F.J.M.B. is a member of the advisory board of Merck and Ferring. J.v.D. reported speakers fee from Ferring. J.S. reports a research agreement with Takeda and consultancy for Sanofi on MR of motility outside the submitted work. M.v.W. received a travel grant from Oxford Press in the role of deputy editor for Human Reproduction and participates in a DSMB as independent methodologist in obstetrics studies in which she has no other role. B.W.M. received an investigator grant from NHMRC GNT1176437. B.W.M. reports consultancy for ObsEva, Merck, Guerbet, iGenomix, and Merck KGaA and travel support from Merck KGaA. V.M. received research grants from Guerbet, Merck, and Ferring and travel and speakers fees from Guerbet. The other authors do not report conflicts of interest. TRIAL REGISTRATION NUMBER International Clinical Trials Registry Platform No. NTR4746. [ABSTRACT FROM AUTHOR]

This article examines the ideas of John Locke, Adam Smith, and David Ricardo in the field of political economy. It explores their perspectives on land, property, and the relationship between humans and the environment. While Locke and Smith believed that improving the earth's fertility could enhance human life and societal progress, Ricardo took a more pessimistic view, emphasizing the scarcity of land and its potential limits on economic growth. The article challenges the notion that early modern philosophers saw nature as "dead matter" and emphasizes the importance of historical context in understanding environmental ideas in political thought. [Extracted from the article]

• We hypothesize that reduced self-employment delays marriage and childbirth. • Empirical evidence shows US-Vietnam trade reduces self-employment for both genders. • Post-2012, women experienced a more significant decline in self-employment. • Survival analysis shows trade exposure reduces the risk of marriage and childbirth. • Nevertheless, trade exposure increases marriage and children for women over 40. This study investigates the impact of a large demand shock driven by the US-Vietnam Bilateral Trade Agreement (BTA) in 2001 on the timing of women's marital decisions and first childbirth experiences in Vietnam. We hypothesize that the reduction in women's and men's self-employment would delay family formation and childbirth, with the ultimate impact on marriage remaining ambiguous. Analyzing data from the Vietnam Household Living Standards Surveys, we find that both men and women are less likely to be self-employed in the face of a substantial trade shock. Notably, the decreasing impact on women's self-employment becomes more pronounced than that for men post-2012, a decade after the agreement's enforcement. Employing the Multiple Indicator Cluster Survey and survival analysis, we empirically demonstrate that increased exposure to trade postpones women's timing of marriage and first childbirth. On average, in 2013, the BTA resulted in a 7.39- and 7.42 %-point decrease in the probability of entering marriage and becoming a mother, respectively. We also present suggestive evidence that increased exposure to trade liberalization eventually increases the likelihood of marriage and the number of children among women over 40. The findings in this study imply that policy promoting trade liberalization should consider its extensive impacts on young labor force's family formation through change in their individual economic prospects. [ABSTRACT FROM AUTHOR]

Studies on immigrant fertility typically compare immigrants and natives or different migrant groups at the same destination but rarely immigrants of the same origins in different destination countries. In this paper, we look at immigrants from multiple origins in multiple destination countries simultaneously, using the European Union Labour Force Survey to compare female immigrants from ten areas of origin in eight destination countries in Europe. Our results indicate a strong origin effect. However, they also suggest that when women migrate to a context where the fertility norm is different from that in their origin, they adjust their behaviors accordingly, which indicates that policy and normative context play an important role in shaping migrants' fertility. From a policy perspective, this is important because it suggests that the fertility of immigrant women, who are exposed to different norms and normative contexts, can resemble that of native women at the destination. Our findings contribute to strengthening the role of destination in shaping fertility behavior and highlighting the importance of looking at all the possible combinations of immigrants coming from and going to different fertility regimes. [ABSTRACT FROM AUTHOR]

Background: spousal violence against women (SVAW) is a common form of violence that occurs within the family context, with spouses being the main perpetrators. Afghanistan has one of the highest rates of SVAW in the world, and its impact on reproductive health and fertility is not well understood. This study aims to investigate the extent to which SVAW influences the total fertility rate (TFR) of Afghan women. Methods: In this study, a regression model of discrete-time survival models was used to calculate the total fertility rate (TFR), parity progression ratio (PPRs), and average closed birth intervals (CBI) between two children. The method used in this study has its roots in the works of Griffin Finney (1983) and was further developed by Redford et al. (2010). The study population utilized the 2015 Afghanistan Demographic and Health Survey, and sample weights were used to ensure accurate estimates for the population of Afghanistan as a whole. Results: The study found that women in Afghanistan who have experienced SV are more likely to progress to the next parity, start childbearing faster, and continue to do so. Women who have not experienced SV tend to progress to higher parities at a slower pace during their initial reproductive years. The study also suggests that women with spousal violence (SV) experience may have slightly higher fertility rates and shorter birth intervals for certain birth orders, although the differences between the two groups are generally small. Specifically, the total fertility rate (TFR) for women who experienced SV was 6.9, while the TFR for women who did not experience SV was 6.2. Conclusions: These results provide valuable information for policymakers and public health professionals in developing effective policies and programs to address SVAW and improve maternal and child health outcomes in Afghanistan. [ABSTRACT FROM AUTHOR]

Backgrounds: Intraplacental choriocarcinoma (IC) is an extremely rare subtype of gestational choriocarcinoma. The long-term follow-up and reproductive outcomes of IC patients remain unclear. Here, we report a series of 14 cases and conduct a literature review to assess the fertility and recurrence results of this rare disease. Results: Fourteen patients with pathologically confirmed IC treated in Peking Union Medical College Hospital between January 2002 and July 2022 were included in this study. Half of them had metastatic IC and were treated by chemotherapy with or without surgery. Only 1 patient had chemoresistant disease, but she achieved complete remission after immunotherapy. The median follow-up time was 45.5 months (range 4-192), and no recurrence occurred. One metastatic IC patient who achieved remission after chemotherapy had a full-term delivery. Among the 5 patients with fertility demands, 3 abandoned their pursuit of pregnancy because of "fear and worry about choriocarcinoma recurrence". We reviewed a total of 89 cases of IC in English and Chinese literature from 1963 to 2022, and only 5 cases with subsequent pregnancy were reported, all of them were nonmetastatic IC cases. Conclusions: IC is sensitive to chemotherapy and has good long-term remission and a low recurrence rate. Patients with metastatic or nonmetastatic IC can have good pregnancy results after treatment. Doctors should pay more attention to the psychology of these patients. Clinical trial registration: N/A. [ABSTRACT FROM AUTHOR]

In China, female employees face the double shackles of pressure to have children and pressure to develop their careers. The influence of fertility on women's work activities is increasingly significant. However, research on the impact of fertility anxiety on work engagement has been neglected. This study proposes a research model that includes fertility anxiety, emotional exhaustion, work engagement, and the ability and willingness to demonstrate family flexibility based on conservation of resources theory and work/family border theory. A structural equation model and bootstrap method were used to analyze the theory models with data collected from 496 survey samples. The findings demonstrate that fertility anxiety increases emotional exhaustion and decreases work engagement. Emotional exhaustion partially mediates the effect of fertility anxiety on work engagement. Family flexibility-ability and family flexibility-willingness moderate the effect of emotional exhaustion on work engagement. This research provides valuable insights and empirical evidence to improve the work engagement of female employees of childbearing age from a multidimensional perspective. [ABSTRACT FROM AUTHOR]