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With the rising spread of Assisted Reproductive Technology (ART), it becomes imperative to understand the determinants of resource utilization in ART versus spontaneous pregnancies to enhance policies directed to pregnancy care. The focus of our study is to examine the costs associated with ART from the perspective of the Italian NHS and to investigate in depth the contributing social and clinical factors. Using the healthcare informative system of Lombardy, a Region of Northern Italy, we gathered individual-level information for a cohort of women who experienced either spontaneous pregnancies or pregnancies following ART from 2007 until 2020. The information covered multiple healthcare services, and we used a propensity score matching technique to match couples of ART/No ART women based on a comprehensive set of confounders. We then applied statistical tests and regression models to identify the impact of ART on the reported cost differences. Our cohort was composed of 44652 women and results revealed significantly higher costs for ART pregnancies, especially in terms of hospital admissions (additional 1611€, 95% CI 1558-1666) and drug prescriptions (additional 216 €, CI 95% 204-228) occurring before delivery. In-depth analysis showed for ART pregnancies, i) a higher likelihood of incurring expenses related to complications and ii) higher costs associated with two established clinical practices that lack scientific evidence supporting their efficacy. Our study sheds light on the complex interplay of clinical and social factors influencing the ART burden, emphasizing the importance of tailored support and evidence-based practices in optimizing outcomes and resource allocation. Key points: • From the NHS perspective, ART pregnancies, compared to spontaneous pregnancies, mainly result in higher costs (especially in terms of hospital admissions and drug prescriptions occurring before delivery), even though they correspond to lower specialistic visits; • The probability of spending for services related to complications is higher for ART pregnancies compared to spontaneous pregnancies, thus confirming the higher risk, regardless of single or twin pregnancy, of several obstetric and perinatal complications; • The higher costs in pregnancies following ART due to two consolidated clinical practices not supported by scientific evidence (aspirin and progestogen prescriptions) call for reflection on the unmet need of women experiencing ART in terms of emotional and psychological support. [ABSTRACT FROM AUTHOR]

Although 20% of couples who seek medically assisted reproduction (MAR) identify as 2S/LGBTQIA+, MAR services are primarily based on a medical/cisgender definition of infertility, failing to account for 2S/LGBTQIA+ individuals' experience of social infertility—that is, their inability to conceive due to their relationship status. Whereas the consequences of the MAR process on various aspects of mixed-gender/sex couples have been demonstrated (e.g., emotional, relationship, sexuality, social life), the generalization of this knowledge to the 2S/LGBTQIA+ community remains unexplored. This qualitative study aimed to explore the specific impacts of MAR on different aspects of 58 Canadian 2S/LGBTQIA+ couples' lives. While participants were asked about the impact of their MAR journey on the various spheres of their lives, the thematic analysis revealed that what proved most central to their experience were the barriers they encountered to access sensitive and inclusive care, echoing themes from existing literature such as heteronormativity and cisnormativity, a lack of tailored services, psychological distress triggered by the MAR process, and experiences of stigma and discrimination. Other themes outside the healthcare context were also identified: financial burden, a lack of social models and support systems, the emotional toll of repeatedly coming out, and microaggressions from family members. These findings underscore the urgent need for targeted research and reforms in reproductive healthcare to better serve 2S/LGBTQIA+ couples and address the systemic barriers they face. [ABSTRACT FROM AUTHOR]

Abstract With the rising spread of Assisted Reproductive Technology (ART), it becomes imperative to understand the determinants of resource utilization in ART versus spontaneous pregnancies to enhance policies directed to pregnancy care. The focus of our study is to examine the costs associated with ART from the perspective of the Italian NHS and to investigate in depth the contributing social and clinical factors. Using the healthcare informative system of Lombardy, a Region of Northern Italy, we gathered individual-level information for a cohort of women who experienced either spontaneous pregnancies or pregnancies following ART from 2007 until 2020. The information covered multiple healthcare services, and we used a propensity score matching technique to match couples of ART/No ART women based on a comprehensive set of confounders. We then applied statistical tests and regression models to identify the impact of ART on the reported cost differences. Our cohort was composed of 44652 women and results revealed significantly higher costs for ART pregnancies, especially in terms of hospital admissions (additional 1611€, 95% CI 1558-1666) and drug prescriptions (additional 216 €, CI 95% 204-228) occurring before delivery. In-depth analysis showed for ART pregnancies, i) a higher likelihood of incurring expenses related to complications and ii) higher costs associated with two established clinical practices that lack scientific evidence supporting their efficacy. Our study sheds light on the complex interplay of clinical and social factors influencing the ART burden, emphasizing the importance of tailored support and evidence-based practices in optimizing outcomes and resource allocation.

Abstract Background Fertility centre websites are a key sources of information on medically assisted reproduction (MAR) for both infertile people and the general public. As part of a global fertility market, they are also a window to attract potential future patients. They give formal and practical information but in the way the information is displayed, they also convey social representations, and in particular, gender representation in its intersectional dimension. The objective is to analyse the sex, class and race representations regarding reproduction and parenthood that are embedded in the content of fertility centre websites in eight European countries. Methods The 5 most visible fertility centres that appeared in the first places on Internet search were selected for each country under study, except for one country which has only three fertility centres. In total, 38 fertility centre websites were considered for a thematic analysis using an iterative approach and a comprehensive perspective. Results Each centre details its services and techniques according to the legal provisions in force in its country. However, on all the websites studied, the fertility centres demonstrate a strong gendered representation. The logos generally depict women or parts of their bodies, as do the photos, which mainly show white women with light eyes. The description of the causes of infertility and the techniques offered by the centres also highlights gender differences. Sperm donation, where MAR is reserved for heterosexual couples, is included among the techniques for women with the comment that it will enable them to fulfil their dream of becoming mothers. Conclusions MAR, and through it the project of having a child and procreative work, is presented as a matter for white, cisgender and heterosexual women, thus fueling stratified reproduction and limiting reproductive justice. The research team formulated guidelines for fertility centres to encourage them to adopt a more inclusive approach in terms of sex, social class and race, so that the diversity of infertile people feel involved and welcome in these centres, to avoid misperceptions about infertility in the general population and to reinforce autonomy and justice in reproductive matters.

Abstract Managing genetic disease using medically assisted reproductive technology is increasingly promoted as a feasible option, given revolutionary advances in genomics. Far less attention has been directed to the issue of whether there is equitable access to this option. Context and circumstance determine equitable access; however, reporting has drawn overwhelmingly from affluent Anglo-western populations in developed countries. The experiences of poorer, less educated subpopulations within affluent countries and populations in less developed countries are underreported. The ability of consumers to understand the opportunities and risks of medically assisted reproductive technology is likewise not well described in the literature despite significant technological complexity and evidence that genetic disease may be overrepresented within some disadvantaged population groups. Equity is achieved by identifying barriers and allocating appropriate resources to enable understanding and access. In the case of utilising medically assisted technology, social and power relationships, regulations, and the presumptions of authority figures and policymakers reduce equitable access. Physical or cultural marginalisation from mainstream health services may result in reduced access to genetic and prenatal testing, in-vitro fertilisation and genetic screening of embryos necessary for medically assisted reproduction. Cost and regulatory frameworks can likewise limit opportunities to engage with services. Moreover, the quality of the information provided to prospective users of the technology and how it is received governs understanding of prevention and inhibits adequately informed choice. Best practice care and adequately informed choice can only be achieved by conscientiously attending to these accessibility issues. Deep engagement with at-risk people and critical reflection on mainstream accepted standpoints is required. This paper outlines issues associated with engaging with medically assisted reproduction encountered by Aboriginal families living with Machado-Joseph Disease in some of the most remote areas of Australia. It is the right of these families to access such technologies regardless of where they live. Current barriers to access raise important questions for service providers with implications for practice as new technologies increasingly become part of standard medical care.

Background Objectives Material and methods Results Conclusion Although some studies have investigated the relationships between beverage intake and reproductive health these have generated conflicting results.To evaluate the associations between men's beverage intake and semen quality parameters and couple outcomes of medically assisted reproduction.The relationship between preconception beverage intake and semen quality was evaluated in 896 semen samples from 343 men. The relation between beverage intake and medically assisted reproduction outcomes (fertilization, implantation, clinical pregnancy, total/clinical pregnancy loss, and live birth) was evaluated in 296 men and their female partners who underwent 714 medically assisted reproduction cycles: 306 intrauterine insemination cycles and 408 in vitro fertilization. Intake of caffeinated, alcoholic, sugar‐sweetened, and artificially sweetened beverages and sub‐groups were considered as exposures.Caffeinated, alcoholic, sugar‐sweetened, and artificially sweetened beverage intake was not associated with semen quality parameters or with fertilization, implantation, clinical pregnancy, or live birth in couples undergoing medically assisted reproduction. When specific types of beverages were explored, there was an inverse association between a greater intake of coffee/tea with caffeine and lower live birth probabilities in couples undergoing in vitro fertilization cycles. The adjusted probabilities (95% confidence interval) of live birth in the lowest and highest tertiles of intake were 0.49 (0.38, 0.61) and 0.33 (0.24, 0.43) for coffee with caffeine, and 0.49 (0.33, 0.51) and 0.31 (0.22, 0.41) for tea with caffeine. A similar trend was detected with liquor intake and live birth probabilities: 0.45 (0.37, 0.53) and 0.32 (0.25, 0.41). We also found an association between a greater beer intake and higher live birth probabilities. The adjusted probabilities (95% confidence interval) in the lowest and highest quartile of intake were 0.32 (0.23, 0.42) and 0.51 (0.39, 0.62).Male preconception intakes of coffee, tea, and liquor were inversely associated, whereas beer intake was positively associated with the probability of live birth during infertility treatment. [ABSTRACT FROM AUTHOR]

STUDY QUESTION What are the current national medically assisted reproduction (MAR) data collection systems across EU Member States, and how can these countries contribute to a unique, cycle-by-cycle registry for the European Monitoring of Medically Assisted Reproduction (EuMAR) project? SUMMARY ANSWER The study identified significant variation in MAR data collection practices across Member States, with differences in data types, collection methods, and reporting requirements; the EuMAR project emerges as an opportunity to enhance data standardization and improve MAR data collection in the EU. WHAT IS KNOWN ALREADY There is a need for new approaches in MAR data collection that include long-term and cross border follow-up. The EuMAR project intends to establish a unified, cycle-by-cycle registry of data on MAR treatments in EU countries, from which accurate cumulative outcomes can be calculated. STUDY DESIGN, SIZE, DURATION This cross-sectional study involved a survey and interviews with stakeholders from 26 EU Member States conducted in 2023 over a period of seven months. PARTICIPANTS/MATERIALS, SETTING, METHODS Representatives from national competent authorities and professional associations involved in MAR data collection in EU countries were invited to complete the survey and interviewed to assess current data flows, information requirements, and their interest in the EuMAR project. MAIN RESULTS AND THE ROLE OF CHANCE Half of the participating countries reported having a national MAR registry with cycle-by-cycle data (n = 13), while 31% reported having a national registry with aggregated data (n = 8) and 19% reported having no national registry (n = 5). Of the countries with a national cycle-by-cycle registry, eight countries collect identifiable data, five countries collect pseudonymized data, and one country collects fully anonymized data. Informed consent is required in 10 countries. The main advantages that participants expected from a European registry like EuMAR were the possibility of obtaining national statistics in the absence of a national registry and improving the calculation of cumulative outcomes. LIMITATIONS, REASONS FOR CAUTION The results of the study are based on self-reported data, which may be subject to bias, however, the validity of the collected information was verified with different means, including follow-up calls for clarifications and sharing final transcript reports. The feasibility of the proposed data flow models will be tested in a pilot study. WIDER IMPLICATIONS OF THE FINDINGS Despite the heterogeneity of data collection practices across EU countries, the results show that stakeholders have high expectations of the benefits that the EuMAR registry can bring, namely the improvement of data consistency, cross-border comparability, and cumulative live birth rates, leading to better information for patients, health care providers and policy makers. STUDY FUNDING/COMPETING INTEREST(S) The EuMAR project was co-founded by ESHRE and the European Commission (101079865—EuMAR–EU4H-2021-PJ2). No competing interests were declared. TRIAL REGISTRATION NUMBER N/A. [ABSTRACT FROM AUTHOR]

Objective: In the context of infertility, women's bodies have a central physical, psychological, and social role. Medically assisted reproduction (MAR) treatment includes highly intrusive procedures targeting women's bodies. This study aimed to develop a preliminary understanding of women's core meanings around their bodies within their experiences of medicalized infertility in Italy. Design: 104 Italian women dealing with infertility and MAR treatments answered open-ended questions, which were part of a broader online survey. A reflexive thematic analysis was performed. Results: Three themes were identified: (a) the paradox of the body: 'I feel like I was born for something that my body can't do'; (b) 'Something only mothers can do': meanings attributed to the physical body; (c) Internalized 'clinical gaze': medicalized body representations. Conclusions: This work provides insights into the meanings assigned to their bodies by Italian women dealing with MAR. This study outlined women's ambivalence towards their bodies, describing them as 'fragmented' into parts and as 'deposits' of their reproductive hopes. Results suggest that Italian pronatalist culture may have potential fallouts for women's gendered sense of self and the integration between their biological and psychosocial body experiences. Study limitations, future research directions, and clinical implications are presented. [ABSTRACT FROM AUTHOR]

Background: Fertility centre websites are a key sources of information on medically assisted reproduction (MAR) for both infertile people and the general public. As part of a global fertility market, they are also a window to attract potential future patients. They give formal and practical information but in the way the information is displayed, they also convey social representations, and in particular, gender representation in its intersectional dimension. The objective is to analyse the sex, class and race representations regarding reproduction and parenthood that are embedded in the content of fertility centre websites in eight European countries. Methods: The 5 most visible fertility centres that appeared in the first places on Internet search were selected for each country under study, except for one country which has only three fertility centres. In total, 38 fertility centre websites were considered for a thematic analysis using an iterative approach and a comprehensive perspective. Results: Each centre details its services and techniques according to the legal provisions in force in its country. However, on all the websites studied, the fertility centres demonstrate a strong gendered representation. The logos generally depict women or parts of their bodies, as do the photos, which mainly show white women with light eyes. The description of the causes of infertility and the techniques offered by the centres also highlights gender differences. Sperm donation, where MAR is reserved for heterosexual couples, is included among the techniques for women with the comment that it will enable them to fulfil their dream of becoming mothers. Conclusions: MAR, and through it the project of having a child and procreative work, is presented as a matter for white, cisgender and heterosexual women, thus fueling stratified reproduction and limiting reproductive justice. The research team formulated guidelines for fertility centres to encourage them to adopt a more inclusive approach in terms of sex, social class and race, so that the diversity of infertile people feel involved and welcome in these centres, to avoid misperceptions about infertility in the general population and to reinforce autonomy and justice in reproductive matters. Plain English summary: Fertility centre websites are a key sources of information on medically assisted reproduction (MAR) for both people undergoing MAR and the general public. As part of a global fertility market, they may also be a window to attract potential future patients. In this context, they convey formal and practical information but also, through their content, narratives and visuals, social representations. The objective is here to analyse the gender representations of reproduction and parenthood that the 38 European fertility centres under study convey through the texts and images they display on their websites. Each centre details its services and techniques according to the social and legal provisions in force in its country. However, on all the websites studied, the fertility centres demonstrate a strong gendered representation, including in terms of social class and race. MAR, and through it the project of having a child and procreative work, is presented as a matter for white, cisgender and heterosexual women, thus fueling stratified reproduction and limiting reproductive justice. [ABSTRACT FROM AUTHOR]

To study educational gradients in births after medically assisted reproduction across 5 countries with different institutional arrangements. We use logistic regression and compute predicted probabilities to estimate the association between education and giving birth after assisted reproduction, before and after adjustment for maternal age at delivery and marital/partnership status, using an overall sample of about 3.9 million live births in 5 countries. Not applicable. This study includes survey or register data containing information on births in 5 countries: N = 61,564 for Denmark, N = 37,533 for France, N = 12,889 for Spain, N = 17,097 for the United Kingdom, and N = 3,700,442 for the United States. None. The probability of a child being born after medically assisted reproduction for mothers with a university degree relative to those having less than a university degree. University-educated mothers are more likely to give birth after assisted reproduction compared with mothers with lower levels of education. After adjustment for socio-demographic characteristics, educational differences disappear in the United Kingdom and to some extent Spain, whereas they attenuate but persist in the other countries. The United States seems to show a larger educational gradient. The results suggest that the institutional setting around assisted reproduction may moderate the gradient. A possible explanation may be access to treatments, as the United States – the context with the lowest subsidization – seems to show larger educational gradients than other contexts. In the context of global postponement of childbearing to older ages, mothers with lower levels of socioeconomic resources might find it more difficult to fully realize their fertility intentions in countries with less generous subsidization of treatments. [ABSTRACT FROM AUTHOR]

Managing genetic disease using medically assisted reproductive technology is increasingly promoted as a feasible option, given revolutionary advances in genomics. Far less attention has been directed to the issue of whether there is equitable access to this option. Context and circumstance determine equitable access; however, reporting has drawn overwhelmingly from affluent Anglo-western populations in developed countries. The experiences of poorer, less educated subpopulations within affluent countries and populations in less developed countries are underreported. The ability of consumers to understand the opportunities and risks of medically assisted reproductive technology is likewise not well described in the literature despite significant technological complexity and evidence that genetic disease may be overrepresented within some disadvantaged population groups. Equity is achieved by identifying barriers and allocating appropriate resources to enable understanding and access. In the case of utilising medically assisted technology, social and power relationships, regulations, and the presumptions of authority figures and policymakers reduce equitable access. Physical or cultural marginalisation from mainstream health services may result in reduced access to genetic and prenatal testing, in-vitro fertilisation and genetic screening of embryos necessary for medically assisted reproduction. Cost and regulatory frameworks can likewise limit opportunities to engage with services. Moreover, the quality of the information provided to prospective users of the technology and how it is received governs understanding of prevention and inhibits adequately informed choice. Best practice care and adequately informed choice can only be achieved by conscientiously attending to these accessibility issues. Deep engagement with at-risk people and critical reflection on mainstream accepted standpoints is required. This paper outlines issues associated with engaging with medically assisted reproduction encountered by Aboriginal families living with Machado-Joseph Disease in some of the most remote areas of Australia. It is the right of these families to access such technologies regardless of where they live. Current barriers to access raise important questions for service providers with implications for practice as new technologies increasingly become part of standard medical care. [ABSTRACT FROM AUTHOR]

• The use of medically assisted reproduction (MAR) has been associated with higher rates of multiple pregnancy. This is due to the use of fertility drugs to stimulate the ovaries, resulting in the release of multiple eggs during a single menstrual cycle, as well as the transfer of multiple embryos. • Changes in IVF procedure strategies, such as single embryo transfer, have contributed significantly to the decline in multiple pregnancies. However, the percentage of multiple pregnancies resulting from first line treatments has remained relatively constant over time. • Despite declining, multiple births resulting from MAR remained about one order of magnitude higher than those resulting from spontaneous pregnancies. Further efforts are needed to reduce multiple pregnancies in infertility treatment. To evaluate the relative impact of different strategies of medically assisted reproduction (MAR), i.e. first line treatment (ovarian stimulation with or without intrauterine insemination) and in vitro fertilization (IVF) procedures (conventional IVF or intracytoplasmic sperm injection), on the risk of multiple births. We utilized the health care utilization databases of the Lombardy region to identify births resulting from MAR between 2007 and 2022. We gathered data on the total number of multiple births and calculated the prevalence rate by dividing the number of multiples by the total number of births. To examine the temporal trend in the proportion of multiple births after MAR over time, a linear regression model was employed separately for different types of techniques and in strata of maternal age. A total of 30,900 births after MAR were included; 4485 (14.5 %) first line treatments and 26,415 (85.5 %) IVF techniques. Overall, 4823 (15.6 %) multiple births were identified. The frequency of multiple births over the study period decreased from 22.0 % in 2007 to 8.7 % in 2022 (p < 0.01). Multiple births from first line treatments were stable ranging from 13.5 % in 2007–2008 to 12.0 % in 2021–2022 (p = 0.29). Multiple births from IVF procedures decreased from 23.8 % in 2007–2008 to 8.4 % in 2021–2022 (p < 0.01). Stratifying for maternal age (i.e. < 35 and ≥ 35 years), the trends remained consistent. The reduction in multiple births has been influenced by changes in IVF strategy and procedures. The decline has been gradual but steady since 2009, when a law restricting embryo freezing was repealed in Italy. In contrast, the proportion of multiple births resulting from first line treatments has remained constant over time. Despite declining, multiple births from MAR remained about one order of magnitude higher than those from spontaneous pregnancies. [ABSTRACT FROM AUTHOR]

Despite the increasing use of medically assisted reproduction (MAR) in modern societies, there is limited evidence on whether conceiving with MAR or remaining involuntarily childless after MAR is associated with partnership stability. While older age, the more advantaged socioeconomic position of women undergoing MAR and their strong fertility intentions could lead to higher partnership stability, the experience of infertility and undergoing MAR may have an opposite effect, especially if couples remain involuntarily childless. Using data on Finnish nulliparous couples from 1995–2017 (N = 149,884) and event‐history models, we compare the risk of separation of couples who remained childless after MAR (N = 3871), who conceived through MAR (N = 14,474), who conceived naturally without MAR (N = 167,962) or with a prior history of MAR (N = 2273). Couples who remained childless after MAR had a higher risk of separation than couples who conceived with MAR or naturally. The higher risk of separation decreased over time since the discontinuation of treatments but persisted over the longer term. There were no differences in the risk of separation between couples who conceived with MAR or naturally. The results suggest that involuntary childlessness after MAR is associated with an increased risk of separation while undergoing MAR/experiencing infertility does not seem to play a role. [ABSTRACT FROM AUTHOR]

Switzerland is one of the most restrictive countries in Europe when it comes to the regulation of egg donation in medically assisted reproduction (MAR). Indeed, even after the introduction of modifications to the law regulating reproductive medicine allowing embryo culture, embryo freezing, and preimplantation genetic testing, egg donation has remained completely forbidden. The absolute ban on egg donation is heavily discussed in academia, society, and politics. After many failed attempts, this prohibition is now on its way to be lifted, after agreement was reached in the legislative institutions. The forthcoming legalisation of egg donation raises, however, several questions on how some aspects of this practice will be regulated. In this contribution, we briefly review the reasons why a ban on egg donation has been present for so long in Switzerland, to then analyse two issues raised by the commitment to lift this ban. First, we reflect on the question of whether the new legislation should introduce chronological age limits for access to heterologous MAR. Second, we consider how the practice of egg sharing could be regulated once egg donation is legal. [ABSTRACT FROM AUTHOR]

Introduction: Preimplantation Genetic Testing (PGT) is a cutting-edge test used to detect genetic abnormalities in embryos fertilized through Medically Assisted Reproduction (MAR). PGT aims to ensure that embryos selected for transfer are free of specific genetic conditions or chromosome abnormalities, thereby reducing chances for unsuccessful MAR cycles, complicated pregnancies, and genetic diseases in future children. Areas covered: In PGT, genetics, embryology, and technology progress and evolve together. Biological and technological limitations are described and addressed to highlight complexity and knowledge constraints and draw attention to concerns regarding safety of procedures, clinical validity, and utility, extent of applications and overall ethical implications for future families and society. Expert opinion: Understanding the genetic basis of diseases along with advanced technologies applied in embryology and genetics contribute to faster, cost-effective, and more efficient PGT. Next Generation Sequencing-based techniques, enhanced by improved bioinformatics, are expected to upgrade diagnostic accuracy. Complicating findings such as mosaicism, mt-DNA variants, variants of unknown significance, or variants related to late-onset or polygenic diseases will however need further appraisal. Emphasis on monitoring such emerging data is crucial for evidence-based counseling while standardized protocols and guidelines are essential to ensure clinical value and respect of Ethical, Legal and Societal Issues. [ABSTRACT FROM AUTHOR]

Almost all countries and fertility clinics impose age limits on women who want to become pregnant through Assisted Reproductive Technologies (ART). Age limits for aspiring fathers, however, are much less common and remain a topic of debate. This article departs from the principle of reproductive autonomy and a conditional positive right to receive ART, and asks whether there are convincing arguments to also impose age limits on aspiring fathers. After considering three consequentialist approaches to justifying age limits for aspiring fathers, we take in a concrete normative stance by concluding that those are not strong enough to justify such cut-offs. We reinforce our position by drawing a comparison between the case of a 39-year-old woman who wants to become a single mother via a sperm donor on the one hand, and on the other hand the same woman who wants to have a child with a 64-year-old man who she loves and who is willing to care for the child as long as he is able to. We conclude that, as long as appropriate precautions are taken to protect the welfare of the future child, couples who want to receive fertility treatment should never be limited on the basis of the age of the (male) partner. An absence of age limits for men would respect the reproductive autonomy of both the man and the woman. [ABSTRACT FROM AUTHOR]

The number of people who undergo medically assisted reproduction (MAR) to conceive has increased considerably in recent decades. However, existing research into the demographics and the partnership histories of this growing subgroup is limited. Using unique data from Finnish population registers on nulliparous women born in Finland in 1971–77 (n = 21 ,129; ∼10 per cent of all women) who had undergone MAR treatment, we created longitudinal partnership histories from age 16 until first MAR treatment. We identified six typical partnership trajectories and used relative frequency sequence plots to investigate heterogeneity in partnership transitions within and between these groups. The majority of women (60.7 per cent) underwent MAR with their first partner, followed by women who underwent MAR in a second (21.5 per cent) or higher-order partnership (7.1 per cent), while 10.7 per cent underwent MAR without a partner. On average, women undergoing MAR were relatively young (with around half starting treatment before age 30) and were highly educated with high incomes. [ABSTRACT FROM AUTHOR]

Introduction: Infertility is one of the main sources of concern for global health and although the evolving medical technology with the method of in vitro fertilization and the use of third party genetic material can be effective, there are ethical concerns about its use. Purpose: This article analyzes the ethical concerns generally surrounding the use of new technology methods for medically assisted reproduction. In addition, it refers to ethical dilemmas regarding the use of third-party genetic material, such as gametes or fertilized eggs, and the legal establishment of the prospective donor regarding whether or not to disclose his identity in case of selection of his genetic material for procreation, issues that need thorough analysis. Material and Method: An English language literature review was done on Scopus, Pubmed and Google Scholar international databases became by using the below keywords. Results: Ethical concerns about medically assisted reproduction, the possibility of extending the age limit for women to have children and the use of third-party genetic material, should on the one hand be adequately examined in all their dimensions and on the other hand be systematically revised due to continuous scientific and technological developments. Conclusions: Legislative changes, for fertilization with assisted reproduction or the transfer of third-party genetic material, are necessary at the global level and the moral dilemmas are manifold. [ABSTRACT FROM AUTHOR]

STUDY QUESTION Does medically assisted reproduction (MAR) use among cisgender women differ among those with same-sex partners or lesbian/bisexual identities compared to peers with different-sex partners or heterosexual identities? SUMMARY ANSWER Women with same-sex partners or lesbian/bisexual identities are more likely to utilize any MAR but are no more likely to use ART (i.e. IVF, reciprocal IVF, embryo transfer, unspecified ART, ICSI, and gamete or zygote intrafallopian transfer) compared to non-ART MAR (i.e. IUI, ovulation induction, and intravaginal or intracervical insemination) than their different-sex partnered and completely heterosexual peers. WHAT IS KNOWN ALREADY Sexual minority women (SMW) form families in myriad ways, including through fostering, adoption, genetic, and/or biological routes. Emerging evidence suggests this population increasingly wants to form genetic and/or biological families, yet little is known about their family formation processes and conception needs. STUDY DESIGN, SIZE, DURATION The Growing Up Today Study is a US-based prospective cohort (n = 27 805). Participants were 9–17 years of age at enrollment (1996 and 2004). Biennial follow-up is ongoing, with data collected through 2021. PARTICIPANTS/MATERIALS, SETTING, METHODS Cisgender women who met the following criteria were included in this sample: endorsed ever being pregnant; attempted a pregnancy in 2019 or 2021; and endorsed either a male- or female-sex partner OR responded to questions regarding their sexual identity during their conception window. The main outcome was any MAR use including ART (i.e. procedures involving micromanipulation of gametes) and non-ART MAR (i.e. nonmanipulation of gametes). Secondary outcomes included specific MAR procedures, time to conception, and trends across time. We assessed differences in any MAR use using weighted modified Poisson generalized estimating equations. MAIN RESULTS AND THE ROLE OF CHANCE Among 3519 participants, there were 6935 pregnancies/pregnancy attempts and 19.4% involved MAR. A total of 47 pregnancies or pregnancy attempts were among the same-sex partnered participants, while 91 were among bisexual participants and 37 among lesbian participants. Participants with same-sex, compared to different-sex partners were almost five times as likely to use MAR (risk ratio [95% CI]: 4.78 [4.06, 5.61]). Compared to completely heterosexual participants, there was greater MAR use among lesbian (4.00 [3.10, 5.16]) and bisexual (2.22 [1.60, 3.07]) participants compared to no MAR use; mostly heterosexual participants were also more likely to use ART (1.42 [1.11, 1.82]) compared to non-ART MAR. Among first pregnancies conceived using MAR, conception pathways differed by partnership and sexual identity groups; differences were largest for IUI, intravaginal insemination, and timed intercourse with ovulation induction. From 2002 to 2021, MAR use increased proportionally to total pregnancies/pregnancy attempts; ART use was increasingly common in later years among same-sex partnered and lesbian participants. LIMITATIONS, REASONS FOR CAUTION Our results are limited by the small number of SMW, the homogenous sample of mostly White, educated participants, the potential misclassification of MAR use when creating conception pathways unique to SMW, and the questionnaire's skip logic, which excluded certain participants from receiving MAR questions. WIDER IMPLICATIONS OF THE FINDINGS Previous studies on SMW family formation have primarily focused on clinical outcomes from ART procedures and perinatal outcomes by conception method, and have been almost exclusively limited to European, clinical samples that relied on partnership data only. Despite the small sample of SMW within a nonrepresentative study, this is the first study to our knowledge to use a nonclinical sample of cisgender women from across the USA to elucidate family formation pathways by partnership as well as sexual identity, including pathways that may be unique to SMW. This was made possible by our innovative approach to MAR categorization within a large, prospective dataset that collected detailed sexual orientation data. Specifically, lesbian, bisexual, and same-sex partnered participants used both ART and non-ART MAR at similar frequencies compared to heterosexual and different-sex partnered participants. This may signal differential access to conception pathways owing to structural barriers, emerging conception trends as family formation among SMW has increased, and a need for conception support beyond specialized providers and fertility clinics. STUDY FUNDING/COMPETING INTEREST(S) The research reported in this publication was supported by the National Institute on Minority Health and Health Disparities of the National Institutes of Health (NIH), under award number R01MD015256. Additionally, KRSS is supported by NCI grant T32CA009001, AKH by the NCI T32CA057711, PC by the NHLBI T32HL098048, BM by the Stanford Maternal Child Health Research Institute Clinical Trainee Support Grant and the Diversity Fellowship from the American Society for Reproductive Medicine Research Institute, BGE by NICHD R01HD091405, and SM by the Thomas O. Pyle Fellowship through the Harvard Pilgrim Health Care Foundation and Harvard University, NHLBI T32HL098048, NIMH R01MH112384, and the William T. Grant Foundation grant number 187958. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The first author recently had a leadership role in the not-for-profit program, The Lesbian Health Fund, a research fund focused on improving the health and wellbeing of LGBTQ+ women and girls. The fund did not have any role in this study and the author's relationship with the fund did not bias the findings of this manuscript. TRIAL REGISTRATION NUMBER N/A. [ABSTRACT FROM AUTHOR]

Previous studies have shown that mothers of naturally conceived dizygotic (DZ) twins tend to be taller, older, and smoke more than mothers of naturally conceived monozygotic (MZ) twin and mothers of singletons. Here, we investigate whether mothers of naturally conceived DZ twins differ from mothers who conceived their DZ twins after medically assisted reproduction (MAR) in eight maternal traits related to fertility based on observational survey data. We include data from 33,648 mothers from the Netherlands Twin Register (NTR) and 1660 mothers of twins from the Norwegian Mother, Father and Child Cohort Study (MoBA). We contrast mothers of naturally conceived DZ twins with mothers of MAR DZ twins. Next, we further segment the MAR group into mothers who underwent hormonal induction of ovulation but not in vitro fertilization (IVF) and those who IVF twins, comparing them both to each other and against the mothers of naturally conceived DZ twins. Mothers of naturally conceived DZ twins smoke more often, differ in body composition, have a higher maternal age and have more offspring before the twins than mothers of MZ twins. Compared to MAR DZ twin mothers, mothers of naturally conceived DZ twins have fewer miscarriages, lower maternal age and increased height, more offspring and are more often smokers. BMI before the twin pregnancy is similar in both natural and MAR DZ twin mothers. Mothers who received hormonal induction of ovulation (OI) have a lower maternal age, fewer miscarriages, and a higher number of offspring before their twin pregnancy than twin mothers who received IVF and/or intracytoplasmic sperm injection (ICSI) treatments. Our study shows that twin mothers are a heterogenous group and the differences between twin mothers should be taken into account in epidemiological and genetic research that includes twins. [ABSTRACT FROM AUTHOR]

Surrogacy is a form of family creation that raises many medical, ethical, and legal questions. This article examines how the European Court of Human Rights (ECtHR) deals with the issue of cross-border surrogacy and its legal consequences in its recent case law. It will demonstrated that the Strasbourg Court has developed a nuanced case law that leaves it in the first place to the national authorities to deal with the complex issue of surrogacy, whereby it is nevertheless clear that further to the Strasbourg case law even if legislators rule out the possibility of surrogacy on their territory, they will have to find solutions to "'regularise"' the de facto situation of the child, taking into account its best interests. [ABSTRACT FROM AUTHOR]

Purpose of Review: Recognizing the link between infertility and sexual health is crucial to providing comprehensive fertility care. The aim of this systematic review was to examine studies investigating the prevalence of sexual dysfunction, factors linked to sexual well-being, and psychosocial interventions targeting sexuality in individuals undergoing medically assisted reproduction (MAR). Recent Findings: An advanced search was conducted in Embase, Web of Science, CINAHL, PubMed, and PsycINFO to find articles published between January 2018 and September 2023. After review for eligibility criteria, 83 articles were reviewed. No studies specifically explored the experiences of sexual and gender/sex diverse individuals. In women, rates of sexual function problems varied from 6.9 to 77.3%, whereas it ranged from 6.7 to 53.6% in men. Most studies revealed significantly lower sexual well-being in individuals with infertility compared to those without. Studies identified that women and men achieving pregnancy through MAR reported lower overall sexual function during pregnancy, compared to women and men who conceived without MAR. Studies identified a range of medical, individual, and relationship factors linked to sexual well-being in the context of MAR and suggested that psychological interventions can enhance the sexual well-being of women with infertility. Summary: This systematic review highlights the clear link between infertility, MAR, and lower sexual well-being in both men and women. Future research should prioritize the use of longitudinal designs to allow for a more in-depth exploration of the dynamic changes in sexual experiences over time. Future research should also consider the distinct challenges of sexual and gender/sex diverse individuals and their experiences of sexual well-being during MAR. Finally, there is a potential gap in research focusing on couple-based interventions. Collaborative efforts between reproductive medicine specialists and mental health professionals could ensure a comprehensive approach to addressing the medical and psychosocial aspects of infertility-related sexual issues. [ABSTRACT FROM AUTHOR]

Researchers interested in causal questions must deal with two sources of error: random error (random deviation from the true mean value of a distribution), and bias (systematic deviance from the true mean value due to extraneous factors). For some causal questions, randomization is not feasible, and observational studies are necessary. Bias poses a substantial threat to the validity of observational research and can have important consequences for health policy developed from the findings. The current piece describes bias and its sources, outlines proposed methods to estimate its impacts in an observational study, and demonstrates how these methods may be used to inform debate on the causal relationship between medically assisted reproduction (MAR) and health outcomes, using cancer as an example. In doing so, we aim to enlighten researchers who work with observational data, especially regarding the health effects of MAR and infertility, on the pitfalls of bias, and how to address them. We hope that, in combination with the provided example, we can convince readers that estimating the impact of bias in causal epidemiologic research is not only important but necessary to inform the development of robust health policy and clinical practice recommendations. [ABSTRACT FROM AUTHOR]

STUDY QUESTION Are there subgroups among patients with cryptozoospermia pointing to distinct etiologies? SUMMARY ANSWER We reveal two distinct subgroups of cryptozoospermic (Crypto) patients based on testicular tissue composition, testicular volume, and FSH levels. WHAT IS KNOWN ALREADY Cryptozoospermic patients present with a sperm concentration below 0.1 million/ml. While the etiology of the severely impaired spermatogenesis remains largely unknown, alterations of the spermatogonial compartment have been reported including a reduction of the reserve stem cells in these patients. STUDY DESIGN, SIZE, DURATION To assess whether there are distinct subgroups among cryptozoospermic patients, we applied the statistical method of cluster analysis. For this, we retrospectively selected 132 cryptozoospermic patients from a clinical database who underwent a testicular biopsy in the frame of fertility treatment at a university hospital. As controls (Control), we selected 160 patients with obstructive azoospermia and full spermatogenesis. All 292 patients underwent routine evaluation for endocrine, semen, and histological parameters (i.e. the percentage of tubules with elongated spermatids). Moreover, outcome of medically assisted reproduction (MAR) was assessed for cryptozoospermic (n = 73) and Control patients (n = 87), respectively. For in-depth immunohistochemical and histomorphometrical analyses, representative tissue samples from cryptozoospermic (n = 27) and Control patients (n = 12) were selected based on cluster analysis results and histological parameters. PARTICIPANTS/MATERIALS, SETTING, METHODS This study included two parts: firstly using clinical parameters of the entire cohort of 292 patients, we performed principal component analysis (PCA) followed by hierarchical clustering on principal components (i.e. considering hormonal values, ejaculate parameters, and histological information). Secondly, for histological analyses seminiferous tubules were categorized according to the most advanced germ cell type present in sections stained with Periodic acid Schif. On the selected cohort of 39 patients (12 Control, 27 cryptozoospermic), we performed immunohistochemistry for spermatogonial markers melanoma-associated antigen 4 (MAGEA4) and piwi like RNA-mediated gene silencing 4 (PIWIL4) followed by quantitative analyses. Moreover, the morphologically defined Adark spermatogonia, which are considered to be the reserve stem cells, were quantified. MAIN RESULTS AND THE ROLE OF CHANCE The PCA and hierarchical clustering revealed three different clusters, one of them containing all Control samples. The main factors driving the sorting of patients to the clusters were the percentage of tubules with elongated spermatids (Cluster 1, all Control patients and two cryptozoospermic patients), the percentage of tubules with spermatocytes (Cluster 2, cryptozoospermic patients), and tubules showing a Sertoli cells only phenotype (Cluster 3, cryptozoospermic patients). Importantly, the percentage of tubules containing elongated spermatids was comparable between Clusters 2 and 3. Additional differences were higher FSH levels (P  < 0.001) and lower testicular volumes (P  < 0.001) in Cluster 3 compared to Cluster 2. In the spermatogonial compartment of both cryptozoospermic Clusters, we found lower numbers of MAGEA4+ and Adark spermatogonia but higher proportions of PIWIL4+ spermatogonia, which were significantly correlated with a lower percentage of tubules containing elongated spermatids. In line with this common alteration, the outcome of MAR was comparable between Controls as well as both cryptozoospermic Clusters. LIMITATIONS, REASONS FOR CAUTION While we have uncovered the existence of subgroups within the cohort of cryptozoospermic patients, comprehensive genetic analyses remain to be performed to unravel potentially distinct etiologies. WIDER IMPLICATIONS OF THE FINDINGS The novel insight that cryptozoospermic patients can be divided into two subgroups will facilitate the strategic search for underlying genetic etiologies. Moreover, the shared alterations of the spermatogonial stem cell compartment between the two cryptozoospermic subgroups could represent a general response mechanism to the reduced output of sperm, which may be associated with a progressive phenotype. This study therefore offers novel approaches towards the understanding of the etiology underlying the reduced sperm formation in cryptozoospermic patients. STUDY FUNDING/COMPETING INTEREST(S) German research foundation CRU 326 (grants to: SDP, NN). Moreover, we thank the Faculty of Medicine of the University of Münster for the financial support of Lena Charlotte Schülke through the MedK-program. We acknowledge support from the Open Access Publication Fund of the University of Münster. The authors have no potential conflicts of interest. TRIAL REGISTRATION NUMBER N/A. [ABSTRACT FROM AUTHOR]

One-carbon (1-C) metabolic deficiency impairs homeostasis, driving disease development, including infertility. It is of importance to summarize the current evidence regarding the clinical utility of 1-C metabolism-related biomolecules and methyl donors, namely, folate, betaine, choline, vitamin B12, homocysteine (Hcy), and zinc, as potential biomarkers, dietary supplements, and culture media supplements in the context of medically assisted reproduction (MAR). A narrative review of the literature was conducted in the PubMed/Medline database. Diet, ageing, and the endocrine milieu of individuals affect both 1-C metabolism and fertility status. In vitro fertilization (IVF) techniques, and culture conditions in particular, have a direct impact on 1-C metabolic activity in gametes and embryos. Critical analysis indicated that zinc supplementation in cryopreservation media may be a promising approach to reducing oxidative damage, while female serum homocysteine levels may be employed as a possible biomarker for predicting IVF outcomes. Nonetheless, the level of evidence is low, and future studies are needed to verify these data. One-carbon metabolism-related processes, including redox defense and epigenetic regulation, may be compromised in IVF-derived embryos. The study of 1-C metabolism may lead the way towards improving MAR efficiency and safety and ensuring the lifelong health of MAR infants. [ABSTRACT FROM AUTHOR]

Purpose: To examine the association between endometriosis and adverse pregnancy and perinatal outcomes (preeclampsia, placenta previa, and preterm birth). Methods: A population-based retrospective cohort study was conducted among 468,778 eligible women who contributed 912,747 singleton livebirths between 1980 and 2015 in Western Australia (WA). We used probabilistically linked perinatal and hospital separation data from the WA data linkage system's Midwives Notification System and Hospital Morbidity Data Collection databases. We used a doubly robust estimator by combining the inverse probability weighting with the outcome regression model to estimate adjusted risk ratios (RR) and 95% confidence intervals (CIs). Results: There were 19,476 singleton livebirths among 8874 women diagnosed with endometriosis. Using a doubly robust estimator, we found pregnancies in women with endometriosis to be associated with an increased risk of preeclampsia with RR of 1.18, 95% CI 1.11–1.26, placenta previa (RR 1.59, 95% CI 1.42–1.79) and preterm birth (RR 1.45, 95% CI 1.37–1.54). The observed association persisted after stratified by the use of Medically Assisted Reproduction, with a slightly elevated risk among pregnancies conceived spontaneously. Conclusions: In this large population-based cohort, endometriosis is associated with an increased risk of preeclampsia, placenta previa, and preterm birth, independent of the use of Medically Assisted Reproduction. This may help to enhance future obstetric care among this population. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to describe characteristics and outcomes of assisted reproductive technology (ART) cycles performed in 2019 in Turkey. Material and Methods: One-hundred and sixty-five ART centers in Turkey were invited to submit data. The survey was sent to center directors via e-mail with anonymous links by Qualtrics™. The survey involved questions about their patient characteristics, clinical practices, and outcomes. Results: Forty-one (24.8%) centers responded to e-mails, and data gathered from 25 centers was included in the analyses. In 25 centers, 18,127 fresh or frozen transfers were carried out during the study period, of which 7796 (43.0%) were fresh and the rest were either frozen (45.2%) or embryo transfers (ET) with preimplantation genetic testing (PGT) (11.8%). The live birth rate per ET was as 30.6%, 40.1%, and 50.7% in fresh, frozen and PGT cycles, respectively. A single embryo was transferred in 65.3% of all transfers and singleton live births comprised 86.1% of all deliveries. For cycles with intrauterine insemination, 1407 were started in 2019, and 195 clinical pregnancies, 150 live births with 19 multiple pregnancies occurred. A total of 1513 ART cycles were initiated for foreign patients. Russia (29.6%), Germany (7.4%), Iraq (4.6%), Uzbekistan (3.1%), and Syria (1.4%) were the top five countries with most patients coming to Turkey for ART. Conclusion: The survey results are in parallel with the reports of international institutions and organizations. With repeated editions, the data collected with annual surveys can be used to inform ART practices in the coming years. [ABSTRACT FROM AUTHOR]

In 2016 Swedish law was amended to allow single women to access fertility treatment with donor sperm. In this paper, based on interviews, document analysis and autoethnographic insights, I examine the implementation of this law using human rights approaches, specifically the availability, accessibility, acceptability, and quality framework (AAAQ Framework). While the law extended the scope of reproductive rights, the health system was unprepared. Five years on, women seek care in the private sector or continue to travel abroad due in large part to waiting times which can be up to four years in some regions. The paper also provides a meeting point between anthropology and policy analysis. The law change provides a pathway for analyzing the Swedish health system and political context, particularly the relationships between the private and public sectors and between different regions, and the balance of responsibility between national and regional levels. While many of the challenges are unique to the Swedish context, they also offer lessons for countries which have or are considering expanding access to fertility treatment for single women and other patient groups, thus demonstrating the importance of ethnographic approaches in health policy analysis. [ABSTRACT FROM AUTHOR]

Purpose: To examine the impact of medically assisted fertility treatments on the risk of developing perinatal and cardiometabolic complications during pregnancy and in-hospital deliveries. Methods: We conducted a retrospective cohort study using medical health records of deliveries occurring in 2016–2022 at a women's specialty hospital in a southern state of the Unites States (US). Pregnancies achieved using medically assisted reproductive (MAR) techniques were compared with unassisted pregnancies using propensity score matching (PSM), based on demographic, preexisting health, and reproductive factors. Study outcomes included cesarean delivery, gestational diabetes mellitus (GDM), hypertensive disorders of pregnancy (HDP), delivery complications, and postpartum readmission. We used Poisson regression with robust standard errors to generate risk ratios (RRs) and 95% confidence intervals (CIs) for all study outcomes. Results: Among 57,354 deliveries, 586 (1.02%) pregnancies were achieved using MAR and 56,768 (98.98%) were unassisted ("non-MAR"). Compared to the non-MAR group, MAR pregnancies had significantly higher prevalence of all study outcomes, including GDM (15.9% vs. 11.2%, p < 0.001), HDP (28.2% vs. 21.1%, p < 0.001), cesarean delivery (56.1% vs. 34.6%, p < 0.001), delivery complications (10.9% vs. 6.8%, p = 0.03), and postpartum readmission (4.3% vs. 2.7%, p = 0.02). In a PSM sample of 584 MAR and 1,727 unassisted pregnancies, MAR was associated with an increased risk of cesarean delivery (RR = 1.11, 95% CI = 1.01–1.22); whereas IVF was associated with an increased risk of cesarean delivery (RR = 1.15, 95% CI = 1.03–1.28) and delivery complications (RR = 1.44, 95% CI = 1.04–2.01). Conclusions: Women who conceived with MAR were at increased risk of cesarean deliveries, and those who conceived with IVF were additionally at risk of delivery complications. [ABSTRACT FROM AUTHOR]

Background: The number and proportion of children conceived through medically assisted reproduction (MAR) is steadily increasing yet the evidence on their mental health in adolescence is inconclusive. Two main mechanisms with opposite effects can explain differences in mental health outcomes by conception mode: while more advantaged parental characteristics could positively influence it, higher parental stress could have a negative influence. Methods: Linear and logistic estimations on a longitudinal population‐based birth cohort study of 9,897 individuals to investigate whether adolescents conceived through MAR are more likely than naturally conceived (NC) children to experience mental health problems at age 17, as reported by adolescents themselves and their parents. We test whether this association is confounded and/or mediated by parental background characteristics collected when the cohort member was around 9 months old (maternal age, maternal education level, ethnicity, income quintile), family structure variables measured in adolescence (number of siblings in the household at age 15, parental household structure at age 14) or maternal distress at age 14. Results: Children conceived naturally and through MAR self‐reported similar mental health outcomes. The only differences between MAR and NC adolescents are in the parental reports, with parents who conceived through MAR reporting their children had 3.82 (95% CI: 1.140 to 11.54) and 2.35 (95% CI: 1.145 to 4.838) higher odds of falling within the high category of SDQ total difficulties and emotional symptoms scales, respectively. The results did not change on adjustment for mediators, such as maternal distress, number of siblings in the household and parental household structure. Conclusions: The results reveal a lack of or small differences in MAR adolescents' mental health outcomes compared to children who were conceived naturally. While the results based on the parental reports could suggest that MAR adolescents are at higher risk of suffering from mental health problems, the differences are small and not supported by adolescents' own reports. The difference between MAR and NC adolescent's parental report might reflect differences in parental concern, their relationship or closeness and can help to reconcile the mixed findings of previous studies. [ABSTRACT FROM AUTHOR]

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Surrogacy represents perhaps the oldest form of assisted reproduction, but at the same time the most controversial form of reproduction, on which reaching any consensus at the international level is almost impossible at the moment. In the last few years, the practice of surrogacy has encountered serious obstacles and challenges, such as the COVID-19 pandemic, but also with the war on the territory of Ukraine, where surrogacy was, until recently, extremely common. As a result of this, but also the fact that some legislations have significantly tightened their regulations, the surrogacy industry has been quickly adapting and looking for alternative ways to continue to run smoothly. That's how the so-called reprowebs, which imply a global network of reproduction consisting of several different locations, more or less connected to each other and which require answers to numerous questions in order to protect all participants in this procedure.

Abstract Background To examine the association between maternal education and adverse maternal and neonatal outcomes in women who conceived using medically assisted reproduction, which included fertility medications, intrauterine insemination, or in vitro fertilization. Methods We conducted a retrospective cohort study utilizing the US Vital Statistics data set on national birth certificates from 2016 to 2020. Women with live, non-anomalous singletons who conceived using MAR and had education status of the birthing female partner recorded were included. Patients were stratified into two groups: bachelor’s degree or higher, or less than a bachelor’s degree. The primary outcome was a composite of maternal adverse outcomes: intensive care unit (ICU) admission, uterine rupture, unplanned hysterectomy, or blood transfusion. The secondary outcome was a composite of neonatal adverse outcomes: neonatal ICU admission, ventilator support, or seizure. Multivariable modified Poisson regression models with robust error variance adjusted for maternal age, race, marital status, prenatal care, smoking during pregnancy, neonatal sex, and birth year estimated the relative risk (RR) of outcomes with a 95% confidence interval (CI). Results 190,444 patients met the inclusion criteria: 142,943 had a bachelor’s degree or higher and 47,501 were without a bachelor’s degree. Composite maternal adverse outcomes were similar among patients with a bachelor’s degree (10.1 per 1,000 live births) and those without a bachelor’s degree (9.4 per 1,000 live births); ARR 1.05, 95% CI (0.94–1.17). However, composite adverse neonatal outcomes were significantly lower in women with a bachelor’s degree or higher (94.1 per 1,000 live births) compared to women without a bachelor’s degree (105.9 per 1,000 live births); ARR 0.91, 95% CI (0.88–0.94). Conclusions Our study demonstrated that lower maternal education level was not associated with maternal adverse outcomes in patients who conceived using MAR but was associated with increased rates of neonatal adverse outcomes. As access to infertility care increases, patients who conceive with MAR may be counseled that education level is not associated with maternal morbidity. Further research into the association between maternal education level and neonatal morbidity is indicated.

Purpose: This study aimed to assess the attitudes and experiences of subfertile couples applying for medically assisted reproduction (MAR) using their own gametes towards reproductive genetic carrier screening (RGCS) for monogenic conditions. Methods: A prospective survey study was conducted where subfertile couples were recruited from the fertility centre of a university hospital in Flanders, Belgium. Participants were offered RGCS free of charge and completed self-administered questionnaires at three different time points. Results: The study sample consisted of 26 couples. Most participants had no children, did not consider themselves as religious, and had some form of higher education. Overall, attitudes towards RGCS were mostly positive and the intention to participate in RGCS was high. Anxiety scores were only elevated and clinically relevant for a limited number of participants. A large proportion of participants would consider preventive reproductive options like prenatal diagnosis or in vitro fertilization (IVF)/intracytoplasmic sperm injection (ICSI) combined with pre-implantation genetic testing for monogenic conditions (PGT-M) in the event of an increased likelihood of conceiving a child with a hereditary condition. Participants were satisfied with their decision to undergo RGCS, and the majority would recommend RGCS to other couples. Conclusion: Our study findings suggest that subfertile couples applying for MAR using their own gametes find RGCS acceptable and have a positive attitude towards it. This study provides valuable insights into the perspectives of these couples, highlighting the need for appropriate counseling and timely information provision. [ABSTRACT FROM AUTHOR]

In the following account, the author reflects on her experiences with individuals and families who have used Medically Assisted Reproduction (MAR) in order to create their families. The article covers some of the history of this constantly developing field, the legislation and regulations in the UK, and some of the inherent complexities. She suggests that Clinical Psychologists need to know more about this area, in order to respond appropriately to those they assess and treat, as in all specialties, issues relating to conception may have a relevance to the issues to be addressed. [ABSTRACT FROM AUTHOR]

Abstract\nLAY SUMMARYInfertility is a common issue, with significant impacts on couples’ lives. Infertility and its treatments can place considerable stress on both partners and lead to relationship insecurity. Several researchers have shown that infertility can reduce the quality of life of both members of the couple. Since partners represent the main source of support for each other in the context of infertility, examining partner support as a potential protective factor for these couples seems highly justified. The objective of this study was to examine the association between partner support and infertility-related quality of life assessed 3 months later among 83 couples using medically assisted reproduction. Partners individually completed online questionnaires at baseline and 3 months later. Path analyses using the actor-partner interdependence model revealed that a person’s perception of greater emotional, informational, and tangible partner support was associated with their own higher emotional and relational infertility-related quality of life 3 months later. Women’s perception of greater physical support was also associated with their partner’s higher relational quality of life. The findings suggest that interventions targeting partner support could reduce the negative effects of infertility and its treatments on infertile couples’ quality of life.Infertility can increase conjugal problems and enhance negative emotions in partners. Our results suggest that even small actions from our partner can make us feel supported when undergoing medically assisted reproduction and improve quality of life. Fertility clinics could highlight the benefits of partner support to help couples preserve their relationship. [ABSTRACT FROM AUTHOR]

Introduction: Evidence on the role of medically assisted reproduction (MAR) in achieving the desired number of children is very limited. The aim of the current investigation was to assess the probability and the mode of conception of a second live birth according to the mode of conception of the first one. Material and methods: This historical cohort study was based on administrative data from regional healthcare databases. Women hospitalized for childbirth in Lombardy between January 1, 2007 and December 31, 2017 were identified. The probability of a second live birth up to 2021 was estimated using the Kaplan–Meier method. We calculated this probability according to the mode of conception of the first birth, and the analysis was also performed in strata of maternal age at first birth. Cox proportional hazards models were fitted to estimate the hazard ratio (HR) and 95% confidence interval (CI) of the association between mode of conception at first live birth and the probability of having a second live birth. Mothers were right‐censored if they moved out of the region, died, or did not have a second live birth by the end of follow‐up. Results: We identified 431 333 women who had their first live birth after a natural conception and 16 837 who had their first live birth after MAR. The probability of having a second live birth was 58.6% and 32.1%, respectively in the two groups (HR = 0.68, 95% CI: 0.66–0.70). Considering solely women who naturally conceived their first live birth, the probability to have a second child with MAR was 1.1% and to have a second child naturally 59.3%. The corresponding values were 11.5% and 25.2% in the group of women with a first MAR‐mediated live birth. Conclusions: In our cohort, one woman out of 10 having a first MAR‐mediated live birth underwent MAR programs again. Considering women who had a first natural live birth, this proportion was drastically reduced. In the field of MAR, more attention should be given to the capacity of a couple to achieve the number of desired children. [ABSTRACT FROM AUTHOR]

Copyright of Actualités Pharmaceutiques is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The field of reproductive genetics has undergone significant advancements with the completion of the Human Genome Project and the development of high-throughput sequencing techniques. This has led to the identification of numerous genes involved in both male and female infertility, revolutionizing the diagnosis and management of infertility patients. Genetic investigations, including karyotyping, specific genetic tests, and high-throughput sequencing, have become essential in determining the genetic causes of infertility. Moreover, the integration of genetics into reproductive medicine has expanded the scope of care to include not only affected individuals or couples but also their family members. Genetic consultations and counselling play a crucial role in identifying potentially affected relatives and offering tailored therapy and the possibility of fertility preservation. Despite the current limited therapeutic options, an increasing understanding of genotype–phenotype correlations in infertility genes holds promise for improved treatment outcomes. The availability of genetic diagnostic tools has reduced the number of idiopathic infertility cases by providing accurate aetiological diagnoses. The transition from research to clinical practice in reproductive genetics requires the establishment of genetic consultations and data warehousing systems to provide up-to-date information on gene–disease relationships. Overall, the integration of genetics into reproductive medicine has brought about a paradigm shift, emphasizing the familial dimension of infertility and offering new possibilities for personalized care and family planning. [ABSTRACT FROM AUTHOR]

Clinical embryologists are highly trained laboratory professionals with multiple roles, including laboratory, clinical, biobanking and quality system management. In most European countries, clinical embryologists are trained to work in Medically Assisted Reproduction (MAR) centres without a specifically dedicated educational path. The criteria required for employment vary according to the educational structure and the public or private nature of the centre. We have herein described the educational profile required by Italian clinical embryologists to work in MAR centres of the National Health System (NHS). Public centres currently represent 36% of all the Italian MAR clinics. According to the Italian law, a future clinical embryologist must achieve a 3–4 year unpaid post-graduate specialization in a different field, choosing from Genetics, Microbiology, Clinical Pathology or Nutrition. Accesses to the above-mentioned post-graduate courses are themselves very limited. Clinical embryologists are basically trained by senior colleagues. This situation makes inevitably difficult to recruit laboratory staff in NHS centres. Moreover, it represents an emblematic example of the need for an equal training curriculum, possibly ensuring a comparable education quality, mobility of trainees and dissemination of skills for clinical embryologists all over Europe. [ABSTRACT FROM AUTHOR]

Background: To examine the association between maternal education and adverse maternal and neonatal outcomes in women who conceived using medically assisted reproduction, which included fertility medications, intrauterine insemination, or in vitro fertilization. Methods: We conducted a retrospective cohort study utilizing the US Vital Statistics data set on national birth certificates from 2016 to 2020. Women with live, non-anomalous singletons who conceived using MAR and had education status of the birthing female partner recorded were included. Patients were stratified into two groups: bachelor's degree or higher, or less than a bachelor's degree. The primary outcome was a composite of maternal adverse outcomes: intensive care unit (ICU) admission, uterine rupture, unplanned hysterectomy, or blood transfusion. The secondary outcome was a composite of neonatal adverse outcomes: neonatal ICU admission, ventilator support, or seizure. Multivariable modified Poisson regression models with robust error variance adjusted for maternal age, race, marital status, prenatal care, smoking during pregnancy, neonatal sex, and birth year estimated the relative risk (RR) of outcomes with a 95% confidence interval (CI). Results: 190,444 patients met the inclusion criteria: 142,943 had a bachelor's degree or higher and 47,501 were without a bachelor's degree. Composite maternal adverse outcomes were similar among patients with a bachelor's degree (10.1 per 1,000 live births) and those without a bachelor's degree (9.4 per 1,000 live births); ARR 1.05, 95% CI (0.94–1.17). However, composite adverse neonatal outcomes were significantly lower in women with a bachelor's degree or higher (94.1 per 1,000 live births) compared to women without a bachelor's degree (105.9 per 1,000 live births); ARR 0.91, 95% CI (0.88–0.94). Conclusions: Our study demonstrated that lower maternal education level was not associated with maternal adverse outcomes in patients who conceived using MAR but was associated with increased rates of neonatal adverse outcomes. As access to infertility care increases, patients who conceive with MAR may be counseled that education level is not associated with maternal morbidity. Further research into the association between maternal education level and neonatal morbidity is indicated. [ABSTRACT FROM AUTHOR]

Although in the Maghreb, and more broadly in Africa, infertility is a source of stigmatisation and social and individual suffering, many countries on the continent still lack reproductive health clinics and health professionals trained in reproductive medicine. This is due to the high cost of biomedical technologies, the lack of specialised training and the absence of national and international policies to support infertile couples in Africa. In recent years, Tunisia has emerged as a regional hub for reproductive care in the Maghreb, and more broadly in French-speaking Africa. Private IVF clinics occupy a strategic commercial position in the region, giving rise to a plurality of new reproductive mobilities. The researchers collected the stories of infertile couples crossing paths in a private fertility clinic in Tunis. In this article, we will present the stories of couples from neighbouring countries to Tunisia (Libya, Algeria), sub-Saharan Africa as well as Tunisians residing abroad (TRA) from different countries of emigration (Europe, Gulf Countries). The observations carried out within the fertility clinic, the exchanges with the medical staff as well as with the management and communication teams provide an understanding of these reproductive itineraries to Tunisia. In this article, we examine the problem of infertility in the Maghreb, the evolution of private IVF clinics in Tunisia and the dimension of intimacy through the stakes, stigmas and gendered norms that characterise medical practices in this field. In particular, our research demonstrates the persistence of certain norms that are part of an older gender regime in which women are solely responsible for infertility. We also look at the reproscapes in the Maghreb, focusing on reproductive itineraries and social conditions of the infertile couples we met, including the dematerialised spaces (internet) they resort to. In the field of health in general, as in that of infertility in particular, virtual spaces and the existence of these online communities have come to play a prominent role. They preserve intimacy and anonymity allowing Internet users affected by infertility to share their experiences and express their suffering without fear of being stigmatised. The over-representation of women on these digital platforms is indicative of gender norms that continue to dominate procreation in Maghreb countries and beyond. Articulated by the infertile North African and West African couples encountered, the transnational reproductive landscapes analysed in the paper offer an original perspective to approach the intimate in the Maghreb. In the context of ARTs, intimacy is defined on the one hand through relationships within the couple, relationships with family and loved ones; and on the other hand, in the therapeutic relationship with medical staff. The reproductive routes taken, invite us to decentralise the gaze and focus on other types of circulation from the Maghreb to the southern shore of the Sahara and even beyond (European and Gulf countries where the TRA have emigrated); to spatialise the narratives of couples in motion while grasping the globalised social transformations they characterise (biomobility, bioeconomies, biotechnologies); and to understand the sensitive nature of these narratives, which carry a very strong emotional charge. The materiality of the reproductive routes deployed (medical structures, technologies, means of transport and communication, etc.) is intertwined with other immaterial aspects intimately linked to the affective dimension behind the desire to procreate and the moral and social suffering in the face of its impossibility. The social stigma linked to the use of ARTs causes the invisibilisation of these transnational trajectories. In conclusion, our research opens up paths of analysis concerning new transnational mobilities in reproductive health as well as their moral, social, familial and emotional implications.

Research Framework: In 2021, medically assisted reproduction (MAR) was opened up to all women in France. The debates that preceded the revision of the law made a new family configuration visible: solo maternity. While studies in other countries have been looking at these maternities since the 2000s, they remain little documented in France.Objectives: The aim is to analyze the profiles and trajectories of women who decide to become solo mothers using MAR.Methodology: As part of the Outside-ART post-survey, semi-structured interviews were carried out in 2022 with 25 women living in France who said they had undergone or were in the process of undergoing solo MAR, either at home or abroad. Results: As in previous studies, recourse to solo MAR often appears to be a second-intention choice for women closer to their forties. However, a new profile is emerging: that of younger women for whom this recourse is an immediate choice. Whether it’s a “plan A” or a “plan B”, these women want to emancipate themselves from the traditional family, which they see marked by inequality. Their plans are meticulously prepared, but they are a few grey areas. The MAR process for future solo mothers remains difficult, because they are regularly reminded of the gendered order of the family and parenthood.Conclusion: In France, the MAR process, historically designed for heterosexual couples, is slowly being adapted to the specificities of solo journeys. Despite social and legal changes, the weight of gender norms governing the family remains strong, even within the medical community.Contribution: This article contributes to a better understanding of the parental projects and MAR journeys of future solo mothers in the French context.

In this Seminar , we present an overview of the current and emerging methods and technologies for optimizing the man and the sperm sample for fertility treatment. We argue that sperms are the secret to success, and that there are many avenues for improving both treatment and basic understanding of their role in outcomes. These outcomes encompass not just whether treatment is successful or not, but the wider intergenerational health of the offspring. We discuss outstanding challenges and opportunities of new technologies such as microfluidics and artificial intelligence, including potential pitfalls and advantages. This article aims to provide a comprehensive overview of the importance of sperm in fertility treatment and suggests future directions for research and innovation. [ABSTRACT FROM AUTHOR]

STUDY QUESTION What is the recommended management for couples presenting with unexplained infertility (UI), based on the best available evidence in the literature? SUMMARY ANSWER The evidence-based guideline on UI makes 52 recommendations on the definition, diagnosis, and treatment of UI. WHAT IS KNOWN ALREADY UI is diagnosed in the absence of any abnormalities of the female and male reproductive systems after 'standard' investigations. However, a consensual standardization of the diagnostic work-up is still lacking. The management of UI is traditionally empirical. The efficacy, safety, costs, and risks of treatment options have not been subjected to robust evaluation. STUDY DESIGN, SIZE, DURATION The guideline was developed according to the structured methodology for ESHRE guidelines. Following formulation of key questions by a group of experts, literature searches, and assessments were undertaken. Papers written in English and published up to 24 October 2022 were evaluated. PARTICIPANTS/MATERIALS, SETTING, METHODS Based on the available evidence, recommendations were formulated and discussed until consensus was reached within the guideline development group (GDG). Following stakeholder review of an initial draft, the final version was approved by the GDG and the ESHRE Executive Committee. MAIN RESULTS AND THE ROLE OF CHANCE This guideline aims to help clinicians provide the best care for couples with UI. As UI is a diagnosis of exclusion, the guideline outlined the basic diagnostic procedures that couples should/could undergo during an infertility work-up, and explored the need for additional tests. The first-line treatment for couples with UI was deemed to be IUI in combination with ovarian stimulation. The place of additional and alternative options for treatment of UI was also evaluated. The GDG made 52 recommendations on diagnosis and treatment for couples with UI. The GDG formulated 40 evidence-based recommendations—of which 29 were formulated as strong recommendations and 11 as weak—10 good practice points and two research only recommendations. Of the evidence-based recommendations, none were supported by high-quality evidence, one by moderate-quality evidence, nine by low-quality evidence, and 31 by very low-quality evidence. To support future research in UI, a list of research recommendations was provided. LIMITATIONS, REASONS FOR CAUTION Most additional diagnostic tests and interventions in couples with UI have not been subjected to robust evaluation. For a large proportion of these tests and treatments, evidence was very limited and of very low quality. More evidence is required, and the results of future studies may result in the current recommendations being revised. WIDER IMPLICATIONS OF THE FINDINGS The guideline provides clinicians with clear advice on best practice in the care of couples with UI, based on the best evidence currently available. In addition, a list of research recommendations is provided to stimulate further studies in the field. The full guideline and a patient leaflet are available in www.eshre.eu/guideline/UI. STUDY FUNDING/COMPETING INTEREST(S) The guideline was developed by ESHRE, who funded the guideline meetings, literature searches, and dissemination of the guideline in collaboration with the Monash University led Australian NHMRC Centre of Research Excellence in Women's Health in Reproductive Life (CREWHIRL). The guideline group members did not receive any financial incentives; all work was provided voluntarily. D.R. reports honoraria from IBSA and Novo Nordisk. B.A. reports speakers' fees from Merck, Gedeon Richter, Organon and Intas Pharma; is part of the advisory board for Organon Turkey and president of the Turkish Society of Reproductive Medicine. S.B. reports speakers' fees from Merck, Organon, Ferring, the Ostetric and Gynaecological Society of Singapore and the Taiwanese Society for Reproductive Medicine; editor and contributing author, Reproductive Medicine for the MRCOG, Cambridge University Press; is part of the METAFOR and CAPE trials data monitoring committee. E.B. reports research grants from Roche diagnostics, Gedeon Richter and IBSA; speaker's fees from Merck, Ferring, MSD, Roche Diagnostics, Gedeon Richter, IBSA; E.B. is also a part of an Advisory Board of Ferring Pharmaceuticals, MSD, Roche Diagnostics, IBSA, Merck, Abbott and Gedeon Richter. M.M. reports consulting fees from Mojo Fertility Ltd. R.J.N. reports research grant from Australian National Health and Medical Research Council (NHMRC); consulting fees from Flinders Fertility Adelaide, VinMec Hospital Hanoi Vietnam; speaker's fees from Merck Australia, Cadilla Pharma India, Ferring Australia; chair clinical advisory committee Westmead Fertility and research institute MyDuc Hospital Vietnam. T.P. is a part of the Research Council of Finland and reports research grants from Roche Diagnostics, Novo Nordics and Sigrid Juselius foundation; consulting fees from Roche Diagnostics and organon; speaker's fees from Gedeon Richter, Roche, Exeltis, Organon, Ferring and Korento patient organization; is a part of NFOG, AE-PCOS society and several Finnish associations. S.S.R. reports research grants from Roche Diagnostics, Organon, Theramex; consulting fees from Ferring Pharmaceuticals, MSD and Organon; speaker's fees from Ferring Pharmaceuticals, MSD/Organon, Besins, Theramex, Gedeon Richter; travel support from Gedeon Richter; S.S.R. is part of the Data Safety Monitoring Board of TTRANSPORT and deputy of the ESHRE Special Interest Group on Safety and Quality in ART; stock or stock options from IVI Lisboa, Clínica de Reprodução assistida Lda; equipment/medical writing/gifts from Roche Diagnostics and Ferring Pharmaceuticals. S.K.S. reports speakers' fees from Merck, Ferring, MSD, Pharmasure. HRV reports consulting and travel fees from Ferring Pharmaceuticals. The other authors have nothing to disclose. DISCLAIMER This guideline represents the views of ESHRE, which were achieved after careful consideration of the scientific evidence available at the time of preparation. In the absence of scientific evidence on certain aspects, a consensus between the relevant ESHRE stakeholders has been obtained. Adherence to these clinical practice guidelines does not guarantee a successful or specific outcome, nor does it establish a standard of care. Clinical practice guidelines do not replace the need for application of clinical judgment to each individual presentation, nor variations based on locality and facility type. ESHRE makes no warranty, express or implied, regarding the clinical practice guidelines and specifically excludes any warranties of merchantability and fitness for a particular use or purpose. (Full disclaimer available at www.eshre.eu/guidelines.) [ABSTRACT FROM AUTHOR]