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An increasing number of women are conceiving through assisted reproductive technology; however, few studies have investigated their mental health after successful conception. This study investigated the changes in depressive symptoms in women using assisted reproductive technology and the association between the mode of conception and perinatal depressive symptoms. A longitudinal observational study was conducted from 2015 to 2019, 542 pregnant women completed questionnaires on depressive symptoms at eight timepoints during the prepregnancy, pregnancy and first-year postpartum periods. Depressive symptoms were assessed using the Center for Epidemiologic Studies Depression Scale. A generalized estimating equation regression model was employed for repeated measures. In the assisted reproductive technology group, depressive symptoms were more prevalent during early pregnancy and at 1 month postpartum than before pregnancy, and more prevalent before pregnancy and at 1 month after childbirth than in the spontaneous conception group. No significant association was identified between the mode of conception and depressive symptoms during the antenatal or postnatal period. The lack of full-time employment and prepregnancy depressive symptoms were associated with antenatal depressive symptoms. Primipara status and depressive symptoms during prepregnancy and pregnancy were associated with depressive symptoms during the first-year postpartum. Assisted reproductive technology was not a risk factor for depressive symptoms during the pregnancy and postpartum periods, whereas primipara status, lack of full-time employment and prepregnancy depressive symptoms were negative predictors. Therefore, targeted mental health interventions should address these specific factors to effectively support maternal mental health.

Background: Since its introduction, assisted reproductive technology (ART) has developed into a common clinical practice around the world; yet it still raises a lot of questions. Throughout time, many researchers have investigated its association with several obstetric incidences and its consequences on perinatal outcomes. The aim of the current meta-analysis was to estimate the correlation between ART procedures and malpresentation of the fetus in singleton pregnancies., Methods: The study was conducted according to the Preferred Reporting Items of Systematic Reviews and Meta-analyses (PRISMA) guidelines and prospectively registered under the PROSPERO database (CRD42023458084). Five databases (Embase, MEDLINE ® , APA PsycInfo, Global Health, Health Management Information Consortium (HMIC)) and two additional sources were searched from inception to 31 May 2023. Quality of the included studies was assessed using the ROBINS-1 scale, whilst quality of evidence by the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework. Summative and subgroup data as well as heterogeneity were generated by the Cochrane platform RevMan Web., Results: Overall, 11 studies were included in the study with a total of 3,360,134 deliveries. Results indicate a higher risk of malpresentation at delivery in fetuses conceived through ART than those conceived naturally (RR: 1.50, (95% confidence interval (CI):1.30, 1.73)). This risk decreased when adjustments for potential confounders were applied (RR = 1.12, 95% CI 1.02, 1.23)., Conclusions: Based on observational studies, this meta-analysis indicated that singleton pregnancies conceived through ART are associated with higher risk of malpresentation than those conceived naturally, albeit the difference was lower when potential confounders were examined. Thus, future large studies are required to better understand possible reversible and irreversible factors of this relationship.

Objectives: We elucidate the impact of the coronavirus disease 2019 (COVID-19) pandemic on assisted reproductive technology (ART) services and birth outcomes and establish an evidence-based framework to maintain the high quality of ART healthcare services and ensure continuous improvement of birth outcomes., Methods: A total of 19,170 pregnant women from Sichuan, Guizhou and Chongqing in Southwest China between 2018 and 2021 were included in this study. The log-binomial regression model was employed to analyse the changes in the probability of adverse birth outcomes, such as low birth weight (LBW), preterm birth (PTB), Apgar score < 7 at 1 min and congenital anomalies (CAs) and their relationship with ART before and after the pandemic. In this analysis, confounding factors such as family annual income, maternal ethnicity, delivery age, subjective prenatal health status, vitamin or mineral supplementation during pregnancy and level of prenatal care provided by the hospital were controlled., Results: ART mothers had the highest probability of giving birth to LBW babies (relative risk (RR): 2.82, 95% confidence interval (CI): 2.32-3.41), experiencing PTB (RR: 2.72, 95% CI: 2.78-3.22) and delivering babies with an Apgar score < 7 at 1 min (RR: 1.73, 95% CI: 1.05-2.69). Before the pandemic, the ART rate increased from 4.42% in 2018 to 6.71% in 2019 (rate difference of 2.29%, P < 0.001). After the pandemic, the ART rate decreased from 6.71% in 2019 to 6.55% in 2020 (rate difference of - 0.16%, P = 0.752). Compared with the pre-pandemic period, the rate difference for LBW decreased from - 0.21% (P = 0.646) in 2018-2019 to an increase of + 0.89% (P = 0.030) in 2019-2020. Similarly, PTB showed an increase in rate difference from + 0.20% (P = 0.623) before the pandemic to + 0.53% (P = 0.256) afterwards. Apgar score < 7 at 1 min had a negative rate difference of - 0.50% (P = 0.012), which changed to a positive value of + 0.20% (P = 0.340). For CAs, the rate difference increased from + 0.34% (P = 0.089) prior to the outbreak to + 0.59% (P = 0.102) at post-outbreak. In 2018 (pre-pandemic), ART was the most significant predictor of LBW, exhibiting an RR of 3.45 (95% CI: 2.57-4.53). Furthermore, in 2020, its RR was 2.49 (95% CI: 1.78-3.42). Prior to the onset of the pandemic (2018), ART (RR: 3.17, 95% CI: 2.42-4.08) was the most robust predictor of PTB. In 2020, its RR was 2.23 (95% CI: 1.65-2.97)., Conclusion: ART services have been significantly impacted by the COVID-19 pandemic, and the resulting delays in ART services have had notable implications for maternal birth outcomes., Competing Interests: Declarations Ethics approval and consent to participate Ethics approval can be seen in the article “Cohort Profile: China Southwest Birth Cohort (CSBC)”. Informed consent was obtained from all participants. Consent for publication Not applicable. Competing interests The authors declare no competing interests., (© 2024. The Author(s).)

Objective: To compare the risk of hospitalisation for conditions originating in the perinatal period between children conceived via assisted reproductive technology and those that are naturally conceived, differentiating by treatment type., Study Design, Setting and Participants: Population-based record-linkage study of children born after assisted reproduction in the UK between 2002 and 2009 (n=44 618), their naturally conceived siblings (n=8462) and matched naturally conceived population (n=89 072) controls linked to their hospital inpatient records up to 31 March 2016., Primary and Secondary Outcome Measures: Robust estimates of the overall and cause-specific risk of hospital admission for adverse perinatal events and the comparison of outcomes by type of treatment., Results: Over the study period, 17 132 (38.40%) children conceived via assisted reproduction and 30 306 (34.02%) and 1738 (20.54%) naturally conceived population and sibling controls, respectively, were admitted to the hospital for severe perinatal events. Compared with the population controls, singletons (Risk ratio (95% CI 1.30 (1.26, 1.34))) and twins (1.01 (0.99, 1.03)) conceived via assisted reproduction exhibited a higher risk of hospitalisation for any adverse perinatal event. However, no such increase was observed in the within-sibling analysis (0.97 (0.84, 1.12)). Similar patterns were seen for diagnoses related to length of gestation and fetal growth (vs population controls: 1.37 (1.29, 1.46); vs siblings: 1.17 (0.86, 1.60)); birth trauma (vs population controls: 1.23 (1.04, 1.44); vs siblings: 0.78 (0.47, 1.30)); respiratory and cardiovascular disorders (vs population controls: 1.28 (1.20, 1.38); vs siblings: 0.72 (0.53, 0.98)); infections (vs population controls: 1.30 (1.06, 1.59); vs siblings: 0,68 (0.24, 1.90)) and several other conditions. Associations were similar when comparing in vitro fertilisation to intracytoplasmic sperm injection and were higher when comparing fresh to frozen embryo transfers., Conclusion: Children conceived via assisted reproduction showed modest increases in the risk of hospitalisations for severe perinatal events when compared with population controls, although these findings were attenuated in the sibling analyses. The imprecision of within-sibling analyses highlights the need for larger studies to explore potential causal effects., Competing Interests: Competing interests: All authors have completed the Unified Competing Interest form (available on request from the corresponding author) and declare that SMN has participated in Advisory Boards and received speakers or consultancy fees from Access Fertility, Beckman Coulter, Ferring, Finox, Merck, MSD, Roche Diagnostics and The Fertility Partnership. SMN has declared funding from the Chief Scientist Office, Wellbeing of Women and National Institute of Health Research, for research unrelated to this paper in the last 36 months. All funds for these grants go to and are managed and audited by the University of Glasgow. DAL has declared funding from the UK Medical Research Council, National Institute of Health Research, British Heart Foundation, Diabetes UK and US National Institute of Research, for research unrelated to this paper in the last 36 months. All funds for these grants go to and are managed and audited by the University of Bristol. DAL is a member of the UK Biobank strategic oversight committee, Chair of the scientific advisory board for the Bradford Health Research Institute public health ‘ActEarly’ Programme and Chair of the NIHR-BHF partnership working group on maternal cardiovascular health; she does not receive any payment for these activities. The authors whose names are listed immediately below certify that they have no affiliations with or involvement in any organisation or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript: AGS, MP, SAR and DRB., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Background: An increased body mass index (BMI) can lead to subfertility; however, current literature fails to exclude the effect of other confounding medical conditions, raising questions regarding the direct link between increased BMI and fertility outcomes., Objectives: To conduct a systematic review and meta-analysis to elucidate the effects of increased BMI on fertility outcomes in females with no other comorbidities., Search Strategy: A comprehensive search was conducted using EMBASE, MEDLINE and the Cochrane library from January 2000 until July 2023., Data Collection and Analysis: Two authors independently conducted data extraction and assessed study quality. Odds ratio (OR) (dichotomous data), standardised mean difference (SMD) (continuous data) and 95% CIs were calculated., Main Results: Nine eligible studies were identified: one natural conception and eight assisted reproductive technology (ART). Aggregated data revealed women with BMI ≥25 were less likely to attain clinical pregnancy (OR 0.76, 95% CIs 0.62 to 0.93, p=0.007), with BMI ≥30 associated with a further decreased likelihood of clinical pregnancy (OR 0.61, 95% CIs 0.39 to 0.98, p=0.04). Women with raised BMI required longer duration of stimulation (SMD=0.08, 95% CIs 0.00 to 0.16, p=0.04) and obtained reduced oocytes (SMD=-0.11, 95% CIs -0.18 to -0.04, p=0.002)., Conclusions: These data demonstrate an adverse impact of being overweight/obese on ART outcomes in women with no other diagnosed medical comorbidities and highlight the distinct lack of data concerning the effects of isolated obesity on natural conception. Infertility represents an enormous burden for couples and society; it is essential to identify and tackle modifiable risk factors to improve chances of conception., Prospero Registration Number: CRD42022293631., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Background: Theoretically, endocrine fluctuations occurring during infertility treatments, including ovulation induction (OI) and assisted reproductive techniques (ART), could be associated with an increased risk of benign breast diseases (BBDs). To date, no studies have been conducted on this association. Therefore, the present study investigated the association between different types of infertility treatments and BBDs., Methods: This case‒control study was conducted in Arash Women's Hospital, Tehran, Iran. The case group included infertile women diagnosed with BBDs without atypia, and the control group included infertile women without breast disease. Breast imaging studies (mammography/ultrasound) were performed for BBD screening, and the diagnosis was confirmed by histopathological examination. Study variables were collected retrospectively from medical records, hospital databases, and questionnaires., Results: Finally, 154 infertile women, including 50 cases (BBDs) and 104 controls (no BBDs), were compared. Our data showed that 66% of cases and 61.4% of controls had undergone at least one course of infertility treatment. There was no association between BBD risk and previous infertility treatments (OR = 1.21; 95% CI = 0.59-2.46), ART (OR = 1.14; 95% CI = 0.90-1.44), or OI cycles (OR = 1.13; 95% CI = 0.98-1.32). Stratification by confounding variables did not change these results., Conclusions: It seems that there is no association between BBDs in infertile women and the type, duration, or number of prior infertility treatments; however, considering the small sample size of the study, the clinical significance of this finding should not be neglected. Therefore, we consider it essential to carry out more extensive, detailed, and prospective studies to distinguish the association of BBDs with different infertility treatments and medications., (© 2024. The Author(s).)

Research Question: What were the utilization, effectiveness and safety of assisted reproductive technology (ART) in Africa during 2020?, Design: Cross-sectional, cycle-based and retrospective summary data were collected from voluntarily participating ART centres., Results: During 2020, 37,063 ART procedures were reported by 67 centres in 15 countries. Autologous fresh transfers were predominant at 65.0%, whereas autologous frozen embryo transfers (FET) represented 26.2% and oocyte donation cycles remained less than 10%. Women undergoing autologous fresh embryo transfer had a mean age of 34.9 years and received a mean number of 2.4 embryos per transfer. The clinical pregnancy rate (CPR) per embryo transfer was 37.3% after fresh embryo transfer and 37.8% after frozen embryo transfer. The cumulative CPR per aspiration was 41.9% in autologous cycles. Most ART procedures resulted in a multiple delivery rate above 20%. After autologous ART, multiples were predominantly born preterm (twin and triplet deliveries 59.5% versus singleton 21.9% born before 37 weeks), with a substantially increased perinatal mortality compared with ART singletons (59.0‰ versus 22.2‰). Cycle-based data documented that elective single embryo transfer (eSET) provides the optimal balance of effectiveness (eSET CPR per embryo transfer 36.7%) and safety., Conclusion: This fourth report of the African Network and Registry for ART provides real-world evidence of ART utilization, practices and outcomes in Africa, which is relevant to many stakeholders. It critically informs and represents regional ART development based on national, regional and global cooperation., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

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., (© The Author(s) 2024. Published by Oxford University Press on behalf of European Society of Human Reproduction and Embryology.)

Research Question: The legislation allowing unmarried women to undergo medically assisted reproduction (MAR) with sperm donation was adopted in France on August 2, 2021. This major advancement, and its impact on French society, led us to a closer examination of the requests made by unmarried women and the outcomes of ART attempts., Design: A retrospective single center cohort study was conducted in a fertility center in Paris, France. All unmarried women and women in heterosexual couple seeking for MAR using sperm donation between September 2021 and October 2022 were included. Medical and socio-demographic data, as well as details and outcomes of MAR attempts were analyzed until October 31, 2023., Results: Two hundred seventy-two unmarried women and 76 women in heterosexual couple were included. Results were compared between the two groups. Unmarried women were significantly older, with a significant decrease in anti-Müllerian hormone (AMH) and antral follicle count (AFC). They also exhibited a higher prevalence of gynecological pathologies associated with infertility, such as endometriosis. Unmarried women were more likely to work in intermediate occupations, whereas women in heterosexual couple more often had employee status. Among unmarried women who had undergone at least one MAR attempt by October 31, 2023, significantly lower cumulative early and ongoing pregnancy rates were observed., Conclusions: Female age appears to play a major role in the likehood of pregnancy and live birth. It is therefore crucial to inform women initiating the process of MAR with sperm donation that success is not guaranteed., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier Masson SAS. All rights reserved.)

Objective: To assess the relationship between meal consumption frequency and assisted reproductive technology (ART) outcomes among female patients with infertility., Research Methods & Procedures: This cohort study was conducted from February 2022 to January 2024 at Tokyo Medical University Hospital. Overall, 101 female patients with infertility issues and without a history of stroke, heart disease, cancer, or type 1 or type 2 diabetes were enrolled in this study. The factors extracted from the questionnaire included demographic information, meal consumption frequency before ART and at 20 years of age, smoking status, and alcohol consumption status. Data on other factors, including age, body mass index, anti-Müllerian hormone level, and parity history, were collected from medical records. The assessed clinical outcomes included number of transplanted embryos, clinical pregnancies, ongoing pregnancies, live births, and miscarriages., Results: After adjusting for potential confounding factors, including age, smoking status, alcohol consumption status, body mass index, anti-Müllerian hormone level, and parity history, a multivariate analysis of ART outcomes was performed. Patients were categorized into groups based on the frequency of weekly consumption of breakfast, lunch, and dinner. Patients who consumed breakfast 6-7 times a week were significantly more likely to have higher rates of live birth and lower rates of miscarriage in pregnancies conceived through ART., Conclusions: Consumption of breakfast 6-7 times a week before ART was associated with increased success rates following ART. This highlights the potential importance of regular breakfast consumption for optimizing ART outcomes., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Masanori Ono reports financial support was provided by Japan Society for the Promotion of Science. Tomoko Fujiwara reports financial support was provided by Japan Society for the Promotion of Science. Hiroshi Fujiwara reports financial support was provided by Japan Society for the Promotion of Science. Yoshiko Maida reports financial support was provided by Japan Society for the Promotion of Science. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this article., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Research Question: Are authors aware when they have cited a retracted paper in their manuscripts in the medically assisted reproduction (MAR) field?, Design: A cross-sectional study based on an online survey was conducted to acquire information on the citation pattern from corresponding authors who had cited a retracted article. A dataset of retracted articles in the MAR field was collected from PubMed and Retraction Watch. A complete list of published articles that cited each retracted article was retrieved. The survey was distributed via e-mail to corresponding authors who had cited a retracted paper in their study., Results: The survey revealed a significant lack of awareness among authors, with 78.7% unaware that they had cited retracted articles. This lack of awareness was attributed to insufficient notification mechanisms within research databases and journals, alongside a reliance on previously stored copies of manuscripts. A notable finding was that reference checks were typically performed by a single author, with no instances of retraction concerns raised during the peer-review process. Only a small fraction (17.8%) of respondents reported verifying retraction notices on both journal websites and scientific databases., Conclusions: Correcting publications that contain references which are subsequently retracted is significant for systematic reviews, meta-analyses and guidelines. Citations of retracted articles perpetuate erroneous scientific data, but assessing the accuracy of citations requires considerable effort. Proper notification of retraction status and cross-checking of citations can help to prevent errors., (Copyright © 2024 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.)

Objective: To report utilization, effectiveness, and safety of assisted reproductive technologies in 2015 and 2016., Design: A retrospective, cross-sectional survey of 3,103 assisted reproductive technology clinics in 74 countries in 2015 and 3,249 clinics in 79 countries in 2016 that submitted cycle and pregnancy outcome data through national and regional registries., Setting: Seventy-nine countries and >3,000 assisted reproductive technology clinics., Patient(s): Patients undergoing assisted reproductive technology procedures., Intervention(s): Assisted reproductive technology., Main Outcome Measure(s): Outcomes on country, regional, and global levels., Result(s): Reported for 2015: 2,358,239 cycles with 548,652 infants born; for 2016: 2,807,963 cycles with 647,188 infants born. Estimated in 2015, ≥2,683,677 cycles resulted in >675,134 infants; in 2016, ≥3,100,448 cycles resulted in ≥723,026 infants. Reported cycles represent approximately 80% of global utilization. In 2015 and 2016, 27.6% and 27.8%, respectively, of women undergoing fresh autologous treatment cycles were aged ≥40 years. Frozen-thawed embryo transfer (ET) cycles accounted for 47.0% and 51.9%, respectively, of all ETs in 2015 and 2016. Oocyte donation cycles accounted for 6.7% and 7.1% of all ETs in 2015 and 2016. Intracytoplasmic sperm injection was performed in 57.7% and 56.4% of autologous aspiration cycles in 2015 and 2016, respectively. The cumulative delivery rate per aspiration cycle for fresh and frozen-thawed ET was 32.4% in 2015 and 33.1% in 2016, respectively. The average number of transferred embryos was 1.70 in 2015 and 1.69 in 2016. The proportion of single ETs in fresh autologous cycles increased from 42.1% in 2015 to 44.0% in 2016. The twin delivery rate decreased from 16.0% in 2015 to 14.7% in 2016, and the triplet rate decreased from 0.6% in 2015 to 0.4% in 2016. The proportion of single ETs in frozen-thawed ET autologous treatment cycles was 62.2% in 2015 and 64.2% in 2016, with twin and triplet rates of 10.1% and 0.3% in 2015 and 10.0% and 0.2% in 2016, respectively., Conclusion(s): Utilization of assisted reproductive technology treatment and births per cycle increased from 2015 to 2016, although multiple births were reduced. An increasing proportion of frozen-thawed ET cycles, continuing wide variation in use of intracytoplasmic sperm injection, and an increase in single ET rates are reported., Competing Interests: Declaration of Interests M.S.K. reports travel support from Ferring, IBSA, and Merck, outside the submitted work. G.M.C. reports funding from the International Committee for Monitoring Assisted Reproductive Technologies (ICMART). The National Perinatal Epidemiology and Statistics Unit (NPESU) of the University of New South Wales, Sydney (UNSW) received funding. S.D. has nothing to disclose. F.Z.H. reports travel expenses to give a scientific lecture from Ferring Pharma, Director, responsible for the Latin American Registry of ART, Chair Committee of Ethics and Public Policies; Chilean Society of Obstetrics and Gynecology, Vice Chair ICMART, outside the submitted work. J.D.M. is Chair of Société de Médecine de la Reproduction, France, unpaid, outside the submitted work. O.I. has nothing to disclose. M.B. reports consulting fees from ABBOTT INIDA; honoraria from BAZEL PHARMA and MERCK SPEC; Board of Director, Pacific Rim Society of Reproductive Medicine; Board of Director, POSEIDON Group; Regional Director, IFFS Triennial Report, outside the submitted work. S.C.J. reports travel fee for lectures supported by Ferring; travel support from the Japan Society for Reproductive Medicine for attending meetings, outside the submitted work. B.F. has nothing to disclose. E.E. has nothing to disclose. V.B. reports consulting fees from Organon, Society for Assisted Reproductive Technology Executive Council, not paid, outside the submitted work. G.D.A. reports honoraria from Organon; travel support from ESHRE; Chair, International Committee for Monitoring ART. unpaid; President, World Endometriosis Research Foundation, unpaid; ICMART NGO Liaison Observer, Board of the International Federation of Fertility Societies, unpaid; ASRM: Member, Global Health Committee, American Society for Reproductive Medicine, unpaid; founder and CEO of Advanced Reproductive Care, Inc. (d/b/a ARC®Fertility), outside the submitted work., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: To assess whether the provision of fertility treatment for patients with polycystic ovary syndrome (PCOS) varies by patient and physician-level demographic characteristics., Design: Retrospective cohort study., Setting: University health system., Patient(s): Patients seeking care for PCOS and infertility from 2007-2021., Intervention(s): Patient age, body mass index, race, ethnicity, estimated household income, primary insurance payor, provider sex, and provider medical specialty., Main Outcome Measure(s): Prescriptions for fertility treatment, including clomiphene citrate (CC), letrozole, and injectable gonadotropins. Differences in patient and physician demographics between patients who did as well as did not receive a prescription were identified with univariable analysis. Multilevel mixed-effects logistic regression was performed to determine associations between patient and physician demographics and prescription receipt., Result(s): A total of 3,435 patients with PCOS and infertility were identified, with a mean age of 31.1 ± 5.7 years. Of the 68.8% of patients who received a prescription, 47.8% of prescriptions were CC, 38.6% were letrozole, and 13.7% were injectable gonadotropins. There were lower odds of prescription receipt for Black patients compared with White patients (adjusted odds ratio [aOR], 0.75; 95% confidence interval [CI], 0.61-0.93), those with estimated household income below the federal poverty level compared with those above the national median (aOR, 0.71; 95% CI, 0.46-0.97), and those with public compared with commercial insurance (aOR, 0.53; 95% CI, 0.40-0.71). These disparities persisted in a subanalysis of patients prescribed oral medications only with lower odds of prescription receipt for Black compared with White patients (aOR, 0.74; 95% CI, 0.57-0.95), those with estimated household income below the federal poverty level compared with above the national median (aOR, 0.93; 95% CI, 0.87-0.98), and those with public compared with commercial insurance (aOR, 0.57; 95% CI, 0.42-0.76). Black patients waited, on average, 153.3 days longer than White patients, from the initial visit to the prescription receipt. Patients had lower odds of receiving any prescription from family medicine physicians (aOR, 0.36; 95% CI, 0.24-0.52) and general internal medicine physicians (aOR, 0.55; 95% CI, 0.42-0.73) compared with reproductive endocrinologists., Conclusion(s): Racial and socioeconomic disparities exist in the provision of infertility treatments for patients with PCOS. Fewer primary care physicians engaged in first-line fertility treatment, indicating an opportunity for physician education to improve access to fertility care., (Copyright © 2024 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.)

Objective: To identify any correlations between evidence levels, adoption rates, and additional costs of in vitro fertilization (IVF) add-ons., Design: Online survey., Subjects: The survey was conducted in 621 assisted reproductive technology-registered facilities that are members of the Japanese Society of Obstetrics and Gynecology from December 22, 2021, to February 13, 2022., Exposure: The survey included details regarding the specific add-on modalities employed and their associated costs; inquiries pertained to the fertility healthcare infrastructure in Japan before the implementation of the National Health Insurance scheme., Main Outcome Measures: The correlation between the adoption rate and cost of IVF add-ons and their evidence levels were analyzed. The evidence level of the add-on treatments was classified into Green, Amber, and Red categories based on the United Kingdom's Human Fertilisation and Embryology Authority and Cochrane systematic reviews., Results: A total of 438 eligible responses were analyzed, with clinics constituting 70.9% of the respondents' facilities. A total of 18 add-ons were assessed, and 96.5% (423/438) of facilities used at least one add-on. A positive correlation of the adoption rate and an inverse correlation of the cost with the evidence level of the IVF add-on treatment were observed (not significant). Outpatient clinics, defined as medical facilities with no beds, had a significantly higher adoption rate (Amber, 65.7%; Red, 52.0%) of add-ons than other facilities, regardless of the evidence rating, although the costs were similar across all site attributes., Conclusion: Accumulating evidence on the efficacy and safety of add-ons will lead to the development of medical care with a high-cost benefit, as an increase in the adoption rate and a decrease in cost are expected when limiting to medical care with a high level of evidence., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Shionoya, Yamada, Harada, Shirasawa, Jwa, Kuroda, Harada and Osuga.)

In recent decades, the use of assisted reproductive technology (ART) has increased rapidly. To assess the relationship between ART and autism diagnosis, we linked California birth records from 2000 through 2016 with contemporaneous records from the National ART Surveillance System (NASS) and autism caseload records from California's Department of Developmental Services from 2000 through November 2019. All 95 149 birth records that were successfully linked to a NASS record, indicating an ART birth, were matched 1:1 using propensity scores to non-ART births. We calculated the hazard risk ratio for autism diagnosis and the proportions of the relationship between ART conception and autism diagnosis mediated by multiple birth pregnancy and related birth complications. The hazard risk ratio for autism diagnosis following ART compared with non-ART conception is 1.26 (95% CI, 1.17-1.35). Multiple birth, preterm birth, and cesarean delivery jointly mediate 77.9% of the relationship between ART conception and autism diagnosis. Thus, increased use of single embryo transfer in the United States to reduce multiple births and related birth complications may be a strategy to address the risk of autism diagnosis among ART-conceived children., (Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health 2024.)

Objectives: To investigate the association between adenomyosis and placenta accreta spectrum (PAS) and to evaluate the effect of assisted reproductive technology (ART) in mediating this association., Methods: We retrieved data for singleton women from the Japanese nationwide perinatal registry between 2013 and 2019, excluding women with a history of adenomyomectomy. To investigate the association between adenomyosis and PAS among women, we used a multivariable logistic regression model with multiple imputation for missing data. We evaluated mediation effect of ART including in vitro fertilization and intracytoplasmic sperm injection on the association between adenomyosis and PAS using causal mediation analysis based on the counterfactual approach., Results: Of 1 500 173 pregnant women, 1539 (0.10%) had adenomyosis. The number receiving ART was 489/1539 (31.8%) and 117 482/1 498 634 (7.8%) in women with and without adenomyosis, respectively. The proportion of women who developed PAS was 21/1539 (1.4%) in women with adenomyosis and 7530/1 498 634 (0.5%) in women without adenomyosis. Adenomyosis was significantly associated with PAS (odds ratio [OR] 1.95; 95% confidence interval [CI] 1.26-3.00; P = 0.002). Mediation analysis showed that OR of the total effect of adenomyosis on PAS was 1.98 (95% CI 1.13-3.04), OR of natural indirect effect (effect explained by ART) was 1.15 (95% CI 1.01-1.41), and OR of natural direct effect (effect unexplained by ART) was 1.72 (95% CI 0.86-2.82). The proportion mediated (natural indirect effect/total effect) was 26.5%. Adenomyosis was also significantly associated with PAS without previa (OR 1.96; 95% CI 1.23-3.13, P = 0.005)., Conclusion: Adenomyosis was significantly associated with PAS. ART mediated 26.5% of the association between adenomyosis and PAS., (© 2024 International Federation of Gynecology and Obstetrics.)

Objective: To investigate the effect of the Assisted Reproduction Act, implemented in 2007 in Taiwan to reduce the number of embryos to transfer, on the trends over time regarding the rate of multiple births, preterm delivery, low birth weight (LBW), and small for gestational age (SGA) among deliveries using assisted reproductive technology (ART)., Study Design: From the Birth Reporting Registry and the Assisted Reproduction Registry, we retrieved data of 4 016 530 live birth deliveries between 2001 and 2020; among them 71 000 (1.77%) were after ART. We calculated the rate of multiples and perinatal outcomes per 1000 deliveries annually from 2001 to 2020 for deliveries using and not using ART and computed the population attributable risk. We performed interrupted time series to assess the effect of the intervention, ie, the Assisted Reproduction Act., Results: The proportion of deliveries following ART was 0.57% in 2001 and increased to 4.03% in 2020. After the intervention, there were decreasing trends over time for rates of multiples (-10.63 per year, P < .001), preterm delivery (-6.74, P = .003), LBW (-9.38, P < .001), and SGA (-4.48, P = .001) among ART deliveries. There was also an immediate decrease right after intervention (-53.45, P = .005) for SGA after ART. The population attributable risk trends before and after intervention were both increasing for all outcomes., Conclusions: The Assisted Reproduction Act in Taiwan was associated with a decreasing trend of multiples, preterm delivery, LBW, and SGA over time since 2008 among ART deliveries. In particular, there was an immediate decrease of SGA right after the intervention., Competing Interests: Declaration of Competing Interest The authors declare no conflicts of interest., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Objective: To study educational gradients in births after medically assisted reproduction across 5 countries with different institutional arrangements., Design: 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., Settings: Not applicable., Patients: 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., Intervention (for Rct) or Exposure (for Observational Studies): None., Main Outcome Measures: 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., Results: 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., Conclusion: 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., Competing Interests: Declaration of Interests A.G. reports funding from European Research Council (Grant agreement n. 803958 MARTE) for the submitted work. P.F. has nothing to disclose. M.S. reports funding from Spanish Ministry of Science, Innovation and Universities (Juan de La Cierva-Incorporación Fellowship 2018; IJC2018-038444-I) and Department of Sociology II, Spanish National University of Distance Education (UNED) for the submitted work. L.S. reports funding from European Commission’s Joint Research Centre (JRC) Centre for Advanced Studies and the DIGCLASS project and Spanish Ministry of Science and Innovation, Ref. PID2019-111564RB-I00 / AEI /10.13039/501100011033 for the submitted work. T.E. reports funding from Comunidad de Madrid (Atracción de Talento Investigador Postdoctoral Fellowship, Ref. 2017-T2/SOC-5560), Department of Sociology II, Spanish National University of Distance Education (UNED), and Department of Sociology and Communication, University of Salamanca for the submitted work; funding from European Commission Joint Research Center – Expert Contract “Scientific support in the development of Centre for Advanced Study (CAS) on Social Classes in the Digital Age (DIGCLASS)” – Research line “research line dealing with health inequalities by socioeconomic position” outside the submitted work. M.C. reports funding from Italian Ministry of Education (PE8-Conseguenze esfide dell’invecchiamento AGE-IT– CUPB83C22004800006) for the submitted work., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: 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., Study Design: 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., Results: 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., Conclusions: 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., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Edgardo Somigliana reports grants from Ferring, grants and personal fees from Merck-Serono, grants and personal fees from Theramex, personal fees from Gedeon-Richter, outside the submitted work. Giovanni Corrao received research support from the European Community (EC), the Italian Agency of Drugs (AIFA), and the Italian Ministry for University and Research (MIUR). He took part in a variety of projects that were funded by pharmaceutical companies (i.e. Novartis, GSK, Roche, AMGEN and BMS). He also received honoraria as a member of the advisory board to Roche. The other authors declare that they have no conflicts of interest to disclose., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Aim: To investigate variation in the diagnosis and treatment of chronic endometritis (CE) at the national level in Japan., Methods: We performed a nationwide survey targeting all assisted reproductive technology (ART) facilities across Japan between 2021 and 2022. Diagnostic methods, criteria, and first- and second-line treatment protocols for CE were collected via a questionnaire., Results: Among 616 ART facilities, 437 responded to the survey (response rate: 70.9%) of which 339 (77.6%) implemented diagnosis and treatment of CE. In the diagnosis of CE, 214 (63.1%) facilities used CD138 immunohistochemical staining of endometrial tissue, while hysteroscopy was the most frequently used as an adjunct diagnostic method (241 facilities, 71.1%). The most frequent cutoff value of CD138-positive cells for diagnosing CE was 3-5 cells/20 high-power fields (50%), but 7.9% (17 facilities) and 5.1% (11 facilities) used cutoff values of 1 and 2 cells, respectively. The most common first- and second-line treatment methods were doxycycline (210 facilities, 61.9%) and ciprofloxacin + metronidazole (164 facilities, 48.0%), respectively., Conclusions: There is considerable variation in the number of CD138-positive cells used for diagnosing CE. Establishing unified diagnostic criteria and therapeutic methods for CE is essential to provide standardized medicine for CE at the national level., (© 2024 The Author(s). Journal of Obstetrics and Gynaecology Research published by John Wiley & Sons Australia, Ltd on behalf of Japan Society of Obstetrics and Gynecology.)

Study Question: How are ART and IUI regulated, funded, and registered in European countries, and how has the situation changed since 2018?, Summary Answer: Of the 43 countries performing ART and IUI in Europe, and participating in the survey, specific legislation exists in only 39 countries, public funding varies across and sometimes within countries (and is lacking or minimal in four countries), and national registries are in place in 33 countries; only a small number of changes were identified, most of them in the direction of improving accessibility, through increased public financial support and/or opening access to additional subgroups., What Is Known Already: The annual reports of the European IVF-Monitoring Consortium (EIM) clearly show the existence of different approaches across Europe regarding accessibility to and efficacy of ART and IUI treatments. In a previous survey, some coherent information was gathered about how those techniques were regulated, funded, and registered in European countries, showing that diversity is the paradigm in this medical field., Study Design, Size, Duration: A survey was designed using the SurveyMonkey tool consisting of 90 questions covering several domains (legal, funding, and registry) and considering specific details on the situation of third-party donations. New questions widened the scope of the previous survey. Answers refer to the situation of countries on 31 December 2022., Participants/materials, Settings, Methods: All members of the EIM were invited to participate. The received answers were checked and initial responders were asked to address unclear answers and to provide any additional information considered relevant. Tables resulting from the consolidated data were then sent to members of the Committee of National Representatives of ESHRE, requesting a second check. Conflicting information was clarified by direct contact., Main Results and the Role of Chance: Information was received from 43 out of the 45 European countries where ART and IUI are performed. There were 39 countries with specific legislation on ART, and artificial insemination was considered an ART technique in 33 of them. Accessibility is limited to infertile couples only in 8 of the 43 countries. In 5 countries, ART and IUI are permitted also for treatments of single women and all same sex couples, while a total of 33 offer treatment to single women and 19 offer treatment to female couples. Use of donated sperm is allowed in all except 2 countries, oocyte donation is allowed in 38, simultaneous donation of sperm and oocyte is allowed in 32, and embryo donation is allowed in 29 countries. Preimplantation genetic testing (PGT)-M/SR (for monogenetic disorders, structural rearrangements) is not allowed in 3 countries and PGT-A (for aneuploidy) is not allowed in 10; surrogacy is accepted in 15 countries. Except for marital/sexual situation, female age is the most frequently reported limiting criterion for legal access to ART: minimal age is usually set at 18 years and the maximum ranges from 42 to 54 with some countries not using numeric definition. Male maximum age is set in very few countries. Where third-party donors are permitted, age is frequently a limiting criterion (male maximum age ranging from 35 to 50; female maximum age from 30 to 37). Other legal restrictions in third-party donation are the number of children born from the same donor (or, in some countries, the number of families with children from the same donor) and, in 12 countries, there is a maximum number of oocyte donations. How countries deal with the anonymity is diverse: strict anonymity, anonymity just for the recipients (not for children when reaching legal adulthood age), a mixed system (anonymous and non-anonymous donations), and strict non-anonymity. Inquiring about donors' genetic screening showed that most countries have enforced either mandatory or scientific recommendations that exclude the most prevalent genetic diseases, although, again, diversity is evident. Reimbursement/compensation systems exist in more than 30 European countries, with around 10 describing clearly defined maximum amounts considered acceptable. Public funding systems are extremely variable. One country provides no financial assistance to ART/IUI patients and three offer only minimal support. Limits to the provision of funding are defined in the others i.e. age (female maximum age is the most used), existence of previous children, BMI, maximum number of treatments publicly supported, and techniques not entitled for funding. In a few countries reimbursement is linked to a clinical policy. The definitions of the type of expenses covered within an IVF/ICSI cycle, up to which limit, and the proportion of out-of-pocket costs for patients are also extremely dissimilar. National registries of ART are in place in 33 out of the 43 countries contributing to the survey and a registry of donors exists in 19 of them. When comparing with the results of the previous survey, the main changes are: (i) an extension of the beneficiaries of ART techniques (and IUI), evident in nine countries; (ii) public financial support exists now in Albania and Armenia; (iii) in Luxembourg, the only ART centre expanded its on-site activities; (iv) donor-conceived children are entitled to know the donor identity in six countries more than in 2018; and (v) four more countries have set a maximum number of oocyte donations., Limitations, Reasons for Caution: Although the responses were provided by well-informed and committed individuals and submitted to double checking, no formal validation by official bodies was in place. Therefore, possible inaccuracies cannot be excluded. The results presented are a cross-section in time, and ART and IUI frameworks within European countries undergo continuous modification. Finally, some domains of ART activity were deliberately left out of the scope of this survey., Wider Implications of the Findings: Our results offer a detailed updated view of the ART and IUI situation in European countries. It provides extensive answers to many relevant questions related to ART usage at the national level and could be used by institutions and policymakers at both national and European levels., Study Funding/competing Interest(s): The study has no external funding, and all costs were covered by ESHRE. There were no competing interests., (© The Author(s) 2024. Published by Oxford University Press on behalf of European Society of Human Reproduction and Embryology.)

Assisted reproductive technologies (ARTs) such as in vitro fertilisation (IVF) and intracytoplasmic sperm injection (ICSI) are still discussed critically, as there is no consensus on whether these treatments could be the cause of risk factors for obstetric problems such as breech presentation. The aim of this study was to test the association between ART and breech presentation among 11920 singleton term births taking place in Vienna from 2010 to 2020. In this single-centre medical record-based study, data concerning the conception mode (spontaneous versus IVF or ICSI), child presentation, birth mode, newborn sex and size as well as age, height, weight, and reproductive history of the mother were included. Three hundred twenty-six newborns (2.7%) were conceived by IVF or ICSI, and 527 newborns (4.4%) were delivered in breech presentation. Breech presentation occurred in 7.6% of IVF/ICSI children but only in 4.3% of spontaneously conceived children ( P = 0.019). ART increased the crude risk of breech presentation significantly (OR = 1.67; 95% CI 1.71 - 2.38). After adjusting for maternal age, height, number of previous births, smoking, and newborn sex, however, ART had no longer a significant impact on the risk of breech presentation. In contrast, breech presentation was significantly associated with higher maternal age as well as a lower number of previous births, but not with ART. This study shows that the adverse outcomes of IVF and ICSI pregnancies may not be due to the ART treatment alone but might also be due to the mostly higher age and lower parity of the mothers using ART.

Purpose: Multifetal gestation (MFG) is much more common in pregnancies that utilize assisted reproductive technologies (ART). We assessed how these rates have changed over the previous decade and the impact on live birth rates (LBR)., Methods: This retrospective cohort study uses the National Summary Reports of the Society for Assisted Reproductive Technology (SART) from 2014 to 2020. Data points included only autologous cycles. The data were divided into five age groups as reported in the database: < 35, 35-37, 38-40, 41-42, and > 42 years old. Descriptive statistics and a two-tailed T-test were used to determine the trends and statistical significance (p < 0.05)., Results: Rates of twin births decreased substantially from 2014 to 2020 for autologous embryo transfers across all age groups and diagnoses. Surprisingly, the overall LBR for autologous IVF cycles decreased at similar rates from 2014 to 2020 in all age groups. The mean number of embryos transferred has dramatically reduced, especially across age groups < 42., Conclusion: Rates of twin and higher-level gestations have decreased substantially over the past decade; the effect correlates with the increased utilization of eSET and PGT. The cause of infertility did not significantly impact the rate of MFG., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Research Question: Is fertility affected in women with multiple sclerosis (MS), and what is their usage of assisted reproductive technology (ART)?, Design: Data regarding multiple sclerosis and ART usage among patients with multiple sclerosis were extracted from the Israeli health maintenance organization Clalit Health Service database. Data regarding the diagnosis and treatment of multiple sclerosis, cause of infertility and use of fertility treatments were collected for all female multiple sclerosis patients aged 18-45 years between 2005 and 2021. Each patient was matched by age in a 1:10 ratio with reference women from the general population. The prevalence of infertility was compared between the two groups. Univariate and multivariate statistical tests were used to analyse the association between multiple sclerosis and fertility treatments including IVF and ovarian stimulation., Results: During the study period, 1309 multiple sclerosis patients were compared with 13,090 controls from the general population matched for age. The mean age was 29 ± 7.8 years. The overall prevalence of infertility was 15.4% (202/1309) among the multiple sclerosis patients, similar to the general population (16.3%; 2129/13090) (P = 0.436). The prevalence of IVF and ovarian stimulation was similar among multiple sclerosis patients and matched controls from the general population (8.1% versus 7.2%, P = 0.240; 13.8% versus 14.3%; P = 0.624, respectively)., Conclusions: The results show similar rates of infertility and fertility treatments among multiple sclerosis patients and the general population. This provides reassurance that fertility among women with multiple sclerosis does not differ from that of women in the general population, and indicates there is no excessive usage of ART., (Copyright © 2024 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.)

Aims: This study aims to comprehensively examine the employment and practices of embryologists in Japan's assisted reproductive technology (ART) laboratories, focusing on the impact of various factors such as ART cycle numbers, add-ons, and regional differences. Additionally, it seeks to assess the extent to which Japanese ART facilities meet international minimum standards set by the American Society for Reproductive Medicine (ASRM)., Methods: A survey was conducted from December 2021 to February 2022 among 621 ART facilities in Japan. The study categorized facilities into five ART cycle groups and compared the number of embryologists across these groups. It also examined the correlation between the number of embryologists, ART cycles, add-ons, and regional differences. Data were analyzed using linear regression and multiple linear regression analyses., Results: The study's findings revealed a significant correlation between the total number of embryologists at each facility and the ART cycles. Notably, there were significant differences in the number of embryologists across all ART cycle categories. Of the 435 facilities, only 44.6% met the ASRM minimum embryologist staffing requirement. The regression analysis further highlighted the significance of ART cycles and preimplantation genetic testing for aneuploidies as factors. Moreover, the number of embryologists stationed at urban facilities was significantly higher than at nonurban facilities, indicating a potential regional disparity., Conclusion: In Japan, it was first found that more than 50% of ART facilities do not have sufficient embryologists in place relative to the number of ART cycles. Furthermore, the add-ons and regional differences affect the placement of embryologists., (© 2024 The Author(s). Journal of Obstetrics and Gynaecology Research published by John Wiley & Sons Australia, Ltd on behalf of Japan Society of Obstetrics and Gynecology.)

Research Question: Is there any association between pelvic pain and primary caesarean delivery for patients undergoing assisted reproductive technology (ART) treatment?, Design: Retrospective cohort study of nulliparous patients with singleton pregnancies who underwent ART treatment and achieved a live birth between 2012 and 2020. Cases included patients diagnosed with pelvic pain. A 3:1 ratio propensity-score-matched population of patients without a history of pelvic pain was included as the control group. Comparative statistics were performed using chi-squared test and Student's t-test. A multivariate regression analysis was conducted to evaluate the association between pelvic pain and mode of delivery., Results: One hundred and seventy-four patients with pelvic pain were compared with 575 controls. Patients with pelvic pain reported a significantly longer duration of infertility compared with controls (18.98 ± 20.2 months versus 14.06 ± 14.06 months; P = 0.003). Patients with pelvic pain had a significantly higher rate of anxiety disorders (115 ± 21.9 versus 55 ± 31.6; P = 0.009) and use of anxiolytics at embryo transfer (17 ± 3.2 versus 12 ± 6.9; P = 0.03) compared with controls. In addition, patients with pelvic pain had a higher rate of primary caesarean delivery compared with controls (59.8% versus 49.0%; P = 0.01). After adjusting for multiple variables, a significant association was found between pelvic pain and increased odds of primary caesarean delivery (adjusted OR 1.48, 95% CI 1.02-2.1)., Conclusion: Patients with pelvic pain have significantly higher odds of primary caesarean delivery compared with patients without a history of pelvic pain. The infertility outpatient setting may be uniquely positioned to identify patients at risk for undergoing primary caesarean delivery, and could facilitate earlier intervention for pelvic floor physical therapy during the preconception and antepartum periods., (Copyright © 2024 Reproductive Healthcare Ltd. Published by Elsevier Ltd. All rights reserved.)

Study Question: Is there an elevated risk of cyanotic congenital heart defects (CCHD) among livebirths following infertility treatments?, Summary Answer: In this population-based study of single livebirths, infertility treatment (either ART or non-ART) was associated with a higher prevalence of CCHD among livebirths., What Is Known Already: The use of infertility treatment has been on the rise over the past few decades. However, there are limited studies assessing the risk of major cardiac defects following infertility treatments., Study Design, Size, Duration: A retrospective cohort study of livebirth data from the National Vital Statistics System (NVSS) was conducted, comprising of 9.6 million singleton livebirths among first-time mothers aged 15-49 years from 2016 to 2022., Participants/materials, Setting, Methods: Information on infertility treatment use and CCHD was obtained from the health and medical information section of birth certificates, which was completed by healthcare staff after reviewing medical records. Logistic regression models were used to estimate odds ratios (OR) and 95% CI. Entropy balancing weighting analysis and probabilistic bias analysis were also performed., Main Results and the Role of Chance: The proportion of births following infertility treatment increased from 1.9% (27 116) to 3.1% (43 510) during the study period. Overall, there were 5287 cases of CCHD resulting in a prevalence of 0.6 per 1000 livebirths. The prevalence was 1.2 per 1000 live births among infertility treatment users (ART: 1.1 per 1000 livebirths; non-ART: 1.3 per 1000 livebirths) while that for naturally conceived births was 0.5 per 1000 livebirths. Compared to naturally conceived births, the use of any infertility treatment (OR: 2.06, 95% CI: 1.82-2.33), either ART (OR: 2.02, 95% CI: 1.73-2.36) or other infertility treatments (OR: 2.12, 95% CI: 1.74-2.33), was associated with higher odds of CCHD after adjusting for maternal and paternal age, race and ethnicity, and education, as well as maternal nativity, marital status, source of payment, smoking status, and pre-pregnancy measures of BMI, hypertension and diabetes. This association did not differ by the type of infertility treatment (ART versus other infertility treatments) (OR: 1.04, 95% CI: 0.82-1.33, P = 0.712), and was robust to the presence of exposure and outcome misclassification bias and residual confounding., Limitations, Reasons for Caution: The findings are only limited to livebirths. We did not have the capacity to examine termination data, but differential termination by mode of conception has not been supported by previous studies designed to consider it. Infertility treatment use was self-reported, leading to the potential for selection bias and misclassification for infertility treatment and CCHD. However, the association persisted when systematic bias as well as exposure and outcome misclassification bias were accounted for in the analyses. Information on the underlying etiology of infertility relating to either maternal, paternal, or both factors, data on specific types of ART and other infertility treatments, as well as information on subtypes of CCHD, were all not available., Wider Implications of the Findings: In light of the increasing trend in the use of infertility treatment in the USA, and elsewhere, the finding of the current study holds significant importance for the clinical and public health of reproductive-aged individuals. The data show that the use of infertility treatment may expose offspring to elevated odds of severe congenital heart defects such as CCHD studied here. These findings cannot be interpreted causally. While our findings can assist in preconception counseling and prenatal care for pregnancies conceived by either ART or other infertility treatments, they also support some current recommendations that pregnancies resulting from infertility treatments undergo fetal echocardiography screening., Study Funding/competing Interest(s): No funding was sought for the study. The authors declare that they have no conflict of interest., Trial Registraion Number: N/A., (© The Author(s) 2024. Published by Oxford University Press on behalf of European Society of Human Reproduction and Embryology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Background: The escalating utilization of assisted reproductive technology (ART) in response to global infertility rates has spurred research into its complications. Short-term and long-term outcomes have been extensively studied, particularly the neurological concerns surrounding attention-deficit/hyperactivity disorder (ADHD) among ART-conceived children. This study aims investigate the association between ART and ADHD., Methods: Medline, Embase, Scopus, and Web of Science databases were searched through April 4, 2023. Cohort, case-control, and cross-sectional studies were eligible for inclusion. primary summary measures included the unadjusted relative risk (RR) and adjusted hazard ratio (HR) with 95 % confidence intervals. Both fixed-effects and random-effects models were utilized for meta-analysis data pooling to determine the overall effect size. The onset of ADHD in children conceived through ART compared to those conceived naturally., Results: The systematic search yielded 8 studies with 10,176,148 individuals included in the meta-analysis. The meta-analysis revealed a pooled RR of 0.93 (0.68-1.26) for cohort studies and a pooled RR of 0.97 (0.41-2.29) for cross-sectional studies, along with a pooled HR of 1.08 (1.03-1.13) for ADHD in the ART group compared to the non-ART group., Conclusion: While this study identifies some potential association between ART and ADHD, the limited effect size and inherent heterogeneity underscore the need for cautious interpretation., Competing Interests: Declaration of Competing Interest All Authors have none to declare, (Copyright © 2024 Elsevier B.V. All rights reserved.)

The Mediterranean Diet, characterized by high consumption of plant-based foods, olive oil, moderate intake of fish and poultry, and low consumption of red meat and processed foods, has been suggested to improve assisted reproductive technology (ART) outcomes. This narrative review aimed to summarize and synthesize the evidence from observational studies on the associations between preconception adherence to the Mediterranean Diet and ART outcomes. PubMed/MEDLINE, Embase, ScienceDirect, Google Scholar, and Web of Science databases were searched to identify relevant studies. Seven observational studies ( n = 2321 women undergoing ART) were included. Adherence to the Mediterranean Diet was assessed using food frequency questionnaires with 6-195 items. Three studies found that higher Mediterranean Diet scores were associated with improved clinical pregnancy rates (OR 1.4, 95% CI 1.0-1.9; RR 1.98, 95% CI 1.05-3.78) or live birth rates (RR 2.64, 95% CI 1.37-5.07). Two studies showed a positive effect on embryo yield ( p = 0.028) and ovarian response. However, two studies reported no significant associations with ultimate ART success, and four studies found no effects on oocyte and embryo number or quality. The heterogeneity in study designs, Mediterranean Diet assessment methods, and ART protocols limited the strength of conclusions. Evidence for the effects of greater adherence to the Mediterranean Diet on ART outcomes is limited but promising. Future research should focus on conducting randomized controlled trials with standardized Mediterranean Diet assessment methods to establish causal relationships between Mediterranean Diet adherence and ART outcomes, and to elucidate potential mechanisms of action.

Fertility procedures recorded in health-care databases can be used to estimate the start of pregnancy, which can serve as a reference standard to validate gestational age estimates based on International Classification of Diseases codes. In a cohort of 17 398 US MarketScan pregnancies (2011-2020) in which conception was achieved via fertility procedures, we estimated gestational age at the end of pregnancy using algorithms based on (1) time (days) since the fertility procedure (the reference standard); (2) International Classification of Diseases, Ninth Revision (ICD-9)/International Classification of Diseases, Tenth Revision (ICD-10) (before/after October 2015) codes indicating gestational length recorded at the end of pregnancy (method A); and (3) ICD-10 end-of-pregnancy codes enhanced with Z3A codes denoting specific gestation weeks recorded at prenatal visits (method B). We calculated the proportion of pregnancies with an estimated gestational age falling within 14 days ($\pm$14 days) of the reference standard. Method A accuracy was similar for ICD-9 and ICD-10 codes. After 2015, method B was more accurate than method A: For term births, within-14-day agreement was 90.8% for method A and 98.7% for method B. Corresponding estimates were 70.1% and 95.6% for preterm births; 35.3% and 92.6% for stillbirths; 54.3% and 64.2% for spontaneous abortions; and 16.7% and 84.6% for elective terminations. ICD-10-based algorithms that incorporate Z3A codes improve the accuracy of gestational age estimation in health-care databases, especially for preterm births and non-live births., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective: This study aims to investigate the correlation between endometriosis (EMS) and adverse obstetric outcomes., Methods: In this retrospective study 2,925 cesarean section cases were analyzed at the Women and Children's Hospital of Ningbo University, Department of Obstetrics, between May 2019 and December 2023. The study included 1,363 women diagnosed with endometriosis during pregnancy at the time of surgery (study group) and 1,562 women without such a diagnosis (control group). The comparative assessment covered the age of first-time mothers, number of pregnancies and births, gestational age at delivery, incidence rates of assisted reproductive technology (ART), spontaneous abortion, preterm birth, placenta previa, placental adhesion, and postpartum hemorrhage., Results: The study group demonstrated a higher average age of first-time mothers, fewer pregnancies and births, and a significantly shorter gestational age at delivery (P < 0.05) compared to the control group. Incidences of primary infertility, spontaneous abortion, and ART utilization were higher in the study group. The occurrence of placenta previa, placental adhesion, and postpartum hemorrhage was also higher in the study group, indicating significant statistical differences (P < 0.05). No significant difference was observed in preterm birth rates between the groups (P > 0.05)., Conclusion: Pregnancy in women with endometriosis is associated with a higher likelihood of adverse outcomes, therefore highlighting the need for increased clinical awareness., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Objective: The purpose of this study was to determine whether website transparency of service costs, accepted insurance plans, and financing options differs between reproductive endocrinology and infertility clinics located in states that do and do not mandate insurance coverage of assisted reproductive technology (ART). Methods: Six hundred forty-six clinics were identified using the Society for Assisted Reproductive Technology online locator. Clinics were excluded for missing website links, duplicate entries, broken websites, or permanent closure. Mandated coverage by state was gathered on resolve.org Chi-squared testing and logistic regression were performed. Results: Of the 311 clinic websites analyzed, 28.6% were in states that mandate ART coverage and 71.4% were not. Clinics in states that have mandated coverage were more likely to list specific prices on their websites. These clinics were 2.13 times more likely to list specific costs (odds ratio [OR]; 95% confidence interval [CI]: 1.19-3.81, p  = 0.01). There was also a significant difference between the percent of clinics in mandated coverage states and nonmandated states that listed accepted insurance plans. These clinics were 2.44 times more likely to report accepted insurance plans (OR; 95% CI: [1.47-4.05], p  = 0.005). There was no significant difference in the mention of financial assistance between the groups. Clinics in states with mandated coverage were more likely to mention discount programs, but there was no significant difference for other types of financial assistance. Conclusion: Clinics located in states that mandate insurance coverage of ART are more likely to list specific costs, accepted insurance plans, and the availability of discount programs on their website. Patients living in states without mandated coverage are more likely to need to finance their own treatment, yet these patients are less likely to have nearby clinics that provide financial transparency on their websites.

Study Question: What is the current practice and views on (expanded) carrier screening ((E)CS) among healthcare professionals in medically assisted reproductive (MAR) practices in Europe?, Summary Answer: The findings show a limited support for ECS with less than half of the respondents affiliated to centres offering ECS, and substantial variation in practice between centres in Europe., What Is Known Already: The availability of next-generation sequencing, which enables testing for large groups of genes simultaneously, has facilitated the introduction and expansion of ECS strategies, currently offered particularly in the private sector in the context of assisted reproduction., Study Design, Size, Duration: A cross-sectional survey evaluating practice and current views among professionals working in MAR practice in different European countries was designed using the online SurveyMonkey tool. The web-based questionnaire included questions on general information regarding the current practice of (E)CS in MAR and questions on what is offered, to whom the test is offered, and how it is offered. It consisted mostly of multiple-choice questions with comment boxes, but also included open questions on the respondents' attitudes/concerns relevant to (E)CS practice, and room to upload requested files (e.g. guidelines and gene panels). In total, 338 responses were collected from 8 February 2022 to 11 April 2022., Participants/materials, Setting, Methods: The online survey was launched with an invitation email from the ESHRE central office (n = 4889 emails delivered) and the European Society of Human Genetics (ESHG) central office (n = 1790 emails delivered) sent to the ESHRE and ESHG members, and by social media posts. The survey was addressed to European MAR centres or gamete banks and to centres located in non-European countries participating in the European IVF-monitoring Consortium. Two reminder emails were sent. After exclusion of 39 incomplete responses received (e.g. only background information), 299 respondents from 40 different countries were included for analyses., Main Results and the Role of Chance: Overall, 42.5% (127/299) of respondents were affiliated to centres offering ECS. The perceived responsibility to enable prospective parents to make informed reproductive decisions and preventing suffering/burden for parents were the main reasons to offer ECS. A single ECS panel is offered by nearly 45% (39/87 received answers) of the centres offering ECS, 25.3% (22/87) of those centres offer a selection of ECS panels, and 29.9% (26/87) offer whole exome sequencing and a large in silico panel. Different ranges of panel sizes and conditions were included in the ECS panel(s) offered. Most of the respondents (81.8%; 72/88 received answers) indicated that the panels they offer are universal and target the entire population. Pathogenic variants (89.7%; 70/78 received answers), and to a lesser extent, likely pathogenic variants (64.1%%; 50/78 received answers), were included in the ECS report for individuals and couples undergoing MAR with their own gametes. According to 87.9% (80/91 received answers) of the respondents, patients have to pay to undergo an ECS test. Most respondents (76.2%; 61/80 received answers) reported that counselling is provided before and after the ECS test. Preimplantation genetic testing, the use of donor gametes, and prenatal diagnostic testing were the three main reproductive options discussed with identified carrier couples. The main reason, according to the respondents, for not offering ECS in their centre, was the lack of professional recommendations supporting ECS (52.5%; 73/139 received answers) and the high cost for couples or reimbursement not being available (49.6%; 69/139). The challenges and moral dilemmas encountered by the respondents revolved mainly around the content of the offer, including the variants classification and the heterogeneity of the panels, the counselling, and the cost of the test., Limitations, Reasons for Caution: Although the total number of respondents was acceptable, the completion rate of the survey was suboptimal. In addition, the heterogeneity of answers to open-ended questions and the ambiguity of some of the answers, along with incomplete responses, posed a challenge in interpreting survey results. It is also plausible that some questions were not easily understood by the respondents. For this reason, response and non-response bias are acknowledged as further limitations of the survey., Wider Implications of the Findings: The results of this survey could aid in identifying potential challenges or areas for improvement in the current practice of ECS in the MAR field and contribute to the discussion on how to address them. The results underline the need to stimulate a more knowledge-based debate on the complexity and the pros and cons of a possible implementation of ECS in MAR., Study Funding/competing Interest(s): All costs relating to the development process were covered from European Society of Human Reproduction and Embryology and European Society of Human Genetics funds. There was no external funding of the development process or manuscript production. A.C. is full-time employee of Juno Genetics. L.H. declared receiving a research grant during the past 36 months from the Netherlands Organisation for Health Research and Development. She has also participated in a Health Council report of the Netherlands on preconception carrier screening and collaborated with the VSOP Dutch Genetic Alliance (patient umbrella organization on rare and genetic disorders). L.H. and C.v.E. are affiliated with Amsterdam University Medical Centre, a hospital that offers ECS in a non-commercial setting. R.V. received honoraria for presentations from Merck Academy and is unpaid board member of the executive committee of the Spanish Fertility Society. The other authors had nothing to disclose., Trial Registration Number: N/A., (© The Author(s) 2024. Published by Oxford University Press on behalf of European Society of Human Reproduction and Embryology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Background: Violence against women is a distressing issue particularly when they are infertile. Nevertheless, many women who are infertile and exposed to violence continue their marriage and justify such choice., Aim: The current study aimed to assess the prevalence of violence against infertile women and its associated factors., Participants and Methods: This cross-sectional study involved 364 Egyptian women with primary infertility; they were randomly selected from the assisted reproductive technique unit of Al-Azhar University's International Islamic Center for Population Studies and Research. The data were collected through an interview questionnaire including the Infertile Women's Exposure to Violence Determination Scale (IWEVDS), socio-demographic, conception, and community-related factors., Results: Moderate/high violence level was detected among 50.5% (95% CI = 45.3- 55.8%) of the studied infertile women, the mean ± SD of total score of IWEVDS was 48.27 ± 21.6. Exclusion was the most frequent type of violence among them. Binary logistic regression revealed that wives who had lower-educated husbands, lived in low-income families, had undergone prior IVF treatment, and who perceived gender inequality acceptance in society were more likely to expose to violence than others (OR = 3.76, 4.25, 2.05, and 2.08 respectively) (P value < 0.05)., Conclusion and Recommendations: Infertile women have frequent exposure to different types of violence and many factors were implicated in such condition. Despite exposure to violence, infertile women refused divorce because they had no alternative financial sources as well as they were afraid of loneliness. A community mobilization approach to control this problem through a collaboration of all stakeholders is recommended., (© 2024. The Author(s).)

Purpose: With the rise of medically assisted reproductive techniques (ART) the number of pregnancies complicated by gestational diabetes mellitus (GDM) has increased. The aim of this study was to evaluate retrospectively the outcomes of pregnancies complicated by GDM who conceive trough ART (cases) compared to those who conceived spontaneously (controls)., Methods: In 670 women with GDM, 229 cases and 441 controls, followed by the Diabetology of Padua, between 2010-2022, clinical-metabolic maternal characteristics and maternal-foetal outcomes were evaluated., Results: As for the maternal clinical-metabolic characteristics, plasma glucose levels at 60' and 120' under oral glucose tolerance test (OGTT) at time of diagnosis were significantly higher in cases (177.4 ± 31.1 vs 170.9 ± 34.1 mg/dl, p = 0.016; 151.5 ± 32.2 vs 144.0 ± 33.4 mg/dl, p = 0.005 respectively). Furthermore, at diagnosis, cases show higher levels of total cholesterol (257 ± 53 mg/dl vs 246 ± 52 mg/dl; p = 0.012) and triglycerides (199.8 ± 83.2 mg/dl vs 184.9 ± 71.3 mg/dl; p = 0.02) compared to controls. As for maternal outcomes, thyroid disfunction, was recorded in a higher percentage in case (21.4% vs 14.3%; p = 0.008), as well as, the frequency of cesarean section (50.3% vs 41.2%; p = 0.038) and twin pregnancies (16.2% vs 2.5%; p < 0.001). As for neonatal outcomes, there were no statistically significant differences, except for the birth weight of the second twin, which was significantly lower in cases (2268 ± 536 vs 2822 ± 297 g; p = 0.002). No other significant differences were found., Conclusion: This study showed no meaningful differences in the outcomes of GDM pregnancies who were conceived with ART compared to that arose spontaneously as the patients were promptly diagnosed and treated., (© 2024. The Author(s), under exclusive licence to Italian Society of Endocrinology (SIE).)

Background: Assisted reproductive technologies (ARTs) have become the main treatment for infertility. ART treatment can be a stressful life event for infertile females. Whether there is an association between ARTs and postpartum depressive symptoms (PDS) has not been established., Methods: PubMed, MEDLINE, EMBASE, PsycINFO, and CNKI were searched. The pooled outcome was the difference in incidence of PDS within 1 year postpartum between ARTs and the spontaneous pregnancy group., Results: A total of 12 cohort studies, which were conducted in eight developed countries and two developing countries, were involved. In total, 106,338 pregnant women, including 4990 infertile females with ARTs treatment and 101,348 women with spontaneous pregnancy, were enrolled in our final analysis. ARTs women had a lower incidence of PDS compared to the spontaneous pregnancy group according to a random effect model (OR = 0.83, 95 % CI: 0.71-0.97, p = 0.022, I 2  = 62.0 %). Subgroup analyses indicated that studies on late PDS (follow-up: 3-12 months postpartum) were more heterogeneous than those on early PDS (follow-up: <3 months postpartum) (I 2  = 24.3 % vs. I 2  = 0 %, interaction p-value < 0.001). There was a strong relationship between ARTs and late PDS (OR = 0.65, 95 % CI: 0.55-0.77, p < 0.001). Therefore, the possible source of heterogeneity was the postpartum evaluation time, which was confirmed by post-hoc meta-regression., Limitations: Some underlying confounders, such as previous psychiatric illness, the limited availability of ARTs, and ethnic disparities, cannot be ignored and may have biased interpretation of the results., Conclusion: The available data suggested that ARTs were associated with lower incidence of PDS, especially when follow-up lasted over 3 months. However, these findings should be interpreted with caution. Better-designed trials are needed to confirm this association., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Importance: Advancements in assisted reproductive technology (ART) have led to an increase in gestational carrier (GC) pregnancies. However, the perinatal outcomes of GC pregnancies remain understudied, necessitating a deeper understanding of their associated risks., Objective: To assess maternal characteristics and obstetric outcomes associated with GC pregnancies., Data Sources: A comprehensive systematic search of publications published before October 31, 2023, using PubMed, Web of Science, Scopus, and Cochrane Library databases was conducted., Study Selection: Two authors selected studies examining obstetric characteristics and outcomes in GC pregnancies with 24 or more weeks' gestation. Studies with insufficient outcome information, unavailable data on gestational surrogacies, and non-English language studies were excluded., Data Extraction and Synthesis: Adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines, 2 investigators extracted and synthesized both quantitative and qualitative data. Both fixed-effect and random-effect analysis were used to pool data., Main Outcomes and Measures: The primary outcomes were obstetric characteristics and outcomes, including hypertensive disorders, preterm birth, and low birth weight. Secondary outcomes included severe maternal morbidity and mortality associated with GC pregnancies., Results: Six studies from 2011 to 2023 involving 28 300 GC pregnancies and 1 270 662 non-GC pregnancies were included. GCs accounted for 2.5% of in vitro fertilization cycles (59 502 of 2 374 154 cycles) and 3.8% of ART pregnancies (26 759 of 701 047 ART pregnancies). GC pregnancies were more likely to be conceived by frozen embryo transfer compared with non-GC ART pregnancies (odds ratio [OR], 2.84; 95% CI, 1.56-5.15), and rates of single embryo transfer were similar between the 2 groups (OR, 1.18; 95% CI, 0.94-1.48). GCs were rarely nulliparous (6 of 361 patients [1.7%]) and were more likely to have multifetal pregnancies compared with non-GC ART patients (OR, 1.18; 95% CI, 1.02-1.35). Comparator studies revealed lower odds of cesarean delivery (adjusted OR [aOR], 0.42; 95% CI, 0.27-0.65) and comparable rates of hypertensive disorders (aOR, 0.86; 95% CI, 0.45-1.64), preterm birth (aOR, 0.82; 95% CI, 0.68-1.00), and low birth weight (aOR, 0.79; 95% CI, 0.50-1.26) in GC pregnancies vs non-GC ART pregnancies. Comparatively, GC pregnancies had higher odds of hypertensive disorders (aOR, 1.44; 95% CI, 1.13-1.84) vs general (non-GC ART and non-ART) pregnancies with comparable cesarean delivery risk (aOR, 1.06; 95% CI, 0.90-1.25). Preterm birth and low birth weight data lacked a comparative group using multivariate analysis. Severe maternal morbidity and maternal mortality were rare among GCs., Conclusions and Relevance: In this systematic review and meta-analysis, although GC pregnancies had slightly improved outcomes compared with non-GC ART pregnancies, they posed higher risks than general pregnancies. Contributing factors may include ART procedures and increased rates of multiple gestations which influence adverse perinatal outcomes in GC pregnancies.

Objective: To use machine learning methods to develop prediction models of pregnancy complications in women who conceived with assisted reproductive techniques (ART)., Design: A nation-wide register-based cohort study with prospectively collected data., Setting: Swedish national registers and nationwide quality IVF register., Patient(s): all nulliparous women who achieved birth within the first 3 ART treatment cycles between 2008 and 2016 in Sweden., Intervention(s): Characteristics before the use of ART, such as demographics and medical history, were considered potential predictors in the development of before treatment prediction models. ART treatment details were further included in after treatment prediction models., Main Outcome Measure(s): Potential diagnoses of preeclampsia, placental complications (previa, accreta, and abruption), and postpartum hemorrhage were identified using the International Classification of Diseases recorded in the Swedish Medical Birth and Patient registers, respectively. Multiple prediction model algorithms were performed and compared for each outcome and treatment cycle, including logistic regression, decision tree model, naïve Bayes classification, support vector machine, random forest, and gradient boosting. The performance of each model was assessed with C statistic, and nested cross-validation was used to aid model selection and hyperparameter tuning., Result(s): A total of 14,732 women gave birth after the first (N = 7,302), second (N = 4,688), or third (N = 2,742) ART cycle, representing birth rates of 24.1%, 23.8%, and 22.0%. Overall prediction performance did not vary much across the different methods used. In the first cycle, the before treatment prediction performance was at best 66%, 66%, and 60% for preeclampsia, placental complications, and postpartum hemorrhage, respectively. Inclusion of after treatment characteristics conferred slight improvement (approximately 1%-5%), as did prediction in later cycles (approximately 1%-5%). The top influential and consistent predictors included age, region of residence, infertility diagnosis, and type of embryo transfer (fresh or frozen) in the later (2 nd and 3 rd ) cycles. Body mass index was a top predictor of preeclampsia and was also influential for placental complications but not for postpartum hemorrhage., Conclusion(s): The combined use of demographics, medical history, and ART treatment information was not enough to confidently predict serious pregnancy complications in women who conceived with ART. Future studies are needed to assess if additional longitudinal follow-up during pregnancy can improve the prediction to allow clinical protocol development., Competing Interests: Declaration of Interests C.W. reports funding from Forte grant number 2016-01202 and the National Institutes of Health (NIH) grant number R01HD088393 for the submitted work; employed as data analyst in Thermo Fisher Scientific, PPD, Evidera after the manuscript completion. A.L.V.J. has nothing to disclose. C.N. is employed as consulting specialist and chief medical manager at the fertility clinic Livio Kungsholmen Stockholm since 2016. A.P. is a medical associate at Cerebriu, a medical artificial intelligence company for radiology. C.A has nothing to disclose. S.H-D. reports funding from NIH grant R01HD088393 for the submitted work; funding from Takeda; consulting fees from JNJ, Moderna, and BWH-MGH outside the submitted work. A.S.O. received personal fees from Abbot for serving on a Scientific and Medical Advisory Council, unrelated to the current work and reports funding from Forte junior research grant no: 2016-01202 for the submitted work; funding from Forte research grant no: 2020-00753, NIH R01 HD088393, Swedish Research council no: 2018-02679, NIH R01 DA048042-01, and NIH R01 HD088393 outside the submitted work., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Problem: There has been an increase in the number of single women deciding to have children through the use of medically assisted reproduction (MAR). These women are referred to as 'single mothers by choice' (SMC)., Background: Previous studies have shown how SMC can feel stigmatised., Aim: Explore if single women seeking fertility treatment in Denmark feel stigmatised., Methods: Six single women undergoing MAR at a public fertility clinic in Denmark were interviewed. The interviews were audiotaped, anonymised, and transcribed in full, after provided written consent by the participants to take part in the study. Data were analysed using qualitative content analysis., Findings: The women would have preferred to have a child in a relationship with a partner. Despite their dream of the nuclear family meaning a family group consisting of two parents and their children (one or more), the women choose to become SMC because motherhood was of such importance, and they feared they would otherwise become too old to have children. The participants did not experience stigma or negative responses to their decision, but they all had an awareness of the prejudices other people might have towards SMC., Conclusion: This study contributes to the understanding of the experiences of single women seeking fertility treatment in a welfare state where there are no differences in the possibilities for different social classes to seek MAR., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Importance: Patients using assisted reproductive technology (ART) may need additional counseling about the increased risks of placental abruption and preterm delivery. Further investigation into the potential additive risk of ART and placental abruption is needed., Objective: To ascertain the risk of placental abruption in patients who conceived with ART and to evaluate if placental abruption and ART conception are associated with an increased risk of preterm delivery (<37 weeks' gestation) over and above the risks conferred by each factor alone., Design, Setting, and Participants: This cross-sectional study used data from the National Inpatient Sample, which includes data from all-payer hospital inpatient discharges from 48 states across the US. Participants included women aged 15 to 54 years who delivered from 2000 through 2019. Data were analyzed from January 17 to April 18, 2024., Exposures: Pregnancies conceived with ART., Main Outcomes and Measures: Risks of placental abruption and preterm delivery in ART conception compared with spontaneous conceptions. Associations were expressed as odds ratios (ORs) and 95% CIs derived from weighted logistic regression models before and after adjusting for confounders. The relative excess risk due to interaction (RERI) of the risk of preterm delivery based on ART conception and placental abruption was also assessed., Results: Of 78 901 058 deliveries, the mean (SD) maternal age was 27.9 (6.0) years, and 9 212 117 patients (11.7%) were Black individuals, 14 878 539 (18.9%) were Hispanic individuals, 34 899 594 (44.2%) were White individuals, and 19 910 807 (25.2%) were individuals of other races and ethnicities. Of the total hospital deliveries, 98.2% were singleton pregnancies, 68.8% were vaginal deliveries, and 52.1% were covered by private insurance. The risks of placental abruption among spontaneous and ART conceptions were 11 and 17 per 1000 hospital discharges, respectively. After adjusting for confounders, the adjusted OR (AOR) of placental abruption was 1.42 (95% CI, 1.34-1.51) in ART pregnancies compared with spontaneous conceptions, with increased odds in White women (AOR, 1.42; 95% CI, 1.31-1.53) compared with Black women (AOR, 1.16; 95% CI, 0.93-1.44). The odds of preterm delivery were significantly higher in pregnancies conceived by ART compared with spontaneous conceptions (AOR, 1.46; 95% CI, 1.42-1.51). The risk of preterm delivery increased when patients had both ART conception and placental abruption (RERI, 2.0; 95% CI, 0.5-3.5)., Conclusions and Relevance: In this cross-sectional study, patients who conceived using ART and developed placental abruption had a greater risk of preterm delivery compared with spontaneous conception without placental abruption. These findings have implications for counseling patients who seek infertility treatment and obstetrical management of ART pregnancies.

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.

A study on infertility in China found that while 543 health care institutions are approved for assisted reproductive technology (ART), only 10.1% offer all ART services, with a significant skew toward the eastern regions, highlighting the accessibility challenges faced by rural and remote populations; this study recommends government measures including travel subsidies and education initiatives to improve ART access for economically disadvantaged individuals., (©Qingqing Zhou, Huatang Zeng, Liqun Wu, Kaichuan Diao, Rongxin He, Bin Zhu. Originally published in JMIR Public Health and Surveillance (https://publichealth.jmir.org), 12.06.2024.)

Objective: This research was conducted to assess access to assisted reproductive technologies (ART) and the current status of the in vitro fertilization (IVF) program that have been implemented in Indonesia over the last 10 years., Methods: We established a retrospective cohort study and descriptive analysis of the current state of access to infertility care in Indonesia. The data were collected from all IVF centers, clinics, and hospitals in Indonesia from 2011 to 2020, including the number of IVF clinics, total ART cycles, retrieved fresh and frozen embryos, average age of IVF patients, IVF pregnancy rate, and causes of infertility., Results: The number of reported fertility clinics in Indonesia has increased from 14 clinics in 2011 to 41 clinics by 2020. As many as 69 569 ART cycles were conducted over the past 10 years, of which 51 892 cycles used fresh embryos and 17 677 cycles used frozen embryos. The leading cause of consecutive infertility diagnosis was male infertility. Nearly half of the women who underwent IVF procedures (48.9%) were under 35 years old. The pregnancy rate outcome of women who underwent IVF ranged from 24.6% to 37.3%., Conclusion: Developments in ART in Indonesia have led to improvements in the ART cycles performed throughout the 10 year period. The identification of key areas that require improvement can provide an opportunity to enhance access to infertility care., (© 2024 International Federation of Gynecology and Obstetrics.)

The aim of the study is to examine the relationship between spiritual well-being, prenatal stress and attachment level of Turkish women conceiving spontaneously or with assisted reproductive techniques (ART). The comparative descriptive study type was conducted between November 2021 and June 2022 with 202 pregnant women, including 87 women conceiving with ART and 115 women conceiving spontaneously, who applied for routine prenatal care checkup in a state hospital in the west of Turkey. Both groups have a high level of spiritual well-being. Pregnant women in the ART group experience higher prenatal distress (9.6% for spontaneous, 12.6% for ART, p = 0.487) and low level of attachment (69.72 ± 7.98 for spontaneous, 66.24 ± 8.88 for ART, p = 0.006) compared to the other group. Additionally, as insufficient partner involvement in the prenatal process increases in pregnant women in both groups, prenatal attachment decreases. It is extremely important that midwives and nurses evaluate the spiritual well-being of pregnant women and provide holistic care in line with their spiritual needs., (© 2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Fertility decline is a complex phenomenon resulting from converging social and cultural changes that are governed through politics. As it has been discussed in many studies, the European's low fertility rate goes hand in hand with the trend of maternity postponement. Although in many European countries over the last decades reproduction is envisaged as an individual choice that can be made at older ages, having a child after a certain age can be impossible -either "naturally" or using assisted reproductive technology-depending on the medical and legislative possibilities and limits of the country in which people live. In the extremely diverse European reproscape, reproductive legislations have forced but also allowed many people to seek reproductive treatments outside their home countries. Spain is a leading destination in Europe for cross border reproductive travel and, of the foreigners it receives, the French are the largest group. Despite having a history of strong pro-natalist policies, France has been one of the strictest European countries regarding access to medically assisted procreation. Until 2022, only heterosexual couples in which women were under 43 years of age could access treatments. Despite the recent opening of access to "all women", including single women and same-sex female couples, women over 43 years of age were once again excluded from the new legal framework and therefore remain condemned to travel abroad to access reproductive treatments. In this article, we analyze the experience of French women over 40 who cross the Spanish border to access reproductive treatments in order to fulfill their desire to have children. Through ethnographic data emerging from six years of participant observation and in-depth interviews with 15 women, we explore why they remain excluded from the French system of reproductive governance and the obstacles they face during their reproductive journey., Competing Interests: Declaration of competing interest The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)