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Fertility desires are fundamental to understanding contraceptive use, yet the relationship between the two remains unclear and is the subject of much debate in demography. To understand the macrolevel relationship between fertility desires and contraceptive transition in low‐ and middle‐income countries, we introduce a conceptual model that articulates the microlevel processes through which a desire to avoid childbearing translates into contraceptive use and reasons for their frequent misalignment. The model calls for a more nuanced understanding of fertility desires, differentiates between the acceptability and accessibility of contraception, and highlights the multilevel forces that shape the costs of fertility regulation. These microlevel processes are key to understanding the evolving role of changes in fertility desires and changes in the implementation of desires on contraceptive transition across time and space. We conclude these relationships are additive, multiplicative, and dynamic over time. [ABSTRACT FROM AUTHOR]

Management of patients with congenital adrenal hyperplasia (CAH) poses challenges during pregnancy and prenatal stages, impacting fertility differently in men and women. Women with CAH experience menstrual irregularities due to androgen and glucocorticoid precursor interference with endometrial development and ovulation. Genital surgeries for virilization and urogenital anomalies further impact fertility and sexual function, leading to reduced heterosexual relationships among affected women. Fertility rates vary, with a lower prevalence of motherhood, primarily among those with classic CAH, necessitating optimized hormonal therapy for conception. Monitoring optimal disease control during pregnancy poses challenges due to hormonal fluctuations. Men with CAH often experience hypogonadotrophic hypogonadism and complications like testicular adrenal rest tissue, impacting fertility. Regular monitoring and intensified glucocorticoid therapy may restore spermatogenesis. Genetic counselling is vital to comprehend transmission risks and prenatal implications. Prenatal dexamethasone treatment in affected female fetuses prevents virilization but raises ethical and safety concerns, necessitating careful consideration and further research. The international "PREDICT" study aims to establish safer and more effective prenatal therapy in CAH, evaluating dosage, safety, and long‐term effects. [ABSTRACT FROM AUTHOR]

Despite a large literature on the importance of childhood neighbourhoods for life course transitions, there is a lack of fertility studies combining a life‐course perspective with detailed neighbourhood measures. Addressing this gap, we use longitudinal data in which the entire population of a Swedish town is geocoded at the address‐level, 1939–1967, and linked to national registers from 1968 to 2015. We study how social neighbourhoods in childhood influence fertility outcomes by constructing individual neighbourhoods at the address level to measure the social class of nearby childhood neighbours. We analyse the age at first and last birth, children ever born, birth spacing and childlessness. Growing up in higher‐status neighbourhoods is associated with delayed fertility for both men and women, but no association is found for the number of children ever born or for childlessness. Associations are stable over time, and later ages of neighbourhood exposure matter more, especially for men. Contrary to prior literature's focus on the lower classes, our results are driven by higher‐status individuals growing up in distinctly white‐collar neighbourhoods. [ABSTRACT FROM AUTHOR]

This paper focuses on age restrictions on access to infertility treatments and eligibility for their public reimbursement, exploring their relevancy in contexts of rising late birth rates (40+). I explore how age‐based reimbursement policies for in vitro fertilization treatments have responded to these fertility trends in 27 high‐income countries and in which regulatory frameworks for medically assisted reproduction (MAR) very late births (45+) have particularly increased. First, I show that while age limits for treatment reimbursement are well aligned with the prevalence of late fertility in some national contexts, in most countries, strict age restrictions are lagging behind the rise in late births. In others, pronatalist policies have prompted permissive age criteria or law revisions, anticipating or adapting to rising trends in late births. Second, the rise in very late births has been limited in some contexts with strict age‐based rules. However, the analysis suggests that the impact of MAR on very late births may also be influenced by contextual factors other than regulations. [ABSTRACT FROM AUTHOR]

While uncertainty has been a key explanation for very low fertility throughout Europe, few studies have analysed how macro-level uncertainty trickles down to shape how people think about having children. Most research focuses on economic uncertainty, not political or social uncertainty. We address these gaps with qualitative data from Ukraine, which has experienced extreme political uncertainty and, for the past decade, armed conflict. Ukraine also had exceptionally low fertility, with an estimated total fertility rate of 1.17 in 2021. In July 2021, we conducted 16 online focus groups on topics related to childbearing with informants living in urban and rural areas in Eastern Ukraine, including areas of Donetsk province that were outside Ukrainian government control. Half the groups consisted of persons displaced by the 2014 Donbas war. The discussions revealed distinct patterns whereby experiences of displacement, the simmering armed conflict, and economic problems combined to produce and intensify uncertainties that discouraged couples from having more than one child. Some blamed the government or delved into conspiracy theories. Armed conflict generates its own forms of uncertainty that interact with persistent economic challenges, dampening fertility. [ABSTRACT FROM AUTHOR]

This article revisits and updates an earlier study of the increased concentration of reproduction that has occurred or is occurring during the fertility transition in developing countries. Using 350 DHS datasets for 87 developing countries, the analysis extends the observation period by several decades, considers a larger range of completed fertility, and expands the geographic coverage by including more countries from all regions of the world. It shows that reproduction tends to become increasingly concentrated within the population during the early stages of the fertility transition in developing countries, but that once completed fertility reaches a level of about 4 children per woman, the concentration of reproduction tends to stabilize. The changing concentration of reproduction over the course of the fertility transition in developing countries has implications for who becomes a parent, who bears the risks of childbearing, and who covers the costs of raising children in a society. [ABSTRACT FROM AUTHOR]

In the Western context of delayed motherhood and declining fertility, an array of fertility enhancements have emerged. While bioethical debates and literature on the technological prowess of these enhancements proliferate, it is useful to explore the lived experience of women undergoing them. This article uses Tabitha Moses' artwork Investment, a series of embroidered hospital gowns, as a vehicle to explore lived experience of women engaging with fertility enhancements, including in vitro fertilisation. This analysis challenges dominant biomedical and corporate discourses framing fertility enhancements as benign. Using constructs of patriarchy, biopower, biopolitics (Foucault), and technobiopower (Haraway), we identify how power over women's bodies is extended through fertility enhancements. Haraway's notion of figuration supports the analysis. Understood as a tropic melding of semiotic and material, the figuration of The Infertile Woman offers a way to explore discursive operations of power and amid them the creation of a new form of reproductive labour. [ABSTRACT FROM AUTHOR]

Purpose: The objective of the trial was to compare the regression rate of atypical endometrial hyperplasia (AEH) in patients treated with megestrol acetate (MA) vs. levonorgestrel-intrauterine device (LNG-IUS). We also aimed to assess the fertility and pregnancy outcomes in these patients. Methods: The study was a phase II multi-centre randomised controlled trial on the use of MA compared to LNG-IUS in the treatment of AEH conducted from January 2020 to January 2024 in Singapore. Women who were diagnosed with AEH and between 21 and 40 years old were included. The patients were randomised to receive either MA (160 mg orally daily) or LNG-IUS. The primary outcomes assessed were the regression rates at 3 months, 6 months and 9 months of treatment. The secondary outcomes assessed were the side effects, patient acceptability and fertility outcomes. Results: Thirty-six patients completed the trial. The overall regression rate was 88.9% by 9 months. There was no statistically significant difference in the 9-month complete regression rate between MA vs. LNG-IUS. There was also no significant difference in side effects and weight change between both arms. Nineteen patients were actively pursuing fertility after complete regression. There were 8 pregnancies achieved, with resultant 4 live births and 4 miscarriages. Conclusion: Our study confirms a high regression rate of AH with medical treatment. LNG-IUS is a non-inferior treatment compared to megestrol acetate. Successful pregnancy outcomes can be achieved after regression of AEH. Long-term studies of sufficient sample-size are needed to assess for fertility and pregnancy outcomes, risk of recurrence and long-term risk of malignancy. Trial registration number: The study was registered with the Health Science Authority (HSA) (License No.: CTA1900087) on September 5, 2019: https://eservice.hsa.gov.sg/prism/ct%5fr/enquiry.do?action=loadSpecificDetail. The trial was registered retrospectively on ClinicalTrials.gov (ID: NCT05492487) on April 7, 2022: https://clinicaltrials.gov/study/NCT05492487. [ABSTRACT FROM AUTHOR]

Background/Objectives: In this observational prospective cohort study, conducted at the Fertility Centre of the University Hospital, Duesseldorf Germany, the spontaneous reversal capacity and the effect of waiting time on an adverse vaginal microbiome profile in subfertile patients were investigated. Methods: Vaginal swabs of 76 patients were obtained before starting a fertility treatment using a commercially available test to perform a microbiome analysis. Patients with a favorable microbiome profile ("medium" or "high profile") according to the manufacturer's algorithm proceeded with the fertility treatment. Patients with an unfavorable microbiome profile ("low profile") postponed their fertility treatment and were sampled up to four times in each successive cycle or until a shift to a more favorable profile was detected. Results: Initially, 54/76 subjects had a high or medium profile and 23/76 had a low profile. Within 3 months, 75% of patients with an initial low profile shifted to a more favorable profile (7/23 dropouts). The presence of Lactobacillus crispatus in the initial sample was associated with a higher likelihood of a spontaneous shift to a more favorable profile. Conclusions: The vaginal microbiome is subject to strong fluctuations. Even an unfavorable microbiome profile can develop into a favorable microbiome profile within a few months without treatment. [ABSTRACT FROM AUTHOR]

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

This study conducts panel analysis on the influence of women's economic participation and employment status on the fertility rate in 16 metropolitan cities in Korea from 2003 to 2019. It indirectly examines whether the positive relationship between women's economic activity and fertility observed in some OECD countries is confirmed in Korea. The analysis reveals a clear negative relationship between female employment and fertility in Korea's metropolitan cities. Particularly, the negative relationship between economic activity and fertility is more pronounced among women aged 30-34, which is leading marriage and childbirth. On the aspect of employment status, regions with a high proportion of permanent workers showed lower fertility rates, implying a tendency for women to prefer careers over family. Therefore, it is necessary for the government and local authorities to implement proactive population policies aimed at advancing the timing of childbirth, focusing on women who intend to have children and those who pursue both work and family simultaneously, in order to solve the problem of low fertility rate. [ABSTRACT FROM AUTHOR]

Background and Aim: On a global scale, an estimated 17.5% of the reproductive‐aged population experiences clinical infertility. Beyond its categorization as a reproductive health concern, infertility emerges as a substantial independent risk factor for the development of various mental health disorders. The current study aims to investigate the prevalence of depression among women experiencing infertility compared to fertile women in Herat city, Afghanistan. Methods: This hospital‐based case‐control study was conducted in Herat city, Afghanistan, during the latter half of 2023 on women aged 15–49. Sociodemographic and infertility data were gathered by a gynecologist using a structured questionnaire with 14 items. Assessment of depression employed the Dari‐translated version of the Patient Health Questionnaire. The data were scored and categorized following the instrument's guidelines. To examine the association between categorical variables, a chi‐square test was conducted, with a significance level set at 0.05 for all analyses. These statistical procedures were performed using IBM Statistical Package for Social Sciences, version 27. Results: Our investigation revealed a statistically significant association (p < 0.001) between infertility and depression. Infertility was associated with a markedly increased risk of depression, as evidenced by a prevalence of 79.0% in infertile women compared to 44.4% in fertile women. The study found a link between depression, health, and nutritional status in both infertile and fertile participants. Notably, within the infertile group, the longer a woman struggled with infertility, the more likely she was to experience depression. Conclusion: Given the substantial prevalence and important correlates of depression among infertile women in Herat, Afghanistan, it is imperative for policymakers, mental health professionals, and gynecologists to specifically address the mental well‐being of this vulnerable population. [ABSTRACT FROM AUTHOR]

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

Background Objectives Materials and methods Results Conclusion Testicular cancer is the most common solid tumour among young men in the reproductive phase. After completing cancer treatment, up to 77% of cancer survivors report an interest in paternity after completing cancer treatment. To preserve fertility, most guidelines recommend that physicians should counsel their patients about sperm cryopreservation before initiating gonadotoxic therapy. However, few studies have assessed fertility parameters after testicular cancer therapies over the last 20 years.To close the gap of data regarding gonadotoxicity of testicular cancer therapies to enable more accurate counselling regarding fertility preservation.A systematic literature search was conducted in Medline, Embase and Cochrane until December 2022. The systematic review included studies of men who had undergone all types of unilateral testicular cancer treatment, whereas the meta‐analysis excluded studies with unspecified treatments, less than 10 patients for outcome evaluation or rare tumours. Infertility (i.e. azoospermia, failure to achieve paternity or the usage of cryosperm) was defined as outcome.The qualitative analysis included 30 studies with a total of 13,718 men after unilateral testicular cancer. Treatment comprised active surveillance after unilateral orchidectomy (32.7%), radiotherapy (23.1%), standard‐ or low‐dose chemotherapy (33.7%) and high‐dose chemotherapy (1.4%). Post‐treatment spermiograms were analysed in 17 studies. The quantitative synthesis included 23 studies, revealing an overall pooled prevalence of infertility (95% CI) of 14% (9%–21%). Azoospermia occurred in 8% (6%–12%). For good‐prognosis patients who received standard therapy, the overall prevalence of infertility was only 4% (2%–10%).So far, this very first meta‐analysis of overall infertility prevalence provides the best approximation of fertility prognosis for men who have undergone testicular cancer therapy. Despite the low prevalence of infertility, it is still recommended to undergo sperm cryopreservation because of the uncertainty of the subsequent therapy and the lack of large longitudinal data on individual treatment effects. [ABSTRACT FROM AUTHOR]

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

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

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

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

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

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

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

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

Problem: The interleukin‐17 (IL‐17) family includes pro‐inflammatory cytokines IL‐17A‐F with important roles in mucosal defence, barrier integrity and tissue regeneration. IL‐17A can be dysregulated in fertility complications, including pre‐eclampsia, endometriosis and miscarriage. Because mammalian subclasses (eutherian, metatherian, and prototherian) have different related reproductive strategies, IL‐17 genes and proteins were investigated in the three mammalian classes to explore their involvement in female fertility. Method of Study: Gene and protein sequences for IL‐17s are found in eutherian, metatherian and prototherian mammals. Through synteny and multiple sequence protein alignment, the relationships among mammalian IL‐17s were inferred. Publicly available datasets of early pregnancy stages and female fertility in therian mammals were collected and analysed to retrieve information on IL‐17 expression. Results: Synteny mapping and phylogenetic analyses allowed the classification of mammalian IL‐17 family orthologs of human IL‐17. Despite differences in their primary amino acid sequence, metatherian and prototherian IL‐17s share the same tertiary structure as human IL‐17s, suggesting similar functions. The analysis of available datasets for female fertility in therian mammals shows up‐regulation of IL‐17A and IL‐17D during placentation. IL‐17B and IL‐17D are also found to be over‐expressed in human fertility complication datasets, such as endometriosis or recurrent implantation failure. Conclusions: The conservation of the IL‐17 gene and protein across mammals suggests similar functions in all the analysed species. Despite significant differences, the upregulation of IL‐17 expression is associated with the establishment of pregnancy in eutherian and metatherian mammals. The dysregulation of IL‐17s in human reproductive disorders suggests them as a potential therapeutic target. [ABSTRACT FROM AUTHOR]

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

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

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

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

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

This paper investigates how becoming a mother—and navigating such a complicated life transition—while pursuing an academic career impacts the way female researchers perceive themselves as acting subjects. By analyzing in‐depth virtual interviews with Italian female early career researchers, this work explores the relationship between fertility decisions, motherhood hardships, self‐identity, and career‐related experiences in the interviewees' biographical trajectories. Despite their consideration of childbearing as a mental and practical obstacle to scientific production, many of the interviewees ascribe positive career outcomes to the arrival of their first child. The reflexivity set in motion by the interview process allows us to observe the collected interviews as double‐layered narratives. The postponement of fertility choices and the presence of work‐family conflict tend to be described as ordinary facets of a common career pattern, intrinsic to the female academic working experience. Meanwhile, the positive impacts of motherhood on self‐identity and work‐related skills are recounted on a more individual level, framed as a sort of paradox, a personal journey of self‐discovery or—to some extent ‐ a heroic performance. [ABSTRACT FROM AUTHOR]

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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