Knowledge of ovulatory cycle (KOC) is a crucial factor for successful conception. Despite sizable number of women suffering from infertility, empirical evidence on the relation between infertility and KOC is rare in South Asia. This study assesses the association between primary infertility and KOC. The data of ever-married women aged 20-49 gathered in the recent rounds of Demographic and Health Survey (DHS) for India (2019-2021), Bangladesh (2017-2018), Pakistan (2017-2018) and Nepal (2022) were analyzed. Bivariate analysis and binary logistic regression were conducted through Stata (V.17) with a 5% significance level. Women with no KOC in India [AOR:1.71, C.I.: (1.54, 1.9)] and Bangladesh [AOR:2.6, C.I.: (1.67, 4.06)] had higher odds of primary infertility than their counterparts with correct KOC. The study concludes that correct KOC is a significant predictor of primary infertility in India and Bangladesh and is insignificant in Pakistan and Nepal. Moreover, higher age at marriage and no-visit to healthcare facility were the other significant predictors of primary infertility in all four countries. Women who are struggling to conceive would benefit from education related to the timing and identification of the fertile window, which may be provided through primary healthcare providers.

Dioscorea esculenta increases sex steroid hormones in obesity and type 2 diabetes that impairs steroidogenesis. However, the effects of chronic D. esculenta intake on testicular sex steroid hormone concentrations and testicular function especially protection from oxidative stress and inflammation is still unclear. The study assessed the effects of chronic D. esculenta intake and exercise training on testicular function in rats with type 2 diabetes. Twenty-week-old Otsuka Long-Evans Tokushima Fatty rats were randomly assigned to the control, exercise training (running at 25 m/min for 1 h, 5 days/week), and D. esculenta intake (0.3 % with normal feed) groups (n = 8 per group). Long-Evans Tokushima Otsuka rats served as the healthy controls (n = 7). Eight weeks of D. esculenta intake or exercise training significantly increased plasma concentrations of dehydroepiandrosterone (DHEA), free testosterone and 5α-dihydrotestosterone (DHT). No significant increases were observed in DHEA, testosterone, and DHT concentrations in the testis. Androgen receptor (AR) expression was significantly increased by D. esculenta intake and exercise training. The expression of cathepsin L, which is involved in sperm modification, did not significantly change, whereas the expression of glutathione peroxidase 4 (GPx4), which protects sperms from oxidative stress, significantly increased in the D. esculenta group. Additionally, metabolic clearance rate (MCR), an index of insulin resistance, significantly correlated with testicular weight and GPx4 expression. These results suggest that improvement in MCR through D. esculenta intake suppresses testicular atrophy and enhances the ability of protection from oxidative stress and inflammation in rats with type 2 diabetes.

Oxidative stress is a well-known underlying mechanism for several diseases in response to environmental pollution. Although there is a lack of evidence on the relationship between air pollution and an established risk factor for urogenital dysfunction. The aim of this study was to investigate the mechanism of particulate matter (PM) on urogenital function and evaluate the potential efficacy of chlorogenic acid (CGA) in preventing urogenital damage in rats. Forty Wistar rats were divided into five groups (n = 8): control, particulate matter exposure (animals were exposed to fine dust in an inhalation chamber for 4 weeks, 3 days a week, for 3 h, PM10 concentration adjusted to 500-2000 µg/m3), and particulate matter plus 3 concentrations of chlorogenic acid (100, 200, and 400 mg/kg, gavage, 4 weeks, 3 days a week). At the end of the study, kidney biomarkers, oxidative stress markers, antioxidant enzymes, the oxidation resistance 1 (OXR1) and its downstream gene expression, sperm count, gonadotropin hormones, and the structure of the kidney, epididymis, and seminal vesicle were evaluated in response to PM exposure and CGA treatment in all groups. The data obtained from the current study showed that PM exposure led to kidney dysfunction and inhibition of oligospermia through oxidative stress, as evidenced by an increase in MDA and a decrease in TAC, SOD, CAT, and GSH concentration levels in blood samples. These results were consistent with the down-regulation of OXR1, Nrf2, and P21 gene expression. In contrast, CGA improved urogenital biomarkers and histopathology structures of the kidney, epididymis, and seminal vesicle by enhancing antioxidant defense system enzymes and modulating the OXR1 signaling pathway. Our findings suggest that environmental air pollution contributes to kidney dysfunction and urogenital damage. Modulation of oxidative stress through the OXR1, P21, and Nrf2 signaling pathways may be the underlying mechanism. Furthermore, chlorogenic acid supplementation could be recommended as a new protective or treatment strategy to safeguard urogenital function against exposure to particulate matter.

Engagement in Assisted Reproductive Technologies (ART) represents a significant source of stress for infertile couples, particularly for females/women undergoing these techniques, which may exacerbate their mental health and the quality of the marital relationship. The aim of this study was to investigate the relationships between male partner support in matters related to ART or the pursuit of pregnancy, concerns regarding the impact of infertility on the relationship, and symptoms of anxiety and depression in couples undergoing ART. Path analyses were conducted using the AMOS structural modeling software, applying an Actor-Partner Interdependence Mediation Model analysis. This approach estimates both the effect of an individual's variable on their own outcome (actor effect) and the effect of the same variable from the perspective of their partner (partner effect) on two outcome variables: symptoms of anxiety and depression. Additionally, analyses of indirect effects between variables were included. The final study sample comprised 96 individuals (48 dyads) from the assisted human reproduction unit of a Spanish hospital. The Hospital Anxiety and Depression Scale (HADS), two ad hoc items assessing perceived support from the male partner to the female partner, and the subscale Concern about the relationship (Fertility Problem Inventory) were used. The results revealed the presence of actor, partner, and indirect effects in males/men, with both self-reported male support and concerns about the relationship predicting symptoms of anxiety and depression. In females/women, only an actor effect was observed: a lower perceived level of male support was associated with greater concern about the marital relationship. These findings highlight the need for interventions that address both male support (self-reported and partner-perceived) and relationship concerns within psychological care programs for individuals undergoing ART.

Although Sudanese women have rich experience in the use of traditional, complementary and integrative medicine, literature discussing the use for self-management of infertility is scarce. Therefore, this study aimed to fill this gap by examining the associations of the socioeconomic characteristics of Sudanese women with, as well as their predictability of, the use of traditional, complementary and integrative medicine for self-management of infertility.

This was a cross-sectional study involving 203 infertile women attending infertility clinics in Khartoum State, Sudan. The interviewers administered the questionnaire in two parts: the first sought to collect data on self-management strategies for infertility, and the second sought to collect personal data from the respondents. Associations between socioeconomic characteristics and the use of self-management strategies for the treatment of infertility were assessed via one-way analysis of variance (ANOVA), whereas determinants of that usage were assessed via simple linear regression.

The majority of the respondents were in the two middle-aged groups (28-37 years and 38-47 years). Few of the respondents had less than just a primary education (3.0%), while those with higher education represented almost half of the sample (49.8%). ANOVA revealed that while only education level was independently associated with the factors that influence Sudanese women's selection of infertility self-management strategies (p = 0.008 and p = 0.030), all socioeconomic characteristics were associated with the types of strategies Sudanese women use for self-management of their infertility. The simple linear regression results revealed that all socioeconomic factors had predictive power (p < 0.05) when correlated with Sudanese women's perceptions of strategies used for self-management of infertility.

Socioeconomic factors that potentially impact Sudanese women's strategies used in the self-management of infertility were identified. The results highlighted the associations of Sudanese women's strategies used in self-management of infertility with the socioeconomic characteristics of the respondents. The study offered policymakers with information to re-examine the loose or relaxed rules governing traditional, complementary and integrative medicine use in the societies of developing countries in general and Sudan in particular, as the culture of these societies seems to encourage the use of self-management strategies.

Nutrition plays a critical role in key physiological processes related to reproduction. However, there is limited understanding of the impact of nutritional factors and interventions on the reproductive outcomes of women in low- and middle-income countries (LMICs).

This systematic review and meta-analysis aimed to synthesise evidence regarding the impact of nutritional factors and interventions on the reproductive outcomes of women in LMICs. Outcomes of interest included fertility and fecundity, menarche and menstrual disorders, miscarriage, stillbirth and live birth. Randomised controlled trials (RCTs) and non-randomised intervention studies with nutritional interventions, and observational cohort studies with nutritional factors, were included. Study selection, data extraction and risk of bias assessment were independently completed by two reviewers. A narrative synthesis of included studies was conducted, and meta-analyses were conducted when feasible.

Systematic search identified 180 studies, including 47 intervention studies and 133 observational cohort studies. From RCTs, there was no clear evidence for an effect of prenatal multiple micronutrient supplementation on the risk of miscarriage (8 RCTs; risk ratio (RR): 0.87; 95% CI 0.75, 1.02; moderate certainty of evidence) or stillbirth (15 RCTs; RR: 0.86; 95% CI 0.73, 1.02; low certainty of evidence). From observational cohort studies, preconceptional obesity was associated with a greater risk of miscarriage (12 studies; RR: 1.27; 95% CI 1.10, 1.47; very low certainty of evidence) and stillbirth (4 studies; RR: 1.66; 95% CI 1.28, 2.14; very low certainty of evidence). Any anaemia during pregnancy was associated with a greater risk of stillbirth (10 studies; RR: 1.26; 95% CI 1.01, 1.58; very low certainty of evidence).

This review highlights the importance of ensuring preconceptional nutrition and preventing anaemia during pregnancy for favourable reproductive outcomes. This review calls for randomised controlled trials to evaluate the effectiveness of preconceptional and prenatal interventions on these outcomes.

CRD42023395937.

What is the risk of endometrial cancer after long-term follow-up in women treated with ART between 1983 and 2001 compared with women in the general population and subfertile women who did not undergo ART?

The risk of endometrial cancer is not increased in women who underwent ART in the Netherlands between 1983 and 2001, neither compared with women from the general population nor compared with subfertile women not treated with ART.

Concerns have been raised that subfertility treatment may be associated with increased risk of endometrial cancer. However, published studies show inconsistent results regarding the effects of ovarian stimulation and specific subfertility diagnoses on endometrial cancer risk.

A nationwide historic cohort study (the OMEGA-cohort) was conducted to examine the risk of cancer in women after ovarian stimulation for ART. The OMEGA-cohort comprises 30 625 women who received ovarian stimulation for ART (ART group) in 1983-2000 and 9988 subfertile women not treated with ART (non-ART group). After a median follow-up of 24 years, endometrial cancer incidence was ascertained through linkage with the Netherlands Cancer Registry. Endometrial cancer risk in the cohort was compared with that in the general population using person-years analyses, and between the ART group and non-ART group using multivariable Cox regression analyses.

Detailed ART-treatment data were obtained from the medical records and complete information on parity and age at first birth was obtained through linkage with the Personal Records Database. Information on hysterectomy and endometriosis was collected through linkage with the Dutch Nationwide Pathology Databank (Palga). Data about lifestyle factors, including BMI, were obtained through a self-administered questionnaire.

After a median follow-up duration of 24 years, 137 endometrial cancers were diagnosed. Endometrial cancer risk after ART was not significantly increased compared with that in the general population (standardized incidence ratio = 1.19; 95% CI = 0.97-1.44) nor compared with that in the non-ART group (multivariably adjusted hazard ratio = 1.11; 95% CI = 0.74-1.67). Risk of endometrial cancer did not increase with longer follow-up or with more ART cycles, and the risk within the cohort, did not vary by cause of subfertility (male, tubal, unexplained, and other). Irrespective of ART treatment, endometrial cancer risk was increased in obese women and women with endometriosis, but decreased among parous women and women who used oral contraceptives.

Although the findings of the study are reassuring, the median age of the women at the end of follow-up (median age 56 years) was still rather young. Therefore, there is a need for at least 10-15 additional follow-up years to draw definitive conclusions. In addition, other large studies are needed to investigate the risk of endometrial cancer in women who underwent ART.

The results of this study contribute to knowledge about long-term health after ART treatment, which is valuable to subfertile couples, considering or undergoing fertility treatments, and their healthcare providers.

This study was supported by a grant from the Dutch Cancer Society (NKI 2006-3631) and a departmental grant from the Department of Obstetrics and Gynecology of Erasmus Medical Center, Rotterdam, the Netherlands (2011-019). Ma.S. is Associate Editor of Human Reproduction Open; A.W.vd.B.-D received support for attending meetings and/or travel from the Dutch Cancer Society; C.B.L. is Editor-in-Chief of Human Reproduction; A.E.P.C. is Associate Editor of Human Reproduction Update, received royalties from Uptodate Hyperthecosis, and participated at the Data Safety Monitoring Board of the DSMB POEM Study; F.B. has received research support from Merck, honoraria or consultation fees from Merck Healthcare KGaA, Bensis Healthcare, CooperSurgical, and participated in an advisory board for Merck and Ferring; J.L. has received research support from Ferring, Merck, and Roche Diagnostics, consulting fees and honoraria from Ferring, participated on a Data Safety Monitoring Board or Advisory Board of the LOCI trial, is President of the AE-PCOS society, and Member of the ASRM Integrity Committee; J.M.J.S. has received honoraria from Ferring and Merck, support for attending meetings and/or travel from Ferring, Merck, and Good Life, and participated in the advisory board of Merck; L.L.v.L. received support for attending meetings and/or travel from Olympus Medical Expert training; M.M.v.R. received support for attending meetings and/or travel from Ferring; M.G. declares departmental research and educational grants from Ferring (location VUmc), unrelated to the presented work. The other authors declare no competing interests.

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This retrospective, observational cohort study investigated the association between treatment of iron deficiency with conception results and pregnancy outcomes in women with infertility and iron deficiency, before and after intravenous ferric carboxymaltose infusion.

Data were collected from electronic health records from the Dextra Fertility Clinic (Helsinki, Finland) between 2015 and 2020. The cohort included 292 women (<43 years) with infertility and iron deficiency (s-ferritin ≤30 μg/L), treated with a ferric carboxymaltose infusion (Ferinject®, 500 mg i.v.). The main outcomes were live birth and miscarriage rates before and after treatment of iron deficiency. The main explanatory variable studied was the administered iron infusion.

Mean s-ferritin levels increased from 16.2 ± 7.0 μg/L before to 81.5 ± 49.8 μg/L after iron infusion. The proportion of patients who conceived increased from 65% before to 77% after treatment of iron deficiency (p < 0.001). Of the study population, 28% of patients experienced miscarriages and 26% gave a live birth before iron infusion, and 13% and 51% after treatment of iron deficiency (p < 0.001). In the model adjusted for age, use of preimplantation genetic testing for aneuploidy, and repeated iron infusions, treatment of iron deficiency with iron infusion was associated with a higher live birth rate (OR = 3.19; 95% CI = 2.21-4.66; p < 0.001). In the model adjusted for age, reason for infertility, and total number of pregnancies, treatment of iron deficiency was associated with lower miscarriage rates (OR = 0.32; 95% Cl = 0.20-0.52; p < 0.001).

Filling of depleted iron stores was positively associated with conception results (higher number of pregnancies) and pregnancy outcomes (higher live birth rates and lower miscarriage rates), regardless of the assisted reproductive technology method used. Screening of iron status seems to be important in patients seeking help for infertility problems.

Oligoasthenoteratozoospermia (OAT) is a frequent but severe type of male infertility. As one of the most multifaceted male infertility resulting from sperm problems, its genetic etiology remains unknown in most cases. In this review, we systematically sort out the latest literature on clinical reports and animal models leading to OAT, summarise the expression profiles of causative genes for OAT, and highlight the important role of the protein transport system during spermiogenesis, spermatid cell-specific genes, Golgi and acrosome-related genes, manchette-related genes, HTCA-related genes, and axoneme-related genes in OAT development. These causative genes would be instrumental in genetic etiological screening, genetic counseling, and pre-implantation genetic testing of patients with clinical OAT.

What is the prevalence and trend of infertility among individuals of childbearing age at global, regional, and national levels by sex and socio-demographic index (SDI) across 21 regions and 204 countries and territories?

Our findings reveal a growing prevalence of infertility among individuals aged 15-49 years worldwide from 1990 to 2021, with an expected continued increase through 2040.

Infertility is a persistent global reproductive health issue, leading to significant societal and health consequences. No study has specifically described the current prevalence of infertility, its secular trend, or the variations between regions or countries with different SDI levels.

A sex- and SDI-stratified systematic analysis of the prevalence of infertility across 21 regions and 204 countries and territories from 1990 to 2021 has been performed.

We retrieved data from the Global Burden of Disease Study (GBD) 2021 on the count and crude rate of infertility prevalence for individuals aged 15-49 years across 204 countries and territories from 1990 to 2021. In the GBD 2021 framework, infertility is defined as the absence of a live birth in a couple who have been in a union for at least 5 years and are actively trying to conceive, or in a couple who have been in a union for at least 5 years since their last live birth, with no use of contraceptives during this period. Estimated annual percent change was calculated to quantify the temporal trend in age-standardized prevalence rates (ASPRs) for infertility by sex, age, and SDI. The Bayesian age-period-cohort model was used to project the ASPRs from 2022 to 2040.

In 2021, an estimated 55 000 818 men and 110 089 459 women were living with infertility worldwide, corresponding to approximately 1820.6 cases per 100 000 population (1.8%) for males and 3713.2 cases per 100 000 population (3.7%) for females. Regionally, the highest infertility prevalence was observed in middle SDI regions, such as East and South Asia and Eastern Europe. Infertility primarily affected the age group of 35-39 years and females in most regions, with some notable exceptions. Between 1990 and 2021, the global ASPRs of infertility increased by an average of 0.49% (95% CI 0.34-0.63) for males and 0.68% (0.51-0.86) for females. Additionally, the fastest increase in female infertility occurred in high SDI regions, while the most significant rise in male infertility was seen in low-middle SDI areas. Furthermore, the global ASPR of male infertility is projected to rise more rapidly than that of female infertility from 2022 to 2040.

The primary data sources for the infertility burden in the GBD 2021 are population-based surveys; however, less-developed regions often lack complete population-based statistics, leading to potential reporting bias of the infertility burden in these areas due to data sparsity and incompleteness. Additionally, this study could not separately assess the prevalence and trends of primary and secondary infertility. Furthermore, the GBD 2021 does not provide the attributable proportion of each cause of infertility; hence, we cannot compare the contribution of these causes to infertility by sex, age, and location.

Sexual and reproductive health are crucial for individuals' health, economic development, and overall human wellbeing. It is essential for governments and the public to recognize the severity of infertility and prioritize the implementation of targeted interventions to enhance reproductive health.

This study was supported by the grants from the Science and Technology Project of Jiangmen (2020030103110009027). The authors have declared no conflict of interest.

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We have previously shown that treatment with recombinant human growth hormone (GH) influences testicular growth in children with GH deficiency (GHD) and have suggested that GH plays a role in testicular growth in childhood. Little evidence is available on testicular function in post-pubertal GHD patients.

This prospective controlled study was undertaken to evaluate testicular function in patients with GHD.

Post-pubertal patients with non-syndromic GHD over the age of 16 years were enrolled. Each patient underwent to the assessment of serum levels of gonadotropins and total testosterone (TT), conventional sperm parameters, and testicular volume (TV) measured by ultrasound examination. Age-matched healthy subjects served as controls. Patients with disorders capable of interfering with testicular function were excluded.

26 patients with GHD and 25 age-matched post-pubertal controls were enrolled. They did not differ in serum luteinizing hormone, follicle-stimulating hormone, and TT levels. However, GHD patients had lower semen volume, total sperm count, progressive motility, and total motility values, and a higher prevalence of oligozoospermia compared to controls. No difference was found in sperm concentration and normal morphology. Importantly, GHD patients had lower TV, and a higher prevalence of testicular hypotrophy.

This is the first evidence of mildly impaired sperm parameters and TV in GHD patients compared to healthy controls. The integrity of the GH-IGF1 axis in prepuberty is important for achieving normal testicular function in adulthood. Evaluating testicular growth over time in GHD children and measuring TV and sperm parameters in postpubertal GHD boys is advisable.

Understanding the potential risks associated with fertility treatments (FTs) can guide clinical decision and patient counseling.

To investigate the validity of the association between the development of female-specific malignancies including ovarian, endometrial, breast, and cervical cancer after FT.

A search of systematic reviews and meta-analyses was performed from inception to April 2022 within several databases: Cochrane Database of Systematic Reviews, EMBASE, Google Scholar, and PubMed.

The inclusion criteria required the incidence of each cancer subgroup to be stated in both the defined treatment group (controlled ovarian stimulation and/or in vitro fertilization [IVF] or intracytoplasmic sperm injection) and the control group (no-FT, general population). From 3,129 identified publications, 11 meta-analytical reviews consisting of 188 studies were selected for synthesis.

The primary outcome of interest was incidence of each subgroup of cancer in the "FT" group compared with the "no-FT" group.

A statistically significant increase in incidence of ovarian (1,229/430,611 in FT group vs. 27,358/4,263,300 in no-FT group) cancer (odds ratio [OR], 1.21; 95% confidence interval [CI], 1.00-1.45) and borderline ovarian tumors (117/414,729 in FT group vs. 934/2,626,324 in no-FT group) (OR, 1.87; 95% CI, 1.18-2.97) was observed. The incidence of ovarian cancer was higher with FT and IVF specifically (OR, 1.65; 95% CI, 1.07-2.54). For borderline ovarian tumors, the incidence was higher, not only with FT overall and IVF, but also according to the fertility drug regimen applied: clomiphene citrate (CC) only (OR, 1.99; 95% CI, 1.02-3.87), human menopausal gonadotropin only (OR, 3.46; 95% CI, 1.39-8.59), and CC and human menopausal gonadotropin combined (OR, 3.79; 95% CI, 1.47-9.77). When using the threshold for statistical significance, the meta-analyses relevant to ovarian cancers remained statistically significant (random-effects method). However, none of the examined associations could claim either strong or highly suggestive evidence.

An observed association between ovarian cancer (including borderline ovarian tumors) and FT has been demonstrated. The association between FT and female-specific malignancy remains a contentious topic because there have been contradictory outcomes among meta-analyses. This umbrella review interrogates existing systematic reviews and meta-analyses on this topic and concludes that a statistically significant increase in the incidence of ovarian cancer and borderline ovarian tumors is associated with FT. These findings have a significant clinical impact because it helps to inform and provide effective counseling for patients undergoing FT.

Although the risk of female infertility increases with advancing age, the underlying mechanisms remain unknown. Exosomes in follicular fluid are suggested to regulate folliculogenesis and influence oocyte quality, potentially playing a critical role in age-related infertility. Elucidating their content could enhance the understanding of the molecular mechanisms associated with female aging-induced infertility. In this study, we explored the proteomic profiles of exosomes derived from human follicular fluid to identify protein signatures associated with infertility in both young and aging women. Despite the lack of significant differences in the morphology and particle size of follicular fluid-derived exosomes between the two groups, proteomic analysis revealed a distinct pattern of differentially expressed proteins (DEPs). DEPs associated with B-cell activation, pathogen invasion, and disrupted metabolic processes were significantly more highly expressed in the aging group than in the young group, indicating their involvement in age-related infertility. In vivo experiments demonstrated that the application of exosomes, particularly those derived from young female group, facilitated the successful maturation of follicles. Key exosomal proteins, including ENO1, HSP90B1, fetuin-B, C7, and APOC4, were found to be associated with follicular maturation. Furthermore, the PI3K/AKT signaling pathway, which is known to be related to folliculogenesis, was activated by the application of exosomes in aging female mice. This study provides novel insights into the aging-associated protein signatures of follicular fluid-derived exosomes and their potential role in infertility. These findings suggest that aging-related protein signatures in exosomes could contribute to the treatment of age-related infertility.

Both early and late age at menarche have been associated with various health issues and may influence the risk of infertility. This present study investigated the relationship between age at menarche and infertility risk.

This study follows PRISMA guidelines. Databases including PubMed, Scopus, Web of Science, Embase, and Cochrane were searched in December 2024. Odds ratios with 95% confidence intervals were estimated using a random-effects model. Heterogeneity was assessed with the I2 index and chi-square, and publication bias was evaluated using Egger's test and a funnel plot. Sensitivity analysis and meta-regression examined study impact and variable influence on heterogeneity.

Out of 7,267 articles screened, 18 primary studies were included, yielding 21 pieces of evidence. The odds ratio (OR) for infertility in the late menarche group compared to the normal menarche group was 1.44 (95% CI: 0.98-2.10), while the OR for the early menarche group versus the normal menarche group was 0.98 (95% CI: 0.68-1.42). Additionally, the OR for infertility in the early menarche group compared to the late menarche group was 0.77 (95% CI: 0.55-1.06). For primary infertility, the OR for the late menarche group relative to the normal menarche group was 1.98 (95% CI: 1.02-3.85), whereas the OR for the early menarche group compared to the late menarche group was 0.59 (95% CI: 0.36-0.97).

Although the overall meta-analysis lacked statistical significance, subgroup analysis revealed a notable association between late menarche and primary infertility. Women with late menarche had higher odds of infertility, supporting a dose-responsive relationship. The observed 44% increase in infertility odds highlights late menarche as a potential risk factor, warranting further investigation into its implications for reproductive health.

Infertility is a significant global issue affecting millions of couples, and increased body fat is considered a major contributing factor. Traditional assessment methods, such as body mass index (BMI) and waist circumference (WC), are limited in accurately reflecting body fat composition. The relative fat mass (RFM) index, a newer tool, provides a more precise assessment of fat content, but its relationship with infertility remains unclear. This study aimed to investigate the correlation between relative fat mass and a history of infertility by analyzing data from the National Health and Nutrition Examination Survey (NHANES). The study included 3915 women aged 18 to 45 years. Infertility status was self-reported, and RFM was calculated using a specific formula. Logistic regression models were employed, adjusting for multiple covariates, to investigate the relationship between RFM and infertility. Women with a history of infertility had a significantly higher RFM when compared to those who were not infertile. Specifically, women in the highest RFM quartile had almost three-fold higher odds of history of infertility than those in the lowest quartile (odds ratio [OR]: 2.87; 95% confidence interval [CI]: 1.85-4.44). Subgroup analyses indicated a stronger association between RFM and a history of infertility; this relationship was predominantly observed in women under 35 years-of-age. Sensitivity analyses confirmed the robustness of these findings. Higher RFM is more likely to be associated with a history of infertility. While RFM provides a more accurate assessment of body fat distribution compared to BMI and WC, making it a valuable tool for evaluating infertility, further research is now needed to determine the impact of interventions based on RFM measurements.

Male infertility is a significant global public health issue, with modifiable lifestyle factors such as smoking, obesity, and psychological stress contributing to impaired semen quality and hormonal dysregulation. This study investigates the relationships between modifiable lifestyle factors, reproductive hormones, and semen quality in Ghanaian males attending an IVF clinic.

A cross-sectional study was conducted with 212 male participants recruited from a fertility clinic in Ghana. Lifestyle factors were assessed using standardized questionnaires, and semen samples were analyzed following WHO guidelines. Hormonal profiles (LH, FSH, testosterone, estradiol) were measured using the enzyme-linked fluorescent assay (ELFA). Statistical analyses included Pearson's product-moment correlation and Bonferroni correction.

Smoking and psychological stress were significantly associated with reduced sperm motility, viability, and concentration (p < 0.05). Elevated BMI correlated negatively with sperm concentration and testosterone levels (p < 0.05). Alcoholic bitters was linked to decreased semen quality, while caffeine consumption showed a positive association with progressive sperm motility.

Modifiable lifestyle factors, such as smoking, psychological stress, and increased body mass index (BMI), play a crucial role in male reproductive health by adversely affecting semen parameters and hormonal balance. These findings emphasize the need for public health interventions targeting modifiable behaviors to improve fertility outcomes.

Ejaculatory abstinence (EA) duration is recognized to impact semen parameters. This study aims to evaluate the effects of varying EA durations on semen quality parameters, distinguishing between normospermic and sub-fertile men, and to provide insights into tailored abstinence recommendations for improved fertility outcomes.

We retrospectively analyzed 23,527 semen samples from men undergoing infertility evaluation from 2013 to 2024. Semen parameters, including sperm concentration, motility, and morphology, were assessed post-abstinence (2-7 days) according to WHO guidelines. Group differences were analyzed, focusing on sperm parameters across abstinence periods in normospermic versus patients with sperm abnormalities.

In normospermic patients we found a trend increase from day 1 to day 7 of abstinence time regarding total sperm count (million) (92.4 vs. 191.1; p<0.01), sperm concentration (million/ml) (44.5 vs. 72.0; p<0.01) and morphology (6 vs. 12.5; p= 0.03) but not regarding motility (A+B) (50.0% vs. 48.0%; p=0.43). Conversely, in the population of patients with sperm abnormality, we found a significant trend increase from day 1 to day 7 of TSC (16.38 vs. 56.0; p<0.01), sperm concentration (million/ml) (8.0 vs. 18.0; p<0.01) and morphology (3.0 vs. 5.0; p<0.01). Interestingly, we found a significant trend decrease of motility (A+B) (28.0% vs. 21.0%; p<0.01) and pH (8.1 vs. 7.9; p<0.01) In patients affected by asthenospermia, motility (A+B) dropped significantly from day 1 to day 7 (11.8% vs. 6.1%; p<0.01) and also in patients with teratospermia morphology dropped significantly (2.13% vs. 1.26%; p<0.01).

The findings support the use of tailored abstinence guidelines to optimize semen quality based on patient-specific semen profiles, with normospermic men benefiting from longer abstinence durations to increase concentrations, while patients with motility or morphology impairments, may benefit from shorter abstinence periods to mitigate sperm quality declines.

The manual method of semen analysis is vital in andrology laboratories. To solve the labor-intensive, time-consuming, and subjective problem, computer-assisted sperm analysis (CASA) systems have been developed. However, it is unclear whether the consistency of semen analysis results especially in male infertility diagnoses can be achieved. A total of 326 individuals were recruited from January 14, 2020, to October 22, 2020. The manual method was used as the gold standard. Pairwise comparisons were conducted between CASAs (Hamilton-Thorne CEROS II Clinical, LensHooke X1 Pro, and SQA-V Gold Sperm Quality Analyzer) and manual method. LensHooke had the best performance in concentration, while the others showed moderate performances (intraclass correlation coefficient [ICC]: CEROS-0.723, LensHooke-0.842, SQA-V-0.631). CEROS II had moderate performances in motility, and the others only had poor agreements (ICC: CEROS-0.634, LensHooke-0.417, SQA-V-0.451). Morphology analyses were not consistent with manual results (ICC: LensHooke-0.160, SQA-V-0.261). In Bland-Altman plots, CEROS II (P = .379) and SQA-V Gold (P = .218) showed consistent measurements in concentrations and total sperm count with the manual method, while the others were inconsistent. LensHooke X1 Pro (κ=0.701) and CEROS II (κ = 0.664) showed substantial performances in oligozoospermia, and SQA-V Gold had moderate agreements (κ = 0.588). In asthenozoospermia, LensHooke X1 Pro had moderate performances (κ = 0.405) and CEROS II had fair agreement (κ = 0.249), while low agreement using SQA-V Gold (κ = 0.157). In teratozoospermia, LensHooke X1 Pro (κ = 0.177) and SQA-V Gold (κ = 0.008) could not have consistent results either. When choosing treatment based on morphology, the ratio of intracytoplasmic sperm injection (ICSI) approximates 0.5 in our unit. However, the ratios were around 0.31 and 0.15 using LensHooke X1 Pro and SQA-V Gold, indicating the reduction of ICSI work in routine treatment. CASA results were not consistent with manual results, and the deviations might result in skewed in vitro fertilization/ICSI allocation in subsequent treatment. Interestingly, tested CASA systems tend to skew to conventional in vitro fertilization instead of ICSI. Although CASA technologies have been improving recently, the manual method cannot be replaced by the tested CASA systems at present and the results should be treated with caution. CASA algorithms should be improved, especially in morphology. Future strict studies should be designed to evaluate the CASA systems with both internal and external validations.

Understanding mammalian preimplantation development, particularly in humans, at the proteomic level remains limited. Here, we applied our comprehensive solution of ultrasensitive proteomic technology to measure the proteomic profiles of oocytes and early embryos and identified nearly 8,000 proteins in humans and over 6,300 proteins in mice. We observed distinct proteomic dynamics before and around zygotic genome activation (ZGA) between the two species. Integrative analysis with translatomic data revealed extensive divergence between translation activation and protein accumulation. Multi-omic analysis indicated that ZGA transcripts often contribute to protein accumulation in blastocysts. Using mouse embryos, we identified several transcriptional regulators critical for early development, thereby linking ZGA to the first lineage specification. Furthermore, single-embryo proteomics of poor-quality embryos from over 100 patient couples provided insights into preimplantation development failure. Our study may contribute to reshaping the framework of mammalian preimplantation development and opening avenues for addressing human infertility.

Oxidative stress plays a crucial role in the female reproductive system. The oxidative balance score (OBS) is a new measure for assessing the balance between antioxidant and pro-oxidative factors in diet and lifestyle. However, limited studies have explored the relationship between OBS and infertility.

We performed a cross-sectional study including 2,664 women aged 20-45 years, based on data from the 2013-2020 National Health and Nutrition Examination Survey (NHANES). The OBS was derived from 16 dietary components and 4 lifestyle factors. We used multivariate logistic regression analysis to examine the association between OBS and infertility.

The analysis revealed a significant negative association between higher OBS and infertility risk, with an odds ratio (OR) of 0.98 (95% CI, 0.95-1.00) after full adjustment. Compared to the first quartile of OBS, the second, third, and fourth quartiles showed ORs of 0.71 (95% CI, 0.45-1.11), 0.79 (95% CI, 0.51-1.22), and 0.57 (95% CI, 0.35-0.92), respectively. Similarly, women in the highest dietary OBS and lifestyle OBS quartiles had a lower infertility risk compared to those in the lowest quartiles, with ORs of 0.60 (95% CI, 0.39-0.94) and 0.54 (95% CI, 0.32-0.93), respectively. Furthermore, subgroup analysis indicated that the association between the fourth quartile of OBS and infertility remained consistent, except among women with other ethnicities-including multi-racial, and college graduate or higher.

These findings suggest that high dietary OBS and lifestyle OBS are associated with a lower risk of infertility.

Given China's low fertility rate, assisted reproductive technology (ART) can be used assist infertile patients in having children. This study aimed to analyse patients' preferences for ART and to determine the relative importance (RI) and willingness to pay (WTP) of key attributes.

We identified six attributes of ART and used a D-efficient design to generate choice sets for conducting a discrete choice experiment. Patients were asked to choose between two scenarios that differed in participation in treatment decision-making (TDM), clinical pregnancy rate, live birth rate, risk of maternal and neonatal complications, and out-of-pocket cost.

Jiangsu province, China. The anonymous survey was carried out between December 2022 and February 2023.

Female patients aged 20-45 years, with low fertility or experience of ART treatment. We recruited 465 participants.

Patient-reported preferences for each attribute were estimated using a mixed logit model. The latent class model was also used to investigate preference heterogeneity.

All attributes were associated with patient preferences. Patients considered the live birth rate as the most important attribute (RI=29.05%), followed by participation in TDM (RI=21.91%). The latent class model revealed two distinct classes named 'outcome driven' and 'cost driven'. Preferences varied according to their age, monthly household income and location.

This study investigated the preferences of infertile patients when seeking medical assistance for infertility. The study outcomes can contribute to evidence-based counselling and shared decision-making and provide an empirical basis for creating and implementing future policies.

Male infertility represents a complex clinical condition that often challenges the ability of reproductive specialists to find its etiology and then propose an adequate treatment. The unexplained decline in sperm count, as well as the association between male infertility and mortality, morbidity, and cancer, has prompted researchers toward an urgent need to better understand the causes of male infertility. Therefore, molecular biologists are increasingly trying to study whether sperm epigenetic alterations may be involved in male infertility and embryo developmental abnormalities. In this context, research is also trying to uncover the hidden role of sperm RNAs, both coding and non-coding. This narrative review aims to thoroughly and comprehensively present the relationship between sperm epigenetics, sperm RNAs, and human fertility. We first focused on the technological aspects of studying sperm epigenetics and RNAs, relating to the complex role(s) played in sperm maturation, fertilization, and embryo development. Then, we examined the intricate connections between epigenetics and RNAs with fertility measures, namely sperm concentration, embryo growth and development, and live birth rate, in both animal and human studies. A better understanding of the molecular mechanisms involved in sperm epigenetic regulation, as well as the impact of RNA players, will help to tackle infertility.

Cadmium (Cd) is a toxic heavy metal that has been extensively implicated in disordered folliculogenesis, but the mechanisms underlying the ovarian toxicity of Cd remain to be explored fully. Granulosa cells are key players in ovarian follicular development and are the primary cells affected by Cd exposure-induced damage and dysfunction. In this study, we investigated how various levels of exposure of Cd (3 and 10 μM) to human granulosa cells (KGN cells) impacted the metabolism of the KGN cells utilizing a non-targeted metabolomics methodology. In vitro cell experiments revealed that Cd exposure dose-dependently diminished the viability of KGN cells. Metabolomics analysis revealed the presence of 296 (182 elevated and 114 reduced) and 397 (244 elevated and 153 reduced) differentially expressed metabolites after exposure to 3 and 10 μM, respectively. Cd exposure was found to significantly enrich nucleotide metabolism, sphingolipid metabolism, and ABC transporters in both groups. Although amino acid metabolic pathways exhibited significant enrichment across all groups, only glutathione, cysteine, and methionine metabolism were notably enriched in KGN cells exposed to 3 μM Cd, while glutathione and tryptophan metabolism were significantly enriched in the 10 μM Cd exposure cohort. The outcomes of this study provide mechanistic clues for elucidating Cd's cytotoxic impact on granulosa cells, and deepen our understanding of the ovarian toxicity of Cd.

Underweight or obesity is associated with infertility in women, but large cohort studies with a life course perspective are rare. We explored the association between body mass index (BMI) at age 18 and subsequent infertility among Japanese women.

In total, 15,907 married women aged 30-44 years who participated in a prospective cohort baseline survey during 2001-2007 were cross-sectionally analyzed. Those with a history of cancer, and those with a partner with infertility or missing data were excluded. All data were obtained from self-reported questionnaires.

The main outcome measure was infertility, defined as a self-reported history of infertility for at least 2 years. Age and cause of infertility were also recorded.

Overall, 2825 participants (17.8 %) reported being infertile. The proportions of women who were underweight (BMI <18.5 kg/m2), overweight (BMI ≥25 and < 30 kg/m2), and obese (BMI ≥ 30 kg/m2) at age 18 were 12.8 %, 4.5 %, and 0.4 %, respectively. Multiple logistic regression analysis revealed a 1.31-fold and a 1.82-fold increase in the rate of infertility in those women who were underweight or obese during adolescence, respectively, compared with those of normal weight. Further analysis by cause of infertility revealed no significant associations with overweight or obesity at age 18, but being underweight was positively associated with infertility of unknown cause.

Being underweight or obese at adolescence is a potential risk factor for subsequent infertility among Japanese women. In particular, being underweight during adolescence may be a contributing factor to unexplained infertility later in life.

Infertility affects a significant proportion of women worldwide, and the colonization of certain vaginal pathogens has been suggested as a possible contributing factor. To explore the relationship between bacterial pathogens and female infertility, a case-control study was conducted involving 55 infertile women as cases and 5 fertile women as controls.

Conventional culture-based techniques and biochemical assays followed by 16S rDNA sequence analysis were employed for the identification of vaginal isolates from the two groups. The strength of association between the isolated bacterium and infecundity was derived by odds ratio calculation.

The investigation revealed the presence of bacteria including Enterococcus faecalis, Escherichia coli, Bacillus spp., Acinetobacter baumannii, Pseudomonas spp., Micrococcus luteus, Staphylococcus aureus, Staphylococcus haemolyticus, Staphylococcus hominis, Staphylococcus capitis, Staphylococcus epidermidis, and Staphylococcus saprophyticus in the vaginal swabs of infertile women. Of these, the odds ratios for Staphylococcus aureus, Klebsiella pneumoniae, E. faecalis, and E. coli were 5.43 (95% CI = 0.28, 103.49), 4.59 (95% CI = 0.24, 87.93), 2.25 (95% CI = 0.11, 44.16), and 1.70 (95% CI = 0.09, 34.01), respectively, displaying an association with infertility. Moreover, vaginal colonization of these four bacterial species was also dominant in cases that were diagnosed with pelvic inflammatory disease and idiopathic infertility by laparoscopic examination.

Overall, the findings of this study indicate a probable association between specific pathogenic microorganisms and women's barrenness, emphasizing the significant role of these disease-causing agents in hindering conception. This highlights the significance of a complete understanding of the vaginal microbiome and emphasizes further research in this area.

Infertility, defined as the inability to establish a clinical pregnancy after a year of regular, unprotected sexual intercourse, impacts 8%-12% of couples worldwide. Many of these couples turn to in vitro fertilization (IVF) to build their families. The success rate of IVF procedures is variable, with estimates of up to 40% of embryo transfers being unsuccessful. Herein we review the existing literature on the role of the female and male urogenital microbiomes and genital inflammation on fertility and IVF outcomes. We discuss the microbiome across the female reproductive tract (FRT) and identify associations with female infertility, female genital tract inflammation, and success of IVF procedures. We also discuss the male urogenital microbiome and the associations between microbial taxa, genital inflammation, and male fertility parameters. Finally, we consider microbial transfer within couples and the impact this may have on fertility and the success of IVF procedures.

To characterize the potential role of Y-chromosome microdeletion (YCM) as a genetic cause for infertility in the Arab population from the Al Madinah Al Munawarah.

We screened 97 infertile men from Al Madinah Al Munawarah, from February 2022 to March 2024. Genomic blood DNA was analyzed for 8 sequence tagged site (STS) markers of Y chromosome by multiplex polymerase chain reaction.

We found microdeletions in 3 infertile men, indicating a prevalence of 3.1%. The STS markers sY254 and sY255 corresponding to AZFc regions were deleted in these men. No deletion was observed in any other STS markers investigated in this study.

Our findings for prevalence in Arab population of Al Madinah Al Munawarah is comparable to other studies from Saudi Arabia. However, large variance in the prevalence of YCM in the Arab population of other Middle Eastern countries is reportedly observed. The YCM has significant prognostic value, since it indicates the spermatogenic profile, the success probability of assisted reproduction technique (ART) procedures as testicular sperm extraction and apprise of potential risk of vertical transmission of microdeletion from father to son in patients opting for ART. With these considerations, we re-emphasize the need for genetic screening of YCM in azoo- and oligozoospermic infertile men.

As unhealthy diets have proliferated, there has been an increasing trend in the prevalence of obesity along with socioeconomic progress. WWI, mainly representing weight-independent central obesity, is a more accurate indicator of obesity than BMI and WC. Klotho is known to be one of the root causes of several age-related illnesses. There has never been any prior evidence associating WWI and serum α-Klotho levels.

The current cross-sectional investigation used data from the National Health and Nutrition Examination Survey (NHANES) 2013-2016. The calculation of each participant's WWI involved dividing their waist circumference in centimeters by the square root of their weight in kilograms. Using multivariable linear regression models, the association between serum Klotho concentrations and WWI was analyzed. Smoothed curve fitting was utilized to investigate the nonlinear connection. In addition, interaction tests and other subgroup analyses were carried out.

With an average age of 57.57 ± 10.81 years, 13,172 participants were enrolled in this study, of whom 51.45 % were female. After full adjustment, each unit increase in WWI was significantly associated with a decrease in Klotho by 23.18 ng/ml [β(95%CI) = -23.18 (-31.34, -15.02)]. Moreover, we uncovered that WWI had a stronger negative correlation with Klotho than other obesity markers, such as WC, body mass index (BMI), and a body shape index (ABSI).

To sum up, weight-adjusted-waist index levels were negatively associated with serum Klotho protein concentration and showed a stronger correlation than other obesity markers. Our findings indicated that WWI may be a predictor of reduced Klotho levels, and that controlling obesity in accordance with WWI may help lower the Klotho levels.

Infertility affects millions of individuals worldwide, imposing significant personal and societal burdens. Assisted reproductive technologies (ART), such as IVF and ICSI, provide hope for many, yet clinical pregnancy rate per embryo transfer remains around 35 %. Modifiable lifestyle factors, including sleep, may influence ART outcomes. However, the relationship between specific sleep characteristics and IVF/ICSI success is unclear. This study aims to explore the associations between sleep characteristics and various IVF/ICSI outcomes. Additionally, we investigated if perceived stress mediates these relationships.

This prospective cohort study enrolled 174 women undergoing IVF/ICSI at Zhongnan Hospital of Wuhan University from December 2021 to December 2023. Prior to initial ART treatment, participants completed the Pittsburgh Sleep Quality Index (PSQI) and the Perceived Stress Scale (PSS-10). IVF/ICSI outcomes such as the number of retrieved oocytes, matured oocytes, number of fertilized oocytes, fertilization rate, good-quality embryos, blastocyst formation rate and early pregnancy outcome (implantation and clinical pregnancy) were obtained from medical records. We employed multivariate generalized linear models to assess the associations between sleep characteristics and IVF/ICSI outcomes. Dose-response relationships between napping duration and maturation rate were analyzed using generalized additive models. Mediation analysis was used to assess the role of stress in the relationship between sleep characteristics and IVF/ICSI outcomes.

Women reporting poor sleep quality had significantly fewer retrieved oocytes (-22.89 %, 95%CI: 37.82 %, -4.00 %) and matured oocytes (-22.01 %, 95%CI: 37.54 %, -2.62 %). Those sleeping ≥10 h per night had fewer retrieved oocytes (-30.68 %, 95%CI: 48.88 %, -6.00 %), matured oocytes (-27.17 %, 95%CI: 46.57 %, -0.73 %), and good-quality embryos (-45.64 %, 95%CI: 65.43 %, -14.51 %). Women experiencing difficulty falling asleep more than three times a week had a significant reduction in blastocyst rates (-64.40 %, 95 % CI: 85.55 %, -12.30 %). Those reporting difficulty falling asleep less than once a week had fewer retrieved oocytes (-28.89 %, 95%CI: 47.34 %, -3.98 %), and matured oocytes (-27.77 %, 95%CI: 46.90 %, -1.73 %). Napping exceeding 1 h daily was associated with a significantly lower oocyte maturation rate (-73.8 %, 95%CI: 88.91 %, -38.06 %). A significant non-linear dose-response relationship was observed between napping duration and maturation rate (p < 0.001), with maturation rates initially increasing slightly with short naps but declining significantly with longer naps, particularly beyond 1 h. This relationship was significant among women with good sleep quality (PSQI ≤5) (p < 0.001) and those with normal BMI (p = 0.0005). Perceived stress did not significantly mediate these associations.

Our findings suggest that sleep characteristics, particularly poor quality, difficulty falling asleep, long sleep durations, negatively impact various IVF/ICSI outcomes. Longer daytime napping is inversely associated with oocyte maturation rates, especially among women with good sleep quality and normal BMI. Perceived stress did not appear to influence the relationship between sleep and IVF outcome. While optimizing sleep patterns may hold promise for improving IVF/ICSI success rates, it is essential to approach lifestyle guidance with caution, given the current limitations in confirming causative roles. Further studies are needed to clarify the extent and nature of the relationship between sleep characteristics and IVF/ICSI outcomes.

Stromal vascular fraction (SVF) is a complex mixture derived from adipose tissue, consisting of a variety of cells. Due to its potential for tissue repair, immunomodulation, and support of angiogenesis, SVF represents a promising frontier in regenerative medicine and offers potential therapy for a range of disease conditions. In this article, we delve into the mechanisms through which SVF exerts its effects and explore its potential applications in treating both male and female reproductive disorders, including erectile dysfunction, testicular injury, stress urinary incontinence and intrauterine adhesion.

Background/Objectives: Infertile people experience a lot of psychological stress due to the inability to conceive and achieve pregnancy. Studies on the quality of life (QoL) of people undergoing infertility treatment typically show a lower QoL for couples struggling with reproductive problems. In recent years, a new factor that may have had a stressful impact on people treated for infertility is the COVID-19 pandemic. The aim of this study is to assess the impact of the COVID-19 pandemic on the QoL of Polish women treated for infertility and on the secretion of selected sex hormones. Methods: The study sample consisted of 600 women undergoing treatment due to infertility and 100 healthy women in a control group. The World Health Organization Quality of Life-BREF (WHOQOL-BREF) and the Polish version of the questionnaire Fertility Quality of Life (FertiQoL) were used for data collection. The levels of selected hormones were measured from blood samples. Results: The effects of the pandemic were visible primarily in the reduced QoL of patients. The QoL in terms of physical health, psychological health, social relationships, and environmental sphere was drastically reduced by COVID-19, especially among women treated with IVF (in vitro fertilization) and IUI (intrauterine insemination). The hormonal status of women treated for infertility during the pandemic significantly changed due to a decrease in FSH (follicle-stimulating hormone) and LH (luteinizing hormone) secretion and an increase in PRL (prolactin). Conclusions: The pandemic resulted in a decline in the QoL of women with reproductive problems. The quality of life was influenced by the type of therapy used during infertility treatment. The study also suggests a relationship between a decrease in the quality of life of persons treated for infertility during the pandemic and their hormonal status.

Religion contributes to the identity, well-being, and life satisfaction of many people globally, however, its traditional stance on infertility and assisted reproductive technologies (ART) can conflict with individuals' personal reproductive aspirations and desire for a family. As the fertility rates of certain ethnic and religious groups decline, it is essential to discuss the interface between religion, infertility and ART, to understand how to best navigate the infertility journeys of proclaimed Christians. This article contextualises this discussion in the experiences of eight Pacific Christian adults living with infertility and/or accessing ART in Aotearoa New Zealand. Participants expressed the importance of having family members or a partner with them on their infertility journey. Although their religious beliefs elicited a sense of shame and hindered their confident participation in ART services, religion also provided access to a supportive community and a strong sense of hope. Culture was another significant influence on their infertility journeys but could be burdensome and a source of internal conflict. Improving ART strategies for service engagement with Pacific communities is an important first step towards ensuring these services are accessible and responsive to individuals' cultural and religious needs.

Nearly 200 million people worldwide suffer from infertility. Disparities exist between developed and developing countries due to differences in the availability of infertility care, different reimbursement policies and socio-cultural differences surrounding procreation. In low- and middle-income countries, specialized infertility centres are either scarce or non-existent, mostly in private settings, and accessible only to the fortunate few who can afford them. The success and sustainability of ARTs will depend on our ability to optimize these techniques in terms of availability, affordability, and effectiveness. A low-cost, simplified IVF system has been developed and shown to be safe, cost-effective, and widely applicable to low-resource settings. Combined with inexpensive mild ovarian stimulation protocols, this could become a truly effective means of treating infertility and performing assisted reproduction at affordable prices, but only if such programmes are sincerely desired and supported by all relevant stakeholders. A receptive political, governmental, and clinical community is essential.

Infertility can harm a patient in physical, psychological, spiritual, and medical ways. This illness is unusual because it affects the patient's companion and the patient individually. Infertility is a multifactorial disease, and various etiological factors like infection are known to develop this disorder. Recently published studies reported that different bacteria, such as Chlamydia trachomatis, Mycoplasma spp., Ureaplasma urealyticum, Escherichia coli, Staphylococcus aureus, and Pseudomonas aeruginosa, can lead to infertility by immunopathological effects, oxidative stress, and adverse effects on sperm concentration, motility, morphology, and DNA condensation. Among viruses, Human papillomavirus and Herpes simplex virus reduce sperm progressive motility and sperm concentration. The viruses can lead to the atrophy of the germinal epithelium and degenerative changes in the testes. Candida albicans also harm sperm quality, motility, and chromatin integrity and induce apoptosis in sperm cells. Finally, Trichomonas vaginalis leads to distorted heads, broken necks, and acrosomes exocytosis in sperms. This parasite decreases sperm viability and functional integrity. Noteworthy, oxidative stress could have a role in many pathological changes in the reproductive system. Recent findings show that microorganisms can increase reactive oxygen species concentration inside the host cells, leading to oxidative stress and sperm distress and dysfunction. Therefore, this article explores the potential significance of critical bacteria linked to infertility and their pathogenic mechanisms that can affect sperm function and the female reproductive system.

This study sought to estimate population level prevalence of infertility and explored whether time to pregnancy is related to selected factors.

This study's analysis was based on data collected from 2081 women who were sampled from participants of the 2016 Ethiopia Demographic and Health Survey based on risk of pregnancy criteria: age between 15 and 49 years, currently married or cohabitating, sexually active, not used contraception method during the 5 years before interview, not menopausal, and not pregnant. We used a current duration (CD) approach in which for each woman we calculated the length of time-at-risk of pregnancy (CD value) in months. A parametric survival model was fitted to CD values from which the median time to pregnancy (TTP) and prevalence of infertility were estimated. To explore variables associated with a longer TTP accelerated failure time, regression models were built to estimate time ratios.

The median TTP was 4 months (95% confidence interval [CI] 3.9-4.1). The 12-month prevalence of overall, primary, and secondary infertility were 29.5% (95% CI 27.50-31.47), 31.1% (95% CI 27.85-34.48), and 27.7% (95% CI 25.30-30.23), respectively. A longer TTP was observed for women aged 35 to 49 (P = 0.001), nulliparous (P = 0.00), when the usual residence of the husband is outside the home (P = 0.001), for women who want to give birth soon (P = 0.00), for cigarette smokers (P = 0.027), for rich women (P = 0.002), and for tertiary (P = 0.00) and primary educated women (P = 0.00).

This study suggests reproductive-age women, which indicates that large numbers of Ethiopian women need fertility services.

Women in couples experiencing infertility are at heightened risk for intimate partner violence (IPV) from husbands and domestic violence (DV) from family. Couples experiencing infertility in Jordan, a patriarchal culture with high rates of IPV and DV, are particularly vulnerable. This article explores the gendered similarities and differences in the experiences of mental health, social support, exclusion, and IPV.

The objectives of this study are to understand both men and women's perspectives on their experiences of infertility and to develop intervention strategies to reduce IPV among married couples experiencing infertility.

This study is a descriptive, observational study.

Through quantitative surveys and in-depth qualitative interviews, we examined key themes including: challenges to mental health and well-being; reproductive health and fertility care-seeking; experiences of shame, isolation, and discrimination; coping skills; sources of support; and challenges within spousal and family relationships.

In this article, we analyze primary areas of gender discordance and discuss how gendered experiences can shape implementation of psychosocial support intervention programs to prevent IPV. Our findings provide important insight into facilitators and barriers to prevention of IPV in this vulnerable group.

We conclude that providing both women and men with culturally appropriate support during fertility treatment-seeking can improve psychosocial health and couple functioning and ultimately to reduce the occurrence of IPV in this vulnerable population.

Infertility is often thought of as a disease of the male or female reproductive system defined by the failure to achieve a pregnancy after 12 months or more of regular, unprotected sexual intercourse. However, as fertility rates rapidly decline worldwide, we observe that the inability to conceive and have children stems not only from anatomical, physiological, or genetic conditions within the body but also from social, structural, and environmental conditions in society. Drawing on a wide array of international and interdisciplinary scholarship, this article rethinks infertility by focusing on the social, structural, and environmental conditions hindering the ability of individuals and couples to have children and become parents. We argue that accounting for infertility requires transcending its biomedical understanding as an individual disease located within the body and address the complex connections between the inability to conceive and the collective and structural dimensions of the environments where people's lives unfold. In doing so, we also emphasise that assisted reproductive technologies are important but not sufficient to tackle the diversity of contemporary infertility experiences. Accomplishing this also requires collective action ranging from family policies improving childcare facilities and parental leave to environmental policies reducing exposure to pollution and toxicity. By rethinking infertility beyond the body, this article contributes new perspectives for understanding the inability to have children, tackling reproductive inequalities, and advancing reproductive justice.

Microplastics (MPs) have emerged as hazardous substances, eliciting widespread concern regarding their potential toxicity. Although our previous research has indicated that polystyrene MPs (PS-MPs) might cause male reproductive toxicity in mammals, their precise effects on sperm motility parameters and acrosomal development remain uncertain. Herein, the effects on sperm motility of PS-MPs at varied particle sizes (0.5 μm, 4 μm and 10 μm) and the underlying mechanisms were examined. The results revealed that PS-MPs caused a decrease in sperm motility, accompanied by abnormalities in the structure and function of the sperm acrosome. Meanwhile, PS-MPs triggered the elevation of intracellular reactive oxygen species levels and the abnormal expression of antioxidant enzymes (γH2AX, GPX4, Peroxiredoxin 5 and SDHB), indicating disruption of the sperm antioxidant system. Furthermore, we observed aberrant expression of key factors involved in mitochondrial fission/fusion (Drp1, Fis1, Mfn1, Mfn2) and biogenesis (Tfam, Nrf1, Pgc1α), potentially resulting in disrupted mitochondrial dynamics and biogenesis in mice testis and Sertoli cells exposed to PS-MPs. Additionally, PS-MPs induced mitochondrial dysfunction by regulating the Sirt1-Pgc1α signaling pathway. Our data provided novel insights into potential mechanisms underlying the spermatogenesis disorders triggered by PS-MPs.

Titanium dioxide nanoparticles (TiO2 NPs) are widely used nanomaterials with potential environmental health concerns, including impacts on male fertility. This study investigated the effects of TiO2 NPs on male reproductive function in mice and the potential protective role of lutein, a dietary antioxidant. Male NMRI mice were exposed to TiO2 NPs (50, 150, and 300 mg/kg) with or without co-administration of lutein (5 or 10 mg/kg) for 35 days. Compared to controls, TiO2 NP exposure significantly decreased DAZL gene expression, testosterone levels, antioxidant capacity, sperm quality (motility, density, morphology, DNA integrity), and testicular tissue parameters (seminiferous tubules volume, germinal epithelium height, spermatogenic cell counts). These effects were associated with increased oxidative stress markers (malondialdehyde levels) and altered testicular architecture (interstitial tissue volume). Notably, co-administration of lutein significantly ameliorated these TiO2 NP-induced adverse effects, suggesting its potential protective role against testicular oxidative stress and dysfunction. Our findings highlight the potential detrimental effects of environmental TiO2 NP exposure on male fertility and the potential benefit of dietary lutein as a protective strategy. Further research is needed to explore the underlying mechanisms and translate these findings to human health.