"Estimating Impact of SARS-CoV-2 Infection on Health-Related Quality of Life among Persons Aged 8 years and Older, August 2020-July 2022"

Sarah Johnson

Centers for Disease Control and Prevention

Abstract: Background Severe COVID-19 results in substantial economic burden and impacts quality of life. Assessing how non-hospitalized COVID-19 impacts health utilities during acute infection and long term is important to estimate the full economic impact of SARS-CoV-2 infection. Methods We analyzed EQ-5D-3L survey data from SARS-CoV-2 infected adults (aged ≥16 years) and children (aged 8-15 years) from three community and household cohorts in the United States (2020-2022). EQ-5D-3L scores were analyzed at three time points after symptom onset or first positive SARS-CoV-2 test result and converted to health utilities on a scale of 0-1 (1=perfect health). Among adults, regression models were used to compare differences in health utility by demographic/clinical characteristics. Results Among 538 SARS-CoV-2 non-hospitalized asymptomatic/symptomatic infections from 575 adults with EQ-5D-3L surveys, mean utilities were near 1 throughout the observation period. During 0-14 days, vaccinated participants had higher health utilities (Beta:0.57, 95% CI:0.07,1.07). Seeking medical care and having gastrointestinal symptoms (vs. none), were associated with lower health utilities (Beta, 95% CI:-0.96, −1.60, −0.31; and −0.76, −1.30, −0.21 respectively). During 15-30 days, unemployment was associated with lower health utility (Beta:-0.64, 95% CI:-1.15,-0.14). During 31-90 days, underlying conditions were associated with lower health utilities (Beta:-0.32, 95% CI:-0.54, −0.09). Results for children were similar to adults. Conclusion Non-hospitalized COVID-19 may have minimal overall impact on quality of life; however, health utilities differed by vaccination status, presence of gastrointestinal symptoms, employment status, and presence of underlying conditions. Vaccination may play an important role in minimizing illness impact from SARS-CoV-2 infection. Key points Severe COVID-19 illness causes substantial economic burden and impacts on quality of life; however, the incidence of non-hospitalized COVID-19 is far greater. Assessing how non-hospitalized COVID-19 impacts health during acute infection and long term is important to understand the full impact of SARS-CoV-2 infection. This study utilizes the EQ-5D-3L, a standardized generic preference-based instrument used in population health studies, to estimate health utilities at multiple time points following SARS-CoV-2 infection. The study also examines demographic/medical characteristics that are associated with health utility over time. While mean health utilities were high for all infection periods regardless of age, health utility was lower at varying time points post-infection among adults who sought medical care, reported gastrointestinal symptoms, were unemployed, and with underlying conditions. Vaccinated adults (vs. unvaccinated) had higher health utility and were less likely to report reduced health. Findings can be used as inputs for economic evaluation and assessing impact of interventions for non-hospitalized SARS-CoV-2 illness, such as vaccination.


Guideline for the prevention, diagnosis and treatment of infertility. Web Annex C. Evidence to decision tables for diagnosis of infertility


The reproductive endocrinology and infertility subspecialist: definition, training, and scope of practice in the United States

Jared Robins

Feinberg School of Medicine, Northwestern University, Chicago, Illinois


Author Correction: Data-driven subtypes of polycystic ovary syndrome and their association with clinical outcomes

Gao X, Zhao S, Du Y, Yang Z, Tian Y, Zhao J, Yuan X, Santos BR, Wei D, Cui L, Yan J, Qin Y, Shi Y, Tang R, Sun Y, Hu J, Ding L, Song X, Ha L, Li J, China Women’s Reproductive Metabolic Network, Zhang H, Spritzer PM, Yildiz BO, Stener-Victorin E, Yong EL, Ou XH, Legro RS, Zhao H, Chen ZJ

Abstract: Collaborators: Zhou L, Ou XH, Bian Y, Wang Q, Zhao Y, Liang X, Liu J, Ma X, Li X, Gu Z, Li Y, Li J, Xia M, Wang S, Li Y, Qian Y, Ma J, He F, Gao S, Liu X, Li S, Jiang Y, Liu Y, Zhang Y, Zhang X, Tian Y, Zhang C, Zhang H, Zhao S, Zhao H.


Overview of HFEA Public Consultation on Choose a Fertility Clinic 2025

Human Fertilisation and Embryology Authority

Abstract:
# Overview of HFEA public consultation on Choose a Fertility Clinic 2025
Consultation held August-September 2025 on clinic’s main profile statistics on the Choose a Fertility Clinic webpage
Published: December 2025
## Table of contents
- [Introduction](https://www.hfea.gov.uk/about-us/publications/research-and-data/overview-of-hfea-public-consultation-on-choose-a-fertility-clinic-2025/#introduction)
- [Main points](https://www.hfea.gov.uk/about-us/publications/research-and-data/overview-of-hfea-public-consultation-on-choose-a-fertility-clinic-2025/#main-points)
- Summary of findings from the consultation
- [Section 1: Overview of response groups](https://www.hfea.gov.uk/about-us/publications/research-and-data/overview-of-hfea-public-consultation-on-choose-a-fertility-clinic-2025/#section-1)
- [Section 2: Main profile page statistic: which was the preferred rate?](https://www.hfea.gov.uk/about-us/publications/research-and-data/overview-of-hfea-public-consultation-on-choose-a-fertility-clinic-2025/#section-2)
- [Section 3: Presenting a combined rate](https://www.hfea.gov.uk/about-us/publications/research-and-data/overview-of-hfea-public-consultation-on-choose-a-fertility-clinic-2025/#section-3)
- [Section 4: Inclusion of different treatment types](https://www.hfea.gov.uk/about-us/publications/research-and-data/overview-of-hfea-public-consultation-on-choose-a-fertility-clinic-2025/#section-4)
- [Section 5: Additional considerations for the HFEA](https://www.hfea.gov.uk/about-us/publications/research-and-data/overview-of-hfea-public-consultation-on-choose-a-fertility-clinic-2025/#section-5)
- [About the HFEA](https://www.hfea.gov.uk/about-us/publications/research-and-data/overview-of-hfea-public-consultation-on-choose-a-fertility-clinic-2025/#about-the-hfea)
## Introduction
The HFEA has a statutory duty to provide information to the public about fertility treatment. Using the data collected from licensed fertility clinics, we publish verified information on th...


Activity-Based Costing in IVF: a framework for transparency and operational scaling of fertility services

Abstract:
PURPOSE: The economics of IVF operations remain opaque despite growing prevalence and substantial investment in fertility services. Traditional accounting methods often fall short by failing to capture the complex relationship between biological inputs (number of eggs and embryos processed), skilled labor, and equipment utilization, creating a distorted view across different procedures and patient characteristics.

METHODS: This paper presents Activity-Based Costing (ABC) as a methodological framework for understanding true IVF laboratory costs. We demonstrate a use case with an analysis of data from five IVF laboratories (600-2200 annual egg retrieval cycles) across different US regions including time studies of 500 + procedures at each site, with theoretical projections to 4000 annual egg retrieval cycles based on queuing theory.

RESULTS: We identify significant cost elasticity with biological inputs; costs increase by 55% for egg freezing when the number of eggs per patient triples, and by 30% for complex IVF procedures (such as those requiring embryo biopsy) when egg count per patient doubles. We also describe substantial scale effects, with marginal lab costs 40% higher in centers performing 500 yearly egg retrieval cycles versus 2000-cycle centers, and 4000-cycle centers estimated to achieve 13-40% lower costs per procedure than operations performing 500 retrieval cycles annually. Finally, we show labor efficiency increases by 30% between centers performing 500 and 2000 annual egg retrieval cycles, an observation supported by a queuing rule of thumb (QROT) analysis, with capital utilization also improving dramatically.

CONCLUSIONS: ABC enables evidence-based pricing, capacity planning, technology assessment, and consolidation strategizing. ABC is intended to inform operational efficiency, not clinical treatment, ensuring that quality of care and patient outcomes remain the primary considerations in fertility services.

Journal of assisted reproduction and genetics


Natural Conception After Tubal Reconstruction: A Rare Success Following Bilateral Fimbrioplasty for Post-pelvic Inflammatory Disease Occlusion

Abstract: Pelvic inflammatory disease (PID) remains a major cause of tubal factor infertility. Although in vitro fertilization (IVF) has largely replaced reconstructive surgery, selected patients with mild tubal damage may still achieve natural conception after surgical repair. This case highlights a spontaneous conception following bilateral fimbrioplasty in a patient with mild post-PID distal tubal occlusion. A 33-year-old, gravida 4 para 2, woman presented with three years of secondary infertility. Hysterosalpingogram (HSG) showed mild bilateral hydrosalpinx and distal tubal occlusion, with normal ovarian reserve and hormonal evaluation. The patient underwent robotic fimbrioplasty on July 23, 2025. Operative findings included Fitz-Hugh-Curtis changes, bilateral filmy adhesions, and grade-I distal occlusion. Bilateral adhesiolysis and fimbrioplasty were performed with restoration of tubal patency on chromotubation. The postoperative course was uncomplicated. Ten weeks after surgery, the patient conceived spontaneously with a normal intrauterine pregnancy. Tubal reconstructive surgery remains a valuable fertility-preserving option for selected patients who decline or lack access to IVF. Success depends on careful patient selection, minimal tubal damage, and meticulous microsurgical technique. Tubal reconstruction can offer selected women an affordable, fertility-preserving option, especially in low-resource settings where IVF is inaccessible.


The effect of uterine entry technique on chorioamniotic membrane separation in fetoscopic laser photocoagulation for twin-to-twin transfusion syndrome: protocol for a randomized controlled trial

Cara Buskmiller

Department of Obstetrics, Gynecology, and Women’s Health, St. Louis University, St. Louis, MO, USA

Roopali V Donepudi

Texas Children's Fetal Center, Baylor College of Medicine, Houston, Texas, USA.


Improving access to care and delivery to marginalized and vulnerable populations: a committee opinion

Practice Committee of the American Society for Reproductive Medicine

Abstract: It has been estimated that only a quarter of persons with infertility in the United States can sufficiently access infertility care. Against this backdrop of disparity, specific populations, including persons of color, sexual and gender minorities, immigrants, and lower-income persons, face barriers that further constrain access to care. This document outlines these communities' barriers and reviews best practice recommendations to extend inclusive access to care for marginalized populations. This reference is intended to support health professionals with knowledge of barriers that limit access to care and to provide practical strategies to improve access and optimize healthcare delivery.


Natural procreative technology (NaProTechnology) for infertility: take-home baby rate and clinical outcomes in a 5-year single-center cohort of 1,310 couples

Abstract:
Introduction: Assisted reproductive technologies (ART) are widely used to address infertility; however, they are costly, associated with medical risks, and often yield suboptimal clinical outcomes. Natural Procreative Technology, also known as NaProTechnology (NPT), provides a systematic and integrative approach to infertility by thoroughly identifying and treating underlying medical conditions to restore the couple's natural fertility potential. Despite its promise, real-world data on NPT effectiveness remain limited. The objective of this study is to evaluate the take-home baby rate in a large population of infertile couples treated with NPT and to synthesize findings from previously published studies.

Methods: A retrospective cohort study was conducted involving 1,310 infertile couples treated at a specialized fertility clinic in Spain over a 5-year period. Participants presented with primary or secondary infertility or recurrent pregnancy loss. Clinical data, diagnoses, and outcomes were analyzed, including surgical interventions and treatment duration.

Results: The mean age of women and men was 35.0 (SD 4.4) and 36.9 (SD 5.3) years, respectively. Primary infertility was the most common subtype (73.5%), the median infertility duration was 24 months, and prior ART attempts were recorded in 27.5% of couples. Mean number of diagnoses per couple was 2.5 (SD 1.3). The crude take-home baby rate was 35.3% (N = 463). Independent predictors of successful take-home baby included female age, recurrent pregnancy loss as the reason for consultation, duration of infertility, and the presence of endometriosis, hormonal dysfunction, male factor, and endometrial disorders as diagnoses. Considering a median duration of NPT of 10.9 months (range 8.1-17.0), the adjusted cumulative take-home baby rate was 62.1%. Rates varied significantly by female age, with higher success observed in younger women: 83.7% at 18-30 years, 53.3% at 36-40 years, and 24.4% over 40 years. A sensitivity analysis was performed to assess the impact of dropout assumptions on cumulative pregnancy rates. Nearly one-third of patients underwent surgery, most commonly hysteroscopy and/or laparoscopy.

Conclusion: In this cohort, NPT was associated with a notably high take-home baby rate in an infertile population with unfavorable prognostic factors, including advanced maternal age, prolonged duration of infertility, or previous failed attempts at conventional ART procedures.


Association between endometriosis and pregnancy complications: A nationwide retrospective analysis (2000-2021)

Abstract:
Objective: Endometriosis is a chronic gynaecological condition affecting reproductive-aged women. It has been associated with infertility and potential risks for adverse pregnancy outcomes, although population-level evidence remains limited.

Methods: This retrospective cohort study, including 147,950 pregnant women aged 20-45 years, used nationwide population-based data to compare the outcomes between women with (n = 11,400) and without (n = 136,550) endometriosis between 2000 and 2021. Baseline characteristics, comorbidities and pregnancy outcomes were compared between the groups. Multivariable regression analyses were performed to calculate adjusted relative risks (aRR) and 95 % confidence intervals (CI) for various pregnancy outcomes, and subgroup analyses were conducted by maternal age and infertility status.

Results: Among 147,950 pregnancies, women with endometriosis [mean ± standard deviation (SD) age 32.38 ± 4.51 years] had higher socio-economic status, more comorbidities, and more surgical history compared with women without endometriosis (mean ± SD age 30.06 ± 4.96 years). Women with endometriosis had increased risk of miscarriage (aRR 1.13, 95 % CI 1.03-1.24), preterm birth (aRR 1.31, 95 % CI 1.26-1.37), premature rupture of membranes (aRR 1.11, 95 % CI 1.06-1.16), placenta previa (aRR 1.63, 95 % CI 1.45-1.84), urinary tract infection (aRR 1.44, 95 % CI 1.31-1.59), and caesarean section (aRR 1.13, 95 % CI 1.11-1.16). Subgroup analysis revealed that risk of miscarriage was only higher in women aged 35-45 years and women without infertility. Risks of preterm birth, placenta previa and caesarean section were elevated across all subgroups, suggesting that endometriosis contributes independently to adverse pregnancy outcomes.

Conclusions: Endometriosis is an independent risk factor for several pregnancy complications, supporting the need for tailored prenatal care and closer monitoring of affected women to improve maternal outcomes.

European journal of obstetrics, gynecology, and reproductive biology


The Fertility Sector 2024/25

The Fertility Sector 2024/25

Abstract:
# The fertility sector 2024/25
Annual publication on HFEA licensed clinics (1 April 2024 – 31 March 2025)
Published: November 2025
[Download the underlying dataset as Excel Worksheet](https://www.hfea.gov.uk/media/cpzhqp1p/the-fertility-sector-2024-25-underlying-dataset.xlsx "The fertility sector 2024/25 - underlying dataset")
## Table of contents
- [1\. How we regulate](https://www.hfea.gov.uk/about-us/publications/research-and-data/the-fertility-sector-2024-2025/#how-we-regulate)
- [2\. Main points](https://www.hfea.gov.uk/about-us/publications/research-and-data/the-fertility-sector-2024-2025/#main-points)
- [3\. How the HFEA inspects clinics](https://www.hfea.gov.uk/about-us/publications/research-and-data/the-fertility-sector-2024-2025/#how-the-hfea-inspects-clinics)
- [4\. Inspections](https://www.hfea.gov.uk/about-us/publications/research-and-data/the-fertility-sector-2024-2025/#inspections)
- [5\. Non-compliances identified at inspections](https://www.hfea.gov.uk/about-us/publications/research-and-data/the-fertility-sector-2024-2025/#non-compliances-identified-at-inspections)
- [6\. Clinic licences](https://www.hfea.gov.uk/about-us/publications/research-and-data/the-fertility-sector-2024-2025/#clinic-licences)
- [7\. Incidents](https://www.hfea.gov.uk/about-us/publications/research-and-data/the-fertility-sector-2024-2025/#incidents)
- [8\. Ovarian Hyperstimulation Syndrome (OHSS)](https://www.hfea.gov.uk/about-us/publications/research-and-data/the-fertility-sector-2024-2025/#ovarian-hyperstimulation-syndrome-ohss)
- [9\. Patient complaints](https://www.hfea.gov.uk/about-us/publications/research-and-data/the-fertility-sector-2024-2025/#patient-complaints)
- [10\. Patient feedback](https://www.hfea.gov.uk/about-us/publications/research-and-data/the-fertility-sector-2024-2025/#patient-feedback)
- [11\. About our data](https://www.hfea.gov.uk/about-us/publications/research-and-data/the-fertility-sector-2024-2025/#about-our-data)
## 1\. How we regulate
The Human Fe...


Comprehensive diagnostic and therapeutic approach to male factor infertility aimed at natural fertility: A multicentric retrospective cohort study

Giuseppe Grande

Unit of Andrology and Reproductive Medicine, Department of Medicine, University of Padova, Padova, Italy.

Emanuela Lulli

Clinical Centre “St. Joseph”  Lucrezia di Cartoceto (PU) Italy

Enrico Busato

Obstetrics and Gynaecology Department Ca' Foncello Hospital  Treviso Italy

Francesco Pesce

Fondazione Centro della Famiglia, Counseling Center, Treviso, Italy.

Alfredo Pontecorvi

Division of Endocrinology, Centre for Natural Reproductive Medicine "ISI - Paul VI", Fondazione Policlinico Universitario "Agostino Gemelli" Scientific Hospitalization and Treatment Institute (IRCC...

Abstract:
BACKGROUND: In infertile couples whose male partner has alterations in semen parameters frequently, a comprehensive andrological approach is lacking and approximately 30-50% are classified as idiopathic infertility. These couples are often directly addressed to assisted reproduction techniques (ARTs). However, several clinical conditions may benefit from medical treatment. By acting on etiology and/or risk factors, this aims at improving seminal parameters and restoring natural fertility.

OBJECTIVES: To verify the impact of a comprehensive andrological assessment on the management of infertility (in particular, in couples with isolated male factor infertility) using as the primary outcome the natural pregnancy rate.

MATERIALS AND METHODS: A multicenter retrospective study was conducted between 2015 and 2022 in 1014 couples with primary infertility seeking natural conception (including 266 couples with previous ART failure). Each couple underwent a multidisciplinary evaluation. This involved: a gynecologist and an andrologist both with expertise in infertility, a psychologist when requested, and a fertility awareness practitioner according to a unique diagnostic and therapeutic multidisciplinary protocol.

RESULTS: An isolated male factor was found in 23% of couples. In 45%, it was associated with female factors also. The comprehensive diagnostic approach reduced the proportion of idiopathic infertility to 8% of the couples. Targeted treatment, based on diagnostic categories, was associated with spontaneous pregnancy in 40.9% of the couples. In the 233 cases without female factors, normal semen parameters were observed only in 13% of patients. Male genital tract inflammation was observed in 48.8% of the patients, genital tract infection in 43.1%, and hypospermatogenesis in 16.7%. Patients with infections were treated with antibiotics and probiotics. If further inflammation was documented, this was followed by low-dose corticosteroids and antioxidants. Follicle stimulating hormone (FSH) treatment was used in patients with hypospermatogenesis, and varicocele repair surgery was performed in four patients.

DISCUSSION AND CONCLUSIONS: Our data underline the efficacy of a comprehensive approach to the diagnostic process of male factor infertility, both in reducing the percentage of idiopathic infertility and in restoring natural fertility based on a targeted treatment.


MON-154 Breast areolar diameter in healthy menstruating women—a single cycle cross-sectional study of associations with body size and ovulatory characteristics

Dharani Kalidasan

University of British Columbia, Vancouver, BC, Canada

Jerilynn C Prior

Vancouver Hospital and Health Sciences Centre

Abstract:
Disclosure: A.V. Baaske: None. S. Shirin: None. C. Bos: None. D. Kalidasan: None. J.C. Prior: None.
Background: Tanner Breast Stage 3 (TB3, at menarche) and Tanner 5 (TB5, once ovulatory cycles established), despite being similar with an “upstanding” nipple, are different. Evidence suggests that steady and high ovulatory-level progesterone exposure accounts for the larger areolar diameter in TB5. Progesterone levels indicate whether the menstrual cycle is ovulatory and have crucial implications for women’s reproductive, metabolic, cardiovascular, and bone health. However, few data show average areolar diameter in regularly cycling women in whom SES, body size, and reproductive variables have been documented.

Objective: As a step towards better understanding the role of areolar diameter in reflecting estradiol-progesterone balance, this study aims to document the average mean bilateral lateral areolar diameter (AD) in a cohort of regularly menstruating, premenopausal women in whom ovulation was documented in one cycle. We also aim to describe relationships between AD and demographic, anthropometric, and reproductive/ovulation variables.

Methods: Women were eligible if aged 19-35 years with about month-apart cycles and no exogenous hormone use in the last 3-months. Participants completed one cycle with a daily Menstrual Cycle Diary© (cycle length, CL) and first morning temperatures for Quantitative Basal Temperature© (QBT©) ovulation analysis (normal luteal phase length ≥10 days). Questionnaires gathered SES, ethnic, general health, and reproductive characteristics. Bilateral horizontal areolar diameters were measured by a woman researcher with the participant supine in a warm room.

Results: From February 2020 to September 2022 (during the SARS-CoV-2 pandemic), 73 women from Metro Vancouver, British Columbia participated. Women were of median (min-max) age 30 (19-35) years, BMI 24.5 (17.1-41.4) and most identified as White (61.6%) with a median of 16 years of education. Median CL was 29 days (n=65) and QBT data showed 39.3% were normally ovulatory, 34.4% had short luteal phases and 26.2% were anovulatory. Median within-woman bilateral AD was 3.85 (2.35-8.00) cm. Left AD exceeded right (L 3.8 [2.3,8.2]; R 3.7 [ 2.4,7.8]; P=.003). Larger AD (≥3.85cm) was associated with greater body size (BMI r=.534), weight and waist circumference. However, earlier age at menarche (P=.02) was also significantly associated. No other reproductive variables (cycle length, luteal phase length, parity, ever use of CHC) were related to AD before body size adjustments.

Conclusions: This study is the first to document, and describe demographic, anthropomorphic and reproductive associations with, AD in community dwelling, regularly cycling, premenopausal women. Future steps will determine the most influential of the anthropometric variables; adjustment for these will facilitate assessments of associations with ovulation related characteristics. Presentation: Monday, July 14, 2025


SAT-128 Prospective 1-year Menstrual CycleBreast Tenderness and Swelling Experiences—data from healthy regularly cycling women initially proven normally ovulatory on two consecutive cycles

Abstract: Disclosure: M. Wood: None. J.C. Prior: None. S. Shirin: None. A. Goshtasebi: None. Breast tenderness and swelling are associated with premenstrual symptoms but have not been well described in healthy, normally cycling women with known ovulatory status. There are documented negative health risks (in bone, the cardiovascular system and cancers) in association with ovulatory disturbances within normal-length cycles. Identifying breast changes across a predictable, month-apart cycle but with Subclinical Ovulatory Disturbances (SOD, short luteal phase [<10 days] and anovulation (with normal estradiol but lower or absent progesterone levels) could advance our understanding of menstrual cycle physiology, women’s health education and identification of those with chronic SOD who may benefit from cyclic progesterone therapy. Our objective was to determine whether within-woman breast tenderness and swelling experiences differed between normally ovulatory and ovulatory-disturbed cycles. In this 1-year prospective observational study, we examined daily breast tenderness (0-4) and swelling (1-5 change from usual = 3) experiences recorded via the Menstrual Cycle Diary© over ≥8 cycles (mean=13/woman) in 53 women. Ovulatory status was documented by the twice-validated Quantitative Basal Temperature© (QBT©) analysis. Cycle and ovulatory data were previously reported (Prior NEJM, 1990); Diary data were unreported. Participants were healthy, community-dwelling women, mean age 34 (32.4:35.5 years), BMI 22.0, primarily White, and about two-thirds were runners (for health or were marathon-training). Comparison of breast parameters in all normally ovulatory (n = 495) vs all SOD cycles (n = 199) (mean cycle length 28.1 [27.5-28.8 days]), showed significantly higher Breast Tenderness Score [intensity X days; 6.0 (range 1.0, 14.0) vs. 3.0 (0.0, 11.0) (P = .001)] and increased breast size [4.0 (2.0, 4.0) vs. 4.0 (0.0, 4.0) (P = .034]) in normally ovulatory cycles. However, in within-woman analysis (n = 47 women with both normally ovulatory and SOD cycles), breast tenderness/swelling did not significantly differ by ovulatory status. We plotted all ovulatory cycles (n=676) centred on ovulation; this revealed parallel timing of increases in breast tenderness and swelling in the late luteal phase. These 1-year prospective data documented that mild breast tenderness and swelling occurred before flow in cycles with normal ovulation; symptoms were less in SOD cycles. Breast changes were totally absent during the follicular phases. Presentation: Saturday, July 12, 2025


"SUN-109 Feasibility of Cyclic Progesterone and Spironolactone for PCOS-specific Health-Related Quality of Life—a six-month, Phase II, single arm, single center, open-label study"

Abstract:
Disclosure: K. Nelson: None. J. Singer: None. A. Pederson: None. D. Kalidasan: None. J. Prior: None.
Polycystic ovary syndrome (PCOS) is an endocrine-metabolic disorder that significantly decreases health-related quality of life (HRQoL). Combined hormonal contraceptives (CHC) are standard-of-care for PCOS but do not mitigate the neuroendocrine cause nor women’s primary concerns. Treatment options need expansion. We hypothesized cyclic oral micronized progesterone (CyclicP4) and spironolactone (Sp) would improve HRQoL, decrease LH, and acne. This Phase II, open-label single-arm pilot study evaluated the 6-month cyclicP4 and Sp treatment feasibility and safety in androgenic PCOS. Our primary outcome was within-woman change in PCOS-HRQoL (PCOSQ). No sample size calculation was possible; 40 was considered feasible. Eligible women were 19-40 years with physician-diagnosed androgenic PCOS. Exclusion criteria included HbA1c > 6.4%, use of metformin or CHC in the last month. Participants received progesterone (300 mg/bedtime 14 days/month); spironolactone (200 mg/day) began in cycle two. Adherence was tracked daily (Menstrual Cycle Diary©) and by pill counts. Safety was assessed by post-study potassium (K+). Feasibility by women’s post-trial treatment intention. PCOSQ, serum LH, calculated bioavailable testosterone (cBAT), HbA1c, hsCRP, and AMH were measured at baseline and trial end. We also assessed perceived acne and sleep changes (-5 to +5), K+ and therapy intent at study end. Six-month change by paired t-test or Wilcoxon signed-rank assessed P < .05 as important. Of 109 expressing interest, 41 enrolled, 36 began therapy (5 did not), and 26 provided final questionnaire data (19 with complete lab data). Completing women were mean age 29 (SD 4.9) years, BMI 30.3 (8.1), 61.5% White and 73.1% with university degrees. Total PCOSQ scores within-woman increased from 3.5±1.0 to 4.9±1.1 (95% CI 3.1-3.8, 4.6-5.3; P<.0000001). Each PCOSQ domain significantly improved (at least P<.001) as did acne and sleep. Weight was unchanged but waist circumference decreased 1.1 cm (NS). LH, cBAT, and AMH each decreased: LH 10.0±5.4 to 8.5±5.2 IU/L (95% CI 7.6-12.3, 6.3-10.8; P<.4), cBAT 0.7±0.4 to 0.6±0.3 nmol/L (0.5-0.9, 0.5-0.8; P<.2), and AMH 10.5±6.5 to 9.7±5.7 ng/ml (7.4-13.7, 7.0-12.4; P<.4). hsCRP remained unchanged (2.8±3.3 to 2.7±3.6 mg/L; P<.8) as did HbA1c (5.2±0.3 to 5.2±0.3%; P<.0). K+ remained within the normal range (3.5-5.0 mmol/L) at final testing (mean 4.0). Two allergic responses to spironolactone and one frequent flow/religious practice led to discontinuation. Feasibility was confirmed and participants strongly preferred continuing therapy (median Likert score=6/7, P<.0001) CyclicP4 and Sp for 6-months was feasible and significantly improved HRQoL in a non-medicine-seeking community women cohort with androgenic PCOS. Though the small sample size limited generalizability, findings are promising. A larger randomized trial comparing CyclicP4 vs. CHC is warranted.
Presentation: Sunday, July 13, 2025


Accuracy of an Overnight Axillary-Temperature Sensor for Ovulation Detection: Validation in 194 Cycles

Anna Thompson

Pediatrics, University of Central Florida College of Medicine, Orlando, USA.

Abstract: Several studies have evaluated the reliability of using temperature sensors placed in different locations on the body to identify the day of ovulation. However, such demonstrations are lacking for axillary temperature wearable devices. This study aimed to evaluate the accuracy with which an axillary temperature armband sensor (Tempdrop) identifies the day of ovulation and the fertile window, using the Clearblue Connected Ovulation Test System as the reference method. A total of 194 cycles were analyzed from 125 women that participated in the study between April 2023 and June 2024. The performance parameters were high: the sensitivity (96.8% (95% CI 95.6; 97.7)), specificity (99.1% (98.8; 99.4)), accuracy (98.6% (98.2; 98.9)), positive predictive value (96.8% (95.6; 97.7)) and negative predictive value (99.1% (98.8; 99.4)). Furthermore, the results revealed a remarkably clear and better-than-expected change in temperature around the time of ovulation. This axillary temperature wearable sensor is an effective alternative to urine ovulation tests for determining the timing of ovulation. Another advantage is that it provides a clear temperature curve that can be used to evaluate the quality of the luteal phase.


Hormone Changes in Polycystic Ovarian Syndrome Identified with a Personal Quantitative Urine Monitor: A Pilot Study

Abstract:
Background/Objectives: Quantitative urine monitors are increasingly being used for a personalized approach to improve menstrual cycle knowledge and to manage fertility. Although several studies have evaluated urine fertility monitors in regular cycles, there is limited research in the use of quantitative monitors in reproductive disorders, such as polycystic ovarian syndrome (PCOS).

Methods: Urine hormone data was collected with the Mira monitor from 20 participants, 10 of whom had PCOS and a matched group who had regular cycles. The main aim of this study was to evaluate the levels of luteinizing hormone (LH), estrone-3-glucuronide (E13G), and pregnanediol glucuronide (PDG) in PCOS menstrual cycles compared to regular cycles.

Results: Women with PCOS had higher BMI than regular cycling women (p=0.02). PCOS cycles were longer (p<0.05), peak day was later in the menstrual cycle (p<0.001), and luteal length was shorter (p < 0.01) compared to regular cycles. In whole cycle comparisons, E13G was found to be lower in PCOS cycles (p<0.01) and PDG was found to be higher in PCOS cycles (p<0.05). E13G was also lower in the follicular phase of and late luteal phase of PCOS cycles (p<0.00001).

Conclusions: The results of this study demonstrate the feasibility of detecting hormonal differences in PCOS compared to regular cycles with at-home measurements with the Mira monitor. The metabolic dysregulation of PCOS is a possible factor in these hormone changes. Larger studies with different sub-types of PCOS will be needed to further clarify these changes and to understand the pathophysiology behind these hormonal changes.


The effect of iodine supplementation on oocyte apoptosis and proliferation in women with diminished ovarian reserve: a pilot study

Abstract: Iodine, an essential trace element, may play a role in reproductive health through its extrathyroidal actions. This study aimed to investigate the effects of iodine supplementation on oocyte apoptosis and proliferation in women with diminished ovarian reserve. A quasi-experimental study was conducted on ten women undergoing two cycles of ovarian stimulation. In the first cycle, they followed the standard protocol, while in the second, they received a daily 150 µg iodine supplement for two months. Urinary iodine levels, cumulus cell apoptosis and necrosis, and PCNA expression were evaluated before and after supplementation. We found that iodine supplementation significantly improved women's iodine status, increasing it from borderline sufficiency to optimal levels. This improvement was accompanied by a significant increase in the number of metaphase II oocytes. Following iodine supplementation, we observed a marked increase in cumulus cell viability and a reduction in both early and late apoptosis. Additionally, the expression of PCNA was upregulated, showing a positive association with the percentage of live cells and a reduction in total apoptosis. These findings suggest that iodine supplementation could be a promising therapeutic strategy for improving oocyte quality and enhancing fertility outcomes, particularly in women with diminished ovarian reserve.


Unlocking the power of semen analysis in primary health care - a path to men's health and lifestyle transformation

Abstract: Declining fertility, overlooked mental health, and reduced life expectancy underscore the urgent need for renewed attention to men's health. A semen analysis, traditionally used to assess fertility, holds untapped potential as a tool for promoting lifestyle changes and preventing chronic diseases in men. Spermatogenesis is highly sensitive to environmental and lifestyle factors and can be an early indicator of overall health. Disruptions in this process can signal underlying systemic issues and predict long-term health risks, including cardiovascular disease and metabolic disorders. An increasing number of men seek to engage in preconception care, as fertility is closely tied to a man's sense of masculinity, identity and aspirations for fatherhood. In this context, a semen analysis can be a powerful motivator to encourage healthy behaviours and proactive health management. By incorporating semen analysis into primary care, health care providers can leverage men's desire for fatherhood as an entry point to discuss broader health concerns, such as mental well-being, nutrition and physical activity. This approach would address immediate reproductive health, and also promote long-term wellness, helping to reduce the burden of chronic disease in men.


Emotion regulation strategies differentially impact memory in hormonal contraceptive users

Abstract: Hormonal contraceptives (HCs) are widely used, yet their effects on emotional and cognitive processes remain poorly understood. This study examined how HC use may influence emotional reactivity, emotion regulation, and emotional memory. Female participants (N = 179), either using HCs (N = 87) or naturally cycling (NC; N = 92), were randomly assigned to one of three groups: no emotion regulation (control), distancing and immersion, or reinterpretation and immersion. The emotion regulation groups completed emotion regulation training in which they viewed emotional images while applying different emotion regulation strategies, followed by a surprise memory test. Overall, HC users showed greater emotional reactivity to emotional images compared to NC participants. Both HC and NC groups successfully applied emotion regulation strategies as measured by changes in emotional affect; however, distancing led to a greater reduction in negative emotions compared to reinterpretation, particularly among HC users. Both HC and NC groups showed better memory for positive images after applying immersion. For negative images, HC users showed reduced memory performance when applying either distancing or reinterpretation, an effect not observed in NC participants. These findings suggest that HC use may influence specific aspects of emotional processing and memory, highlighting the need for more nuanced research on the cognitive and emotional effects of hormonal contraceptives.


Impacts of fetal/infant and adolescent exposure to famine on age at menopause in Chinese women

Abstract:
Background: Early-life nutritional deprivation may influence lifelong health, but its role in the broader process of reproductive aging remains underexplored. Guided by the Developmental Origins of Health and Disease framework, this study investigates the impacts of fetal/infant and adolescent exposure to famine on age at natural menopause, a key indicator of reproductive aging.

Methods: The study sample comprised 4256 women from the China Health and Retirement Longitudinal Study. Participants were categorized into fetal/infant (1959-1962 births) or adolescent (1942-1946 births) famine-exposed cohorts and non-exposed controls. Multivariable linear and logistic regression models were used to assess associations between famine exposure and age at natural menopause or early menopause, adjusting for sociodemographic, economic, and behavioral covariates.

Results: Famine exposure was associated with an earlier age at natural menopause: 1.16 years earlier for fetal/infant exposure (β = -0.12, p = 0.002), and 0.72 years earlier for adolescent exposure (β = -0.07, p = 0.014); it was also associated with increased odds of early menopause (odds ratio [OR] = 1.05, 95 % confidence interval [CI] 1.01-1.10). No significant association with premature menopause was observed.

Conclusion: Nutritional deprivation during critical developmental windows-particularly adolescence-has distinct, long-term effects on the trajectory of reproductive aging. These observational findings, which cannot establish causality, underscore the importance of early-life nutrition in shaping female reproductive health and are consistent with the Developmental Origins of Health and Disease framework in reproductive health.


Energy intake and appetite in laboratory and free-living conditions may be consistent across menstrual cycle phases

Jonathan Little

Faculty of Medicine, Department of Medicine, Southern Medical Program, Centre for Chronic Disease Prevention and Management, Kelowna, BC, V1V 1V7, Canada; Faculty of Health and Social Development, ...

Miranda Smith

Department of Pathology, Southern Regional Area Health Education Center, Fayetteville, North Carolina, USA.

Zoë Soon

University of British Columbia, Okanagan Campus

Abstract:
Background: Self-reported dietary intake varies across menstrual cycle phases, but objective assessments of dietary intake together with appetite and resting metabolic rate (RMR) are limited. This study aimed to assess differences in dietary intake, appetite, and RMR during two hormonally-distinct menstrual cycle phases in laboratory and free-living settings.

Methods: Healthy premenopausal females with predictable normal-length menstrual cycles completed two study visits: one in the late-follicular and one in the mid-luteal phase. Menstrual cycle phases were assessed using urinary luteinizing hormone surge and prospective cycle days. Participants consumed a 2-day energyand macronutrient-balanced run-in diet prior to each visit. RMR was measured with indirect calorimetry, followed by appetite ratings before and after a standardized breakfast, and a food cravings questionnaire. Appetite was also tracked for 2.5 days post-visit in a free-living environment. Ad libitum energy and macronutrient intakes were measured using pre-weighed plus weighing of uneaten food at an in-laboratory lunch meal, as well as during the 2.5-day free-living period.

Results: Eighteen participants were included (age: 21 ± 4 years; body mass index: 21.2 ± 1.5 kg/m2). There were no differences between in-laboratory ad libitum energy or macronutrient intakes, appetite, or food cravings between phases. RMR did not differ between phases, although the mid-luteal phase RMR tended to be higher (104 ± 218 kcal/day higher; P = 0.074). No main or interaction effects for phase or time were observed for free-living dietary intake nor appetite ratings.

Conclusions: Although RMR tended to be increased during the luteal phase, comprehensive appetite and energy intake assessments showed no significant cycle-phase differences in these 18 participants.


ART in Europe, 2020: results generated from European registries by ESHRE

Goossens V; European IVF-monitoring Consortium (EIM); European Society of Human Reproduction and Embryology (ESHRE)

Abstract:
**STUDY QUESTION:** What are the data and trends of ART and IUI cycle numbers and their outcomes, and of fertility preservation (FP) interventions, reported in 2020 as compared to previous years?

**SUMMARY ANSWER:** This 24th ESHRE report highlights the number of ART treatment cycles and children born over the years, showing a decline in the total number of treatment cycles, when comparing 2020 with 2019, alongside a decline in twin deliveries owing to a decrease in transfers of multiple embryos; however, fresh IVF or ICSI cycles and frozen embryo transfers (FET) showed similar pregnancy rates, and the reported IUI cycle numbers decreased while maintaining stable outcomes.

**WHAT IS KNOWN ALREADY:** ART aggregated data generated by national registries, clinics, or professional societies have been gathered and analyzed by the European IVF Monitoring (EIM) consortium since 1997 and reported in a total of 23 manuscripts published in *Human Reproduction* and *Human Reproduction Open*.

**STUDY DESIGN, SIZE, DURATION:** Data on medically assisted reproduction (MAR) from European countries are collected by EIM for ESHRE each year. The data on treatment cycles performed between January 1 and December 31, 2020, were provided by either national registries or registries based on initiatives of medical associations and scientific organizations or committed persons in the 44 countries that are members of the EIM Consortium.

**PARTICIPANTS/MATERIALS, SETTING, METHODS:** Overall, 1440 clinics offering ART services in 41 countries reported 923 318 treatment cycles (−14%; in 2019: 1 077 813), including 135 231 with IVF, 356 408 with ICSI, 305 373 with FET, 57 051 with preimplantation genetic testing (PGT), 64 007 with oocyte donation, and 4895 cycles using frozen oocytes. A total of 1288 institutions reported data on IUI cycles using either husband/partner's semen (IUI-H; n = 112 663) or donor semen (IUI-D; n = 38 839) in 30 and 21 countries, respectively. Sixteen countries reported 29 566 interventions in pre-and post-pubertal patients for FP, including oocyte, ovarian tissue, semen, and testicular tissue banking.

**MAIN RESULTS AND THE ROLE OF CHANCE:** In 24 countries (21 in 2019) in which all ART clinics reported to the registry, 356 427 treatment cycles were registered for a total population of approximately 268 million inhabitants in these countries, allowing the best estimate of a mean of 1330 cycles performed per million inhabitants (range: 142–3230). Among the reporting countries, for IVF, the clinical pregnancy rates (PR) per aspiration were similar to that in 2019 (22.1% versus 21.8% in 2019). For ICSI, the corresponding PRs showed similar trends (20.0% in 2020 versus 20.2% in 2019). When freeze-all cycles were excluded from the calculations, the clinical PRs per aspiration were 26.4% (28.5% in 2019) and 25.6% (26.2% in 2019) for IVF and ICSI, respectively. After oocyte donation, the PR per embryo transfer was 51.3% (50.5% in 2019) with freshly donated oocytes and 45.7% (44.8% in 2019) with thawed oocytes. After FET, the PR per thawing was 34.9% (versus 35.1% in 2019). In fresh cycles of both IVF and ICSI, the trend towards the transfer of fewer embryos continued with the transfer of 1, 2, 3, and ≥4 embryos in 57.2%, 37.8%, 4.8%, and 0.2%, of all treatments, respectively (corresponding to 55.4%, 39.9%, 2.6%, and 0.2% in 2019). This resulted in a reduced proportion of twin delivery rates (DRs) of 10.9% (11.9% in 2019) and a similar triplet DR of 0.2%. In FET cycles in 2020, the twin and triplet DRs were 7.9% and 0.1%, respectively (versus 8.9% and 0.1% in 2019). While the number of IUI cycles in 2020 decreased from 2019, the DRs remained stable at 8.8% after IUI-H (8.7% in 2019) and at 12.5% after IUI-D (12.1% in 2019). Twin and triplet DRs after IUI-H were 7.9% and 0.4% (in 2019: 8.7% and 0.4%) and 5.7% and 0.1% after IUI-D (in 2019: 6.2% and 0.2%), respectively. Data on FP were provided by 16 countries (18 in 2019), reporting a total of 29 566 interventions (24 139 in 2019). Cryopreservation of ejaculated sperm (n = 21 864 versus n = 11 592 in 2019) and cryopreservation of oocytes (n = 6077 versus n = 10 784 in 2019) were the most frequently reported forms of FP.

**LIMITATIONS, REASONS FOR CAUTION:** Caution with the interpretation of results should remain as data collection systems and completeness of reporting vary among European countries.


Understanding Restorative Reproductive Medicine

Phil C Boyle

NeoFertility Clinic, Suite 7, 1st Floor, Beacon Mall, Sandyford, Dublin 18, Ireland. Phil.Boyle@NeoFertility.ie.

Abstract:
Recently, editorials have been published in reproductive medical journals that have misunderstood and misrepresented the origin and meaning of “restorative reproductive medicine” (RRM).1,2 This term was first used in 2000 when a group of physicians established the International Institute for Restorative Reproductive Medicine (IIRRM, iirrm.org ). I am a founding member and am currently president of the IIRRM.
The IIRRM was founded as a secular, not a faith-based organization. We adhere to time-honoured medical principles to understand and treat underlying factors responsible for infertility. We are always seeking to improve our diagnosis and treatment of those factors, the training of clinicians who offer RRM, and the quality of clinical practice of RRM. We believe that in the clinical realm, in vitro fertilization (IVF) is often offered quickly without sufficient efforts first made to help couples conceive naturally.
IVF was originally developed to treat patients with bilateral tubal occlusion who could not conceive through sexual intercourse. Most patients who undergo IVF today do not have blocked fallopian tubes. Intracytoplasmic Sperm Injection (ICSI) was developed for patients with severe male factor infertility. Most patients who undergo ICSI today do not have severe male factor infertility. Remarkably, the most recent Cochrane review of IVF indicates ongoing uncertainty about whether IVF improves the live birth rate compared to expectant management for previously untreated couples with “unexplained” subfertility.3
I am an active RRM clinician since 1998 and I have treated thousands of couples. When patients present for fertility treatment, I do not ask them what religion, political view, or philosophy they support, because that is irrelevant to people who want a solution for their infertility. If they have a condition that is better treated by IVF, I tell them that at the first appointment. If natural conception is possible with RRM, I explain what is involved and outline the treatment process which can take up to 12 cycles (most often less) to reach a healthy ongoing pregnancy, or a full course of treatment.
RRM honours patient autonomy. We do not seek to prohibit patient access to IVF. Patients seek us out. RRM expands their choices and options. Many of my patients were previously seen in fertility clinics that offer IVF. Patients repeatedly tell me they did not receive the same depth of investigation or non-IVF treatment in the IVF clinics. I recently received these comments from patients, “RRM empowered us in our fertility journey. It provided a personalised approach. We are so grateful.” And “even if we didn’t conceive, we’d never regret trying RRM as my health improved immeasurably…”
The World Health Organization states that “Infertility is 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”.4 As RRM physicians, we respectfully suggest a slight but essential alteration: “Infertility is a medical condition defined by failure to achieve a pregnancy after 12 months or more of regular sexual intercourse without contraception, which is caused by one or more underlying diseases and conditions involving the male or female reproductive system.” This definition indicates that infertility is not a singular condition to be treated solely by treatments to generate a pregnancy and birth. Rather, it is “a canary in the coal mine” for human health, indicating the need to identify and address underlying health concerns. 5,6
As RRM physicians and clinicians we have training and backgrounds that allow us to treat infertility patients with a focus on treatments and approaches that restore and optimize natural function. The specialty of reproductive endocrinology and infertility has extensive training with a particular focus on IVF and treatments to improve the success of IVF. But we can and should be in agreement to offer patients evidence-based information and treatments that meet the needs and preferences of patients.
Further research is needed and is currently ongoing on patient-relevant questions, such as: How does an RRM evaluation differ in process and results from a fertility evaluation before initiating IVF? How do the outcomes of RRM and IVF compare on multiple levels including live birth rates, premature delivery, patient satisfaction, health improvement, and repeat successful births?7
For the sake of our patients with infertility, let us strive to be objective about the scientific facts, and meet all patients with respect. Surely as we challenge and learn from one another and strive for excellence, the patients will be the ultimate beneficiaries.

Journal of Restorative Reproductive Medicine


Restorative reproductive medicine (RRM) outcomes compared to in-vitro fertilization (IVF) for the treatment of infertility:  a retrospective evaluation of a 2019 clinic cohort compared to one cycle of IVF

Craig Turczynski

RRM Diagnostics, Dallas, TX, USA; Duquesne University College of Osteopathic Medicine, Pittsburgh, PA, USA

Abstract:
Objectives: Restorative reproductive medicine (RRM) is an emerging approach that can be used to treat infertility. Our goal was to compare RRM to IVF outcomes in 2019.
Design: We conducted a retrospective clinic-based analysis and referenced it against publicly available data from IVF registries, as published by the Centers for Disease Control and Prevention (CDC) or the Society for Assisted Reproductive Technology (SART) in the USA, and the Human Fertilization and Embryology Authority (HFEA), in the UK. Data from 2019 was collected from routine medical records following treatment at one clinic in Dublin, Ireland during 2019. We defined the demographics, diagnoses, and treatments and then calculated the crude percentages of conception, live birth, multiple pregnancy, prematurity, and low birth weight. These results were benchmarked against data reported in IVF databases.

Results: 249 couples had at least one RRM consultation, 187 committed to the RRM treatment program and met the inclusion criteria. The average female age for all included patients was 36.4 years and couples were trying to conceive for a mean of 32.2 months. Of the 187 patients/couples who underwent treatment, 28% had a previous live birth, 30% had a previous miscarriage, and 42% had never conceived;19% (35/187) had previously had IVF, 2.3 + 1.6 IVF cycles per couple. Of the 187 couples, 52% (98/187) conceived, 41% (77/187) had a documented live birth. There were 75 singletons and 2 sets of twins, producing 79 babies. Time to conception for live birth patients averaged 12 + 8 months. The average birth weight was 3422g (7lb 9oz) and average weeks’ gestation at delivery was 39 + 1.5 weeks. 4.0% (3/75) of singleton babies were premature (33-37 weeks) and none were very premature (< 32 weeks). 5.3% (4/75) of singleton babies had low birth weight (< 2,500g). When we compared births across age groups, the RRM percentages with live birth were comparable to those in a single cycle of IVF with multiple subsequent embryo transfers, and greater than a single cycle of IVF with a single embryo transfer. Furthermore, RRM babies had fewer multiple pregnancies, and singleton RRM pregnancies had less than half as many premature deliveries compared to IVF, (6.5% RRM all pregnancies or 4.0% RRM, singleton pregnancies vs 14.4% SART, all pregnancies or 11.8% CDC, singleton pregnancies). 74% (26/35) of couples who remained in contact with us and tried for another pregnancy had a repeat successful live birth.

Conclusions: In our clinic, a comprehensive RRM assessment and treatment followed by up to 12 optimal cycles of timed intercourse resulted in a 41% live birth rate (crude rate). We propose that using RRM may improve a couple’s chance of having a healthy pregnancy and reduce the demand for IVF. Furthermore, RRM reduces the risk of multiple pregnancy, low birth weight and premature delivery compared to IVF. The majority of couples who sought a second live birth were successful.
Limitations and Future directions: This is a retrospective analysis with a small number of RRM patients, compared to large IVF databases of patients using one cycle of IVF, including all transfers made from the IVF retrieval. While useful for benchmarking, conclusions are limited by sample size, and the lack of relevant prognostic data (other than female age) for the IVF patients. Larger prospective studies with full prognostic data are needed to make a proper comparison of RRM and IVF outcomes.


Ambient air pollution during developmental windows of spermatogenesis and semen quality among an infertility treatment seeking population

Neil J Perkins

Eunice Kennedy Shriver National Institute of Child Health and Human Development

Pauline Mendola

University at Buffalo, State University of New York

Rachael B. Hemmert

Division of Public Health, Department of Family and Preventive Medicine, University of Utah Health, Salt Lake, UT, USA.

Allison M Ring

Department of Atmospheric and Oceanic Science, University of Maryland, College Park, MD 20742, USA.

Lindsey M Russo

Division of General Internal Medicine, Weill Cornell Medicine, 420 East 70th Street, New York, NY 10021, USA.

Abstract: Prior studies have observed impacts of air pollution on semen quality, but timing of exposure during developmental windows of spermatogenesis and impacts of low-to-moderate air pollution is less well understood. We examined the relation between air pollution and semen quality in the Folic Acid and Zinc Supplementation Trial (2013-2018), which enrolled male partners of couples seeking infertility treatment in the Salt Lake City, Utah region (n = 2015). Semen quality parameters were assessed at baseline, 2-, 4-, and 6-months follow-up. Measures of daily air pollutants at each participant's residence were abstracted from Community Multiscale Air Quality models (fine particulate matter: PM2.5, sulfur dioxide, nitrogen dioxide, and ozone: O3), linked to participants' residential addresses, and averaged across the 74-day spermatogenesis window prior to the sample collection date for each study visit, and across four developmental windows of spermatogenesis (mitosis, meiosis I-II, spermiogenesis, and spermiation). Generalized linear mixed models considered four repeated semen sample measures per participant and adjusted for co-pollutants, age, season, and income. In multi-pollutant models, O3 during early-to-mid spermatogenesis (meiosis I+II and spermiogenesis) was related to lower percent normal morphology (% difference -6.73, 95 % CI -9.82, -3.54 and % difference -3.83, 95 % CI -7.51, 0.00, respectively). Additionally, PM2.5 and O3 during late spermatogenesis (spermiation) were associated with lower count and concentration, and PM2.5 with lower progressive motility. These findings suggest that exposure to low-to-moderate levels of air pollution may negatively impact semen quality and indicate that exposure to O3 during meiosis and spermiogenesis may particularly affect normal sperm morphological development.


Assessing the impact of real-world environmental factors on low-cost PM2.5 monitor performance by comparing calibration before and after deployment

Abstract: Understanding and mitigating health risks from poor indoor air quality, particularly fine particulate matter (PM2.5), is critical, yet conventional monitoring methods are costly and require skilled operators. Low-cost sensors (LCS) offer an accessible alternative; however, their accuracy under varying environmental conditions remains uncertain. This study evaluates how humidity, temperature, deployment duration, and concentration levels affect the calibration accuracy of low-cost PM2.5 monitors. Nineteen Plantower PMS 3003 sensors deployed in 11 Salt Lake County homes participating in the Green & Healthy Homes Initiative were calibrated before and after residential deployment using a TSI DustTrak aerosol monitor. Linear and Lasso regression analyses were performed to evaluate the influence of environmental factors on calibration parameters. Significant variability was observed in environmental conditions. Higher humidity (p = 0.0197) and longer deployment durations (p = 0.0178) significantly altered calibration slopes, while mean PM2.5 exposure (p = 0.0040) was strongly associated with intercept adjustments. These findings emphasize the need to account for environmental factors in calibration models to improve LCS accuracy and reliability. Environmental conditions significantly impact the performance of low-cost PM2.5 sensors. Modeling these impacts can streamline the calibration process, making it more efficient and cost-effective. Future research should focus on refining calibration models and exploring additional environmental factors to optimize LCS performance.


Child Opportunity Index at birth and asthma with recurrent exacerbations in the US ECHO program

Miller RL, Schuh H, Chandran A, Habre R, Angal J, Aris IM, Aschner JL, Bendixsen CG, Blossom J, Bosquet-Enlow M, Breton CV, Camargo CA, Carroll KN, Commodore S, Croen LA, Dabelea DM, Deoni SCL, Ferrara A, Fry RC, Ganiban JM, Geiger SD, Gern JE, Gilliland FD, Gogcu S, Gold DR, Hare ME, Harte RN, Hartert TV, Hertz-Picciotto I, Hipwell AE, Jackson DJ, Karagas MK, Khurana Hershey GK, Kim H, Litonjua AA, Marsit CJ, McEvoy CT, Mendonça EA, Moore PE, Nguyen AP, Nkoy FL, O'Connor TG, Oken E, Ownby DR, Perzanowski M, Rivera-Spoljaric K, Sathyanarayana S, Singh AM, Stanford JB, Stroustrup A, Towe-Goodman N, Wang VA, Woodruff TJ, Wright RO, Wright RJ, Zanobetti A, Zoratti EM, Johnson CC, ECHO Cohort Consortium

Journal of Allergy and Clinical Immunology


Assisted Reproductive Technology in Australia and New Zealand 2023

Abstract: ANZARD annual report on assisted reproductive technology activity, outcomes, and safety across Australia and New Zealand for 2023. Covers fresh-cycle and FET cycle counts, single-embryo transfer rates, clinical pregnancy and live birth rates, ART-conceived births, multiple pregnancy rates, and patient demographics. Published by the National Perinatal Epidemiology and Statistics Unit (NPESU) at UNSW Sydney with data submitted from all RTAC-accredited ART units in Australia and New Zealand.

National Perinatal Epidemiology and Statistics Unit, UNSW Sydney


Fertility awareness in 97,414 women trying to conceive: gaps, misconceptions, and  implications for reproductive education

Helen C O'Neill

Research and Development, Hertility Health Limited, London, UK. helen.o@hertilityhealth.com.

Abstract:
Background: Fertility rates in the UK are at an all-time low, with infertility affecting approximately 1 in 7 couples. Despite the rising demand for fertility services, fertility awareness, specifically knowledge of ovulation and the fertile window, remains low among women of reproductive age. Most existing studies offer a broad perspective, lacking focus on women actively trying to conceive (TTC). This study aims to assess the level of understanding surrounding the fertile window among women TTC, identifying factors associated with knowledge gaps.

Methods: A retrospective, cross-sectional analysis of 97,414 women actively TTC who answered an online health assessment was conducted. Participants provided information on menstrual cycle characteristics, previous pregnancies, and fertility knowledge, including the timing of the fertile window. Frequencies, percentages were calculated and chi-squared tests performed to assess differences in categorical data. Logistic regression models were used to calculate odds ratios (ORs) to better understand factors significantly associated with not knowing the fertile window.

Results: Out of the total respondents (97,414), over a third (33,756, 41%) could not accurately identify the fertile window, with substantial misconceptions observed across all age groups and ethnicities. Women with previous pregnancies were more likely to correctly identify the fertile window (OR = 1.45, 97.5% CI: 1.20-1.75, p < 0.001). However, knowledge was significantly lower among those with irregular cycles, non-White ethnicities, younger age groups and longer time TTC. Additionally, misconceptions about cycle regularity were apparent, of 60,322 women describing their cycles as regular 10% did not know their cycle length (66,95) and a further 2.9% fell outside of the clinically regular 21-35 day range. These misconceptions followed a similar trend with younger age groups, non-white ethnicities and longer time TTC having significantly increased rates of misidentifying regular cycles. This further increased the odds of not knowing their fertile window (OR = 2.99, 97.5% CI: 2.83-3.17, p < 0.001).

Conclusions: The findings reveal gaps in fertility awareness among women actively TTC. Addressing these knowledge gaps through targeted educational interventions could potentially reduce time-to-pregnancy and the reliance on assisted reproductive technologies. Improved fertility education focusing on cycle tracking and ovulation timing is essential to assist women with accurate information during their TTC journey.


Hot flashes? Night sweats? Progesterone can help reduce symptoms of menopause

Jerilynn C Prior

Vancouver Hospital and Health Sciences Centre


The Boston IVF Handbook of Infertility

The Boston IVF Handbook of Infertility


Human ovulatory phase-increasing odors cause positive emotions and stress-suppressive effects in males

Abstract: In many animals, olfactory cues are key for recognizing their sex, kinship, and reproductive status. In humans, it has been proposed that males find female body odors attractive during the ovulatory phase, coinciding with peak fertility. However, the molecular and physiological foundations of this attractiveness remain unclear. In this study, we combined sensory evaluation with gas chromatography-mass spectrometry for chemical analysis and identified volatile compounds that fluctuate across menstrual cycle phases. We identified three ovulatory phase-increasing compounds that mitigate the basal unpleasant axillary odor, resulting in the ovulatory-phase body odor being perceived as the most pleasant by males. Additionally, these compounds alleviated hostility and stress induced by the basal axillary odor, leading to relaxation in males and an enhanced positive impression of female facial images. Our results suggest that several ovulatory phase-increasing compounds may contribute to the positive effects of ovulatory female odor on males, as proposed in previous research.


Beyond the gut: decoding the gut–immune–brain axis in health and disease

Kwon H

University of Illinois at Urbana-Champaign

John Chulhoon Park

Pohang University of Science and Technology

Abstract: Emerging research underscores the pivotal role of the gut–immune–brain axis, a dynamic bidirectional communication system involving intricate interactions between the gut microbiota, immune responses, and the central nervous system. Gut microbes and their metabolites have profound effects on immune and neurological homeostasis, influencing the development and function of multiple physiological systems. Disruption of the composition of the gut microbiota and barrier integrity has been implicated in various neurological and psychiatric disorders, including autism spectrum disorder, Alzheimer’s disease, Parkinson’s disease, depression, and anxiety. Most insights into these host–microbiota interactions come from preclinical models, revealing both the complexity and potential therapeutic opportunities of the gut–brain communication pathways. This review synthesizes the current understanding of these intricate interactions, exploring how microbiota-driven modulation of the gut and brain barriers, immune signaling, and neuronal pathways, such as those through the vagus nerve, contributes to health and disease. We further explore therapeutic implications, including personalized precision microbiota interventions, microbiome-derived biomarkers, and barrier-strengthening strategies. Advancing this field offers transformative potential for developing innovative, personalized therapies tailored to individual microbiomes and immune profiles, ultimately redefining clinical approaches to neurological and immune-mediated diseases.


Evaluation of the evidence on acetaminophen use and neurodevelopmental disorders using the Navigation Guide methodology

Abstract:
BACKGROUND: Acetaminophen is the most commonly used over-the-counter pain and fever medication taken during pregnancy, with > 50% of pregnant women using acetaminophen worldwide. Numerous well-designed studies have indicated that pregnant mothers exposed to acetaminophen have children diagnosed with neurodevelopmental disorders (NDDs), including autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD), at higher rates than children of pregnant mothers who were not exposed to acetaminophen.

METHODS: We applied the Navigation Guide methodology to the scientific literature to comprehensively and objectively examine the association between prenatal acetaminophen exposure and NDDs and related symptomology in offspring. We conducted a systematic PubMed search through February 25, 2025, using predefined inclusion criteria and rated studies based on risk of bias and strength of evidence. Due to substantial heterogeneity, we opted for a qualitative synthesis, consistent with the Navigation Guide's focus on environmental health evidence.

RESULTS: We identified 46 studies for inclusion in our analysis. Of these, 27 studies reported positive associations (significant links to NDDs), 9 showed null associations (no significant link), and 4 indicated negative associations (protective effects). Higher-quality studies were more likely to show positive associations. Overall, the majority of the studies reported positive associations of prenatal acetaminophen use with ADHD, ASD, or NDDs in offspring, with risk-of-bias and strength-of-evidence ratings informing the overall synthesis.

CONCLUSIONS: Our analyses using the Navigation Guide thus support evidence consistent with an association between acetaminophen exposure during pregnancy and increased incidence of NDDs. Appropriate and immediate steps should be taken to advise pregnant women to limit acetaminophen consumption to protect their offspring's neurodevelopment.

Environmental health : a global access science source


Feeling of self-worth in healthy premenopausal women-relationships with menstrual cycles and ovulation over 1-year in the prospective ovulation cohort

Sonia Shirin

University of British Columbia, Vancouver, BC, Canada

Abstract: Self-Worth is an over-arching evaluation of a person's sense of individual value. Self-worth, however, is an underappreciated concept. It has rarely been reported related to physiological data; we found no studies related to the menstrual cycle or ovulation. It is also unclear if Self-Worth is a stable trait or a variable state. We sought to discover if "Feeling of Self-Worth" (as recorded daily) was related to cycle phases and ovulation of spontaneous menstrual cycles (without hormonal contraception) in healthy premenopausal women over one-year in data from the Prospective Ovulation Cohort. Participating women were invited to complete the Menstrual Cycle Diary© (Diary©) daily; it describes cycle-related and other comprehensive everyday life experiences including negative moods as well as changes from each person's usual Feelings of Self-Worth. Women recorded their Feeling of Self-Worth on a 5-level ordinal scale as a letter translated to a number originally centered on their usual feeling (U = 3) with two higher and two lower (letters) levels. The validated Quantitative Basal Temperature© (QBT©) method was used to assess ovulation and luteal lengths. Fifty-three healthy, community dwelling, normal-weight, non-smoking premenopausal women mean age 33.9 (95% CI 32.4, 35.5) years old were studied. All participants were first required to document two consecutive normal-length (21-36 days) and normally ovulatory (luteal length ≥10 days) cycles before enrolment. Each participant completed the Diary© and QBT© records daily over a mean of 13 cycles (minimum = 8). During the study, cycle lengths were mean 28.04 (95% CI 27.80, 28.28) days with 71% of all cycles being normally ovulatory, 26% having short luteal phases (SLP, LL < 10 days) and 2.6% being anovulatory. Results in all women and all cycles showed that the mean annual Feeling of Self-Worth was 3.01 (95% CI 2.94, 3.09), thus very tightly related to their usual Feeling of Self-Worth. There were only small, inconsistent differences between Feeling of Self-Worth in the follicular versus luteal phases comparing normally ovulatory versus all ovulatory cycles (including those with short luteal phases). Analysis of Self-Worth within the 46 women having both normally ovulatory and ovulatory disturbed cycles (short luteal and anovulatory) showed that it was slightly lower in these women's normally ovulatory cycles (P = .03). Principal Components Analysis of all Diary© data showed that Feeling of Self-Worth was positively related to Interest in Sex and Feeling of Energy (together explaining 9% of all variance). In addition, Feeling of Self-Worth had a significant, negative loading on the Negative Mood Factor (that explained 14.2% of total variance). These data suggest that Feelings of Self-Worth in this comprehensive menstrual cycle and ovulation dataset in healthy women were not related menstrual phases and ovarian hormone levels.


Pregnancies, intentions, and fertility behaviors during use of the Creighton Model FertilityCare System after initial intention to avoid pregnancy: Results from the Creighton Model effectiveness, intentions, behaviors assessment study

Chun-Pin Esther Chang

Department of Family and Preventive Medicine, Office of Cooperative Reproductive Health, Division of Public Health, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, United...

Chun-Pin Chang

Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, and Huntsman Cancer Institute, Salt Lake City, UT, United States of America.

Abstract:
Background: Knowledge of the fertile and infertile phases of the menstrual cycle can be applied to conceive or to avoid pregnancy. Fertility intentions and sexual behaviors during the fertile time may influence whether and when pregnancy occurs. The Creighton Model FertilityCare System (CrMS) is a specific system of fertility appreciation used to conceive or to avoid pregnancy. The objective of this paper is to report intentions, behaviors, and pregnancy rates during use of the CrMS among couples who initially intended to avoid pregnancy.Data and methodsWe analyzed a prospective cohort study conducted in 17 CrMS centers across the USA and Canada, following 296 couples for up to one year after onset of initial use of the CrMS to avoid pregnancy. Baseline data included demographics, motivations, and pregnancy intentions for each partner. Couples contributed 2894 menstrual cycles, most of which had data collected (by questionnaires and daily diary) on cycle-specific pregnancy intentions, days of potential fertility, and fertility behaviors. Pregnancies were prospectively actively ascertained.

Results: We found a high concordance (91%) in cycle pregnancy intentions between partners. However, 44% of cycles with strong intentions to avoid pregnancy included intercourse on potentially fertile days or days of undetermined fertility status. Across all sensitivity scenarios, cumulative 13-cycle pregnancy rates with cycle intention to conceive ranged from 88.0% to 89.8%, and cumulative 13-cycle pregnancy rates with cycle intention to avoid ranged from 29.1% to 35.3%. In multivariate analysis, baseline motivations and intentions for pregnancy within 2 years were strongly correlated with the likelihood of pregnancy, more so than cycle intentions.

Conclusion: The findings suggest that in some populations using natural family planning, baseline motivations and intentions may be more strongly related to pregnancy rates than cycle intentions. Our findings also highlight essential elements for evaluating correct use, including complete recording of intercourse and its timing.


The Role of MRI in Diagnosis and Pre-Surgical Mapping of Endometriosis

Abstract: Endometriosis is a chronic multisystem disease caused by the presence of endometrium-like tissue outside the endometrial canal, inciting inflammation and fibrosis. Transvaginal ultrasound (TVUS) and MRI have replaced diagnostic laparoscopy as the noninvasive imaging modalities of choice for diagnosis and pre-surgical planning. Advanced disease in the pelvis can distort/obliterate anatomic planes and obscure the extent of pelvic organ involvement at laparoscopy. Unlike laparoscopy, MRI is not limited by anatomic distortion and provides accurate multi-compartment assessment of deep pelvic endometriosis involving the uterus and its ligaments, adnexa, bowel, distal ureters, urinary bladder, and pelvic nerves. Additionally, MRI can help detect extra-pelvic organ involvement in the same study. Use of a dedicated MRI protocol and structured reporting template improves multidisciplinary communication and provides a pre-surgical road map; helps patient counseling as well as assessing the need for additional intraoperative organ-specific expertise such as colorectal surgery or urology. Knowledge of MRI and laparoscopic correlation enhances recognition of the key MRI findings to include in the report for optimizing surgical outcomes. This article focuses on the role of MRI in the diagnosis and pre-surgical mapping of pelvic endometriosis, with correlation to laparoscopic findings. Evidence level: 1. Technical efficacy: 5.

Journal of magnetic resonance imaging : JMRI


A systematic review on the role of paternal factors in human placental development, function, and pregnancy-related disorders

Abstract:
Background: The human placenta plays an important role in pregnancy and offspring health. The paternal genome contributes significantly to placental growth and development. While the maternal factors affecting gestational health are thoroughly investigated, the paternal factors are often overlooked. Thus, it is important to understand various paternal factors affecting placental development and function.

Objective: To assess the effect of various paternal factors on placental development, function, and pregnancy-related disorders.

Materials and methods: This review was registered in PROSPERO (Registration number CRD420250634649). Literatures across databases like JSTOR, Scopus, Google Scholar, ScienceDirect, and PubMed were screened through a set of criteria. Forty-eight studies were selected that included low-to-moderate risk paternal factors like age, smoking, race/ethnicity/location, genetic, epigenetic factors, exposure to chemicals, seminal plasma, and lifestyle factors.

Results: Increased paternal age was reported to contribute towards higher risks of preeclampsia, spontaneous abortions, preterm birth, stillbirth, and higher placental and fetal birth weight. Paternal smoking, on the other hand, was found to be an associated risk factor for placental abruption and stillbirth. Exposure to various chemicals was found to be associated with changes in sperm epigenome and placental dysfunction.

Discussion and conclusions: Paternal health, lifestyle, and exposure to chemicals may affect placental development and pregnancy. Paternal factors may alter seminal plasma proteome, cytokine profile, and abnormal sperm DNA methylation of imprinted genes which is associated with adverse pregnancy outcomes. Pre-conceptional health assessment of prospective fathers might be helpful in ensuring optimal placental development in pregnancies to follow, in addition to newborn health.

Journal of Assisted Reproduction and Genetics


The State of the Science of Natural Family Planning: A Report from NFP Scientists' Meeting Held in Orlando, FL, September 4, 2024

Abstract:
A one-day meeting was held as a pre-conference to the Catholic Medical Association Annual Educational event in 2024. A panel of eighteen physicians, scientists, and researchers involved in NFP work was convened to review the available evidence in four topical areas: (i) evidence for effectiveness of NFP methods to postpone and achieve pregnancy, (ii) evidence for effectiveness in the postpartum and perimenopause transition periods, (iii) evaluate the current state of technology in NFP (specifically app and quantitative hormone monitoring), and (iv) evidence examining the impact of NFP on marital relations. In each topical area, the panel worked to reach a consensus opinion on the currently available evidence and identified priorities for further research. Results from these discussions and a set of priorities for further work are presented here.
Summary: An expert panel was convened to review the current evidence supporting use of NFP in various settings, utilization of new technology, and the impact of NFP on marital dynamics. Results from these discussions and a set of priorities for further work are presented here.


The Presence of Microplastics in Human Semen and Their Associations with Semen Quality

Abstract: Microplastics (MPs) are becoming one of the most serious environmental threats worldwide. They have been shown to induce male reproductive toxicity in animal studies. However, evidence of their adverse effects on male reproductive health in human is still lacking. In this study, we evaluated the presence of MPs in human semen and explored their associations with semen quality. A total of 45 semen samples from men attending a fertility center were collected. MPs in the semen samples were analyzed by laser direct infrared (LD-IR) spectroscopy. MPs were found in 34 out of 45 semen samples, with an average abundance of 17.0 (42.0) particles/g. The size of MPs ranged from 20.3 μm to 189.7 μm and the majority (57.8%) were smaller than 50 μm. A total of 15 distinct MPs polymers were identified, and polyethylene (PET) accounted for 35.9% of the total amount of MPs, followed by butadiene rubber (BR, 26.4%) and chlorinated polyethylene (CPE, 12.2%). Analysis of the association of MP exposure with semen quality showed that participants exposed to PET MPs experienced a reduction in sperm progressive motility (20.6% ± 12.8% vs. 34.9% ± 15.9%, p = 0.056). However, no significant association was found between MP exposure and sperm concentration or total sperm count. Our findings confirmed the presence of MPs in human semen and suggested that MP exposure might have adverse impacts on male reproductive health. However, further large-scale studies are needed to confirm these findings.


Combined hysteroscopic and laparoscopic management of an isthmocele: about a case report

Abstract: This case underscores the effectiveness of a combined laparoscopic and hysteroscopic approach in managing isthmocele, achieving symptom resolution and uterine integrity restoration. Individualized management and long-term follow-up are essential for optimizing outcomes.

International Journal of Surgery Case Reports


Effects of strength training on quality of life in pregnant women: A systematic review

P. Blanco-Giménez

Valencia Catholic University Saint Vincent Martyr

Paula Blanco‐Giménez

Department of Physiotherapy, Medicine and Health Science School, Faculty of Medicine and Health Science Catholic University of Valencia  Valencia Spain

Abstract:
Introduction: Physical activity is known to improve physical and psychological outcomes in pregnant women. While aerobic exercise is typically emphasized in physical activity guidelines for pregnant women, emerging research suggests that strength training may offer unique benefits beyond those provided by aerobic exercise alone. This systematic review aimed to systematically explore the effects and characteristics of strength training interventions on the health‐related quality of life of pregnant women, with the goal of informing more comprehensive and specific exercise guidelines.

Material and Methods: A systematic literature search was conducted across PubMed, Web of Science, and EBSCO Host databases without time restrictions, following PRISMA guidelines (Prospero Id: CRD42024511477). Nine randomized controlled trials met the inclusion criteria, involving a total of 1581 participants.

Results: The studies reviewed demonstrated that strength training during pregnancy can mitigate excessive weight gain, alleviate low back and sciatic pain, enhance mood, and improve various aspects of health‐related quality of life. These aspects include physical activity levels, muscular strength, flexibility, sleep quality, energy expenditure, and psychological well‐being.

Conclusions: Despite these promising findings, this review highlights the need for standardized methodologies and detailed reporting in future research. Incorporating strength training into general exercise recommendations for pregnant women has the potential to optimize maternal health outcomes such as muscle strength, weight gain, physical activity levels, low back pain, pelvic pain, fatigue, anxiety, energy levels, vitality, sleep duration, and health status.

Acta Obstetricia et Gynecologica Scandinavica


Bisphenol compounds in female underwear manufactured in China and their potential risks to women's health

Abstract: Currently, there is limited information regarding the presence of chemicals in female underwear and the potential risks involved. This study investigated the levels of ten bisphenols in brassieres and briefs made in China, revealing total concentrations ranging from 13.9 to 52,967 ng/g. Bisphenol S (BPS), bisphenol F (BPF), and bisphenol A (BPA) made up a median of 53.2 %, 24.4 %, and 22.2 % of the total concentrations, respectively. The concentrations of bisphenols were significantly higher in darker samples compared to most other colors. When compared to previous reports on other textiles, this study found similar levels of BPA but higher concentrations of BPF and BPS. Furthermore, the median migration rates of BPF (39.1 %) and BPS (25.2 %) in artificial sweat were significantly greater than that of BPA (6.58 %), leading to higher exposure levels for BPF and BPS. The estimated non-carcinogenic risks associated with the three primary bisphenols in the underwear were deemed acceptable. However, the estimated exposure to BPS and BPF from this source represented about 2.53-12.0 % and 11.8-38.2 % of total human exposure, respectively, suggesting that the contamination of these chemicals in underwear is a concern that should not be overlooked.


Reduced risk of cesarean delivery with oxytocin discontinuation in active labor: a systematic review and meta-analysis

Abstract:
OBJECTIVE: Our objective was to determine if oxytocin discontinuation in the active phase of labor impacts the rate of cesarean delivery compared to continuation of oxytocin.

DATA SOURCES: This study was a systematic review and meta-analysis of randomized controlled trials. A research librarian performed a database search using a combination of standardized terms and keywords related to oxytocin discontinuation and stages of labor from database inception until February 2024. This protocol was registered in The International Prospective Register of Systematic Reviews (PROSPERO).

STUDY ELIGIBILITY CRITERIA: Randomized controlled trials of pregnant patients who received oxytocin for induction or augmentation of labor, whose outcomes compared discontinuation and continuation of oxytocin in active labor, were included. We defined "active phase of labor" as defined by each trial. Nonrandomized trials, quasi-randomized trials, and animal models were excluded. The primary outcome was the rate of cesarean delivery. Secondary maternal outcomes included postpartum hemorrhage, total blood loss, and infectious outcomes. Secondary neonatal outcomes included Apgar score at 5 minutes <7, umbilical arterial pH <7.10, neonatal therapeutic hypothermia, neonatal intensive care unit admission, neonatal resuscitation at birth, and neonatal death.

STUDY APPRAISAL AND SYNTHESIS METHODS: The risk of bias in each study was assessed using the guidelines outlined in the Cochrane Handbook for Systematic Reviews of Interventions. Heterogeneity was measured using Higgins I2. Meta-analysis was performed in Review Manager 5.4.1 and StataSE 16 to determine summary treatment effects in terms of relative risk or mean difference with 95% confidence intervals. The adherence of each included trial to the trustworthiness criteria outlined by the OBGYN Editors' Integrity Group was assessed, and a leave-1-out analysis was performed to evaluate the effect of studies with concerns regarding trustworthiness.

RESULTS: Fifteen randomized controlled trials, including 5734 patients, were ultimately included in the meta-analysis. The rate of cesarean delivery, reported in 13 studies, was lower with discontinuation of oxytocin in the active phase of labor (relative risk=0.80; 95% confidence interval, 0.66-0.97; 95% prediction interval, 0.38-1.22). Discontinuation of oxytocin was also associated with a lower risk of uterine tachysystole (relative risk=0.45; 95% confidence interval, 0.34-0.60; I2, 26%), and nonreassuring fetal heart rate tracing (relative risk=0.64; 95% confidence interval, 0.49-0.82; I2, 41%). Discontinuation of oxytocin increased the duration of active labor by an average of 30 minutes and second stage of labor by an average of 6 minutes.

CONCLUSION: Although associated with an extension of labor by half an hour, discontinuation of oxytocin in the active phase of labor was associated with a 20% decreased risk of cesarean delivery and a lower risk of uterine tachysystole and nonreassuring fetal heart rate tracing. While the pooled analysis suggests a beneficial effect, this finding is dependent on the inclusion of studies with concerns regarding trustworthiness.

American journal of obstetrics and gynecology


Revitalizing reproductive health: innovations and future frontiers in restorative medicine

Maria Elisabetta Coccia

Department of Biomedical, Experimental and Clinical Sciences “Mario Serio”, University of Florence, 50134 Florence, Italy

Francesco Maria Bulletti

Hôpital Orthopédique de la Suisse Romande

Evaldo Giacomucci

Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico

Abstract:
Background: Infertility affects around 17.5% of reproductive-aged individuals worldwide, posing significant personal and public health challenges. Although Medically Assisted Reproduction and Assisted Reproductive Technology (ART; e.g., in vitro fertilization) have advanced outcomes, many couples fail to conceive due to unaddressed pelvic, uterine, or systemic factors.

Objectives: We aim to (1) define the current usage of Restorative Reproduction Medicine (RRM) in clinical practice, (2) compare RRM outcomes with conventional ART, and (3) propose an integrated model of RRM plus ART for optimal fertility care.
Design: A systematic review following PRISMA guidelines was conducted (INPLASY registration no. INPLASY2024110069). Data sources and

methods: We searched PubMed, Scopus, and Web of Science (January 1995–October 2024), combining terms such as “restorative reproductive medicine,” “intrauterine adhesions,” “myomas,” “polyps,” “hydrosalpinx,” “endometritis,” “BMI,” “thyroid dysfunction,” “microbiome,” and “assisted reproductive technology.” Inclusion criteria: studies on uterine/systemic factors affecting infertility, focusing on surgical/pharmacological RRM interventions and ART limitations. Exclusion criteria: male-only infertility, case reports, narrative reviews, non-English publications. Quality assessment employed the Newcastle-Ottawa Scale and the Cochrane Risk of Bias Tool. We also briefly noted potential publication bias due to language and study-type restrictions.

Results: From >25,000 initial titles, 3 sequential screenings yielded 145 key articles addressing uterine (septum, myomas, polyps, adhesions) and systemic (body mass index (BMI) extremes, thyroid dysfunction, microbiome imbalance) factors. Surgical corrections (e.g., hysteroscopic removal of polyps/myomas, salpingectomy for hydrosalpinx) significantly improved natural conception and ART success (⩾20%–40% increase in clinical pregnancy). Chronic endometritis treatment, endometrial microbiome modulation, and BMI/thyroid optimization further improved pregnancy rates by 15%–20%. Comparisons of RRM versus ART alone indicated that RRM often lowers overall cost and may reduce miscarriage, while ART offers immediate embryo transfer. Combining RRM to correct pathologies prior to ART can boost implantation and live birth rates (⩾40%–70% improvement in some studies).

Conclusion: Restorative Reproductive Medicine comprehensively addresses pelvic and systemic abnormalities, thereby enhancing fertility outcomes and complementing ART. A proposed integrated model—RRM diagnostics/interventions followed by ART if needed—maximizes success, reduces time/cost, and emphasizes holistic reproductive health. Further multicenter trials are warranted to standardize protocols and fully realize RRM’s potential in modern fertility care.

Therapeutic advances in reproductive health


Rates of successful conceptions according to COVID-19 vaccination status: Data  from the Czech Republic

Abstract:
Background: Adverse effects of COVID-19 vaccination on human menstrual cycle characteristics have been observed, but limited data are available on the relationship between COVID-19 vaccination status and birth rates.

Objectives: Therefore, we used nationwide data from the Czech Republic to examine rates of successful conceptions (SCs), that is, conceptions leading to live births 9 months later, for women who were either vaccinated or unvaccinated against COVID-19 before SC.

Methods: Summary monthly COVID-19 vaccination and birth data for women in the Czech Republic aged 18-39 years were retrieved for the period from January 2021 to December 2023. The numbers of SCs per month per 1000 women were calculated for preconception-vaccinated or unvaccinated women, respectively, as well as the number of SCs per month per 1000 women for all women aged 18-39 years.

Results: During the study period, there were approximately 1,300,000 women aged 18-39 years in the Czech Republic, and the proportion of COVID-19-vaccinated women increased from January 2021 until reaching a steady state of around 70% by the end of 2021. At least from June 2021, SCs per 1000 women were considerably lower for women who were vaccinated, compared to those that were unvaccinated, before SC. Furthermore, SC rates for the vaccinated group were much lower than expected based on their proportion of the total population.

Conclusions: In the Czech Republic, SC rates were substantially lower for women vaccinated against COVID-19 before SC than for those who were not vaccinated. These hypothesis-generating and preliminary results call for further studies of the potential influence of COVID-19 vaccination on human fecundability and fertility.

The International Journal of Risk & Safety in Medicine


Successful Aging Beyond 90 in the US: A Retrospective Cohort Study Leveraging Electronic Health Records and a Computable Phenotype

Shaffer JG, Jazwinski SM, Carton TW, Anton S, Batsis JA, Bensken WP, Bian J, Boyce RD, Busby-Whitehead J, Carnahan R, Chatterjee R, Chodosh J, Chuang C, Cottrell EK, Danesh V, Fisher AL, Gallo J, Garrett K, Giovannetti T, Jefferson AL, Lacritz L, Luo S, Qi L, Rundek T, Sano M, Schliep K, Smith G, Weiner M, Whitson HE, Wu Y, Maraganore D


Human health risks from textile chemicals: a critical review of recent evidence  (2019-2025)

Abstract: Global textile production, driven by consumer demand, raises significant concerns about exposure to chemicals in clothing and related products. This review synthesizes evidence (2019-2025) on hazardous substances in textiles, including dyes, plasticizers, per- and polyfluoroalkyl substances (PFAS), and metals, and identifies and categorizes their associated human health risks. Emerging evidence highlights microfibers as critical vectors for chemical exposure via inhalation and dermal routes, necessitating updated risk assessments. Focusing on dermal absorption as the primary exposure route, risks to vulnerable populations (e.g., infants, pregnant women) and gaps in regulatory frameworks are highlighted. The current analysis reveals that chronic exposure to chemical mixtures in textiles remains poorly understood, with current safety assessments often neglecting synergistic effects. Key findings include elevated risks from phthalates in infant clothing, PFAS in water-repellent fabrics, and carcinogenic aromatic amines (AAs) from azo dyes. We underscore the urgency of harmonized global regulations, advanced biomonitoring, and sustainable alternatives (e.g., enzymatic dyes, biodegradable finishes). Public awareness initiatives and stricter enforcement of certifications like OEKO-TEX(®) or GOTS are critical to mitigating risks. Interdisciplinary collaboration among textile technologists, toxicologists, and public health experts is essential to develop safer textile alternatives and integrate health-centric approaches into sustainability agendas, safeguarding consumers, workers, and ecosystems.

Journal of Environmental Science and Health. Part A, Toxic/hazardous Substances &  Environmental Engineering


Knowledge of OBGYN Residents of Fertility Awareness Based Methods of Family Planning

Emily Damba-Cunningham

Sisters of Charity Hospital, University at Buffalo, Buffalo, NY, USA

Abstract:
Background: Fertility awareness-based methods (FABM) of family planning have increased in popularity in recent years. The effectiveness of various methods can vary substantially and can be user dependent. For various reasons, there is a bias in OBGYN physicians against the use of FABMs for family planning. However, once educated about the methods of FABMs, this bias improves. There is limited regarding the education dedicated to FABM use in residency. We hypothesized that the residency education obtained regarding FABMs would be insufficient in preparing resident OBGYNs in effectively counseling patients regarding FABMs.

Methods: a 16-question survey was created via SurveyMonkey and was sent to all ACGME accredited OBGYN residency programs for distribution to current residents. The survey was administered from October 2023 to December 2023.

Results: 125 responses were collected. Less than 40% of residents received formal training in regards to FABMs. Respondents indicated they felt most comfortable describing the calendar method to patients (68% respondents agree or strongly agree when queried if they could describe the method). 79.5% of respondents could not describe mucus-only, hormone monitoring, or sympto-thermal methods of family planning. When questioned if they were prepared to counsel postpartum patients who refused contraception regarding FABM, 58% of respondents indicated they could not assist their patients.

Conclusions: Despite increased use in recent years and multiple options for FABM use, resident education in the application and use of FABMs is lacking. Additionally, residents indicated they are most familiar with the least effective methods (calendar method) which would likely be a significant detriment to their patients.

Journal of Restorative Reproductive Medicine