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RRM postgraduate education pathways: certificate, diploma, fellowship, and board certification program framework

International Institute for Restorative Reproductive Medicine, 2026·International Institute for Restorative Reproductive Medicine

Fertility awareness among Chinese university students: scale development and cross-sectional study

Niu C et al., 2026·Frontiers in public health

Global fertility rates are declining. In China, the total fertility rate dropped sharply from 5.59 in 1971 to 1.15 in 2021. Chinese university students often lack adequate fertility awareness, yet no validated instrument exists to assess this construct in this population, despite its recognized importance for informed reproductive decision-making. The Fertility Awareness Scale for University Students (FASUS) was developed through literature search, semi-structured interviews, and two rounds of Delphi expert consultation. Psychometric properties were tested using exploratory and confirmatory factor analysis, Cronbach's α, split-half reliability, and test-retest reliability. A cross-sectional survey of 750 students examined fertility awareness levels and influencing factors via univariate analysis and multiple linear regression. The final FASUS Scale consisted of 22 fertility-related knowledge, reproductive health attitudes, and reproductive health skills, with a cumulative variance contribution rate of 67.952%. The scale demonstrated strong reliability (Cronbach's α = 0.97, split-half reliability = 0.885, test-retest reliability = 0.981). A survey of 750 students revealed an average fertility awareness score of 78.01 ± 16.44, indicating a low to moderate level. Key influencing factors included gender, ethnicity, education level, only-child status, and prior fertility knowledge education. This study utilized a self-developed scale to assess fertility awareness among Chinese university students. The results showed that the fertility awareness level of Chinese university students was generally low. We suggest that health care institutions implement targeted intervention measures to improve reproductive health outcomes.

Balancing metabolic optimization and reproductive safety in Polycystic Ovary Syndrome: a Bayesian-informed framework for GLP-1 receptor agonists

Song E et al., 2026·Frontiers in nutrition

GLP-1 receptor agonists (GLP-1RAs) address key metabolic drivers of Polycystic Ovary Syndrome (PCOS), yet their integration into fertility management remains challenging because reproductive efficacy is variably reported, preconception washout is required, and standardized clinical pathways are lacking. We present a structured, fertility-centered, hypothesis-generating narrative synthesis of the metabolic-reproductive-pregnancy continuum in PCOS, integrating evidence from randomized trials, observational studies, reviews, and clinical guidance. Heterogeneous findings are organized by intervention/comparator, follow-up window, and key effect modifiers, including baseline obesity/insulin-resistance phenotype, concomitant metformin, and lifestyle co-interventions. The clinical framework is derived from this narrative synthesis rather than from quantitative reproductive meta-analysis. As a methodological proof-of-concept only, we additionally performed a Bayesian network meta-analysis restricted to body-weight change within a prespecified 12-16-weeks window in the largest connected treatment network. Because ovulation, clinical pregnancy, time to pregnancy, and live birth were inconsistently defined and sparsely reported across trials, no confirmatory quantitative synthesis or treatment ranking was undertaken for these reproductive outcomes. We therefore distinguish evidence domains explicitly, with relatively robust support for short-term metabolic benefit but substantially greater uncertainty for reproductive translation and periconception safety. The narrative evidence supports positioning GLP-1RAs as time-limited, preconception metabolic-optimization tools, not as confirmed fertility-enhancing therapies per se. Their use in PCOS fertility care should be individualized through shared decision-making, with explicit discussion of the difference between established metabolic benefit and hypothesis-generating reproductive benefit, together with drug-specific washout planning and strategies to minimize post-discontinuation rebound. Future trials should standardize reproductive endpoints and systematically capture periconception exposure to enable confirmatory synthesis and individualized benefit-risk estimation.

Information and misinformation on assisted human reproduction techniques in Europe: a normative analysis of the information provided on the websites of medically assisted reproduction clinics

Albert M et al., 2026·BMC medical ethics

As part of the European Be better informed about Fertility project (B2-InF), we carried out a normative analysis of the information provided online by assisted reproduction clinics to the European public. This analysis aimed to determine the degree to which this information complies with regulations of medically assisted reproduction (MAR) and commercial information, and the main ethical implications related to the duty of information. Information was gathered from the websites of 33 clinics across 8 European countries (Albania, Belgium, Spain, Italy, Kosovo, Northern Macedonia, Slovenia, Switzerland). Nearly 2000 pages of information were reviewed and checked for compliance with relevant frameworks of national and international law. The assessment revealed significant inconsistencies in how clinics present information online, with particular concerns regarding transparency about success rates, associated risks, add-on techniques and the legal and ethical issues that may arise during the use of these techniques. The results of our analysis indicate an urgent need for enhanced regulatory oversight and standardized information requirements for assisted reproduction clinics across Europe. These findings suggest the necessity for harmonized legal frameworks that mandate comprehensive disclosure standards and establish effective enforcement mechanisms to ensure transparent and accurate information provision to potential patients.

Global, regional, and national burden of breast cancer among females, 1990-2023, with forecasts to 2050: a systematic analysis for the Global Burden of Disease Study 2023

GBD 2023 Breast Cancer Collaborators, 2026·The Lancet Oncology

The Role of Nutrition on the Pathogenesis of Endometriosis

Osińska D et al., 2026·Nutrients

Lipid metabolism drives dietary effects on T cell ferroptosis and immunity

Wang N et al., 2026·Nature

Reply of the authors: "Response to "The illusion of reproductive choice: how restorative reproductive medicine violates reproductive autonomy and informed consent"" by Frank-Herrmann et al

Stanford JB et al., 2026·Fertility and sterility

Anatomy, Abdomen and Pelvis, Ovary Corpus Luteum

Oliver R et al., 2026

The corpus luteum is a vital yet temporary organ that plays a crucial role in fertility during the luteal phase. An endocrine structure in females exists within the ovary once the ovarian follicle releases a mature ovum during ovulation. See Image. Anatomy of the Internal Structures of the Ovary. The secretion of hormones from the corpus luteum stops within 14 days after ovulation if the oocyte is not fertilized. It then degenerates into a scar within the ovary, known as corpus albicans. The corpus luteum's role is to maintain a uterine environment that allows for implementation and pregnancy. This occurs by the release of pregnancy-related hormones and regulation of the hypothalamic-pituitary access through inhibition of gonadotropin-releasing hormone from the hypothalamus, which in turn decreases the luteinizing hormone (LH) and follicle-stimulating hormone (FSH) released from the anterior pituitary. The primary hormone produced by the corpus luteum is progesterone, but it also produces inhibin A and estradiol. In the absence of fertilization, the corpus luteum regresses over time. A corpus luteum develops each time a woman ovulates so that she produces a corpus luteum numerous times throughout her lifetime.

Response to "The illusion of reproductive choice: how restorative reproductive medicine violates reproductive autonomy and informed consent"

Frank-Herrmann P et al., 2026·Fertil Steril

Peipert et al. (1) claim that restorative reproductive medicine (RRM) originated as a political and religious movement with the purpose to limit access to in vitro fertilization (IVF). In so doing, they mischaracterize the origin, development, and aims of RRM, as articulated by the International Institute for Restorative Reproductive Medicine, founded in 2000. They do not refer to any peer-reviewed medical literature published by clinicians and researchers working to develop RRM. Objecting that certain political or economic interests promote RRM (or, alternatively, IVF) does not constitute the basis for an evidence-based scientific critique or discussion. Thus, their editorial falls short of a serious effort to understand RRM scientifically.

Assisted Reproductive Technology in Japan: A Summary Report for 2023 by the Committee on Professional Scientific Conduct and Clinical Ethics of the Japan Society of Obstetrics and Gynecology

Katagiri Y et al., 2026·Reproductive Medicine and Biology

To summarize assisted reproductive technology (ART) data for 2023 collected through the Japan Society of Obstetrics and Gynecology registry. 625 out of 638 registered ART facilities took part in the study, documenting 561 664 treatment cycles and 85 048 newborns (+3.3% and +10.2% increases from 2022). The average age of women undergoing treatment was 37.3 years (standard 4.8); 205 986 cycles (36.7%) involved women aged ≥ 40 years. Among fresh cycles, oocyte retrieval was performed in 281 665 cycles, including 168 343 freeze-all cycles (59.8%). A total of 2329 pregnancies and 3375 newborns resulted from in vitro fertilization and intracytoplasmic sperm injection cycles, yielding 1772 and 2502 newborns, respectively. The overall rates for single embryo transfer (SET) and singleton delivery were 80.5% and 96.5%. Frozen-thawed embryo transfer accounted for 271 361 cycles, resulting in 109 850 pregnancies and 80 774 newborns, with a SET rate of 84.7% and a singleton delivery rate of 96.3%. In 2023, the second year of insurance coverage, the registry recorded the highest numbers of treatment cycles and newborns. Effective registry systems planned for 2026 will enable comprehensive evaluation of emerging trends in Japanese ART practice.

Natural killer cell dysregulation in polycystic ovary syndrome: immunometabolic and reproductive implication

Jiang N et al., 2026·Frontiers in immunology

Polycystic ovary syndrome (PCOS), a complex endocrine and metabolic disorder, involves significant dysregulation of the immune system. Natural killer (NK) cells, as key components of innate immunity, demonstrate notable phenotypic and functional alterations in women with PCOS. These changes include not only an elevated proportion in peripheral blood but also dynamic shifts within the local microenvironments of the ovary and endometrium. The increased level of peripheral NK cells correlates with a chronic low-grade inflammatory state, potentially serving as a predictive marker in infertile PCOS patients. Within the endometrium, uterine NK (uNK) cells exhibit reduced numbers and impaired function, accompanied by dysregulation of cytokine networks such as IL-15 and IL-18, which disrupts the immune equilibrium essential for embryo implantation. Abnormal NK cell function further involves alterations in killer immunoglobulin-like receptor (KIR) repertoires and dysregulated secretion of angiogenic factors, thereby compromising endometrial receptivity and vascular remodeling. Hyperandrogenemia modulates the distribution and activity of NK cells in reproductive tissues by influencing their surface activation markers, while insulin resistance promotes the generation of myeloid-feature NK (myNK) cell subsets via the IL-6/Stat3 signaling pathway, collectively exacerbating metabolic inflammation and reproductive dysfunction. Deciphering the role of NK cells in the immunometabolic interplay of PCOS reveals their position as a critical link between. May represent a potential cutoff requiring validation in larger cohorts reproductive impairment and metabolic disturbances, opening new avenues for targeted immunomodulatory interventions. Collectively, NK cells appear to present an important immunometabolic link between reproductive dysfunction and metabolic disturbance in PCOS, highlight their potential relevance as therapeutic targets.

Assisted reproductive technology in Latin America: the Latin American Registry, 2022

Zegers-Hochschild F et al., 2026·Reproductive Biomedicine Online

What are the trends and effects of assisted reproductive technology (ART) interventions on the effectiveness and safety of ART carried out in Latin America during 2022. Retrospective collection of cycle-based multinational data obtained from ART procedures carried out by 204 accredited institutions in 16 countries. In total 123,265 initiated cycles resulted in 19,663 deliveries and 22,203 births. Use of ART varied greatly, from 643.3 cycles/million inhabitants in Uruguay to 28.8 in Guatemala. In autologous cycles, the proportion of women aged ≥40 years represents 35.1% of cycles, whereas women <34 years represents only 18.8%. The proportion of single embryo transfers (SET) increased from 42.4% in 2021 to 47.3% in 2022. Out of 22,203 babies born, 77.4% were singletons, 21.7% twins and 0.9% triplets or more. Intracytoplasmic sperm injection represented 85.4% of fertilization techniques, and blastocyst transfer increased from 79.3% in 2021 to 85.3% in 2022. Delivery rate after fresh blastocyst elective single embryo transfer (32.6%) was significantly higher than after the transfer of one frozen embryo transfer (FET) from freeze-all cycle (25.2%) (P = 0.0001). The number of aspirations leading to preimplantation genetic testing increased 2.6 times in 6 years, and significantly increased delivery rates/transfer (P ≤ 0.008) and reduced miscarriage at all ages (P ≤ 0.004) in autologous cycles, but not in oocyte donation cycles. Delivery rates after fresh transfer of embryos from vitrified-warmed donated oocytes, generated similar outcome to FET from fresh oocyte donation cycles (P = 0.5621). Perinatal mortality increased from 7.5‰ in singletons to 22.8‰ in twins. Systematic collection of cycle-based multinational data contributes to cooperative sustained development and helps implement evidence-based reproductive decisions.

"Response to ""The illusion of reproductive choice: how restorative reproductive medicine violates informed consent for infertility treatment"""

Frank-Herrmann P et al., 2026·Fertility and Sterility

The Effectiveness of an Elective About Fertility Awareness-Based Methods on Students’ Knowledge: A Quasi-Experimental Study of Nursing and Medical Students

Duane M et al., 2025·J Restorative Reprod Med

To assess the effectiveness of an elective to improve students’ knowledge of fertility awareness-based methods for family planning and to determine whether there was a difference in knowledge gained by student type and/or course structure. A quasi-experimental study of preand postassessment scores among three different groups of healthcare students. In one group, 24 undergraduate nursing students in a semester-long hybrid course. In a second group, 16 second year medical students in a six-week hybrid selective course. In the third group, 80 fourth year medical students in a two-week online elective for a total of 120 students completing the elective from January 2018 to June 2020. All students completed a knowledge assessment before the course, and the identical assessment after the course, with a maximum possible score of 20. ANOVA and non-parametric tests were used for data analysis. The main outcome measure was comparison of post-course scores to pre-course scores. The mean pre-course score of about 50% in the undergraduate nursing group (x) was lower than the medical students in the six-week course (y) and two-week course (z) both about 70%. However, there was no difference in the mean post-course scores between the groups, which was about 90%. Assessments were mandated, but lectures were not, which could skew assessment scores. Additionally, the study focused on students signing up for the elective so it may not be generalizable to all medical and nursing student populations. Finally, educational interests and demographics impacting a student’s ability to learn and retain FABM knowledge is beyond the scope of this study. This elective was effective in improving fertility awareness-based method knowledge of medical and nursing students. All student groups had strong post-course knowledge scores – 90% accuracy, regardless of course structure. A fully online elective has the potential to make this knowledge easily available worldwide.

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

Johnson S et al., 2025

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

World Health Organization, 2025·World Health Organization

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

Gracia C et al., 2025·Fertility and Sterility

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

Gao X et al., 2025·Nature medicine

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, 2025

# Overview of HFEA public consultation on Choose a Fertility Clinic 2025 Consultation held August-September 2025 on clinic’s main profile statistics December 2025 ## - [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 - [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: 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) ## 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

Chavez-Badiola A et al., 2025·Journal of assisted reproduction and genetics

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. 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. 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. 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.

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

Kumari S et al., 2025·Cureus

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

Burnett BA et al., 2025·BMC pregnancy and childbirth

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

Practice Committee of the American Society for Reproductive Medicine, 2025·Fertility and sterility

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

Sánchez-Méndez JI et al., 2025·Front Reprod Health

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. 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. 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 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. 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)

Hsu JZ et al., 2025·Eur J Obstet Gynecol Reprod Biol

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. 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. 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. 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.

The Fertility Sector 2024/25

Human Fertilisation and Embryology Authority, 2025

# The fertility sector 2024/25 Annual publication on HFEA licensed clinics (1 April 2024 – 31 March 2025) 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") ## - [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\. The Human Fe...

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

Grande G et al., 2025·Andrology

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. 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. 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. 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. 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. 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

Baaske AV et al., 2025·Journal of the Endocrine Society

A.V. None. S. None. C. None. D. None. J.C. None. 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. 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. 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. 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. 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. 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

Wood M et al., 2025·Journal of the Endocrine Society

M. None. J.C. None. S. None. A. 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. 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"

Nelson K et al., 2025·J Endocr Soc

K. None. J. None. A. None. D. None. J. 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, 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. Sunday, July 13, 2025

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

Shpaichler Y et al., 2025·Sensors

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 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

Bouchard TP et al., 2025·Preprints.org

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). 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. 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). 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

Masoumi M et al., 2025·Scientific reports

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

Lyons HE et al., 2025·Nature reviews. Urology

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

Brandao BM et al., 2025·Hormones and Behavior

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 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

Wang H et al., 2025·Maturitas

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. 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. Famine exposure was associated with an earlier 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. 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

Smith M et al., 2026·Appetite

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. Healthy premenopausal females with predictable normal-length menstrual cycles 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. Eighteen participants were included (age: 21 ± 4 years; 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. 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

De Geyter C et al., 2025·Human Reproduction

**STUDY ** 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 ** 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 ** 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, ** 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, ** 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 ** 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, ** Caution with the interpretation of results should remain as data collection systems and completeness of reporting vary among European countries.

Understanding Restorative Reproductive Medicine

Boyle P, 2025·J Restorative Reprod Med

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 “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, 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.

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

Boyle P et al., 2025·J Restorative Reprod Med

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. 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. 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. 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 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

Russo LM et al., 2025·Ecotoxicol Environ Saf

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 PM2.5, sulfur dioxide, nitrogen dioxide, 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

Fang R et al., 2025·Sci Total Environ

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 et al., 2025·Journal of Allergy and Clinical Immunology

Assisted Reproductive Technology in Australia and New Zealand 2023

Kotevski DP et al., 2025·National Perinatal Epidemiology and Statistics Unit, UNSW Sydney

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.

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

Wainwright E et al., 2025·Reprod Health

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. 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. 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). 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

Prior JC, 2025

The Boston IVF Handbook of Infertility

Alper M et al., 2025

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

Ohgi N et al., 2025·iScience

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

Park JC et al., 2025·Cell Mol Immunol

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.