Reproductive Biomedicine Online[JOURNAL]
Sun
200 papers
From the shadow of pregnancy loss to a new pregnancy: couples' perspectives and medical care priorities.
Koert E, Mackel R, Hartwig TS … +2 more , Schmidt L, Nielsen HS
Reprod Biomed Online · 2026 May · PMID 42302669 · Publisher ↗
RESEARCH QUESTION: What are couples' perspectives on a new pregnancy after a recent pregnancy loss, and what do they need from medical care? DESIGN: Qualitative interview study of 20 couples recruited from the Copenhagen...
RESEARCH QUESTION: What are couples' perspectives on a new pregnancy after a recent pregnancy loss, and what do they need from medical care? DESIGN: Qualitative interview study of 20 couples recruited from the Copenhagen Pregnancy Loss (COPL) Research Programme (a prospective study of over 3000 couples in Denmark seeking acute care for pregnancy loss before 22 weeks of gestation). Couples who had experienced one or two pregnancy losses participated in joint semi-structured interviews 1-12 weeks after the loss (median 3 weeks). Data were analysed inductively using reflexive thematic analysis following Braun and Clarke's approach. Researcher reflexivity and iterative discussions enhanced analytic credibility and transparency. RESULTS: An overarching theme was developed from the data: 'stepping out of the shadow of pregnancy loss towards a new pregnancy'; this described couples' efforts to move forwards while navigating emotional uncertainty. Four themes captured their experiences: (i) 'focusing on a new pregnancy as a way to cope with and heal from loss'; (ii) 'recognizing that emotional readiness is fluid and never fully attainable'; (iii) 'approaching a new pregnancy with cautious optimism while managing co-existing, conflicting emotions'; and (iv) 'seeking medical care and support to plan and prepare for a future pregnancy'. Couples valued empathetic, individualized discussions about future pregnancy during follow-up, rather than being told they can 'just try again' at the time of pregnancy loss. CONCLUSIONS: This study offers insight into how couples navigate the transition from pregnancy loss to planning another pregnancy. Findings highlight the need for follow-up care integrating emotional readiness with reproductive planning, delivered through compassionate family-centred care to improve trust, continuity and patient experience.
Delayed childbearing and its impact.
Vergara V, García-Velasco JA
Reprod Biomed Online · 2026 May · PMID 42288049 · Publisher ↗
Delayed childbearing is a global social and demographic trend with significant social, familial and individual consequences. Among the individual impacts, reproductive ageing plays a central biological role, leading to a...
Delayed childbearing is a global social and demographic trend with significant social, familial and individual consequences. Among the individual impacts, reproductive ageing plays a central biological role, leading to a decline in ovarian reserve and deterioration of oocyte quality. Key mechanisms underlying oocyte ageing include mitochondrial dysfunction and increased oxidative stress. These metabolic changes are associated with alterations in cell division mechanisms that lead to embryonic aneuploidy, the most important cause of reduced fecundity in natural cycles, lower implantation rates in IVF treatments and higher miscarriage rates. In addition to oocyte-related changes, endometrial function may also be affected, although this becomes clinically relevant later and is less evident compared with oocyte ageing, as observed in assisted reproductive techniques such as oocyte donation. Strategies from assisted reproductive technology include preimplantation genetic testing for aneuploidies for embryo selection, embryo and oocyte accumulation, and social oocyte preservation at younger ages. Furthermore, advanced maternal age is associated with altered pregnancy outcomes, including increased risks of maternal, fetal and neonatal complications, particularly in the presence of pre-existing comorbidities.
Random start natural progesterone-primed ovarian stimulation (NPPOS) enables maximal flexibility: analysis of 1202 freeze-all cycles.
Vandierendonck F, Biesbroek A, Dhaenens L … +6 more , Rottiers AS, Meerschaut FV, Heindryckx B, Tilleman K, De Roo C, Stoop D
Reprod Biomed Online · 2026 May · PMID 42284694 · Publisher ↗
RESEARCH QUESTION: Can a random start natural micronized progestin-primed ovarian stimulation (NPPOS) protocol provide an equivalent and flexible alternative strategy for elective freeze-all stimulation cycles compared w...
RESEARCH QUESTION: Can a random start natural micronized progestin-primed ovarian stimulation (NPPOS) protocol provide an equivalent and flexible alternative strategy for elective freeze-all stimulation cycles compared with a conventional start gonadotrophin-releasing hormone (GnRH) antagonist protocol? DESIGN: This retrospective cohort study included 1202 elective freeze-all cycles between 2022 and 2024. Four groups were compared: GnRH-antagonist early follicular (n = 503), NPPOS early follicular (n = 319), NPPOS late follicular (n = 163) and NPPOS luteal (n = 217) starts. The primary endpoint was the number of metaphase II (MII) oocytes retrieved. The secondary endpoints included the follicular output rate (FORT), follicle-oocyte index (FOI) and the duration of stimulation. A predefined subgroup analysis was conducted in poor ovarian responders. RESULTS: The concentration of anti-Müllerian hormone was comparable across groups, and the median number of MII oocytes retrieved was similar: NPPOS late follicular group, 8 (IQR 5-15); GnRH-antagonist group, 10 (IQR 6-16); NPPOS early follicular group, 10 (IQR 6-16); and NPPOS luteal group, 10 (IQR 5-16) (P = 0.20). A generalized estimating equation Poisson regression model analysis confirmed equivalence. FORT and FOI-MII remained stable across the NPPOS early and late follicular, and luteal groups: estimated marginal mean ± SD FORT, 37.1 ± 9.9%, 40.4 ± 24.8% and 39.8 ± 24.9 (P = 0.30); and FOI-MOI, 70.8 ± 38.7%, 73.5 ± 44.2% and 75.0 ± 43.6% (P = 0.60), respectively. The NPPOS luteal group required a longer mean ± SD duration of stimulation (11 ± 2 days) compared with the NPPOS early follicular group (9 ± 2 days; P < 0.001), NPPOS late follicular group (10 ± 3 days; P = 0.004) and GnRH-antagonist group (10 ± 2 days; P < 0.001). In poor ovarian responders, the MII yield was comparable across all groups. CONCLUSIONS: Random start NPPOS using micronized progesterone is an effective and flexible alternative to a conventional GnRH-antagonist protocol in freeze-all cycles. The ability to initiate stimulation irrespective of menstrual phase combined with the use of oral progesterone may reduce treatment delays and improve convenience without compromising ovarian response.
PGT-A is associated with a reduced live birth rate in routine practice: evidence from the UK ART register.
Roberts SA, Brison DR, Harper J … +2 more , Kondowe F, Vail A
Reprod Biomed Online · 2026 May · PMID 42275751 · Publisher ↗
RESEARCH QUESTION: Does the use of preimplantation genetic testing for aneuploidy (PGT-A) improve the treatment success rate in routine IVF practice? DESIGN: A bespoke dataset from the UK Human Fertilisation and Embryolo...
RESEARCH QUESTION: Does the use of preimplantation genetic testing for aneuploidy (PGT-A) improve the treatment success rate in routine IVF practice? DESIGN: A bespoke dataset from the UK Human Fertilisation and Embryology Authority (HFEA) register was used to analyse a cohort of all available treatment episodes (oocyte retrieval and all associated transfers) in the UK which started between 2014 and 2018. The data included whether PGT-A or preimplantation testing for monogenic diseases (PGT-M) was employed in any cycle. The 111,975 treatment episodes included 2243 patients who received PGT-A and 2078 patients who received PGT-M at any point in the episode. Logistic regression models compared PGT-A and PGT-M with standard IVF cycles without PGT with careful adjustment for age, cause of infertility, previous IVF treatment, ovarian stimulation, intracytoplasmic sperm injection, number of oocytes, number of embryos, and treatment centre. Live birth events, multiple births and pregnancy loss were considered for both the first transfer following oocyte retrieval and cumulatively for all transfers from the initial oocyte retrieval. RESULTS: PGT-A was associated with a decrease in the live birth rate in the first transfer (OR 0.86 95% CI 0.77-0.97) and cumulatively (OR 0.74, 95% CI 0.67-0.82) compared with standard IVF cycles. Pregnancy loss was reduced per pregnancy in the first cycle (OR 0.47, 95% CI 0.36-0.61) and cumulatively (OR 0.64, 95% CI 0.52-0.78). In 48% of PGT-A treatments, no embryos were transferred in the first cycle, compared with 5% of standard IVF cycles. CONCLUSIONS: HFEA register data from 2014 to 2018 show that PGT-A as used in routine care was associated with a reduced live birth rate and reduced pregnancy loss compared with standard IVF cycles.
IVF patient subgroups benefit from preimplantation genetic testing for aneuploidy: a prospective multicentre cohort study.
Møller SL, Borgstrøm M, Hindkjær J … +14 more , Kesmodel US, Bogstad J, Madsen MB, Alosi D, Petersen MR, Aagaard J, Cissé A, Olsen KW, Roos LK, Hertz JM, Madsen K, Klajnbard A, Nøhr B, Grøndahl ML
Reprod Biomed Online · 2026 May · PMID 42275750 · Publisher ↗
RESEARCH QUESTION: Can preimplantation genetic testing for aneuploidy (PGT-A) improve the ongoing pregnancy rate per transfer and reduce miscarriage rate in patients with advanced maternal age (AMA), recurrent implantati...
RESEARCH QUESTION: Can preimplantation genetic testing for aneuploidy (PGT-A) improve the ongoing pregnancy rate per transfer and reduce miscarriage rate in patients with advanced maternal age (AMA), recurrent implantation failure (RIF), recurrent pregnancy loss (RPL), or both, without affecting cumulative pregnancy rate? DESIGN: Prospective cohort study of 260 patients undergoing PGT-A aged 36 years or over (AMA group), with a history of three or more blastocyst transfers without birth (RIF group), two or more early pregnancy losses (RPL group), or all. Trophectoderm biopsy was conducted day 5 or 6, and comprehensive chromosome screening was used for PGT-A before single frozen embryo transfer (PGT-A-FET). A total of 3060 patients undergoing single conventional frozen embryo transfer (FET) served as a historical reference group. RESULTS: Patients had increased odds of positive serum beta-HCG after PGT-A-FET compared with FET in the AMA (OR 1.53, 95% CI 1.06 to 2.21) and RIF (OR 2.11, 95% CI 1.41 to 3.14) groups. The PGT-A-FET group significantly improved the odds of ongoing pregnancy in the AMA (OR 2.20, 95% CI 1.52 to 3.18), RIF (OR 3.96, 95% CI 2.60 to 6.04) and RPL (OR 2.81, 95% CI 1.52 to 5.21) groups. The odds of pregnancy loss were significantly reduced with PGT-A-FET in the AMA (OR 0.36, 95% CI 0.21 to 0.64), RIF (OR 0.10, 95% CI 0.04 to 0.26) and RPL (OR 0.14, 95% CI 0.04 to 0.53) groups. Cumulative pregnancy rate did not differ between PGT-A and conventional cycles (RR 0.94, 95% CI 0.80 to 1.10). CONCLUSIONS: PGT-A improved the odds of ongoing pregnancy and reduced the odds of pregnancy loss in all groups. The cumulative pregnancy rate did not differ between PGT-A and conventional cycles. Findings should be interpreted in the context of the observational design.
Human menopausal gonadotrophin in a pre-filled injection pen is non-inferior to the US-approved powder formulation.
Witz C, Foster ED, Grover SA … +2 more , Heiser PW, CLARA (Comparison of MENOPUR Liquid and Powder in Women Undergoing ART) trial group
Reprod Biomed Online · 2026 Jun · PMID 42270471 · Publisher ↗
RESEARCH QUESTION: Is non-inferiority demonstrated for highly purified human menopausal gonadotrophin (HP-HMG) in an injection pen versus the US approved HP-HMG powder formulation for number of fertilized oocytes in wome...
RESEARCH QUESTION: Is non-inferiority demonstrated for highly purified human menopausal gonadotrophin (HP-HMG) in an injection pen versus the US approved HP-HMG powder formulation for number of fertilized oocytes in women undergoing ovarian stimulation? DESIGN: Randomised, double-blind, double-dummy, parallel group, multicentre, non-inferiority trial at 19 US reproductive medicine centres enrolling 401 women ages 18‒42 years, randomised 1:1 to HP-HMG pen or HP-HMG powder. After downregulation in a gonadotropin-releasing hormone agonist (GnRHa) cycle, ovaries were stimulated with HP-HMG pen or HP-HMG powder at a starting dose of 225 IU for the first 5 days, with subsequent dose adjustments as needed. The number of fertilized (two pronuclei [2PN]) oocytes 19 ± 2 h after insemination was the primary end point. RESULTS: The primary end point was met, and HP-HMG pen was non-inferior to HP-HMG powder, with the mean ± SD number of fertilized 2PN oocytes 8.2 ± 5.5 and 6.6 ± 4.3, respectively (adjusted treatment difference: 1.50, 95% CI 0.57 to 2.42). The number of oocytes retrieved was 14.3 ± 8.1 with HP-HMG pen and 11.4 ± 6.3 with HP-HMG powder. The mean number of blastocysts was 4.8 ± 3.8 in the HP-HMG pen group and 3.9 ± 3.0 in the HP-HMG powder group. The ongoing pregnancy rate per started stimulation cycle was 45.0% in the HP-HMG pen group and 42.7% in the HP-HMG powder group and the live birth rate was 44.1% and 42.2% after fresh transfer, respectively. The incidence of early ovarian hyperstimulation syndrome was 3.5% in both groups. CONCLUSIONS: HP-HMG as a solution for injection in a pre-filled injection pen is an effective and safe alternative to the approved powder formulation.
Etiology of thin endometrial lining and euploid single embryo transfer outcomes.
Clarke EA, Nieto CH, Park J … +6 more , Siddiqui S, Kripalani S, Baird M, Lee JA, Copperman AB, Buyuk E
Reprod Biomed Online · 2026 May · PMID 42263418 · Publisher ↗
RESEARCH QUESTION: Do frozen euploid single embryo transfer (SET) outcomes differ in patients with thin endometrial lining based on the cause of thin endometrium? DESIGN: Single-centre retrospective cohort study includin...
RESEARCH QUESTION: Do frozen euploid single embryo transfer (SET) outcomes differ in patients with thin endometrial lining based on the cause of thin endometrium? DESIGN: Single-centre retrospective cohort study including patients with thin endometrial lining (<7 mm) undergoing euploid SET between 2016 and 2024. Patients were grouped by cause of thin lining: 'thin-surgery' (history of uterine surgery) and 'thin-constitutional' (no prior uterine surgery). Reference groups were patients with normal endometrial thickness (≥7 mm) who underwent previous uterine surgery (normal-surgery) and those who did not (normal-constitutional), matched (3:1) by oocyte age, body mass index and treatment year. Primary outcome was live birth. Secondary outcomes included pregnancy, biochemical and clinical pregnancy loss rates. A subgroup analysis evaluated surgical patients with Asherman's syndrome. RESULTS: A total of 272 cycles from 218 patients were included: 120 cycles (n = 89 patients) in the thin-surgery cohort and 152 cycles (n = 129 patients) in the thin-constitutional cohort. Live birth was lower in the thin-surgery compared with the thin-constitutional cohort (25.8% [31/120] versus 44.7% [68/152], P = 0.001, adjusted OR 0.51, 95% CI 0.29 to 0.91, P = 0.02). Both thin lining cohorts had lower live birth rates compared with reference groups: thin-surgery (25.8% [31/120]) versus normal-surgery 49.2% [177/360], P < 0.001) (OR 0.32, 95% CI 0.20 to 0.54, P < 0.001); thin-constitutional (44.7% [68/152]) versus normal-constitutional 55.3% [252/456], P = 0.04), aOR 0.66, 95% CI 0.44 to 0.97, P = 0.01). Although within the thin-surgery cohort, a lower live birth rate was observed in patients with Asherman's syndrome than those without (19.2% [9/47] versus 30.1% [22/73], aOR 0.51 95% CI 0.23 to 1.13, P = 0.09); this failed to reach statistical significance. CONCLUSION: Patients with thin endometrium who underwent previous uterine surgery had lower live birth rates after euploid SET compared with those with constitutionally thin lining. The cause of thin endometrial lining may serve as a valuable prognostic factor when counselling and managing patients with persistently thin lining.
A feasibility study to examine the link between lifestyle and environmental exposures and endometriotic phenotype.
Knapman B, Ng C, McKinnon B … +5 more , Gonzalez AM, Amoako A, Henders AK, Abbott J, Mortlock S
Reprod Biomed Online · 2026 Jan · PMID 42263340 · Publisher ↗
RESEARCH QUESTION: Are there differences in lifestyle and environmental exposures, and clinical characteristics between patients with histologically confirmed endometriosis residing in regional and metropolitan locations...
RESEARCH QUESTION: Are there differences in lifestyle and environmental exposures, and clinical characteristics between patients with histologically confirmed endometriosis residing in regional and metropolitan locations in Australia, and their impact on phenotype and disease severity? DESIGN: A retrospective study of patients with histologically confirmed endometriosis and detailed phenotypic mapping willing to participate in a Lifestyle and Environmental Risk Factor questionnaire. Demographic, lifestyle, environmental and clinical factors were compared between patients residing in regional and metropolitan locations in Australia, and between patients presenting with different lesion types. RESULTS: Body mass index (BMI; mean ± SD 27.16 ± 5.39 and 25.22 ± 4.93, respectively) and exposure to animal and plant toxins (14.0% and 3.0%, respectively; P = 0.0020) and pesticides (20.0% and 6.0%, respectively; P = 0.0059) were higher in regional participants compared with metropolitan participants. Increasing age (mean ± SD 36.26 ± 8.09, 40.84 ± 7.81 and 33.88 ± 8.39, respectively; P < 0.0001), leiomyomata (16.4%, 19.5 and 6.8%, respectively; P = 0.03) and infertility (63.9%, 63.4% and 40.9%, respectively; P = 0.04) were associated with higher rates of deep infiltrating endometriosis (DIE) and ovarian endometrioma (OMA) compared with superficial disease (SUP). Mental and behavioural problems were reported more often in patients with SUP and DIE than OMA (52.4%, 59.2% and 38.1%, respectively; P = 0.01). CONCLUSIONS: This study suggests significant differences in environmental exposures and lifestyle factors between patients with endometriosis living in regional areas of Australia compared with patients with endometriosis living in metropolitan areas of Australia. These findings emphasize the importance of environmental and lifestyle considerations in understanding the clinical variability of endometriosis.
The gap in fertility care.
Anderson L, Meyers AJ, Domar AD
Reprod Biomed Online · 2026 May · PMID 42263339 · Publisher ↗
Patients undergoing treatment for infertility experience higher levels of psychological distress than the general population. Current research suggests that the increased stress, anxiety and depression levels in these in...
Patients undergoing treatment for infertility experience higher levels of psychological distress than the general population. Current research suggests that the increased stress, anxiety and depression levels in these individuals may be affecting their emotional well-being, treatment drop-out rates and clinical outcomes. To mitigate the effects of mental health symptoms for fertility patients, psychological interventions should be considered a vital part of fertility care. Treatments such as cognitive-behavioural therapy, the Mind-Body Program for Infertility and virtual mental health services have all been integrated into fertility care with success in relieving distress and improving clinical outcomes. Many barriers to accessing mental health treatment exist in the fertility space, such as inadequate communication of available services, a lack of mental health professionals trained in reproductive medicine, cost and stigma. Reproductive care providers should be aware of the risk factors that may increase a patient's need for psychological intervention and choose options that best support both their patient population and clinic staff when selecting what mental health services to provide.
Between demographic targets and personal desire: lived experiences of infertility.
Calhaz-Jorge C, Fincham A, Śmiechowski M
Reprod Biomed Online · 2026 May · PMID 42258999 · Publisher ↗
Infertility is a globally prevalent disease affecting approximately 1 in 6 people at some stage in their lives. Despite its profound personal significance, access to fertility care remains uneven, shaped by legal, financ...
Infertility is a globally prevalent disease affecting approximately 1 in 6 people at some stage in their lives. Despite its profound personal significance, access to fertility care remains uneven, shaped by legal, financial, cultural and infrastructural barriers. While declining fertility rates have prompted some policymakers to frame medically assisted reproduction within demographic strategies, we argue that fertility care must be fundamentally understood as a matter of individual rights, reproductive autonomy and self‑fulfilment. International human rights instruments increasingly recognize equitable access to fertility treatment as a core component of reproductive health, yet country-level disparities in eligibility, public funding and available treatment options persist. These inequalities disproportionately affect marginalized groups, leading many to delay or abandon treatment or to seek cross‑border care. The fertility journey is further burdened by emotional strain, stigma, workplace challenges and financial and psychological uncertainty. Individuals who remain involuntarily childless after treatment may require long‑term psychosocial support, underscoring the need for patient‑centred, rights‑based policies that extend beyond medical intervention. Ensuring fair access to fertility care, improving outcome reporting and integrating psychological and social support are essential to addressing infertility as both a private struggle and a broader public health issue.
Association between physical fitness and semen quality: a cross-sectional study in a Spanish male cohort.
Pérez-Prieto I, Plaza-Florido A, Molina NM … +9 more , Sola-Leyva A, Canha-Gouveia A, Vargas E, Salas-Espejo E, Gámiz-Aguilera M, Molina M, Castilla JA, Ortega FB, Altmäe S
Reprod Biomed Online · 2026 May · PMID 42250331 · Publisher ↗
RESEARCH QUESTION: Do semen quality parameters differ between 'high' and 'low' levels of physical fitness in a cohort of Spanish men? DESIGN: Semen samples donated by 324 Spanish men without known reproductive disorders...
RESEARCH QUESTION: Do semen quality parameters differ between 'high' and 'low' levels of physical fitness in a cohort of Spanish men? DESIGN: Semen samples donated by 324 Spanish men without known reproductive disorders were analysed to determine sperm count, concentration and progressive motility. Overall fitness, cardiorespiratory fitness and muscular strength were self-reported using the International Fitness Scale. Additionally, muscular strength was assessed objectively using a handgrip dynamometer. Analyses of covariance and adjusted linear regression analyses were performed to explore the association between the components of physical fitness and semen quality parameters. RESULTS: Men with higher self-reported cardiorespiratory fitness and muscular strength presented higher sperm counts compared with men with lower values [adjusted raw mean difference 44.315 × 10 (95% CI 7.699-80.931) spermatozoa/ejaculate and 42.766 × 10 (95% CI 6.215-79.316) spermatozoa/ejaculate; adjusted mean Z-score difference 0.232 (95% CI 0.014-0.449) SDs and 0.236 (95% CI 0.019-0.453) SDs; P = 0.037 and 0.033, respectively]. Objectively measured handgrip muscular strength was not associated with any semen quality parameter. CONCLUSIONS: This cross-sectional study suggests that self-reported cardiorespiratory fitness and muscular strength are positively associated with semen quality parameters, while objectively measured handgrip strength shows no association. These results may provide insight into modifiable lifestyle factors potentially related to semen quality, and help guide future randomized controlled trials to clarify causal pathways.
Effects of excess folic acid and high blood folate during preconception and pregnancy: systematic review.
Ledowsky C, Scarf V, Sobczyńska-Malefora A … +3 more , Carter T, Timbrell NE, Steel A
Reprod Biomed Online · 2025 Sep · PMID 42248048 · Publisher ↗
Adequate folate is essential to prevent neural tube defects; therefore, supplementation with folic acid is widely recommended for women during preconception and early pregnancy. However, the potential risks associated wi...
Adequate folate is essential to prevent neural tube defects; therefore, supplementation with folic acid is widely recommended for women during preconception and early pregnancy. However, the potential risks associated with excessive intake of folic acid and/or an elevated blood folate concentration are not well recognized. The aim of this review was to evaluate the potential adverse health outcomes associated with excessive intake of folic acid and/or an elevated blood folate concentration during preconception and pregnancy. The review included studies that measured intake of folic acid via dietary sources and supplements, and/or quantified serum/plasma and red blood cell folate concentrations. Excessive intake of folic acid and an elevated blood folate concentration were associated with several adverse outcomes. The most notable association was with gestational diabetes mellitus, where elevated intake of folic acid and a high blood folate concentration were found to increase the risk. Excessive intake of folic acid supplements and a high blood folate concentration were associated with gestational diabetes mellitus, and adverse neurodevelopmental issues in offspring, as well as large-for-gestational-age infants and higher birth weight. Clear definitions of safe upper limits for intake of folic acid and blood folate concentration are needed urgently to prevent potential adverse outcomes.
Increased prevalence of postpartum haemorrhage in pregnancies resulting from oocyte donation compared with IVF or natural conception: a systematic review and meta-analysis.
Koetsier DD, van Bentem K, van Wanrooij FM … +3 more , Cessie SL, van der Hoorn MP, Lashley LEELO
Reprod Biomed Online · 2025 Dec · PMID 42229054 · Publisher ↗
Oocyte donation enables an increasing number of women to conceive. However, oocyte donation pregnancies have a high risk for pregnancy complications, such as severe postpartum haemorrhage (PPH). This systematic review an...
Oocyte donation enables an increasing number of women to conceive. However, oocyte donation pregnancies have a high risk for pregnancy complications, such as severe postpartum haemorrhage (PPH). This systematic review and meta-analysis were conducted to provide an overview of current existing knowledge on the risk of developing PPH in oocyte donation pregnancies, and its possible pathophysiology. A systematic search was conducted in PubMed and Embase databases to retrieve observational studies that compared oocyte donation pregnancies with autologous oocyte IVF/intracytoplasmic sperm injection (AO-IVF/ICSI) pregnancies and naturally conceived pregnancies, reporting on PPH as one of the outcome measures. The literature search yielded 18 eligible studies for the systematic review; of these, 17 were included in the meta-analysis. The meta-analysis showed an overall significantly higher risk of PPH in oocyte donation pregnancies compared with AO-IVF/ICSI pregnancies (OR 2.32, 95% CI 1.88-2.87) and naturally conceived pregnancies (OR 3.15, 95% CI 2.01-4.94), although heterogeneity was present. All subanalyses using different definitions of PPH, as well as sensitivity analyses for adjusted OR and low risk of bias, showed similar results. This systematic review and meta-analysis confirm and provide more robust evidence compared with previous meta-analyses, with increased risk of PPH in oocyte donation pregnancies compared with naturally conceived pregnancies and AO-IVF/ICSI pregnancies.
Age-related female infertility: aetiological mechanisms and evidence-based and experimental interventions.
Palomba S, Seminara G, Sarica M … +1 more , Aversa A
Reprod Biomed Online · 2026 Apr · PMID 42224774 · Publisher ↗
Age-related infertility has become the primary determinant of reproductive failure in modern societies due to a growing mismatch between biological and social fertility timelines. Accordingly, this review, adopting a uni...
Age-related infertility has become the primary determinant of reproductive failure in modern societies due to a growing mismatch between biological and social fertility timelines. Accordingly, this review, adopting a uniquely holistic perspective, highlights the critical intersection between the demographic shift towards delayed parenthood and the physiological limitations of female reproductive aging, aiming to synthesize both established practices and the most promising regenerative frontiers. Reproductive aging involves a multifactorial decline across ovarian, uterine and tubal microenvironments, characterized by follicular depletion, oocyte aneuploidy, mitochondrial dysfunction, chronic inflammation, and structural macro- and microarchitectural modifications. While oocyte and ovarian tissue cryopreservation remain the most effective established clinical strategies, their success is strictly age-dependent and cannot reverse underlying cellular deterioration. The decline of the reproductive tract mirrors general organismal aging. Consequently, research is shifting towards new pharmacological interventions and regenerative approaches, such as coenzyme Q10, platelet-rich plasma, stem-cell-based therapies and artificial ovary development. These advancements suggest that future fertility preservation will adopt a holistic, anti-aging perspective, aimed at extending reproductive longevity as part of general organismal health. Additional research is needed to establish the long-term safety and clinical efficacy of these emerging experimental technologies before they can be integrated into routine practice.
Fertility awareness and choices among young people.
Balen AH, Dugdale G
Reprod Biomed Online · 2026 May · PMID 42224767 · Publisher ↗
There is a lack of knowledge about fertility and reproductive health among the public and also, importantly, healthcare professionals. Sex and relationship education in schools has traditionally focused on avoiding unwan...
There is a lack of knowledge about fertility and reproductive health among the public and also, importantly, healthcare professionals. Sex and relationship education in schools has traditionally focused on avoiding unwanted pregnancy. Programmes such as the Fertility Education Initiative in the UK have introduced education on all aspects of reproductive health so that young people are empowered with the knowledge to make the right reproductive choices at the right time.
Reproductive risks and fertility preservation in women treated with radioactive iodine therapy for thyroid cancer.
Aktoz F, Gunes AC, Tercan C … +2 more , Demirkol MO, Yakin K
Reprod Biomed Online · 2026 May · PMID 42217417 · Publisher ↗
Radioactive iodine (RAI) therapy is widely used after thyroidectomy in differentiated thyroid cancer. As most of these patients are young women, the potential effects of RAI on reproductive health are of clinical importa...
Radioactive iodine (RAI) therapy is widely used after thyroidectomy in differentiated thyroid cancer. As most of these patients are young women, the potential effects of RAI on reproductive health are of clinical importance. Several studies show menstrual irregularities, transient amenorrhoea and early menopause in women with thyroid cancer. Emerging evidence shows that RAI therapy is associated with a decline in anti-Müllerian hormone levels. As reproductive safety of RAI therapy has not been proven, it is debatable whether proactive fertility preservation should be offered before RAI exposure to safeguard reproductive autonomy. This narrative review summarizes the current evidence on the reproductive risks associated with RAI therapy, and the strengths, weaknesses, opportunities, and threats analysis evaluates the rationale for fertility preservation. The goal is to review benefits versus risks, areas of uncertainty and prospects for future research to support evidence-based counselling and decision-making in women of reproductive age who are candidates for RAI therapy for thyroid cancer.
Effect of focal adenomyosis on pregnancy outcomes: retrospective propensity score matching analysis of 13,186 IVF/ICSI cycles.
Shen X, Zhang Q, Luo M … +2 more , Huang G, Ye H
Reprod Biomed Online · 2026 Jan · PMID 42208174 · Publisher ↗
RESEARCH QUESTION: What is the impact of focal adenomyosis on IVF/iICSI outcomes, and what is the optimal protocol for these patients? DESIGN: This retrospective study screened 66,711 first IVF/ICSI cycles and identified...
RESEARCH QUESTION: What is the impact of focal adenomyosis on IVF/iICSI outcomes, and what is the optimal protocol for these patients? DESIGN: This retrospective study screened 66,711 first IVF/ICSI cycles and identified 598 women with focal adenomyosis and 12,588 matched controls with tubal infertility. After 1:3 propensity score matching, 582 patients with focal adenomyosis and 1718 controls were included. Binary logistic regression and generalized estimating equation analyses were performed to analyse pregnancy outcomes. RESULTS: Focal adenomyosis was not associated with implantation, clinical pregnancy, early miscarriage, late miscarriage or live birth rates, but was associated with higher preterm birth risk in twin pregnancies (adjusted odds ratio [aOR] 2.84, 95% CI 1.14-7.11, P = 0.025). In the focal adenomyosis group, frozen embryo transfer (FET) was associated with lower clinical pregnancy (aOR 0.57, 95% CI 0.36-0.90, P = 0.016) and live birth rates (aOR 0.45, 95% CI 0.27-0.72, P = 0.001), and a higher early miscarriage risk (aOR 3.47, 95% CI 1.23-9.76, P = 0.019) than fresh embryo transfer. Twin pregnancies showed a higher preterm birth risk (aOR 23.54, 95% CI 10.45-53.03, P < 0.001) than singleton pregnancies. Ovarian stimulation protocols and lesion size or number were not associated with pregnancy outcomes. CONCLUSIONS: Focal adenomyosis increaseded the risk of preterm birth, especially in twin pregnancies. Fresh embryo transfer may be preferable to FET, and elective single fresh embryo transfer should be considered to optimize outcomes. Prospective studies are needed to validate this strategy.
The 'Fertility Freefall': a complex phenomenon requiring a multifaceted approach.
Fauser BC, García Velasco J, Macklon N
Reprod Biomed Online · 2026 May · PMID 42202706 · Publisher ↗
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The economics of hope: valuing the long-term fiscal returns from assisted reproduction.
Connolly MP
Reprod Biomed Online · 2026 May · PMID 42202705 · Publisher ↗
In society, parents bear most costs of raising children, while the majority of economic benefits accrue to society and governments. From this perspective, parenting can be viewed as a public service from which society ob...
In society, parents bear most costs of raising children, while the majority of economic benefits accrue to society and governments. From this perspective, parenting can be viewed as a public service from which society obtains financial benefits from the future productive output of children. Understanding where benefits accrue from future output attributed to children born today and in the future is important for establishing how to value live births attributable to assisted reproduction. Low fertility, driven by delayed childbearing, rising opportunity costs and reproductive ageing, currently contributes to population ageing, higher dependency ratios and fiscal pressure on pensions, healthcare and social transfers. Consequently, ageing populations currently being experienced in many developed economies have increased relevance to the children born every year and their lifetime contributions to the economy. Assisted reproduction and related fertility services partially offset these dynamics by converting unmet fertility intentions into additional births. From a fiscal perspective, live births achieved through assisted reproduction can yield substantial net lifetime returns to the public sector, supporting the view that fertility treatment is an investment in human capital and intergenerational equity rather than a purely consumptive healthcare expense. Reproductive medicine policy should therefore integrate demographic and fiscal impacts when setting coverage and subsidy levels for infertility care.
Assisted reproduction and family diversity.
Jadva V
Reprod Biomed Online · 2026 May · PMID 42202704 · Publisher ↗
The current debates about a 'fertility crisis' focus on increasing rates of delayed parenthood and decisions not to have a child. Delayed childbearing may lead to a rise in the number of people using assisted reproductiv...
The current debates about a 'fertility crisis' focus on increasing rates of delayed parenthood and decisions not to have a child. Delayed childbearing may lead to a rise in the number of people using assisted reproductive technology, including using donor gametes. Empirical research consistently shows that families formed through donor conception function similarly to families formed through unassisted conception. However, some families experience stigma and a lack of understanding from others. Studies highlight both the strengths and weaknesses of being an older parent, and older parents who use assisted reproduction may differ from those who conceive without medical assistance. Inconsistent definitions of what constitutes 'older' parental age further complicate the synthesis and comparison of existing research. Debates about a fertility crisis must also be situated within a broader landscape of expanding reproductive possibilities, including parenthood among solo parents and LGBTQ+ parents. While reproductive options are expanding for some, access remains uneven and is constrained for many by financial, cultural and legal barriers.
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