Changes in societal norms over the last few decades have resulted in novel family planning trends, notably delayed childbearing and increased maternal age at the birth of the first child. Despite advances in reproductive medicine, ageing poses significant challenges. Natural conception in women ≥ 45 years of age is rare, with high rates of pregnancy loss, and assisted reproduction using autologous oocytes yields limited success. Oocyte donation offers higher live birth rates, exceeding 50%. Elective oocyte cryopreservation could aid in family planning; nevertheless, its success depends on the age at which cryopreservation is performed. These facts highlight the correlation between advancing age and a decline in oocyte quality and quantity. An age-related decline in endometrial receptivity could pose an additional barrier, although the evidence remains controversial. Furthermore, pregnancies in older women carry high risks for both the mother and child, which should be considered before assisted conception attempts. This comprehensive narrative review examines the advancements in assisted reproductive technology that have expanded the possibilities for delayed childbearing, while underlining at the same time the major challenges in the field. Innovations such as ovarian tissue cryopreservation and stem cell-based therapies have the potential to reshape reproductive options for these women. However, thorough counselling and tailored management remain of paramount importance.

Previous studies have linked workplace conditions, including chemical and physical exposures, and reproductive health outcomes in women. Our study included 603 oocyte donors who underwent 967 controlled ovarian hyperstimulation (COH) cycles for planned oocyte vitrification between 2008 and 2020. Cohorts of oocytes were then thawed and fertilized with resultant embryos utilized by intended parents. In our cohort of young, healthy oocyte donors, those employed in “healthcare practitioners and technical” occupations and in “office and administrative support” roles had lower ovarian reserve testing by antral follicle count and fewer mature oocytes retrieved COH when compared to the reference group. In vitro fertilization and embryo transfer outcomes, including live birth, for oocyte recipients were not statistically different between occupation groups when compared to the reference group. Future research is needed to clarify specific occupational exposures that may be driving these observed differences.

Male obesity impairs early embryonic development and increases miscarriage risk in oocyte donation cycles.

Artificial Reproductive Technologies (ART) like IVF and surrogacy have really changed the way people in India face infertility. Although in 2025, India handles over 200,000 IVF cycles each year. The paper examines into those challenges through the lens of ethics, real court cases, and the latest laws. In keeping with this, The Assisted Reproductive Technology (Regulation) Act, 2021, and the Surrogacy (Regulation) Act, 2021, established laws for hospitals, make registration mandatory, and ban commercial surrogacy. Still, ethical problems haven’t gone away. There’s constant debate should embryos be used in research or just discarded. Is consent truly informed in egg donation or surrogacy, or are poor women getting the worst of it? Unofficial sex selection persists, even though the 1994 PCPNDT Act bans it, and this pushes a troubling “better babies” mindset. Indian surrogacy laws draw a hard-line single people, LGBTQ+ peoples, and foreigners get shut out. That’s sparked lawsuits from people fighting for the right to build families on their own terms. Cases like Baby Manji Yamada (2008) and Jan Balaz (2010) dragged issues like citizenship and parental rights into the spotlight, while recent 2025 court rulings on age limits show the legal landscape isn’t standing still. This article deals with where the laws fall short and pushes for reforms fairer access, tighter oversight, and strong ethics that actually line up with the rights promised in Articles 14, 15, and 21 of India’s Constitution. If India wants a just future for families, it needs to strike the right balance between cutting-edge tech and real fairness. Keywords: Informed Consent, Embryo Ownership, Surrogacy Laws, Genetic Privacy, Parental Rights, Bioethics.

Assisted reproductive technology in Africa: the African Network and Registry for ART, 2021 and 2022.

Women with longer exposure to paternal antigens, such as a long duration of sexual cohabitation, are known to have a higher chance of successful placentation. However, it is still unknown how repeated exposure to the same sperm donor affects the outcome. We have studied the rates of pregnancy, live birth, and miscarriage among 1077 women undergoing IUI or IVF/ICSI, using either the same donor during two consecutive treatment cycles or two separate donors. Oocyte donation and frozen embryo transfer cycles were excluded. No difference was found either in pregnancy rate or live birth rate when comparing repeated treatments with the same donor (n = 815) to treatments with two separate donors (n = 262) (success rate (SR) 0.96, 95 % CI 0.75-1.23, p = 0.75; SR 1.18, 95 % CI 0.84-1.65, p = 0.33, respectively). A significant difference in miscarriage rate was observed (relative risk (RR) 0.58, 95 % CI 0.35-0.96, p = 0.03). However, after adjusting for treatment method, maternal age, BMI, and individual clinic, no significant differences were observed in any of the outcomes: pregnancy rate (adjusted SR 1.05, 95 % CI 0.79-1.39, p = 0.76), live birth rate (adjusted SR 1.20, 95 % CI 0.83-1.73, p = 0.33), or miscarriage rate (adjusted RR 0.61, 95 % CI 0.33-1.12, p = 0.11). Consequently, this study could not demonstrate any advantageous effects of repeatedly using the same sperm donor on pregnancy rate or live birth rate. However, given the limited sample size, an effect on the miscarriage rate cannot be ruled out.

Artificial cycle frozen embryo transfer improves uterine perfusion during later pregnancy but is associated with higher preeclampsia incidence.

Assisted Reproductive Technology in Women with Endometriosis and a History of Catamenial Pneumothorax: Reproductive Outcomes and Safety Considerations.

Impact of pelvic endometriosis on the chances of pregnancy in the context of oocyte donation.

Delayed childbearing has increased the reliance on in vitro fertilization (IVF) with donor oocytes for women of advanced maternal age often facing more obstetric complications compared to younger women using self-oocytes. This study evaluated and contrasted key obstetric and perinatal parameters between these two groups. In this retrospective multicenter study, completed IVF embryo transfer cycles were analyzed. Clinical data including clinical pregnancy, miscarriage, ectopic pregnancy rates, and major pregnancy complications were collected. Obstetric outcomes (e.g., mode of delivery, preterm birth, and neonatal parameters such as birth weight, Apgar scores, and NICU admissions) were compared between the donor-oocyte recipients (DOR-IVF) and self-oocyte (SO-IVF) groups. Statistical analysis comprised chi-square tests, t-tests, and multivariable logistic and linear regressions to adjust for potential confounders. The DOR-IVF group demonstrated a clinical pregnancy rate of 44.8% (196 cases) with an 8.8% miscarriage rate, while the SO-IVF group reported 242 clinical pregnancies with an 8.1% miscarriage rate. Overall, nine ectopic pregnancies (2%) were noted, with statistically significant differences in ectopic and miscarriage rates between the groups (p=0.008 and p=0.025, respectively). Although the mean gestational age was similar and NICU admissions did not differ significantly (p=0.125), the DOR-IVF group exhibited a higher incidence of pregnancy complications (p=0.009). Multivariable logistic regression identified DOR-IVF as an independent predictor for pregnancy complications (adjusted odds ratio 2.38; 95% confidence interval=1.53-3.70). Additionally, subgroup analyses revealed that 1-minute Apgar scores were positively associated with DOR-IVF status (p=0.048) and birth weight was inversely related to the number of babies transferred (p=0.006). DOR-IVF patients experience significantly increased risk in obstetric complications compared to younger women using SO-IVF, although neonatal outcomes remain largely similar.

Preface: 13th International Workshop Reunion Island Reproductive Immunology, immunological tolerance and immunology of preeclampsia; 9-12 December 2024.

In vitro fertilisation via oocyte donation is a unique reproductive technique in which the embryo is fully separate from the receiver. This compels the immune system to exert more effort at the interface between the uterus and the remainder of the body. This setting has maintained interest in peri-transfer glucocorticoid treatment as a possible approach to modify endometrial immunity and enhance implantation. Nevertheless, the data for this procedure are disjointed and mostly derive from investigations on autologous in vitro fertilisation. This narrative review consolidates contemporary evidence on endometrial immunology in oocyte donation cycles, analysing the mechanistic basis, clinical results, and constraints related to peri-implantation glucocorticoid therapy. Outcomes from randomised studies in autologous cycles consistently demonstrate that there is no advantage in live birth rates, but the claimed improvements in clinical pregnancy rates are from heterogeneous and low-quality data. Limited research exists on people who have received oocyte donations. The majority are diminutive and non-random, often integrating glucocorticoids with other therapies such as antibiotics, granulocyte colony-stimulating factor, or endometrial damage. These designs inhibit the dissociation of the independent impact of glucocorticoids. Recent comprehensive randomised studies on recurrent implantation failure further demonstrate the lack of advantages in live births and highlight possible safety issues. The current data do not support the usual use of peri-transfer glucocorticoids in oocyte donation for in vitro fertilisation; nevertheless, short-term, low-dose treatment may be justified in meticulously chosen immunological profiles. There is an urgent need for rigorously designed randomised studies focused only on oocyte-donation recipients to elucidate the therapeutic effectiveness, safety, and suitable clinical context for glucocorticoid treatment in this expanding patient demographic.

Over a number of years, there has been growing interest in the introduction of more invasive ARTs, such as nuclear transfer, otherwise referred to as mitochondrial donation, and mitochondrial supplementation/transfer into clinical medicine. They have been proposed to overcome repeated failed fertilization or developmental arrest or to prevent carriers of mitochondrial DNA disease from having affected children. These technologies require considerable manipulation of the oocyte, which can affect its epigenetic programming that was established as it grew and developed into a fertilizable oocyte. Consequently, when a nucleus is transferred into an enucleated oocyte or pronuclei are transferred into an enucleated zygote, the nucleus must adapt to its new cytoplasmic environment in readiness for the waves of DNA demethylation and methylation that take place during preimplantation development. As a result, some key developmental gene networks are affected. Additionally, these approaches also affect patterns of mitochondrial DNA inheritance, with some embryos and offspring possessing mitochondrial DNA carried over into the oocyte with the nucleus, as well as the mitochondrial DNA from the donor oocyte. Similar outcomes result from the addition of extra mitochondrial DNA into oocytes through mitochondrial supplementation. We provide a background as to how these technologies evolved and discuss recent outcomes associated with clinical work so far undertaken within these approaches and their consequences for the offspring. We conclude that these technologies are not simply replacing or replenishing defective ooplasms with new or extra mitochondria but rather induce a series of genomic and epigenomic events that we do not yet fully understand. To our minds, these issues should be first addressed before clinical trials are continued.

Background: In medicated frozen embryo transfer (FET) cycles, exogenous progesterone is essential during the luteal phase to support implantation and early pregnancy due to the absence of the corpus luteum. Among the variable forms of exogenous progesterone, intramuscular (IM) progesterone in oil (P-in-oil) is generally considered the most effective. However, some patients experience hypersensitivity reactions, raising concerns about their potential impact on implantation success and early pregnancy development. Progesterone plays a central role in the dynamic immune balance necessary to establish and maintain a successful pregnancy. Progesterone hypersensitivity reaction could disrupt this delicate balance, potentially leading to adverse reproductive outcomes and affecting future fertility care. Although hypersensitivity reactions to P-in-oil are rare, they warrant attention due to their potential implications for clinical management and patient outcomes. Notably, data on reproductive outcomes in patients experiencing hypersensitivity to exogenous progesterone, particularly P-in-oil, remains limited. Objectives: This study aims to evaluate the prevalence of progesterone hypersensitivity in women undergoing medicated FET cycles utilizing P-in-oil and to investigate the clinical implications of such reactions on reproductive outcomes. Methods: A retrospective cohort study was conducted including 814 medicated FET cycles at a private assisted reproductive technology program between April 2022 to August 2023. All patients received exogenous IM P-in-oil for luteal phase support. We excluded cycles involving donor oocytes or embryos, as well as those using gestational carriers, to ensure a homogeneous study population. Cycles that involved alternative or combined progesterone regimens were also excluded to isolate the effects of IM P-in-oil. Statistical analysis included Chi-squared tests for categorical variables and T-tests for continuous variables. Relative risks (RR) and 95% confidence intervals (CI) were calculated using multivariate logistic regression to adjust for potential confounders. A p-value of < 0.05 was considered statistically significant throughout the analysis. This study was approved by the Institutional Review Board of Indiana University. Results: A total of 673 patients who underwent medicated FET cycles were analyzed within the cohort. Approximately 10.3% (n=69) of patients using P-in-oil supplementation reported experiencing a reaction during one of their treatment cycles, resulting in an overall reaction rate per cycle of 8.5%. Symptoms of progesterone hypersensitivity (PH) varied widely and included dermatitis, urticaria, edema, fever, nausea, and dyspnea. Dermatologic manifestations were the most frequently reported symptoms, occurring in 95.5% of patients who experienced adverse reactions. In contrast, systemic adverse reactions were uncommon, reported in less than 5% of cases. The live birth rate was significantly higher in patients who experienced a reaction (68.1%, n=47) compared to those without a reaction (47.7%, n=355) (p = 0.001; RR 2.19, CI 1.35-3.56). No significant difference was found in the miscarriage rate between patients with and without reported reactions (8.7%, n=6 vs. 8.7%, n=65, respectively) (p = 0.99; RR 1.00, CI 0.45 – 2.22). Conclusions: Hypersensitivity to P-in-oil presents a unique and underrecognized challenge in management of patients undergoing medicated FET cycles. This is the largest cohort analyzing progesterone hypersensitivity in patients using P-in-oil. Our data suggests that this rare occurrence has a minimal negative impact on reproductive outcomes. Notably, patients who experienced hypersensitivity reactions during P-in-oil use were more than twice as likely to achieve a live birth compared to those without reactions. Patients who experience hypersensitivity reactions while using P-in-oil can be reassured that their medication regimen is unlikely to negatively impact their success rates. However, given the complex immune-hormonal interactions involved in early pregnancy, larger prospective studies are warranted to validate these findings and better understand their clinical implications.

Introduction Ovarian hyperstimulation syndrome (OHSS) is a serious complication of ovarian stimulation in assisted reproductive technologies, characterized by an exaggerated ovarian response leading to increased vascular permeability, fluid accumulation, and potential severe outcomes such as ascites, thrombosis, and peritonitis. Diagnosing OHSS-related ascites can be challenging, particularly in the medicine wards when patients conceal reproductive interventions. Case Summary A 24-year-old female presented with progressive abdominal distention and shortness of breath. Initial examination revealed abdominal distention, bilateral pleural effusions, and a transudative ascitic fluid with normal cytology. Ultrasonography (USG) indicated moderate ascites and bilateral enlarged ovaries. Despite denying prior interventions, the patient was later admitted to egg donation. Treatment with intravenous (IV) fluids, antibiotics, and albumin initially improved her condition. However, she developed peritonitis, indicated by gross pus in a repeat ascitic tap and a positive Escherichia coli culture. Following intensive treatment and peritoneal drainage, the patient improved and was discharged. Discussion Ascites in OHSS, particularly with covert ovum extraction, can be misleading, complicating diagnosis and management. Progression to peritonitis, characterized by severe abdominal pain and systemic inflammation, can be insidious and challenging to detect without thorough examination. Effective management involves addressing fluid balance, preventing complications such as thrombosis and infection, and ensuring prompt intervention to avoid severe outcomes. Conclusion OHSS-related ascites presents a diagnostic challenge, especially when linked to covert reproductive procedures. Peritonitis can complicate OHSS and necessitate vigilant monitoring and management. A detailed patient history and thorough clinical evaluation are crucial for accurate diagnosis and effective treatment, emphasizing the need for awareness among healthcare providers.

Purpose : to determine whether transvaginal ultrasound-guided ovum pick-up (OPU) procedures influence the concentrations of stress-associated hormones in the serum of Holstein heifer oocyte donors, and to assess whether the intensity and duration of donor use affect these hormonal indicators. Materials and Methods . The study was conducted at the L. K. Ernst Federal Research Center for Animal Husbandry (FGBNU FIC VIZh) on Holstein heifers (n = 10) with synchronized estrous cycles. Four days after the onset of estrus, transvaginal ultrasound-guided follicular aspiration was performed. Five animals (regimen 1w) underwent OPU once per week at 7-day intervals, while another five animals (regimen 2w) were subjected to OPU twice per week at 3—4-day intervals. The total number of procedures was 10 for regimen 1w and 20 for regimen 2w, each divided into two equal-duration periods. Blood samples were collected the day after estrus onset and on each OPU day. Serum concentrations of cortisol, adrenaline, and noradrenaline were determined using enzyme- linked immunosorbent assay (ELISA). Results . Following the first OPU session, serum concentrations of stress-related hormones in donors increased significantly. Cortisol levels rose from 15,8 [4,8; 36,2] ng/mL before OPU to 26,8 [15,5; 49,0] ng/mL after the first aspiration (p = 0,0195); adrenaline increased from 60,3 [44,8; 108,1] to 105,0 [69,2; 132,6] pg/mL (p = 0,0488); noradrenaline from 51,0 [43,7; 53,9] to 70,7 [54,8; 82,5] pg/mL (p = 0,0137), respectively. No significant differences in hormone concentrations were observed between regimens 1w and 2w when compared within identical periods (p>0,05). Cortisol levels remained comparable across the studied time points (p>0,05). In both regimens, adrenaline and noradrenaline concentrations were higher during OPU sessions than outside OPU periods. In the twice-weekly regimen (2w), the concentrations of the analyzed hormones in the second period (OPU11—20) were significantly higher than in the first (OPU1—10) (p<0,05), whereas no such differences were detected under the once-weekly regimen (1w) (p>0,05). These findings are preliminary, as comprehensive evaluation of the technology’s efficiency requires consideration of reproductive outcomes in light of the obtained data.

IntroductionPreeclampsia (PE) is a hypertensive disorder in pregnancy, influencing global health risks due to its poorly understood aetiology involving immune mismatches. Oocyte Donation increases PE risk due to complete HLA incompatibility, leading to immune activation. MicroRNAs (miRNAs) emerged as crucial regulators in placental development, immune regulation, and endothelial function, acting as post-transcriptional gene regulators. This study aims to explore whether specific miRNAs, previously implicated in PE, can be used to distinguish preeclamptic and non-preeclamptic mothers undergoing oocyte donation pregnancy.MethodsThis prospective study enrolled 20 mothers, divided into four groups: oocyte donation normotensive, oocyte donation preeclamptic, spontaneous normotensive, and spontaneous preeclamptic mothers. Maternal and cord blood samples were collected postpartum, along with placental biopsies. Tissue samples underwent histological examination. Total miRNAs were extracted from plasma, cord blood, and placenta and quantified via digital droplet PCR. The secretome analysis of cytokine/chemokines was performed on the mother’s plasma and cord blood by Luminex ELISA.ResultsIn oocyte normotensive the epigenetic (miR-155, miR-17, miR-30) and immune profile (CXCL10, VEGF), displayed only limited variations compared to spontaneous normotensive. Conversely, preeclamptic oocyte recipients exhibited marked molecular dysregulation, characterized by significant upregulation of pro-inflammatory miRNAs (miR-155, miR-17, miR-223) and cytokines (IL-6, IL-1β, TNF-α, IFN-γ) in maternal plasma and placental tissue, indicating heightened immune activation. Notably, miR-30 and let-7c were downregulated. Intriguingly, miRNA expression in umbilical cord plasma was often inversely correlated with maternal and placental profiles, suggesting complex miRNA trafficking and fetal protection mechanisms. Placental histology showed minimal pathological changes in preeclamptic oocyte recipients, contrasting with more severe lesions in preeclamptic spontaneously conceived pregnancies, reflecting differing underlying pathogenic processes.ConclusionThis study highlights significant alterations in miRNA expression and cytokine profiles associated with PE, particularly in oocyte donation pregnancies. The findings suggested a complex interplay between maternal immune regulation and placental function, with distinct maternal and fetal immune responses. Understanding these molecular and immunological changes may facilitate the development of novel diagnostic biomarkers and targeted therapies to improve maternal and fetal outcomes in PE.

The type of endometrial preparation for embryo transfer after egg donation affects obstetric outcomes and the expression of placental angiogenic biomarkers.

Pregnancy requires local immune tolerization. Oocyte donation (OD) pregnancies, with extensive fetal-maternal human leukocyte antigen (HLA) mismatching, are at higher risk of pre-eclampsia. We hypothesize that immune adaptations are needed at the fetal-maternal interface to maintain healthy pregnancy despite high HLA dissimilarity. By multispectral imaging, myeloid cells constituted 65% of the decidual immune cells and encompassed 12 distinct clusters. Fully-allogeneic healthy OD pregnancies displayed a higher frequency of CD163+HLA-DR+ myeloid cells and FoxP3+CD4+ Tregs near CD4+ T cells compared to semi-allogeneic healthy pregnancies and pre-eclampsia, together with a Treg-reinforcing gene signature. Contrastingly, pre-eclampsia was characterized by enhanced inflammatory chemokine expression and oxidative-stress-gene imbalance. Pregnancy outcomes were unaffected by decidual pathology, maternal HLA antibodies, or fetal HLA-C/maternal KIR haplotypes. This study highlights the frequency, phenotypic diversity, and T cell proximity of decidual myeloid cells in OD pregnancies and suggests their immune regulatory effects to compensate for higher fetal-maternal HLA mismatch loads.

Donor identity in Aotearoa New Zealand: a survey of parents regarding disclosure of donor conception to their donor-conceived children.