ObjectiveTo characterize interspecialty variation and areas of consensus in the understanding and clinical management of functional hypothalamic amenorrhea among physicians from different clinical specialties in China.MethodsWe conducted a nationwide, cross-sectional questionnaire survey of licensed physicians practicing in reproductive endocrinology, obstetrics and gynecology, and related specialties involved in functional hypothalamic amenorrhea care. The survey was administered anonymously via a national continuing medical education platform affiliated with the Peking Union Medical College Hospital Alliance between 1 November and 30 November 2025.ResultsA total of 2026 questionnaires were included in the final analysis, comprising 112 reproductive endocrinologists (5.5%), 1516 obstetricians-gynecologists (74.8%), and 398 physicians from other specialties (19.6%). Overall, only 62.7% of respondents recognized genetic susceptibility as a contributing factor to functional hypothalamic amenorrhea, and only 43.9% of respondents perceived that functional hypothalamic amenorrhea was generally diagnosed appropriately. Compared with physicians from other specialties, reproductive endocrinologists and obstetricians-gynecologists were significantly more likely to prioritize sex hormone evaluation, pelvic ultrasonography, and assessment of the thyroid and adrenal axes (all p < 0.01), whereas physicians from other specialties more frequently reported emphasizing assessments of energy metabolism (p < 0.01). Among women without fertility intentions, reproductive endocrinologists were more likely to report prioritizing elimination of precipitating factors (p < 0.05) and recommending hormone replacement and bone-targeted therapies (both p < 0.01). For women desiring pregnancy, reproductive endocrinologists were more likely to report recommending ovulation induction (p < 0.01), whereas physicians from other specialties reported greater support for the use of pulsatile gonadotropin-releasing hormone pumps (p < 0.01).ConclusionsVariations were observed in physicians' self-reported diagnostic and management approaches to functional hypothalamic amenorrhea across clinical specialties in China. These findings suggest the importance of promoting multidisciplinary consensus, developing standardized clinical pathways, and strengthening interdisciplinary collaboration to improve the quality of care for women with functional hypothalamic amenorrhea.

The International Glossary on Infertility and Fertility Care, 2025†.

Infertility is a major public health concern, and many individuals face substantial barriers to accessing fertility care. Across jurisdictions, regulations, eligibility criteria and funding frameworks for fertility care vary considerably, particularly in relation to lesbian, gay, bisexual, transgender, intersex and queer/questioning people (LGBTIQ+), as well as unpartnered individuals. Moreover, existing definitions and prevalence estimates of infertility are largely derived from studies of heterosexual couples which may underestimate the need for fertility care among other populations. This protocol describes a systematic review designed to synthesise current evidence on the need for and access to fertility care among LGBTIQ+ populations and unpartnered individuals as well as the policies and regulations that govern such care. This protocol follows the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guidelines. Systematic searches were conducted in MEDLINE (Ovid), Embase, Web of Science, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL) and Global Health, as well as grey literature sources including ProQuest Dissertations & Theses, ECRI Guidelines Trust, Canadian Medical Association Journal (CMAJ) Guidelines, National Institute for Health and Care Excellence, fertility societies guidelines and Google Scholar. Eligible studies will include quantitative, qualitative, mixed-methods, narrative synthesis and typology mapping designs. Two reviewers will independently perform title/abstract and full-text screening, data extraction and quality assessment. The Critical Appraisal Skills Programme checklist will be used for qualitative studies and the Joanna Briggs Institute tools for quantitative studies. Completeness and credibility assessments will be applied to narrative syntheses and typology mappings. The primary outcomes will include measures of fertility care need, indicators of access and policy frameworks influencing service availability. This study does not involve human participants. The protocol received an exemption from Research Ethics Board review by the McGill University Health Centre Research Ethics Board. Findings will be disseminated through peer-reviewed publications, conference presentations and professional networks and shared with the WHO to inform evidence-based policy. CRD420251126056.

Preconception dietary patterns in association with live birth and pregnancy loss: a couples-based approach.

ABSTRACT Key Content Work‐up of azoospermic men includes a detailed history, physical examination and investigations to find the underlying cause. Causes and management of azoospermia (pre‐testicular, testicular and post‐testicular) with case presentations. Importance of multidisciplinary team input including fertility specialists, healthcare scientists, urologists, endocrinologists and geneticists. Impact of genomics and novel biomarkers in diagnosis and prognosis of retrieving sperm surgically. Learning Objectives To understand how to take a detailed history, perform a physical examination and interpret the results of investigations of the azoospermic male. To recognise the link between azoospermia and certain medical conditions and poor general health. To know the surgical sperm retrieval techniques, the alternative options and understand patient selection. To familiarise with the process of spermatogenesis induction in hypogonadotropic hypogonadism. Ethical Considerations Azoospermia is a distressing diagnosis. Insufficient understanding of the condition and its implications can be a missed opportunity to improve these patients' health and wellbeing. Increased risk of birth defects or transmission of genetic abnormalities with intracytoplasmic sperm injection (ICSI) using surgically retrieved sperm is still under debate.

The global burden of infertility and its associated psychological distress is substantial, yet many individuals face barriers to accessing psychological support. A scalable, low-cost online intervention presents a promising solution. A randomized controlled trial (RCT) was conducted (experimental vs. waitlist control group) to evaluate the efficacy of a fully automated cognitive behavioral therapy (CBT) program in reducing infertility-related stress among women attempting to conceive. Data were analyzed using linear mixed models on an intention-to-treat basis. The study enrolled 63 Icelandic women experiencing infertility-related stress. The intervention, Overcome Fertility Stress, is an online program designed to identify and modify maladaptive behaviors and thought patterns contributing to infertility-related distress. It delivers personalized treatment through prewritten text, audio, and video responses based on user input. Infertility-related stress was measured using the 46-item Fertility Problem Inventory (FPI), which assesses a global stress score and five domains of infertility-related stress. Participants in the experimental group demonstrated a significant reduction in infertility-related stress (mean reduction score = 22.85, p < 0.05), whereas the control group showed no significant changes (p > 0.05). The within-group effect was large, but controlled between-group effects and confidence intervals should be prioritized when interpreting treatment benefit. These findings provide preliminary controlled evidence that a fully automated CBT program may reduce infertility-related stress, although the underpowered sample and low adherence require cautious interpretation. This RCT, alongside prior feasibility studies, suggests that Overcome Fertility Stress may be a promising low-intensity intervention for infertility-related stress. No significant effects were observed on secondary outcomes measuring depression, anxiety, stress, or worry, suggesting the program is specific to infertility-related stress rather than a broader intervention for emotional disorder symptoms. Larger, adequately powered trials with stronger engagement strategies are needed. Future research should focus on expanding access and integrating digital psychological support into standard fertility care.

This narrative review examines the emerging role of glucagon-like peptide-1 (GLP-1) receptor agonists in reproductive medicine, combining a narrative review of current literature with novel investigational pilot survey data from women seeking fertility care. The survey explores perceptions regarding weight, and weight loss methods including use or awareness of GLP-1. The integration of these perspectives reveals the potential for significant gaps between patient awareness and provider communication regarding these medications, while highlighting their potential therapeutic benefits for obesity-related infertility. A narrative literature review of GLP - 1 receptor agonists in reproductive medicine. An IRB approved anonymous investigational pilot survey to evaluate weight loss perceptions and methods used by those seeking care in a single academic infertility clinic. Narrative literature review with clinic recommendations was completed. Our findings demonstrate that while 86% of patients were aware of GLP-1 medications, only 19.3% had substantive discussions with healthcare providers despite 84.2% attempting weight loss in the past year. This disconnect occurs within a context where emerging evidence suggests GLP-1 receptor agonists may offer unique advantages for fertility optimization through weight loss, metabolic improvement, and potential direct reproductive effects.

Follicular fluid is a complex biological microenvironment essential for oocyte maturation and folliculogenesis. Alterations in follicular fluid composition have been associated with reproductive disorders reflecting compromised oocyte quality. Emerging evidence suggests that malignancies also significantly alter the composition of follicular fluid, potentially compromising the follicular microenvironment and impacting fertility preservation outcomes. Interestingly, the follicular fluid itself exhibits tumor-initiating and tumor-promoting properties, inducing DNA damage, pro-inflammatory signaling, mild proliferation, and suppressing apoptosis. Understanding cancer-associated follicular fluid alterations may improve fertility care, identify early biomarkers, and inform strategies for ovarian cancer prevention and therapy. This review aims to summarize current knowledge on how cancer can alter follicular fluid composition and its role in ovarian malignancies.

Decision-Making Criteria in Polygenic Embryo Screening: A Survey of Reproductive Medicine Physicians.

Fertility care and family building for LGBTQ+ individuals: a committee opinion.

Women with advanced chronic kidney disease (CKD) encounter reproductive health challenges, including reduced fertility, menstrual irregularity, and sexual dysfunction. This study examined changes in sex hormones in patients with CKD, their correlation with sexual function, and changes after transplant. This study recruited women aged 18-51 years with CKD stages 3b-5 from outpatient clinics and dialysis units. Exclusion criteria included active pregnancy, menopause, prior hysterectomy/bilateral oophorectomy, or use of hormonal contraceptives/therapy. Data were collected at enrollment and at 6 months post-transplant. Thirty-eight subjects met eligibility criteria and enrolled in the trial (8 in CKD stage 3b, 10 in CKD stage 4, and 20 in CKD stage 5/5D). Sexual dysfunction (25/38, 65.8%), defined as total female sexual function index score < 26.55, and menstrual irregularities (17/38, 44.7%) were common, with abnormal elevation of luteinizing hormone present in the follicular phase in the majority of patients. There was a significant negative association between total female sexual function index score and prolactin (β = -0.26, P = 0.03) and dehydroepiandrosterone sulfate (β = -0.07, P = 0.01) after adjusting for age. After transplant, there was also a significant improvement in both prolactin and dehydroepiandrosterone sulfate levels, although sexual dysfunction persisted. This study highlights the complex interplay between advanced CKD, reproductive endocrinology, and sexual health. Significant hormonal dysregulation and associated reproductive challenges were observed. The prominent role of dehydroepiandrosterone sulfate in sexual dysfunction among women with CKD requires further study.

This paper uses a small-stories positioning framework to analyse metaphors of the body and related claims of identity in Muslim women's infertility blogs. I first conduct a directed qualitative content analysis to identify metaphorically used words and group them into a small set of metaphor families; I then apply Metaphor-Led Positioning Analysis to interpret how those metaphors position narrators, audiences, and institutions across small stories. I examine how narrators construct gendered selves in context - alternately contesting or adopting positions of victimhood - vis-à-vis hegemonic medical, social, and religious Discourses and key interlocutors (partners, families, clinicians, peers). Focusing on figurative language (e.g., the body as defective machine, battleground, empty container, rebellious agent, or season/journey), The article shows how metaphors mediate alignment with audiences, index affect, and enable stance shifts that both reproduce and resist pronatalist and medicalising ideologies. It argues that these cultural-rhetorical manifestations expose the workings of hegemony around femininity and the body in relation to reproductive 'failure', while also furnishing resources for re-authoring womanhood beyond gestation. Implications include faith-literate, lineage-sensitive communication in fertility care, and narrative-focused support for coping.

Expanded carrier screening (ECS) is a commonly used preconception screening test, especially in fertility practices given available interventions to mitigate risks of genetic disease among offspring. However, little is known about the implementation of ECS by Reproductive Endocrinology and Infertility (REI) physicians. This study assessed ECS practices among REI physicians in the United States (U.S.) and physician or clinic factors associated with requiring patients' ECS to result prior to initiating any fertility treatment (in vitro fertilization or intrauterine insemination). A 23-question survey assessing ECS practices of U.S. REI physicians was sent to 802 Society for Reproductive Endocrinology and Infertility members. Analyses included descriptive statistics, chi-square and Fisher's exact tests, and multivariable logistic regression analysis to identify factors associated with requiring ECS results prior to fertility treatment. Among 143 respondents (response rate: 17.8%), 62.2% required patient ECS results prior to initiating fertility treatment. Genetic counselors were employed at 27.3% of practices. Pretest counseling was most commonly performed by physicians (80.4%). In a multivariable logistic regression containing fellowship region and practice setting, physicians trained in the West were less likely to require ECS compared to those trained in the Northeast (aOR: 0.29; 95% CI: 0.09,0.89; p = 0.03). Physicians in hybrid practices had higher odds of requiring ECS compared to those in academic practice (aOR: 6.97; 95% CI: 2.02, 24.11; p < 0.001). ECS practices vary among REI physicians, potentially influenced by practice setting and fellowship training region. These differences may contribute to inequitable patient access and highlight the need for standardized guidelines specific to reproductive medicine.

Beyond comfort: Basic environmental enrichment accelerates sexual development in mouse pups.

Media representations have long influenced public understandings of infertility and assisted reproductive technologies (ART), with traditional media frequently relying on moralized or sensational narratives that reinforce stigma and oversimplification. The rise of social media and artificial intelligence (AI) has reshaped reproductive health communication, allowing patients to share lived experiences, build community, and access information outside clinical settings, while also increasing exposure to misinformation. This review synthesizes peer-reviewed research, clinical commentary, and digital media analyses to examine infertility narratives, online patient engagement, and AI-driven information dissemination. Findings indicate that social media has expanded patient agency and reduced isolation, but AI-generated content and influencer marketing contribute to the rapid spread of inaccurate or misleading fertility information. Despite these risks, digital platforms offer significant opportunities for evidence-based education and empathetic engagement. Clinicians who thoughtfully engage with social media and AI can counter misinformation, direct patients to trustworthy resources, and strengthen patient-physician relationships. When used responsibly, these tools can enhance communication and promote more informed, compassionate infertility care.

Oncofertility is the practice of joining oncology clinicians with reproductive endocrinologists to assess patients' tumor biology, tumor stage, and mutation analysis to discuss the infertility risks from tumor-directed treatments and provide fertility preservation opportunities to patients who will undergo or have received tumor-directed therapy since cancer treatments can affect fertility. Tumor-directed therapies, such as radiation and antineoplastic agents, have greatly expanded beyond traditional deoxyribonucleic acid (DNA)-damaging agents to encompass pharmacologic agents, such as targeted monoclonal antibodies, kinase inhibitors, and immune activating therapies that may have varying effects on women's fertility. Here, we review the current literature to provide a comprehensive summary on the effect of cancer treatment modalities on female fertility, fertility preservation options in female patients, and the role of pharmacists in oncofertility practice.

IntroductionInfertility affects millions of people globally. The presence of key indicators of infertility and fertility care is critical to monitoring access and utilisation of services as part of universal health coverage. In the area of infertility, it is important to track both clinical and non-clinical outcomes of care. Previous reviews have examined clinical indicators for infertility and fertility care; however, non-clinical indicators have received limited attention. This systematic scoping review aims to map the literature related to the non-clinical indicators of fertility care and their types and dimensions.Methods and analysisThis review will adhere to the established reporting guidelines for systematic scoping reviews and has been registered in the PROSPERO database to avoid duplication. A systematic literature search strategy will be developed and adapted to four electronic bibliographic databases (Medline [PubMed], EMBASE [Embase.com], CINAHL [EBSCOhost] and Web of Science [Clarivate]). Supplemental searches will be performed to obtain relevant grey literature from major health research institutes and international organisations. The search will be limited to literature published from 1990 to date. This review will cover all non-clinical interventions relevant to human infertility and fertility care. Two reviewers will independently screen papers and identify relevant studies for inclusion using predetermined criteria and extract data based on a predefined template. Types and dimensions of non-clinical indicators will be identified and a descriptive narrative synthesis will be used to describe the overall landscape. This review is expected to start on 1 June 2026 and conclude by 15 December 2026. A preliminary search strategy has been developed.Ethics and disseminationAs this study is based on a review of publicly available literature, ethical approval is not required. This scoping review will provide a comprehensive overview of the existing non-clinical indicators used to measure, report and monitor infertility and fertility care services. The findings will provide a comprehensive evidence base for developing a set of core indicators to monitor infertility and fertility care that can be adopted globally. Results will be disseminated through peer-reviewed publications, scientific conferences and webinars.PROSPERO registration numberCRD420251177901.

To assess patients' attitudes and preferences on the use of intracytoplasmic sperm injection (ICSI) for non-male factor infertility (NMFI) in in vitro fertilization (IVF). A multicentre, cross-sectional, closed online survey was conducted across three large fertility centres between October 2019 and July 2024. Participants with a diagnosis of NMFI planning their first IVF treatment were randomly selected to participate. Participants were excluded from the study if they had a diagnosis of male factor infertility; were using a sperm and/or egg donor, planning pre-implantation genetic testing (PGT), and/or were thawing previously cryopreserved oocytes. One-hundred and twenty-three participants (N = 123) were surveyed across all three centers. Most participants identified as female (95%) and were under the age of 35 (50%). Prior to speaking with their physician, 59% of participants were already familiar with the different types of fertilization techniques, and 34% of them believed ICSI provided them with the best chances of having a child. Most participants did not have a personal, ethical, and/or religious contraindication to the use of ICSI (85%). Ultimately, most participants preferred their physician's recommendation (55%). Our study indicates that the increased use of ICSI for NMFI does not appear to be driven by patients' attitudes or preferences. Fertility specialists should bear the responsibility of bridging the gap between our current practices and the existing evidence within the literature.

What is the association between treated (ART, ovulation induction (OI)) and untreated subfertility and risk of cerebral palsy (CP)? There is no increased risk of CP in births to subfertile untreated women; the risk of CP has declined in ART conceptions (IVF, ICSI) and is greatest in births conceived using OI medications as a sole therapy. Nordic data suggest a decline in risk of CP for ART births over time with the shift to single embryo transfer (SET), but there are no recent data from other countries and no Australian data for births after 2002. Few studies have examined the risk of CP in births conceived after OI or untreated subfertility; these comparison groups may assist in separating ART treatment effects from potential effects of subfertility itself. Retrospective cohort study using linked population-based data for women with a live birth (LB) in Western Australia from 2003 to 2014, corresponding to 10126 ART births (3.1%), 4102 births after OI (1.2%), 11554 births to subfertile untreated women (3.5%), and 305508 (92.2%) births to fertile women conceiving naturally. Statutory ART, birth, hospital, CP, and pharmacy data were linked to identify four 'conception groups' (ART, OI, subfertile untreated, and fertile natural conceptions), outcome data, and potential confounders. CP descriptions were verified at 5 years of age. Birth prevalence of CP was calculated for each conception group per 1000 LB. Poisson regression with robust standard errors was used to estimate adjusted risk ratios (aRR) for CP with adjustment for maternal demographic characteristics, pre-existing conditions, and adverse obstetric history (with 95% CI). Births to fertile women were the reference group. Analyses included all children and singletons and twins separately. Weinberg's differential rule was used to estimate the rate of monozygotic twinning across our four conception groups and, for ART births, by length of embryo culture. CP was diagnosed in 29 ART children (2.9/1000 LB; 95% CI 1.92-4.11), 16 children born after OI (3.9/1000 LB; 95% CI 2.23-6.33), 23 children in the subfertile untreated group (2.0/1000 LB; 95% CI 1.26-2.99), and 610 in the fertile group (2.0/1000 LB; 95% CI 1.84-2.16). When stratified by plurality and prematurity, risk was increased only for ART twins (aRR 2.8, 95% CI 1.42-5.39) born preterm (<37 weeks) and OI singletons (aRR 2.9, 95% CI 1.41-5.84) born preterm. Twins after SET comprised an increasing proportion of all ART twins over time, and of all ART twins with CP. Most twins after SET were same-sex twins (90.7%) and we estimated that 81% were monozygous, with the majority conceived after the transfer of a single blastocyst. The monozygotic twinning rate was higher after blastocyst-SET compared with cleavage-SET (prevalence ratio 1.7 (95% CI 1.07-2.73)). Small numbers of children with CP in subfertile groups prevented more detailed analyses of pregnancy complications and ART cycle characteristics. More recent data from larger populations are required to confirm whether risk of CP is increased following blastocyst transfer, in twins after SET, and following OI as a sole therapy. As zygosity data were not available, Weinberg's differential rule was used to estimate the rate of monozygotic twinning and may have led to some misclassification. Prevalence of CP following ART has declined in Western Australia, as in the Nordic countries. Avoiding multiple embryo transfer remains important. Monozygotic twinning after SET may increase the risk of CP for ART twins and is more common after blastocyst compared with cleavage-stage transfer. Embryo culture, manipulation, and freezing strategies to reduce monozygotic twinning should be explored. Data about OI (as a sole therapy) are not routinely collected in most countries, but OI-conceived births had the highest risk of CP and may warrant closer scrutiny. Pre-treatment counselling should continue to promote SET while incorporating the small risk of embryo splitting; risk of multiple birth should be discussed with those planning to use OI. This work was supported by the Australian National Health and Medical Research Council, grant number 1086530 (to M.H.) and The Research Foundation of Cerebral Palsy Alliance, grant number 06221 (to M.H.). The sponsors had no role in the design or conduct of the study, or the decision to submit for publication.Professor Hart is the Medical Director of Fertility Specialists of Western Australia and National Medical Director of City Fertility Clinic, a shareholder in CHA SMG; he has received accommodation support from Merck to attend ESHRE and has received travel and accommodation support, as well as educational sponsorship from MSD, Merck-Serono, Origio, Igenomix, and Ferring Pharmaceuticals. He has also received personal fees for presenting a Merck webinar. There are no other conflicts of interest to declare. N/A.

PurposeUterine fibroids commonly impact women of reproductive age, with the submucosal subtype known to adversely affect fertility. Recently, non-cavity distorting intramural fibroids have been found to impair the uterine environment leading many reproductive endocrinologists to surgically remove these fibroids prior to infertility treatment. However, the frequency with which this intervention occurs in actual practice remains in question.Patients and MethodsA database of 407 US-based reproductive endocrinology and infertility (REI) clinics was synthesized from the Centers for Disease Control & Prevention National ART Surveillance System and the Society for Assisted Reproductive Technology’s Clinic List. Medical directors at each site were invited to complete a REDCap-administered cross-sectional survey on management of non-cavity distorting intramural fibroids in patients pursuing infertility treatment.ResultsA total of 112 (28%) REI physicians completed the survey, representing a variety of clinic settings, locations, and volumes. The majority of respondents (72%) consider surgical management of non-cavity distorting intramural fibroids based on factors such as size, with myomas 4.1–6 cm or larger more likely to be considered for removal. Approximately 42% of REI physician respondents surgically remove non-cavity distorting intramural fibroids themselves, while 58% refer to other gynecologic surgeons.ConclusionMany physicians consider the removal of non-cavity distorting intramural fibroids prior to infertility treatment. Additional research is needed to better understand the indications for surgical management of various fibroid subtypes and the true scope of removal in current practice.