Species-level analysis of intrauterine cavity fluid microbiota in cesarean scar disorder.

Infertility affects 17.5% of adults globally, with women facing severe social consequences. Early diagnosis and treatment are crucial in addressing this significant health issue. This cross-sectional study aimed to evaluate the clinico-radiological status of infertility among Bangladeshi women and identify associated factors. A total of 35 women aged 18 and above who sought infertility care at Popular Diagnostic Centre, Dhaka, were included. After consent, participants underwent Hysterosalpingography (HSG) and Transvaginal Sonography (TVS). Data were collected via interviews and analyzed using SPSS (Version 23.0). The participants, all married, had an average age of 29.0±6.30 years. Most were Muslim (88.6%) and homemakers (80.0%), with 25.7% having a college/university education. Secondary infertility (65.8%) was more common than primary infertility (34.3%). The average marriage duration was 8.93±5.26 years. Comorbidities were noted in 74.3%, including anxiety/depression (34.3%), obesity (25.7%), thyroid dysfunction (25.7%) and diabetes (8.6%). Hysterosalpingography (HSG) showed normal findings in 60.0%, while others had abnormalities like a bicornuate uterus, tubal blockages, or cervical incompetence. Only 11.6% had normal Transvaginal Sonography (TVS) results. Common findings included absent dominant follicles (28.6%), PCOS (20.0%) and a right ovarian chocolate cyst (5.8%). All participants were undergoing hormonal or fertility treatment during TVS. No statistically significant associations were found between participants' diagnoses, their husbands' semen analysis, or age and abnormal HSG or TVS findings. The revelations of this study underscore the urgency of addressing infertility in Bangladesh, aiding strategy development and resource allocation for better management in resource-limited settings.

Caesarean scar defects, known as isthmocele, are increasingly recognized in women with secondary infertility, yet hysterosalpingographic (HSG) criteria remain poorly defined. We describe a reproducible HSG feature, the "pocket sign," observed in seven women with prior caesarean delivery. This finding appears as contrast pooling in the anterior lower uterine segment near the internal cervical os. In all cases, it correlated with transvaginal ultrasound and hysteroscopic findings. Although non-specific and not diagnostic, the pocket sign may serve as an adjunctive indicator prompting further evaluation. Given anatomical variability and intrinsic limitations of HSG, multimodal imaging remains essential.

A comparative study of factors associated with primary and secondary infertility among women attending a tertiary care hospital in Western India

This study aimed to evaluate the prevalence and metabolic, hormonal and clinical characteristics of metabolic syndrome among women with polycystic ovary syndrome (PCOS) in the Oran region (western Algeria). Cross-sectional study. Outpatient endocrinology and gynaecology services in the Oran region, western Algeria. A total of 313 women aged 16-45 years diagnosed with PCOS according to the Rotterdam 2004 criteria. Prevalence of metabolic syndrome and differences in anthropometric (body mass index (BMI)), metabolic (fasting glucose and lipid profile), hormonal (gonadotropins, androgens, anti-Müllerian hormone (AMH), progesterone, vitamin D) and clinical features (hyperandrogenism, menstrual irregularity, infertility) between women with and without metabolic syndrome. Of the 313 participants, 181 (57.9%) met the criteria for metabolic syndrome. These women had significantly higher BMI (26.70±5.93 vs 25.06±6.47 kg/m²; p=0.004), elevated fasting glucose (133.43±28.52 vs 105.41±28.54 mg/dL; p<0.0001) and triglycerides (p<0.0001), but lower high-density lipoprotein (HDL)-C (p<0.0001). They also exhibited elevated luteinising hormone (LH), LH/follicle-stimulating hormone ratio, total testosterone and AMH levels, and reduced progesterone and vitamin D concentrations (all p<0.0001). Clinical hyperandrogenism, menstrual irregularity and secondary infertility were significantly more prevalent in this group. More than half of women with PCOS exhibited metabolic syndrome, characterised by obesity, dyslipidaemia, insulin resistance and vitamin D deficiency. These findings highlight the need for early metabolic screening and holistic management in women with PCOS to reduce long-term cardiovascular and reproductive risks.

Understanding the genetics of reproductive disorders is key to improving diagnosis, treatment, and overall reproductive health. This study aimed to describe the characteristics, assessment, investigations, and recommendations in patients seeking genetic counseling for infertility and pregnancy loss. This is a retrospective cross-sectional study that included couples who presented to the Genetic Disease Clinic, University Hospital, King Abdullah Medical City, Bahrain, with a chief complaint of infertility or pregnancy loss over 13 years from 2012 to 2024. Out of 912 patients who approached the clinic, 175 records (19.2%) belonged to couples (n = 350) who visited the clinic with infertility or pregnancy loss. Eighty couples (45.7%) were diagnosed with primary infertility, while 95 couples (54.3%) were diagnosed with secondary infertility. The mean marriage duration before visits was 7.7 ± 4.9 years. Meanwhile, 19 couples were identified as having advanced age in both partners (10.9%), 30 couples with advanced maternal age (17.1%), and 11 couples with advanced paternal age (6.3%). Additionally, couples with secondary infertility had an average of 1.6 pregnancies, with a mean of 1.4 early pregnancy losses. A male factor was identified in 30.3% of the couples (n = 53) and a combination of both male and female factors was reported in 52.0% (n = 91). Infertility and pregnancy loss were attributed to chromosomal aberrations solely in 27.4% of the couples (n = 48) and to monogenic carrier status in 14.3% of the couples (n = 25). Exome sequencing and gene panels were recommended and/or conducted in 49 couples (28%). In vitro fertilization and preimplantation genetic testing were recommended for couples with proven monogenic or chromosomal-related infertility. A couple's genetic profile significantly impacts fertility potential and outcomes. Genetic counseling, screening, and diagnostic testing enable timely and personalized interventions.

Isthmocele is a defect in the myometrium at the site of a previous uterine scar. It often presents with intermenstrual bleeding, dysmenorrhea, chronic pelvic pain, and secondary infertility, affecting patients' quality of life (QoL). The treatment of symptoms includes medical therapy and minimally invasive surgical approaches, such as hysteroscopic isthmoplasty. The aim of this study was to evaluate the efficacy of hysteroscopic isthmoplasty in treating isthmocele-related symptoms. The primary outcome was improvement of intermenstrual bleeding, primarily assessed as a reduction in symptom intensity. The impact of isthmoplasty on pelvic pain, dysmenorrhea, dyspareunia, obstetric outcomes, and improvement in QoL was also assessed. The single-center observational study, conducted at Mauriziano Hospital, Turin, Italy, included women who underwent hysteroscopic isthmoplasty for intermenstrual bleeding between 2018 and 2023, performed in an outpatient setting without anesthesia. The median follow-up was 54 months. Clinical and medical history data were collected using a specific questionnaire. The intensity of symptoms was evaluated through the Numerical Rating Scale item (NRS). We included 32 patients (mean age 44 years). Hysteroscopic isthmoplasty was associated with symptom improvement in most patients: 56.3% of women reported no more intermenstrual bleeding, and the other 43.7% reported a decrease in its intensity (from 7.14 to 4.07 on NRS, P<0.01). The frequency of dysmenorrhea (from 71.9% to 46.9%) and non-hematic vaginal discharge (from 53.1% to 18.7%) decreased. QoL improved, with resolution of self-esteem issues where present (from 31.2% to 0%). No severe complications were reported. No statistically significant differences were observed between laser and bipolar techniques; however, this comparison was exploratory, and the study was not powered to detect differences between surgical approaches. Hysteroscopic isthmoplasty in an outpatient setting is an effective and well-tolerated procedure to treat isthmocele-related symptoms. However, the retrospective design and small sample size warrant caution in interpreting the findings. Larger prospective studies are needed to confirm these results.

Infertility is a growing global health concern, affecting 60-80 million couples worldwide, of which 15-20 million are in India. Cervical health plays a pivotal role in reproduction, acting as both a barrier to infection and a facilitator of fertilization. Pap smear test (PST), though traditionally used for cervical cancer screening, may provide valuable insights into cervical pathology, infections, and microenvironmental changes associated with infertility. The aim and objectives of the present study are to evaluate cytomorphological alterations on PST in women with infertility and assess their role in identifying reversible causes affecting fertility. An ambispective study was conducted in the Department of Pathology and Laboratory Medicine at AIIMS Kalyani over three years (July 2022-June 2025). Women with primary or secondary infertility were included. PST were prepared using both conventional and liquid-based cytology, stained as per standard protocols, and reported using the Bethesda System for reporting cervical cytology (2014). Clinical and demographic data were recorded, and statistical analysis was applied to evaluate findings. A total of 241 infertile women underwent PST. Of these, 204 (84.6%) had primary infertility and 37 (15.3%) had secondary infertility. Inflammation was detected in 234 cases (97.1%), ranging from mild (58.8%) to severe (9.1%). Significant PST changes were observed in 153 (63.5%) cases, including moderate to severe inflammation, infections, and epithelial abnormalities. Infectious aetiologies included bacterial vaginosis (24.5%), Candidiasis (5.4%), and Trichomoniasis (0.8%). Lactobacilli depletion was noted in 28% of cases. Epithelial abnormalities were rare, with one case of Low-grade Squamous intraepithelial lesion (LSIL) and one case of Atypical squamous cells of undetermined significance (ASC-US). PST, being simple, cost-effective, and widely accessible, is a valuable tool for identifying reversible causes of infertility such as infections, inflammation, and altered microbiota. Incorporating PST into routine infertility workup may facilitate timely diagnosis and management, ultimately improving reproductive outcomes.

Intrauterine adhesion (IUA) causes secondary infertility and recurrent miscarriage, yet therapeutic options remain limited. Paeonol is widely used for gynecological diseases, but its precise role in IUA therapy is unclear. This study aims to explore the molecular mechanism of paeonol in IUA. Network pharmacology identified paeonol's potential targets and core proteins via a protein-protein interaction network. Bioinformatic pathway enrichment analyses and molecular docking elucidated mechanisms and validated binding. The optimal concentration and treatment time of paeonol were screened using Cell Counting Kit-8 (CCK-8) assays. In a transforming growth factor (TGF)-β-induced activated primary endometrial stromal cell (ESC) model, paeonol's effects on proliferation and migration were evaluated using CCK-8, wound healing, and Transwell assays. Expression levels of AKT1 and collagen synthesis-related markers were assessed by Western blotting. Protein levels of type I collagen and vimentin were assessed by immunofluorescence staining. In a IUA rat model, the in vivo efficacy of paeonol in alleviating IUA via AKT1 regulation was validated based on pathological, inflammatory, and reproductive parameters. Paeonol targets were significantly enriched in the phosphoinositide 3-kinaseK-AKT pathway. In vitro, paeonol blocked TGF-β-induced activation of primary ESC, reducing cell viability and migration. Mechanistically, paeonol antagonised TGF-β-induced ESC activation by suppressing AKT1, thereby attenuating IUA. In vivo, paeonol alleviated pathological changes of endometrial tissues, reduced fibrosis, and suppressed inflammation in IUA rats. Paeonol blocks AKT1 activation to suppress inflammation and fibrosis, ultimately slowing IUA progression. This study provides a new theoretical basis for paeonol use in IUA therapy.

Background/Objective: Asherman syndrome is an acquired intrauterine adhesive disorder associated with menstrual abnormalities, infertility, recurrent pregnancy loss, and adverse reproductive outcomes. Data from Latin American tertiary referral centers remain limited. To characterize clinical history, classification, hysteroscopic management strategies, and anatomical and reproductive outcomes in a single cohort of Mexican women with Asherman syndrome. Methods: This retrospective cohort study included women identified through institutional electronic records between July 2016 and December 2023 with a diagnosis of Asherman syndrome and analyzable hysteroscopic records. Women were followed for twelve months. Recurrence was defined as hysteroscopic evidence of intrauterine adhesions during follow-up. Among women with follow-up hysteroscopy, two-sided Fisher’s exact tests were used to calculate odds ratios and 95% confidence intervals. Results: Fifty-four women were analyzed. A prior uterine procedure was documented in 44 women (81.5%), with sharp curettage in 35 (64.8%). The most common reasons for consultation were secondary infertility (29.6%), abnormal uterine bleeding (27.8%), primary infertility (20.4%), and recurrent pregnancy loss (13.0%). Disease severity was classified as mild in 30 women (55.6%), moderate in 11 (20.4%), and severe in 7 (13.0%). Hysteroscopic intervention was predominantly performed with cold knife adhesiolysis (83.3%). Twelve-month follow-up hysteroscopy was performed in 38 women (70.4%); recurrence was identified in 30 (55.6%). Among the 34 women with reproductive intent, 12 achieved a live birth, corresponding to a live birth rate of 35.3%. Conclusions: Prior uterine instrumentation, particularly sharp curettage, was the most frequent antecedent. Recurrence remained common despite surgical management, highlighting the need for standardized postoperative surveillance and preventive strategies.

A uterine niche (cesarean section scar defect), defined as an indentation ≥ 2mm in the myometrium at the site of a previous cesarean scar, reflects impaired myometrial healing after cesarean delivery. Its prevalence increases with the number of cesarean deliveries and is associated with abnormal uterine bleeding, pelvic pain, secondary infertility, cesarean scar ectopic pregnancy, placenta accreta spectrum disorders, and uterine rupture in subsequent pregnancies. While secondary surgical correction may alleviate symptoms, preventive strategies implemented at the time of repeat cesarean delivery remain insufficiently studied. This trial evaluated whether resection of the previous cesarean scar during repeat cesarean delivery reduces uterine niche formation and related morbidity without increasing operative risk. This single-center, prospective, parallel-group, randomized controlled superiority trial was conducted at a tertiary university hospital between February and November 2025. A total of 170 multigravida women aged 18-45 years with ≥ 1 prior cesarean delivery undergoing elective or urgent repeat cesarean section were randomized (1:1) to either repeat cesarean delivery with resection of the previous cesarean scar (scar-resection group, n = 85) or standard repeat cesarean section without scar resection (control group, n = 85). Outcome assessors were blinded to group allocation. The primary outcome was the incidence of uterine niche (≥ 2mm) at 6 months postpartum, assessed using saline-infusion sonohysterography. Secondary outcomes included operative time, additional hemostatic sutures, estimated blood loss, niche dimensions, residual myometrial thickness, and cyclic menstrual bleeding abnormalities at 6 months postpartum. Analyses were conducted on a modified intention-to-treat basis excluding participants lost before outcome assessment. A total of 160 participants (80 per group) completed the 6-month assessment. Operative outcomes, including total operative time, number of additional hemostatic sutures, and estimated intraoperative blood loss were comparable between groups (all P > 0.05). At 6 months postpartum, the incidence of uterine niche was significantly lower in the scar-resection group than in the control group (45.0% vs. 78.8%; relative risk 0.57, 95% CI 0.44-0.75; P < 0.001), corresponding to an absolute risk reduction of 33.8% and a number needed to treat of 3. These results remained significant after adjustment for number of previous cesarean deliveries. Among women who developed a niche, scar resection was associated with significantly smaller niche depth, length, and width, greater residual myometrial thickness, and significantly fewer postmenstrual or intermenstrual spotting days and total bleeding days per cycle (all P < 0.0001). Resection of the previous cesarean scar during repeat cesarean delivery significantly reduces the incidence and severity of uterine niche formation, improves residual myometrial thickness, and decreases niche-related menstrual morbidity, without increasing operative time or blood loss. This standardized surgical modification represents a feasible preventive strategy to reduce cesarean scar-related morbidity. ClinicalTrials.gov, NCT07228858. Registered 20 December 2025 (retrospectively registered).

Embryo selection in assisted reproduction is pivotal for optimizing pregnancy outcomes. While Day 5 blastocysts are generally preferred due to earlier development, the clinical efficacy of high-quality Day 6 embryos remains debatable, particularly concerning aneuploidy risk and pregnancy loss. This study aims to compare chromosomal euploidy rates and clinical outcomes between Day 5 blastocysts and Day 6 blastocysts after preimplantation genetic testing for aneuploidy (PGT-A). This retrospective cohort study included 349 frozen embryo transfer cycles (Day 5: n = 165, Day 6: n = 184). All embryos underwent PGT-A using next-generation sequencing. Clinical outcomes, fetal loss, and ploidy status were assessed. Logistic regression identified predictors of fetal loss and aneuploidy. No significant difference in overall aneuploidy rates was observed between Day 5 and Day 6 embryos (47.9% vs. 48.9%, p = 0.847). However, early fetal loss (< 12 weeks) was higher among Day 6 embryos (26.6% vs. 17.6%, p = 0.043). Regression analysis revealed Day 6 transfer was associated with increased odds of fetal loss (OR = 1.707, p = 0.045), while greater blastocyst expansion and secondary infertility were protective. Higher FSH levels and inner cell mass (ICM) Grade B were significant predictors of aneuploidy. Top-quality Day 6 embryos demonstrate similar aneuploidy rates to Day 5 embryos but are associated with higher early pregnancy loss. Morphological grading and hormonal markers remain essential adjuncts in embryo selection post-PGT-A.

Endometrial osseous metaplasia is a rare benign condition characterized by the presence of bone within the endometrial cavity. It is an uncommon cause of abnormal uterine bleeding and secondary infertility, often following abortion. We report the case of a 28-year-old female presenting with irregular menstrual bleeding after two consecutive abortions. Ultrasonography suggested osseous metaplasia, and an endometrial biopsy was performed. Histopathological examination revealed well-formed bony trabeculae with hematopoietic elements, without evidence of atypia or malignancy, confirming the diagnosis of endometrial osseous metaplasia. This case emphasizes the pivotal role of histopathology in establishing a definitive diagnosis and excluding important differential diagnoses such as retained fetal bone and malignant endometrial lesions.

Introduction: Twenty five to thirty five percent of female infertility cases were caused by tubal factors, though it offers little morphological detail. Hysterosalpingography (HSG) is still the recommended first test for tubal clarity evaluation. A non-surgical option that may be used to more characterize tubal disease is transvaginal sonography (TVS). Aim of the Study: To evaluate the role of TVS following HSG in confirming and characterizing tubal blockage in infertile women. Methodology: This observational study included 59 infertile women who underwent both HSG and subsequent TVS at our institution. Demographic data, medical history, and surgical background were recorded. HSG was performed using standard radiographic contrast technique. TVS was conducted by experienced sonographers who were aware of HSG findings. Cross-tabulation analysis assessed concordance between modalities. Results: Mean age was 29.5 years; 50.8% had primary and 49.2% secondary infertility. HSG demonstrated right tube blockage in 27.1% and left tube blockage in 25.4%. TVS showed perfect concordance with HSG 100% agreement for both patent/normal and blocked/dilated categories. Those 20 patients who had confirmed blockage, TVS identified hydrosalpinx in 33.9% containing 10 bilateral, 6 right, 4 left and adhesions in 25.4% containing 9 bilateral, 4 right, 2 left. Conclusion: TVS following HSG confirms tubal blockage while providing morphological characterization. Hydrosalpinx detection carries direct therapeutic implications for IVF planning. We recommend routine TVS when HSG demonstrates tubal obstruction to optimize fertility management.

Infertility affects 15% of reproductive-age people worldwide and continues to impose a significant health burden. Several recent studies have linked ambient air pollution to infertility, but the evidence remains limited and inconclusive. We obtained global data on prevalence of infertility for 534 global spatial units and high-resolution air pollutants from the Global Burden of Disease (GBD) study during 2005-2020. Using a difference-in-differences approach, we estimated that each 10 μg/m3 increase of exposure to fine particulate matter (PM2.5) and ozone (O3) was significantly associated with a 28% and 17% higher risk of infertility prevalence, respectively, while an inverted U-shaped association was observed for nitrogen dioxide (NO2). These associations were generally stronger for secondary infertility compared with those for primary infertility. We identified stronger associations of exposure to both PM2.5 and O3 with infertility in the middle latitude and low GDP per capita regions. If the exposure to PM2.5, O3, and NO2 was decreased to levels recommended by the 2021 WHO AQGs, 17.4%, 24.2%, and 5.0% of the infertility prevalence would be avoided, respectively. Our findings strengthen the evidence that long-term exposure to ambient air pollution elevates the risk of infertility, highlighting the importance and urgency of reducing exposure to air pollution in improving human reproductive health.

Reproduction is a fundamental characteristic of all living organisms, and infertility in one or both spouses represents a significant obstacle to family formation and social stability. This study aims to determine the prevalence of infertility in hospitals of Al-Muthanna Governorate through a descriptive and analytical review of hospital records of married patients who have not conceived. The findings indicate that infertility affects both males and females, with most patients aged between 18 and 48 years. Primary infertility was found to be more common than secondary infertility. Environmental pollution and exposure to radioactive materials are considered major contributing factors to the increasing infertility rates in Iraq. The research consists of three chapters: the first covers the introduction, research problem, significance, and hypotheses; the second reviews historical background, causes, and treatment methods of infertility; and the third presents the field study framework, including data collection, sample selection, statistical analysis, and hypothesis testing..

Background: Infertility is a significant global health and socio-psychological burden, affecting an estimated 60–80 million couples worldwide, with a disproportionate impact in sub-Saharan Africa. Among its various aetiologies, biochemical derangements represent an important, treatable cause. Data on biochemical infertility patterns from private Nigerian hospitals remain scarce. Objectives: To determine the pattern and prevalence of biochemical abnormalities among female partners of infertile couples attending Nizamiye Hospital, Abuja — a private tertiary facility — and to compare findings with those from public health institutions. Materials and Methods: A retrospective, cross-sectional review of records from 52 consecutive female partners of infertile couples who presented between January 2015 and December 2019. Fasting serum reproductive hormone profiles (FSH, LH, prolactin, progesterone, oestradiol, and testosterone) were assayed using Accubind ELISA Kits (Monobind Inc., Lake Forest, USA). Patients were classified by clinical and biochemical criteria. Data were analysed using SPSS Version 21 with Pearson correlation and independent-samples t-tests. Results: The mean age was 32.65 ± 5.21 years (range: 22–42). Primary and secondary infertility accounted for 42.3% and 57.7% of cases respectively. Of all subjects, 82.7% were normo-gonadotrophic, 53.8% were hyper-prolactinaemic, 36.5% had polycystic ovarian syndrome (PCOS), and 17.3% were hyper-gonadotrophic. No subject had hypo-gonadotrophism. The prevalence of PCOS was significantly higher than in comparable public-sector Nigerian data. Conclusion: Biochemical infertility is highly prevalent in this private hospital cohort, with hyper-prolactinaemia and PCOS as leading diagnoses. The prevalence pattern differs from public-sector counterparts, possibly reflecting socioeconomic and metabolic differences in the patient population. Routine biochemical fertility profiling should be integrated into early infertility evaluation in all clinical settings

To compare the frequency of ovarian hyperstimulation syndrome in infertile females with GnRH agonists versus GnRH antagonists seeking invitro fertilization Study design A prospective cohort study Settings and duration At Obstetrics and Gynecology Department of Hameed Latif Hospital, Lahore,from 4th January 2024 to 4th January 2025 Methods A total of 60 infertile women aged 20-40 years referred for the first IVF/ ICSI were selected for the study, using non-probability, consecutive sampling.Women were divided into two groups: Group A and Group B. Patients in Group A were 30 women administered 500 µg GnRH agonist (Buserelin) subcutaneously every day since the 21st day of the menstrual cycle. The dose was reduced by 300 µg on the 2nd day of the cycle after pituitary suppression, and 150 µg gonadotropin was added to the regimen. Patients in Group B were 30 women administered 0.25 mg GnRH antagonist (Cetrotide) subcutaneously. 150 IU Pregonal was administered intramuscularly from the third day.After ovum retrieval,if more than three follicles had estradiol greater than 3000 pg/ml at 3 months and 6 months, it was described as OHSS, which was managed by standard procedure Results The frequency of primary infertility patients in Group A was 16 (53.3%), and secondary infertility was 14(46.7%). The frequency of primary infertility patients in GroupB was 19(63.3%), and secondary infertility was 11(36.7%). The mean number of mature follicles of patients in GroupA was 14.4±1.27 (1-35). The mean number of mature follicles of patients in GroupB was 13.6±1.24 (2-27). The mean E2 level in patients of GroupA was 3261.8±134.7 (Range: 1008-4215) and the mean E2 level in patients of GroupB was 3500±167.4 (Range: 1000-4890). The frequency of patients with ovarian hyperstimulation syndrome in GroupA was 2 (6.7%) and in GroupB was 8 (26.7%). Conclusion GnRH agonist is more effective than GnRH antagonist in terms of frequency of ovarian hyperstimulation syndrome in infertile women seeking invitro fertilization.

Due to the increase in caesarean sections worldwide, caesarean scar defects (CSD), also referred to as niches or isthmoceles, are becoming an increasingly more recognized complication. CSD can create long-term gynecological and reproductive complications. This review was conducted at Zulekha Hospital Sharjah United Arab Emirates from October 2025 till December 2025. This review included 65 studies conducted between the years 2000 and 2025 that examined imaging findings and clinical outcomes in relation to CSD. Transvaginal ultrasound (TVS) was the primary diagnostic method used, occasionally in conjunction with saline infusion sonohysterography (SIS) and three-dimensional (3D) ultrasound, as the 3D viewing angle permitted better accuracy of the diagnosis. There arecommon associated imaging findings such as niche depth was &gt; 2mm and residual myometrium thickness (RMT) of &lt; 3mm. CSD is also associated with secondary infertility in 28% - 40% of cases due to chronic inflammation with a likely impaired endometrial receptivity period. Obstetrical risks with CSD include uterine rupture, caesarean scar ectopic pregnancy, and placenta accreta spectrum when the RMT is &lt; 2.5 mm. Although CSD is clinically significant in the caesarean population, there is still much inconsistency with the imaging diagnostic methods and management. There is a necessity for and consensus on the diagnostic criteria and further prospective research to establish the best possible management in clinical practice to improve reproductive outcomes for affected women.

What are the prevalence, type, and stratified risks (reproductive failure subtype, sex, age, semen quality, and prior adverse pregnancy events) of chromosomal aberrations in couples seeking ART treatment in a large-scale cohort study? The prevalence of chromosomal aberrations in couples with reproductive failure was 3.42%, with a higher prevalence in younger individuals, men with poorer semen quality, and those experiencing multiple adverse pregnancy outcomes. Reproductive failure is a global health issue, with chromosomal aberrations playing an important role. ART is widely used for the treatment of reproductive failure; however, large-scale, comprehensive studies characterizing the stratified risks of chromosomal aberrations in couples seeking ART remain scarce. This retrospective study analysed chromosomal data from 227818 couples seeking ART at our hospital between January 1993 and March 2024. This study included 227818 couples with reproductive failure, including 130213 couples with primary infertility, 58161 with secondary infertility, and 39444 with adverse pregnancy outcomes. All participants underwent routine cytogenetic analysis using GTG-banding prior to ART. Statistical analysis was performed using R software (v4.4.0), with significance set at P < 0.05. Chromosomal aberrations were detected in 7785 couples (3.42%), with the highest prevalence in those with adverse pregnancy outcomes (4.83%), followed by those with primary infertility (3.54%) or secondary infertility (2.18%) (all P < 0.001). Significant sex differences were observed in infertile couples (men: 1.91% vs women: 1.52%) and couples with adverse pregnancy outcomes (men: 2.04% vs women: 2.81%), (P < 0.001). The prevalence of chromosomal aberrations was inversely correlated with age (2.36% in <25 years to 1.29% in ≥35 years) and increased significantly with poorer semen quality (0.89% in normozoospermia to 12.54% in azoospermia) and more adverse pregnancy events (3.07% in 1 event to 9.38% in ≥3 events, P < 0.001). Common structural aberrations included reciprocal and Robertsonian translocations and inversions, with frequent breakpoints at 11q23, 22q11, and 7q22. The percentage of haploid length of each autosome and the corresponding percentage of breakpoints showed a strong Pearson's correlation (R = 0.933, P < 0.001, two-tailed test). Robertsonian translocations and t(11;22)(q23;q11) were recurrent. The most frequent aneuploidies identified were 47,XXY (Klinefelter) and 45, X (Turner) syndromes, in both mosaic and non-mosaic forms. The lack of detailed clinical characteristics limited patient stratification and hindered the in-depth analysis of karyotype-phenotype relationships. The absence of a large fertile control group restricted comparative analysis. Conventional GTG-banding resolution may miss some cryptic chromosomal abnormalities. Single-centre data may limit the generalizability of our findings to more diverse populations. Stratified risk data (such as the higher prevalence of chromosomal aberrations in younger populations, individuals with poor semen quality, or those with a history of multiple adverse pregnancies) provide crucial evidence for clinicians to assess reproductive risks associated with chromosomal aberrations and make karyotyping decisions prior to ART treatment. This work was supported by the National Key Research and Development Program of China (2023YFC2705605). The authors declare that there are no competing interests. N/A.