Female infertility is a major reproductive health concern. Hepatic steatosis index (HSI), a non-invasive marker of liver-related metabolic burden, has not been well studied in relation to infertility across its distribution. We analyzed women aged 20-49 years from three NHANES cycles (2013-2018). HSI was examined as both a continuous variable and in quartiles, and restricted cubic spline models were used to assess potential nonlinearity. Sensitivity analyses using alternative infertility definitions and exploratory interaction analyses were also performed. Among 3,007 women, 416 (13.8%) were classified as having infertility. In the fully adjusted model, women in the highest HSI quartile had higher odds of infertility than those in the lowest quartile (OR 1.66, 95% CI 1.08-2.57; P = 0.031), with a significant trend across quartiles (P for trend = 0.010). Restricted cubic spline analysis showed a nonlinear association between HSI and infertility (P for overall association = 0.005), which was more evident at higher HSI levels. Higher HSI was associated with greater odds of infertility among reproductive-aged women.
The increasing use of direct-to-consumer genetic testing revealed not only more, but also different types of insemination fraud worldwide, making research into the topic urgently needed. This study explores how donor-conceived people and parents experience insemination fraud and their need for and perception of psychosocial support. We conducted a qualitative interview study with 19 participants affected by insemination fraud from the Netherlands and Belgium. Insemination fraud occurs when the doctor uses a different sperm sample for insemination than the (prospective) parents consented to. The study includes eight different cases of insemination fraud. Participants experienced important challenges in fundamental aspects of life, related to reorganizing their identity, changing their family-conception story, navigating dualities regarding the donor, and coping with breaches of trust. Participants described the complex emotional processes they faced and how insemination fraud affected multiple relationships, revealing deeply entangled relational processes. These processes were complicated and/or facilitated by (non-)disclosure of donor conception by parents, type of insemination fraud, presence of heritable disease, the donor/doctor being alive or deceased, the clinic's reaction, and the reaction of the donor's legal family. Participants described short-term and long-term implications and needs for (peer) support. The article concludes with recommendations for clinical practice and policy.
This study investigates the socioeconomic determinants of the total fertility rate (TFR) in Türkiye, with a particular focus on regional disparities. A comprehensive panel data analysis, including the fixed effect regression analyses, was conducted by using a dataset from all 81 provinces over the years 2011 to 2023. TFR exhibits substantial variation across the provinces and regions. To have more homogeneous data, the provinces were classified into two groups based on their 2024 TFR values: high-TFR (>1.5) and low-TFR (≤1.5). This classification also aligns with regional categorisation as higher TFR levels are predominantly concentrated in southeastern Türkiye. The analysis investigates the effects of eight key variables on TFR. The results indicate that female marriage age, marriages between cousins, infant mortality rate, and the number of health care professionals are significant factors across provinces, although the strength of these relationships varies across estimation methods. The findings also reveal important divergence between the province groups. While crude death rate and educational attainment emerge as influencing factors in the low-TFR provinces, no significant evidence is found to support their role in high-TFR provinces. The study provides valuable insights into the fertility behaviour in Türkiye and contributes to a better understanding of the fertility pattern in other countries or regions facing similar demographic transitions. The findings can play an important role in developing relevant policies.
An increasingly common family type, often referred to as 'solo mothers', 'single mothers by choice' or 'choice mothers', comprises women who intentionally become mothers without the involvement of a partner. Although solo mothers are often described as self-determined, motivated and well prepared for parenting, with both economic and social resources, little is known about their parenting experiences and emotional and practical support needs. This cross-sectional exploratory study used an online survey to examine sources of emotional and practical parenting support, ease of asking for help and parenting confidence. A total of 139 participants responded between July 2021 and February 2022. The most used sources of support were family networks and friendship groups of non-solo mothers. Paid childcare was also frequently used, with many solo mothers accessing it at least a few times per week. While most participants felt confident in their parenting, many occasionally struggled to ask for help and required additional practical, emotional and/or financial support. Positive correlations were found between feeling supported and parenting confidence (r = 0.405, p < 0.001) and between ease of asking for help and feeling supported (r = 0.458, p < 0.001). Greater efforts are needed to ensure solo mothers have equitable access to tailored emotional and practical support resources.
Online sperm donation (OSD) connects prospective parents ('recipients') with donors via digital platforms. While prior research has focused on motivations and experiences, little attention has been given to the norms, identities, and relational dynamics shaping interactions on OSD platforms. Drawing on a year-long digital ethnography of five OSD platforms, this paper reports on a thematic analysis of multi-modal data that show that mistrust was pervasive. Users engaged in ongoing surveillance and scrutiny to 'stay safe' and protect others and future donor-conceived children. Norms about who was 'safe' or a 'good' donor or recipient influenced self-presentation and selection. Experienced donors were often constructed as knowledgeable, legitimising their authority to define what was 'normal'. Platform architectures, including user-driven safety features and gamification, shaped interactions, sometimes paradoxically contributing to harm rather than preventing it. These findings are situated within broader literature on digital sharing economies and connection platforms.
Subclinical hypothyroidism (SCH) is a biochemical diagnosis with ongoing uncertainty regarding management in reproductive medicine. We performed a retrospective cohort study evaluating fertility and pregnancy outcomes in women undergoing assisted reproductive technology (ART), focusing on untreated preconception SCH with TSH up to 6.0mIU/L. Secondary analysis used data from women screened for thyroid function and thyroid peroxidase antibodies (TPOAb) during the TABLET trial at Birmingham Women's Hospital, UK (June 2012-December 2013). Women with TSH ≥6.0mIU/L received levothyroxine. The primary outcome was live birth. The main comparison was 'total SCH' (TSH >3.63mIU/L) versus 'euthyroid-1' (TSH 0.44-3.63mIU/L), with subgroup analyses comparing 'untreated SCH' (TSH 3.64-5.99mIU/L) to 'euthyroid-1' women, and a stricter euthyroid threshold ('euthyroid-2'; TSH 0.44-2.5mIU/L) versus 'untreated high-normal-mild SCH' (TSH 2.5-5.99mIU/L). Multivariable logistic regression adjusted for key confounders. Of 944 women screened, 560 had outcome data; 60 had SCH. SCH was associated with fewer oocytes retrieved (9.0 vs 10.4, p = 0.02) and mature oocytes (7.4 vs 8.4, p = 0.05), but no difference in live birth was seen across comparisons: 'untreated SCH' vs euthyroid-1 (aOR 1.01, 95% CI 0.54-1.87, p = 1.0) and 'untreated high-normal-mild-SCH' vs euthyroid-2 (aOR 0.96, 95% CI 0.65-1.42, p = 0.8). In women with untreated SCH achieving live birth, TSH normalised spontaneously in 8/15 cases, with no adverse outcomes observed. Untreated TSH <6.0 mIU/L does not appear to adversely affect ART or live birth outcomes, although larger prospective studies are needed.
The objective was to investigate whether there are differences in cumulative live birth rate, cumulative clinical pregnancy rate, or perinatal outcomes after delaying ICSI timing. The design was a retrospective cohort study at Fertility North in Australia using 1,969 ICSI cycles with different ICSI timings among 1,078 patients from 2017 to 2022. Cumulative outcomes included cumulative live birth and cumulative clinical pregnancy rates per oocyte retrieval cycle. Perinatal outcomes included preterm birth, low/high birthweight, and small/large for gestational age. Binomial logistic regression and multinomial logistic regression were used. Generalised estimating equation (GEE) was incorporated into the logistic regression analyses to account for the cluster effect from patients undergoing multiple retrieval cycles. ICSI timing was grouped into quartiles: Q1(37.1-41.1h, n = 498), Q2(41.2-42.4h, n = 510), Q3(42.5-43.3h, n = 483), and Q4(43.4-46.8h, n = 478). No significant difference was found in cumulative live birth in Q2 (aOR: 0.79, 95%CI: 0.55-1.14), Q3 (0.87, 0.61-1.25), and Q4 (0.86, 0.58-1.27), compared with Q1, respectively. Similarly, there was no significant difference in cumulative clinical pregnancy rate between the four groups. Furthermore, no significant differences were found in preterm birth, low birth weight, high birth weight, small for gestational age, and large for gestational age in Q4, compared to Q1. Delaying ICSI until 46.8 hours post-trigger does not compromise cumulative clinical pregnancy or live birth rates, or increase adverse perinatal risks.
This study investigated the association between dietary quality indices and female infertility using data from the National Health and Nutrition Examination Survey (NHANES) 2013-2020. A total of 5,477 women aged 18-59 years were included. Dietary quality was assessed using 24-hour dietary recall data and summarised by four predefined indices: the alternate Mediterranean diet score (MED), the Healthy Eating Index-2020 (HEI-2020), the Alternate Healthy Eating Index (AHEI), and the Dietary Approaches to Stop Hypertension (DASH) score. Weighted logistic regression models were used to estimate the associations between dietary quality and infertility, and restricted cubic spline (RCS) analyses were used to examine potential dose-response patterns. After adjustment for age, race/ethnicity, education level, body mass index (BMI), smoking status, alcohol consumption, marital status, menstrual regularity, age at menarche, history of pelvic inflammatory disease, and total energy intake, higher MED, HEI-2020, AHEI, and DASH scores were inversely associated with infertility. RCS analyses suggested approximately linear inverse associations for these indices (all P for nonlinearity >0.05). Higher overall diet quality was associated with lower odds of infertility among adult women in the United States (US). Because this was a cross-sectional study using self-reported infertility, the findings should be interpreted as associative rather than causal.
As more jurisdictions allow donor-conceived persons (DCPs) access to their genetic information and direct-to-consumer DNA testing becomes increasingly popular, contact between those involved in donor conception, including DCPs, donors, parents and same-donor families, has grown. This mixed methods systematic review (MSSR) collates and examines research on how contact is experienced by these groups in the context of donation from donors previously unknown to recipients prior to donation. A bibliographic search of English-language, peer-reviewed studies was conducted following PRISMA 2020 guidelines across several databases, including CINAHL, JSTOR, MEDLINE, PsycINFO, PubMed, Scopus, Ovid Emcare and Google Scholar. Studies were included if they used empirical methods (quantitative, qualitative, or mixed) and involved participants with post-birth contact experiences following donation to recipients from donors not known to recipients prior to donation. These could include clinic-recruited donors (both anonymous/non-identified and identity-release) and donors recruited by recipients, such as through online platforms. From 1,397 initial records, 231 were full text screened. 57 studies meeting inclusion criteria and varying in methodology and sample size were assessed using the Joanna Briggs Institute (JBI) Checklist for Systematic Reviews and Research Synthesis. Findings were synthesised by stakeholder groups (DCPs, donors, parents), examining the form, frequency and experience of contact, as well as influencing factors. Contact ranged from occasional online interactions to regular in-person meetings, with experiences generally positive across all groups. Variations in experience were associated with attitudes towards and expectations of contact, and the size of donor networks. Further research is needed on how contact evolves over time, particularly regarding early linking (before the legislated age of access in identity-release jurisdictions) and connections made via DNA testing.
This article examines the reproductive decisions and concept of kinship of single mothers by choice (SMBC) in Hungary who pursued motherhood through assisted reproductive technologies (ART). Twenty-one women in Hungary participated in interviews examining their decisions to become SMBCs, to select ART, and whether to seek information or contact with their child's genetic relatives. The findings show that genetic ties were central to reproductive decisions. All reported a strong desire to have a child; most had hoped to conceive within a relationship but, approaching the end of their reproductive years, had opted for ART. The use of donor eggs was considered as a last resort; maintaining genetic links to the child was important for their sense of motherhood. Many described their child's interest in knowing about genetic relatives. Most participants attempted to identify donor-conceived half-siblings, and several were successful. In the Hungarian context, this study highlights the increasing importance of digital technologies in challenging the legal framework of anonymity, enabling women to locate donors or their children's half-siblings. The study contributes to debates on family, kinship, and reproductive autonomy, and provides insights into how SMBCs navigate donor conception under conditions of strict donor anonymity and constrained access to ART.
The aim of this article is to analyse the motivations, expectations, and experiences of information exchange and contact among parties linked through donor conception of solo mothers who had their children with the help of assisted reproduction technology (ART) across donor types (e.g. sperm, egg, embryo) and settings in Spain, where donation is anonymous, and the United Kingdom, where donor anonymity was lifted in 2005. This study draws on ethnographic research that took place in Madrid (Spain) and in London (the United Kingdom), where I conducted 60 in-depth interviews with solo mothers.
The objective of this retrospective cohort study was to evaluate whether air quality index (AQI) on the day of embryo transfer (ET) is associated with differences in clinical pregnancy rates (CPR). The study included all patients who underwent either fresh or frozen embryo transfer between June 1 - July 31, 2023 at a single academic fertility centre in New York. During this time, smoke originating from wildfires in Eastern Canada caused significant air pollution in New York. Patients who underwent single euploid embryo transfer were included and analysed separately. The main outcome measure was clinical pregnancy rate (CPR). Secondary outcomes included biochemical pregnancy rate, miscarriage rate, ectopic pregnancy rate, and live birth rate (LBR). Outcomes after ET were compared between three groups stratified by AQI category as defined by the EPA: Good: 0-50, Moderate: 51-100, and Unhealthy: >100. Chi square analyses were used to compare outcomes between groups. There were 190 ETs performed: 142 (74%) when the AQI was Good, 37 (19.5%) when the AQI was Moderate, and 11 (5.8%) when the AQI was Unhealthy. Higher CPRs were observed for ETs performed when AQI was Good vs. Unhealthy (62.0% vs. 27.3%, p = 0.02) and when Moderate vs. Unhealthy (64.9% vs. 27.3%, p = 0.03). There were 127 single euploid embryo transfers (SETs) performed: 96 (75.6%) when the AQI was Good, 23 (18.1%) when the AQI was Moderate, and 8 (6.3%) when the AQI was Unhealthy. Higher CPRs were observed when AQI was Good vs. Unhealthy (70.8% vs. 37.5%, p = 0.052,) although this was not statistically significant. The CPR was not significantly different for SET when AQI was Moderate vs. Unhealthy (69.6% vs. 37.5%, p = 0.11). While the LBR was lower when AQI was Unhealthy, statistical significance was not reached (p = 0.21 for the whole cohort and p = 0.28 for SET). This study found that poor air quality on the day of ET is associated with a decreased CPR. Embryo transfers performed when the AQI is Unhealthy results in decreased CPRs compared to ETs performed when the AQI is Good and Moderate.
These guidelines replace the previous (2019) UK guidelines for the medical and laboratory screening of sperm, egg and embryo donors and were achieved by a joint working group composed of representatives from the Association of Reproductive and Clinical Scientists (ARCS), the British Fertility Society (BFS), the British Association for Sexual Health and HIV (BASHH) and the British HIV Association (BHIVA), with review and comments from their respective memberships. It was written to guide best practice in clinics but is not intended as a tool to judge the practice of centres within the UK or beyond. Guidance on core information that should be supplied to all parties involved in donation is provided. Screening tests and standards required are summarised, as are specific considerations for known donation and embryo donation. The assessment of genetic risk and heritable disorders has been fundamentally reviewed in light of technological advances. Extended carrier screening is also discussed, although we do not suggest that this is routinely performed.
Women's perceptions of long-term outcomes of assisted reproductive technology (ART) remain underexplored in the United Kingdom. National database studies investigating these outcomes may provide clearer information. This survey investigates women's perceptions of: long-term ART outcomes, information provision on these outcomes, and such national database studies. Over an 8-month period, women who had undergone ART, were considering ART, or had conceived naturally completed an anonymous, cross-sectional survey distributed via social media. Descriptive and inductive, semantic thematic analyses were performed. Of 562 respondents, most were aged 25-40 (72.4%) and underwent private ART (37.9%). Most reported no concerns about maternal health (51.8%), child health (66.9%) and child education (82.5%). Reported concerns focused on maternal reproductive, cancer and endocrine outcomes, and child reproductive, neurodevelopmental, developmental and learning outcomes. Information on long-term outcomes was frequently not provided by fertility clinics (up to 91.9%). While up to 68.3% considered national database studies useful for investigating offspring outcomes, some raised data confidentiality concerns. Dissemination via healthcare professionals sensitively pre-treatment was preferred. Overall, most women reported no concerns about and received no information on long-term ART outcomes in maternal health, child health and child education. Improving clinician-led information provision may address knowledge gaps and support research dissemination.
The objective was to examine the prevalence of lifetime psychiatric disorders among women initiating intrauterine insemination (IUI) and their association with psychological distress at treatment onset. Ninety women were evaluated prior to treatment at an academic fertility center. Lifetime psychiatric diagnoses were assessed using the Structured Clinical Interview for DSM-IV-TR. Psychological distress was measured with the Beck Depression Inventory (BDI) and Perceived Stress Scale (PSS), and personality traits with the Eysenck Personality Questionnaire-Revised. Group differences were analyzed using t-tests and chi-square tests, and multivariate logistic regression identified predictors of elevated distress (BDI or PSS > 14). A lifetime Axis I disorder was identified in 36.7% of participants, most commonly mood (28.9%) and anxiety (15.6%) disorders. Women with a psychiatric history reported higher depression scores (10.5 vs. 5.5, p = 0.005), stress levels (18.8 vs. 12.8, p = 0.002), and neuroticism (p < 0.05). Lifetime psychiatric history remained independently associated with elevated distress (OR = 2.83, 95% CI: 1.14-7.01, p = 0.025). Over one-third of women initiating IUI have a lifetime psychiatric history, associated with greater distress at treatment onset. Routine psychiatric screening may help identify at-risk patients and support targeted interventions.
Pleural effusion as the predominant manifestation of severe ovarian hyperstimulation syndrome (OHSS) is rare and may occur with minimal or absent ascites. We present a recent retrospective case series from two UK centres describing presentation, investigations, management and outcomes of three patients developing large pleural effusions after medically assisted reproduction (MAR) in 2024-2025. All patients underwent antagonist stimulation with human chorionic gonadotropin (hCG) trigger and single fresh day-5 blastocyst transfer. Pleural effusions were diagnosed within a week of transfer, were predominantly right sided, and occurred despite modest ovarian enlargement and minimal or absent ascites. Patients required ultrasound-guided intercostal drainage with controlled outflow and albumin support. Pleural biochemistry was assessed in one case and this met 'Light's criteria' for exudate effusions. All patients improved rapidly after drainage and supportive management. Two pregnancies continued (one to term, one viable at 7 weeks), and one cycle did not result in pregnancy. In conclusion, pleural-predominant OHSS is a rare, yet recognisable phenotype. Early thoracic ultrasound, with careful interpretation of pleural biochemistry (including the serum-pleural albumin gradient in equivocal cases), avoidance of diuretics, selective albumin for intravascular support, timely ultrasound-guided drainage and venous-thromboembolism prophylaxis can optimise management. These cases also highlight the importance of preventive OHSS measures for future cycles.
The aim of the current review is to summarise information from publications on the impact of antioxidants on seminal outcomes in infertile men. A systematic search was performed in the five valid databases (Scopus, PubMed, Medline, Embase, and Web of Science) utilizing two sets of keywords up to September 2025, according to the PRISMA approach. Of the 11749 papers identified, 101 papers were included in this review, for a total of 11889 infertile men. Sperm concentration, normal sperm morphology, progressive sperm motility, and total sperm motility, were considerably higher in experimental groups compared with control groups. Both sperm concentration (106 mL-1) and total motility (%) were higher in experimental groups compared to control groups with an overall pooled standardised mean difference (SMD) of 2.33 (95% CI: 1.73, 2.94) for sperm concentration and SMD of 1.62 (95% CI: 1.20, 2.04) for total motility (%). Subgroup analysis demonstrated that duration of treatments of more than 6 months were more effective than those of less than 3 months. Based on the findings of this review, no definitive recommendation can be made regarding the use of antioxidants as a therapy for male infertility, and further research is necessary.
The uptake of assisted reproductive technologies (ART) has increased rapidly in recent decades, and yet migrant and ethnic minority communities continue to experience barriers to accessing these services. In Aotearoa New Zealand, the Pacific diaspora have the lowest participation in ART services despite having the highest rates of infertility. The reasons for this phenomenon have yet to be fully explained. In this qualitative cross-sectional study, 13 participants (12 women, one man) self-identifying as Pacific people who had experienced infertility participated in 45-90-minute talanoa (semi-structured interviews) either in-person or online. Talanoa were audio recorded and transcribed verbatim. Transcripts were thematically analysed using a hybrid inductive-deductive approach to identify factors that acted as enablers or barriers to ART services. Three key themes were developed from transcripts. Theme one captures the importance of strong relational ties and support networks for ART service access, and the negative impacts of absent familial support. Theme two highlights the role of health literacy and service awareness in promoting self-efficacy and health-seeking behaviours, but that many participants did not feel they had this. Theme three emphasises the tension between cultural expectations and religious beliefs that influenced participants' perceptions of infertility and decisions to access ART. Altogether, these narratives bring to the forefront the challenges of navigating a sensitive health issue such as infertility in a contemporary society amidst family pressures, cultural obligations, and religious ideals. Importantly, this study also highlights the valuable role that families and churches play in supporting Pacific people to access ART, and the importance of digitally accessible health information so that people can make informed decisions about their reproductive health. This paper contains useful insights for fertility service providers and clinicians working with Pacific peoples and individuals from other communities that are culturally diverse or have high religiosity.
Infertility is becoming increasingly common and more people are turning to assisted reproductive technologies. However, success rates remain disappointingly low, and improving outcomes for every treatment is a major priority. Accurate embryo placement during embryo transfer (ET) is critical for implantation and livebirth. While two-dimensional (2D) ultrasound-guided embryo transfer (USGET) approaches are standard, evidence for four-dimensional (4D)USGET is limited. This review aimed to determine whether 4DUSGET improves embryo placement accuracy and clinical reproductive outcomes, informing clinical practice and guiding future research. A narrative review of literature across databases was performed. Data extraction included study design, sample size, embryo placement technique, and pregnancy outcomes. 4DUSGET was associated with enhanced accuracy of embryo deposition, particularly in women with abnormal uterine anatomy or when targeting the maximal implantation potential point. Several studies reported higher clinical pregnancy and livebirth with 4D compared to 2D guidance. Evidence base is limited by a small number of studies, heterogeneous outcomes and potential bias inherent to narrative syntheses, making definitive conclusions challenging. Nonetheless, emerging data suggest 4DUSGET may provide meaningful benefit in anatomically complex cases with the potential to improve IVF success rates. Trials are needed to confirm findings and establish generalisability across IVF populations.
