The global prevalence of obesity among women has increased dramatically over 3 decades, profoundly impacting reproductive health. Polycystic ovary syndrome (PCOS), affecting 12% of women, exemplifies the intersection of metabolic and reproductive pathology. This narrative review synthesizes epidemiological data from 200 countries (1990–2022), 52 systematic reviews from the International PCOS Guideline development, and recent genetic studies, including Mendelian randomization analyses exploring BMI-PCOS relationships. PCOS demonstrates bidirectional relationships with obesity: elevated BMI increases PCOS risk while PCOS predisposes to weight gain, with Mendelian randomization confirming causal relationships. Higher BMI exacerbates PCOS severity through enhanced hyperandrogenism and insulin resistance, driving ovulatory dysfunction, infertility, pregnancy complications, and elevated long-term risks, including diabetes and cardiovascular disease. The International PCOS Guideline emphasizes evidence-based, life-course management incorporating lifestyle intervention, pharmacotherapy, and surgical options. Addressing PCOS requires multidisciplinary approaches integrating metabolic and reproductive health strategies to improve outcomes for millions of affected women worldwide.
Introduction: The prevalence of infertility globally among reproductive-aged couples is increasing. Although there are regional disparities in prevalence, the influence of environmental, cultural, and societal factors on sexual and reproductive health rights cannot be overemphasized. In view of the rising trend of infertility prevalence worldwide, we decided to do a desktop review of the literature regarding infertility in the Gambia. Methodology: A desktop review of available literature was performed. Queries included articles published or unpublished from 1998 to 2023. Keywords were prevalence, epidemiology, and causes of infertility in the Gambia. Community and hospital-based studies were identified, and the trend of changes was measured with descriptive statistics. Results: The prevalence of infertility in the Gambia was 9% in 1998. Primary sterility was found to be fairly uncommon (3%), and secondary infertility to be more frequent (6%). In 2012, primary infertility was at 2% and secondary infertility at 10.6%. Overall prevalence was 12.6%. In 2017, the primary rate was 4.8% and the secondary rate was 9.5% resulting in a prevalence of 14.3%. About 1:7 couples who attended gynecology clinics presented with infertility. Primary and Secondary infertility rates were 13.6% and 5.7%, respectively, in 2023. The prevalence of 19.3% about approximately 1:5 couples. That tubal factor has decreased from 17.4% in 2017 to 13.2% in 2023. The male factor increased by multiple folds from 8.9% in 2017 to 45.4% in 2023. In 2017 and 2023, ovulatory factor and unexplained infertility were 13.4% and 22.4%, 10% and 13.8%, respectively. The male factor increased 3-fold the tubal factor in 2023. Conclusion: The prevalence of infertility is increasing, and primary infertility has become the most common type of infertility in the Gambia. The review showed a high prevalence of male factor infertility, which may be responsible for the change in infertility epidemiology in the Gambia
Mental health problems such as anxiety, mood disorders, posttraumatic stress disorder, obsessive-compulsive disorder, stress-related disorders, and feelings of guilt may develop during the perinatal period and are more common during the perinatal period. Perinatal mental illness is associated with a high risk of maternal and infant morbidity and disability. The prevalence of perinatal mental disorders varies from 5.6% to 85.6% in different parts of the world. Patient demographic factors, socioeconomic status, lifestyle, pandemic (COVID-19), previous chronic disease, and psychiatric and nonpsychiatric disease conditions are risk factors for having mental illness during the perinatal period in women. Mental disorders during the perinatal period have serious consequences for both mothers and children. Decreased brain development and risk of type 1 diabetes mellitus are among the complications of mental disease in children. Early detection, screening, and intervention of perinatal mental disease in the pre- and postpartum period are important to maintain women’s mental health. Interventions like psychological interventions, family support, partner support, and dietary management are common nonpharmacological interventions. Selective serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitors and benzodiazepines are effective nonpharmacological agents for short-term treatment.
Reproductive, maternal, and neonatal health is the foundation of sustainable development for families and societies. Accumulating evidence suggests that environment and climate are key determinants of overall health, including reproductive health and maternal-neonatal well-being. In this article, we highlight the evidence on the impacts of air pollution, endocrine-disrupting chemicals, greenness, and climate change on reproductive health and pregnancy outcomes. Strategies for mitigating environmental and climatic risks are discussed, underscoring the need for robust public health policies at the population level.
In the context of persistently low fertility rates across Europe and increasing reproductive challenges, public funding of assisted reproductive technologies (ART) has emerged as a potential demographic intervention. Poland launched a nationwide ART funding program in June 2024, aiming to improve access to infertility treatment and mitigate population decline. This study assesses the expected demographic and economic impact of the program during its initial years, with a focus on treatment outcomes, cost-effectiveness, and return on investment (ROI). This study analyzed data from the first 7 months of the program (June 2024–December 2024), encompassing 39,682 ART procedures. Projections through 2030 were constructed using epidemiological modelling, conservative assumptions regarding birth outcomes, and 3 economic valuation approaches for human life, with a base model utilizing GDP per capita and life expectancy. Extrapolated estimates suggest that ∼499,060 ART procedures will be conducted by 2030, resulting in 97,533 pregnancies and around 85,829 live births. ART is projected to contribute to at least 5.3% of all births in Poland. The economic return from ART-related births, based on the base variant, is estimated at PLN 69.2 billion (USD 17.3 billion) annually, against an average public investment of PLN 0.8 billion (USD 0.2 billion). Public funding of ART in Poland represents a highly cost-effective demographic and economic investment. To sustain its benefits, the program requires flexible financing mechanisms, improved data infrastructure, and adherence to evidence-based practices. ART should be recognized not only as a clinical necessity but as a strategic component of national demographic policy.
