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 Queries included articles published or unpublished from 1998 to 2023.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.
Ovarian response is crucial in assisted reproductive technology, and mature oocyte retrieval is directly linked to higher live birth rates. Poor ovarian responders (POR) experience limited stimulation outcomes that contribute to significant cycle cancellations. Managing POR involves tailored protocols, yet no single approach has been universally validated as the most effective. Addressing this challenge, the Indian Fertility Society (IFS) developed comprehensive evidence-based guidelines for the diagnosis and management of POR. Using the PICO framework, a Guideline Development Group (GDG) conducted a comprehensive literature review across major databases up to October 31, 2023. Key outcomes included efficacy, safety, and patient-related measures. The GDG employed the GRADE approach to assess the quality of evidence and risk of bias. Recommendations were formulated based on the strength of evidence, benefit-harm balance, feasibility, stakeholder acceptability, and resource implications. The resulting evidence-based recommendations (EBRs) reflect the certainty of evidence and consensus among GDG members. The guidelines offered 44 EBRs (33 strong and 11 conditional) addressing 37 key questions to guide the management of POR. Among the EBRs, 1 was based on high-quality evidence, 6 on moderate-quality evidence, 25 on low-quality evidence, and 8 on very low-quality evidence and lack of evidence with recommendation for further research in 4. Most of the EBRs were based on low or very low-quality evidence, underscoring the need for further research. These guidelines prioritize patient safety and improve clinical outcomes, offering actionable insights into POR diagnosis and treatment protocols. Anti-Müllerian hormone and antral follicle count are reliable predictors for identifying patients at high risk of POR. The Corifollitropin alfa offers a comparable alternative to traditional gonadotropins. These guidelines serve as a valuable resource for assisted reproductive technology professionals by promoting a structured approach to managing POR and highlighting areas for future research.
Fertility trends are decreasing worldwide. A total fertility rate (TFR) of 2.1 is required to maintain population size, but it has been below replacement level in the industrialized nations for decades. Governmental policies have introduced various measures to boost pregnancy rates. Increasing access to assisted reproduction (ART) is one such measure. In Hungary, the TFR has been below 2.1 since 1978, despite a generous ART reimbursement scheme with recent further changes that have been introduced. This article discusses the impact of these changes on access to fertility care and ART utilization. Narrative review of the recent legislative and financial changes related to ART in Hungary and an evaluation of their impact on access and use of fertility treatments based on official statistical records, reports submitted to ESHRE, and our own clinic data. The changes affecting the type and number of reimbursed ART treatments are favorable for patients. The overall legal framework, however, has not been modified. Most of the additional financial resources are spent on treatments of an unfavorable population whose contribution to the TFR is negligible. While access to care has improved, the number of clinics or their personnel has not increased, adding work for the existing clinics. Importantly, due to reporting anomalies, accurate data on ART outcomes and, therefore, a proper assessment of the impact of the introduced measures are not yet possible. ART has been reported to be responsible for 1%–10% of births in different countries. In Hungary, based on nonofficial data, about 4%–5% of live births can be attributed to ART treatments. Further adjustments of the financial policies and broadening of the available services could further increase the role of ART. Before introducing substantial changes, proper data collection is needed to better assess the impact.
The global decline in total fertility rate (TFR) has raised serious concerns about the sustainability of our population. Projections indicate that by 2050, as many as 77% of countries will be below the replacement level of 2.1. Therefore, it is important to recognize family formation as a fundamental human right by ensuring that all women have fair access to fertility care, especially in terms of creating affordable assisted reproductive technologies (ART). Although in vitro fertilization (IVF) has become more common globally, many still face barriers due to financial, logistical, and emotional challenges. Increasing access to affordable ART is crucial, and mild ovarian stimulation has shown promising results for various patient groups. This article delves into clinical outcomes related to cost-effective IVF methods, such as mild ovarian stimulation protocols, the simplified IVF culture system (SCS), natural cycle endometrial preparation, and minimal ovarian stimulation (MOS) for those with poor ovarian response (POR). Recent research supports the use of simple IVF culture systems (SCS) as a method to reduce costs while simultaneously improving perinatal outcomes. Furthermore, factors such as endometrial thickness (EMT) and the approaches to endometrial preparation during frozen embryo transfer (FET) play a significant role in determining the reproductive outcomes. When compared with hormone replacement cycles, endometrial preparation in natural cycles shows better results in reproductive outcome. In Indonesia, minimally stimulated IVF is gaining attention, yet it still encounters challenges regarding costs, accessibility, and clinical expectations. Thus, further enhancements in treatment protocols, human resources, and health infrastructure are essential.
Infertility is a disease that affects one in 6 people of reproductive age globally and is increasingly encountered in primary care centres. A comprehensive, holistic approach to initial assessment of female and male infertility is crucial, and this manuscript outlines a systematic framework for general practitioners to assess infertility from the female perspective. We propose that early, holistic approach to female infertility investigations and counselling can reduce the need for physically, emotionally, and financially taxing therapies such as medically assisted reproduction (MAR) and even help couples achieve spontaneous pregnancies while awaiting specialist review. The evaluation of male infertility, though equally important, falls outside the scope of this discussion. A comprehensive literature review was performed using national and international articles, guidelines, and scientific publications. Findings were analysed and collated to develop a practical, systematic approach to the initial female infertility investigations suitable for use in primary care. A 3-tiered, evidence-based assessment framework was developed, encompassing all aspects of initial investigations performed in a primary care setting. For ease of understanding, this manuscript presents a pragmatic approach to thinking about and pursuing the female infertility investigations by asking 3 questions: (1) Does the female have an ovulatory disorder? (2) Is the female anatomy allowing normal function and a pregnancy? (3) Are there other female factors preventing a pregnancy? Emphasis is placed on identification of reversible risk factors for female infertility, with the aim to optimise natural conception and streamline referral and management by fertility specialists. Comprehensive female investigations and management in the primary care setting, alongside the exclusion of male factor infertility, can be a means to achieve pregnancy spontaneously without the need for MAR. If onward referral to fertility specialists and MAR is needed, this thorough assessment will enable early counselling of patients as regards to expected ovarian response, egg quality, likelihood of pregnancy, and risks of MAR. This structured and holistic approach empowers both general clinicians and fertility specialists to deliver personalised care to optimise reproductive outcomes, addressing the ever-growing pandemic of infertility.
The aims of the International Federation of Fertility Societies (IFFS) include “to stimulate research, and to promote the superior clinical care of patients in all aspects of reproductive research and fertility medicine”. Fertility treatments are a rapidly developing area. In the effort to improve outcomes, new technologies and pharmaceuticals are often introduced before they have been adequately assessed in terms of improving live birth rates. The clinical research behind these technologies is often flawed and may be misleading for clinicians and people wanting to build their families. We need to have a coordinated approach to improve the research for fertility treatments. What role could the IFFS have in promoting better research?
This paper discusses the potential impact of a pandemic on fertility services. Experiences from 2 European countries during the COVID-19 pandemic are drawn on to illustrate the issues that may arise during a pandemic, their consequences, and potential for mitigation. As part of disaster planning, the special impact of pandemic should be included. This must include the need for immediate response, but also, as we have discovered, the slow-burn impact on continuing services. It is also vital that international institutions focusing on health care work closely to monitor potential risk factors and develop emergency plans, based on all possible hypothetical scenarios, and set up effective alert systems.
Reproductive cells and tissue cryopreservation have revolutionized the provision of fertility services. The International Federation of Fertility Societies surveillance has collected global data on regulation and access to cryopreservation for many years. We used the triennial International Federation of Fertility Societies surveillance reports to assess trends, over the past 21 years, regarding the type of regulation implemented (none, statutes or guidelines), conditions for allowing use (medical/non-medical), tissue type and cryostorage duration permitted. We observed a 105.3% increase in the number of countries that regulate cryopreservation by statutes and 54.5% by guidelines. There has been a 103.6% increase in countries that allow cryopreservation for fertilized oocytes/preimplantation embryos, 205.3% for oocytes/ovarian tissue, and 134.6% for sperm/testicular tissue. More countries are allowing cryostorage surpassing 10 years, from 1% in 2001 to 25% in 2022. Since 2016, on average 15.6% of countries allow cryopreservation for medical reasons only, while allowance for non-medical reasons is growing. The number of countries reporting cryopreservation data has substantially increased, reflecting both customer demand and regulator awareness. Regulation by guidelines has decreased since 2010, while regulation by statutes has increased, indicating a shift towards more rigorous governing. To allow a better understanding of restrictions and facilitation of cryopreservation at a global level, an increase in the number of countries forwarding data on a regular basis is desirable, with clear benefits for regulators, practitioners, and patients.
Assisted reproductive technology (ART) legislation varies across the world, and although most countries providing in vitro fertilization (IVF) treatment have some form of regulation, its extent varies significantly. Although the birth of the first IVF baby was nearly 50 years ago, aspects of fertility treatment can still raise concerns and be influenced by society, such as by religious views. ART also moves forward rapidly with scientific advances, and as new treatments are introduced, these may require legislation. Clinics working within a regulated sector may be confronted with the challenge of legislation changes. This paper outlines examples of legislative change, the consequences, and challenges these may present to an ART clinic, and considers how such changes may be managed effectively.
Medical errors or nonconformances are not uncommon. Unfortunately, there is a fear related to their reporting, and if they are not systematically tracked this could lead to further errors. In the field of assisted reproduction, sparse reporting of errors exists. This article provides guidance using examples of types of errors related to the in vitro fertilization laboratory, specific challenges they provide, and how they can be resolved. We provide a guide on the quality management cycle for reporting nonconformances, documenting, responding, and correcting them. This cycle, when implemented, reduces the likelihood of non-conformances occurring.
Evidence continues to emerge on the reproductive hazards induced by microplastics (MPs) in humans and animals. However, conclusive evidence for the reproductive toxicity of MPs in human contexts is still limited, and understanding the intergenerational and transgenerational reproductive toxicity of MPs in mammals remains elusive. In this report, we found evidence that lactating exposure to 1 μm of MPs (a similar dose that human infants are exposed to during artificial feeding), induced reproductive toxicity in female mice and their offspring.
The COVID-19 pandemic made telehealth a vital tool in reproductive health care, yet patient perspectives in the field of Reproductive Endocrinology and Infertility (REI) remain underexplored. This study assesses patient satisfaction with telehealth in an REI department, focusing on ease of use, technical challenges, preferences for future consultations, and the influence of socioeconomic and insurance factors. A survey of 50 REI telehealth patients was conducted, capturing ratings for satisfaction and ease of use on a 1–10 scale. Findings showed that 36% rated satisfaction a perfect 10, and 44% rated ease of use similarly. However, 60% preferred in-person consultations moving forward, particularly among Medicare and Medicaid patients who valued the thoroughness of in-person exams and faced challenges with telehealth instructions due to language barriers and digital literacy issues. The findings highlight the importance of offering flexible care options to meet the diverse needs of patients who may face additional challenges in telehealth settings.
Genetic etiologies of infertility are little mentioned in Africa, mainly due to the lack of technical genetics platforms in many African countries. Identifying these genetic factors involves the use of cytogenetic and molecular genetic techniques. In this retrospective study spanning 13 years, we assessed the role of chromosomal anomalies in the etiology of couple infertility in Benin. This study included patients admitted to the cytogenetics laboratory of the Faculty of Health Sciences of Cotonou for a cytogenetic examination as part of a couple infertility exploration from January 2010 to December 2022. Out of 1996 karyotype requests, 205 karyotypes were carried out to explore the couple's infertility (10.27%). We found 5.34% numerical anomalies and 7.28% structural anomalies. These findings highlight the significance of cytogenetic analyses in the etiological investigation of couple infertility in Benin and enable the establishment of adequate genetic counseling for infertile couples.
Preterm birth occurs when a baby is born alive before the full 37 weeks of pregnancy. Preterm delivery can occur spontaneously or be a sign that a doctor should schedule an early cesarean section or induction of labor. The purpose of this review was to advance our understanding of preterm birth and its preventive measures. This review examined the preterm birth epidemiology, risk factors, clinical evaluation, management, and preventive strategies. The primary maternal predisposing factors associated with preterm birth were birth defects, maternal infection, the presence of polymorphism genes, mothers of rural residents, mothers with a history of prior abortions, hypertensive disorders during pregnancy, low birth weight, elementary education level, and immigrants. To prevent preterm birth, pregnant women should receive counseling regarding a balanced diet, social drug usage, follow-up visits to medical facilities, and relaxation techniques. Some evidence suggests that low-dose aspirin and other cyclooxygenase inhibitors help prevent preterm birth in cases where traditional treatments are ineffective. More research will be necessary to enhance the outcomes of preterm birth care and reproductive health.
Background: Infertility is a public health problem that has received little or no attention in most sub-Saharan Africa, especially in the Gambia. The prevalence of infertility in the Gambia is increasing from 9.0% in 1998 to 14.3% in 2017. Tubal factor was the predominant leading cause for decades, but recent reviews suggest that male factor is driving the epidermic of infertility worldwide. Therefore, the aim of this study was to determine the prevalence and etiological factors of infertility in our practice. Methodology: The design was a retrospective quantitative study. Data collection tool was developed and variables were retrieved from case notes between August 2022 to March 2023 at a specialist hospital in the Gambia. The data were entered into a computer database and analyzed using descriptive statistics. Results: Total number of women in the reproductive age of 15–49 years that attended gynecology clinic was 1475. Two hundred eighty-five couples (285) had infertility. The prevalence of infertility is 19.3% ~1:5 couples. The causes showed male factor 69 (45.4%), ovulation disorder 34 (22.4%), tubal factor 20 (13.2%), uterine factor 8 (5.3%), and unexplained 21(13.8%). Ovarian factors showed age-related poor ovarian reserve. Overall, male factor infertility was 53%, and female factor infertility was 47%. Conclusions: The prevalence of infertility is increasing and male factor is 3-folds and 2-folds higher than tubal and ovarian factors, respectively. The study observed increasing desire of fertility among female in advanced age. Universal access to assisted reproductive technology is essential.
Great progress has been made in the genetic research of PCOS, thanks to the application of genome association study (GWAS) technology. However, in the post-GWAS era, investigating the pathogenic mechanisms related to numerous genetic loci has become challenging, leading to the current generalized approach to treating PCOS. To address this issue, taking the significantly associated susceptibility gene THADA as an example, we share a series of advancements from the perspectives of genetic evolution, epigenetics, and gene function studies. Our aim is to provide guidance for a better understanding of the essence of PCOS.
