Background Patients commonly struggle with secondary infertility following a prior cesarean section due to factors related to the delivery. Distortions in the pelvic anatomy may complicate subsequent treatment attempts using assisted reproductive technology (ART) on different levels, including the myometrium, endometrium, and cervix, as well as intraperitoneal structures.Methods In this narrative review, major databases were searched to examine the effect of a prior cesarean delivery (CD) on pregnancy outcomes from subsequent ART treatments.Findings Some mechanisms for the detrimental effect of CD on subsequent ART success, such as the development of a cesarean scar defect (CSD), are well-supported by existing evidence. Other putative mechanisms, namely an increase in difficulty of subsequent embryo transfers, are more speculative at this time.Conclusion/future directions Rigorous standardization of CD technique as well as transparent meticulous reporting may mitigate the detrimental effect of prior CD on subsequent ART success.

RESEARCH QUESTION:In letrozole-stimulated frozen embryo transfer (FET) cycles, is oestradiol concentration on the day of ovulatory trigger associated with live birth? DESIGN:Retrospective cohort study of all patients in a private fertility network who underwent autologous single blastocyst letrozole-stimulated FET cycles from January 2017 to November 2023. Patients with recurrent pregnancy loss, unmitigated uterine factor, use of gestational carriers or donor gametes, and use of gonadotrophins or oestradiol supplementation to increase endometrial thickness were excluded. RESULTS:In total, 968 FET cycles were performed in 883 patients. The mean ± SD maternal age was 35.2 ± 3.9 years, median peak oestradiol concentration on trigger day was 184.9 pg/ml (IQR 126.0-249.1), and median endometrial thickness was 8.9 mm (IQR 8.1-10.1). Oestradiol concentration was not significantly associated with live birth when evaluated either continuously or categorically (adjusted for age, body mass index, and use of preimplantation genetic testing for aneuploidy). The point estimate for live birth was 8% lower at 60 pg/ml [risk ratio (RR) 0.92, 95% CI 0.71-1.19] and 15% higher at 200 pg/ml (RR 1.15, 95% CI 0.92-1.45) relative to 100 pg/ml, with rates plateauing thereafter up to 400 pg/ml. CONCLUSION:In this cohort, no significant association was found between oestradiol concentration on trigger day in letrozole-stimulated FET and live birth. Although a reduction in live birth was observed as the oestradiol concentration decreased below 100 pg/ml on trigger day, this finding did not reach significance. Importantly, even among cycles with lower oestradiol concentrations, the probability of live birth remained >40%.

Research Question To evaluate live birth relative to estradiol level on the day of ovulatory trigger in letrozole-stimulated frozen embryo transfer (FET) cycles. Design This is a retrospective cohort study. All patients in a private fertility network who underwent autologous single blastocyst letrozole-stimulated FET cycles from January 2017 to November 2023. Patients with recurrent pregnancy loss, unmitigated uterine factor, use of gestational carriers or donor gametes, and use of gonadotropins or estradiol supplementation to increase endometrial thickness were excluded. Results A total of 968 frozen embryo transfer cycles were performed in 883 patients. Mean maternal age was 35.2 ± 3.9 years, median peak estradiol at trigger was 184.9 pg/mL (IQR 126.0–249.1), and median endometrial thickness was 8.9 mm (IQR 8.1–10.1) (Table 1). Estradiol levels were not significantly associated with live birth when evaluated either continuously or categorically (adjusted for age, BMI, and use of PGT-A). Live birth increased slightly up to 200 pg/mL (RR, 60 vs. 100 pg/mL: 0.92, 95% CI: 0.71–1.19; RR, 200 vs. 100 pg/mL: 1.15, 95% CI: 0.92–1.45), plateauing thereafter up to the highest measured level of 400 pg/mL. Conclusion In this cohort, no significant association between estradiol levels in letrozole-stimulated frozen embryo transfers and LB was found. Although a reduction in LB was observed as estradiol level decreased below 100 pg/mL at the time of ovulatory trigger, this finding did not reach statistical significance. Importantly, even among cycles with lower estradiol levels, the probability of live birth remained above 40%.

Artificial intelligence (AI) is increasingly used in reproductive endocrinology and infertility (REI), influencing nearly all aspects of assisted reproduction. Reported applications include ovarian stimulation, gamete and embryo assessment, endometrial evaluation, and prediction of IVF outcomes. These tools may reduce subjectivity, standardize grading, and provide individualized prognostic information. Predictive models for fertilization, implantation, miscarriage risk, and live birth have been developed, along with decision-support tools for embryo transfer and treatment continuation. However, most studies are retrospective and limited to intermediate outcomes. Concerns about generalizability, transparency, accountability, and equity remain. AI represents both hope and hype, pending rigorous, outcome-based validation.

PURPOSE OF REVIEW:This review is timely and relevant as it addresses recent guideline updates regarding subclinical hypothyroidism (SCH) in infertility. The manuscript examines updates in SCH management, focusing on a significant shift in guidelines following the exclusion of a key randomized-controlled trial. This trial, central to previous guidelines and included in multiple meta-analyses, was excluded because of concerns about its validity, prompting a re-evaluation of management approaches. RECENT FINDINGS:There is insufficient data to definitively link SCH to infertility. Current evidence does not support universal screening or treatment of SCH in infertile women. Specifically, levothyroxine treatment for SCH has not been shown to reduce pregnancy loss or improve pregnancy outcomes, including live birth rates. SCH is not associated with a significantly increased risk of miscarriage. Routine screening for thyroid antibodies in the infertile population is not recommended. Following a re-evaluation of the literature, the latest guidelines emphasize selective screening for SCH rather than universal screening or treatment in the general infertile population. SUMMARY:These findings challenge previous guidelines advocating routine screening and treatment of SCH in infertile women. The updated guidelines now recommend more personalized approaches, with selective screening for women with specific risk factors.

Access to state-of-the-art ART can be viewed as a marker of societal development. The recent Alabama Supreme Court ruling represents a major local setback in the access to state-of-the-art ART. If this isolated local incident becomes a national trend, the USA will lose ground in this emerging area of healthcare, and its citizens will be left with substandard treatment options for the redress of infertility.

Infertility is a growing global health issue that significantly affects quality of life (QoL). Understanding its impact on QoL is essential for developing effective healthcare interventions. This study explored QoL, well-being, and spiritual needs among individuals affected by infertility, with implications for healthcare provision. Standardized questionnaire data from an anonymous mixed-methods study that was conducted from October 2022 to January 2023 in Switzerland and addressing QoL (FertiQoL), spiritual needs (SpNQ-20), and psychological well-being (WHO-5) of individuals undergoing fertility treatments. The analysis included 326 participants. FertiQoL scores were lowest in the emotional domain (M = 46.35) and highest in the relational domain (M = 68.51), with a mean overall score of 56.69, indicating moderate QoL impacts. Participants without children reported significantly lower FertiQoL and WHO-5 well-being scores than those with children (p < 0.05). The WHO-5 mean score indicated moderate well-being (M = 13.89). SpNQ-20 results showed the highest needs in inner peace (M = 1.82), followed by generativity (M = 1.09) and existential needs (M = 0.86), with religious needs scoring the lowest (M = 0.43). Participants without children had significantly higher spiritual needs (p < 0.05). This study highlights the emotional and spiritual challenges of infertility, revealing differences in experiences between individuals with and without children. It emphasizes the importance of addressing mental health and well-being in infertility care. Further research should focus on the psychological impacts of fertility treatments, including depressive mood states.

Infertility, affecting one in six individuals worldwide, poses substantial emotional and physical challenges. Its impact on quality of life (QoL), mental health and social relationships is well documented. However, qualitative insights into the lived experiences of those affected remain limited, as do the perspectives of health professionals involved in their care. This study presents qualitative findings from a mixed-method approach. Data were collected through 23 semi-structured interviews with 26 affected individuals and three focus group discussions with 20 healthcare professionals. The results underscore the multifaceted burden of infertility, including emotional distress, relationship strain and a pervasive sense of social exclusion. Participants expressed a clear need for more empathetic and individualized care, while healthcare professionals pointed to structural barriers. The study also identified a lack of societal recognition for infertility and the complex challenges. In some narratives, spirituality emerged as a personal coping resource - though one that is often overlooked or insufficiently addressed in clinical practice. Key recommendations include the expansion of peer support networks, public awareness raising, flexible treatment models and interprofessional collaboration. Future research should evaluate the effectiveness of peer support systems and interdisciplinary care models in addressing the complex and diverse needs of individuals affected by infertility.

Introduction and aims of the study: The quantity and quality of oocytes continuously decline throughout the female reproductive period.1–3 This process, along with advanced maternal age, results in decreased fertility but also increased rates of obstetric and perinatal complications.4,5 However, there is evidence that women in developed countries delay childbearing and start family planning at higher reproductive ages.6

Serious complications of assisted reproductive technology (ART) including in vitro fertilization (IVF) are rare and have decreased since the first successful IVF cycle more than four decades ago. Complications of IVF can be divided into short-term complications of ovarian stimulation and the egg retrieval procedure, and medium- to long-term complications from the whole process. The process of controlled ovarian hyperstimulation (COH) may be complicated by ovarian torsion, venous thromboembolism, and psychological morbidity (as well as ovarian hyperstimulation syndrome, discussed in a separate chapter). The egg retrieval procedure carries risks of hemorrhage, infection, damage to surrounding organs, and anesthetic complications. Medium- to long-term complications of IVF include increased pregnancy-related risks and potential health consequences including alterations in the risk of cancer.

As the space industry grows exponentially and aspirations for space travel expand, we are entering a new era where we will very likely become an interplanetary species. Although reproduction is an essential human function and necessary for species survival, we have remarkably little knowledge regarding the impact of space travel on the female reproductive system. The effects of spaceflight on human reproductive potential, fertility, implantation and subsequent pregnancy resulting in a healthy live birth must be considered before planning prolonged spaceflight missions and the colonization of planets. In this review, we explore what is known and what remains to be learned about the effects of space travel on female reproductive endocrinology. We also delve deeper into reproductive endocrinology and discuss normal physiologic mechanisms at the molecular level to have a better understanding of how it may change during spaceflight. The rigors of spaceflight including radiation, gravitational stressors, and circadian rhythm changes could potentially affect ovulation, fertilization, endometrial receptivity, preimplantation embryo development, embryo implantation, placentation, and pregnancy. Thus, we will examine what is known about spaceflight effects on the hypothalamic–pituitary–gonadal (HPG) axis, ovarian folliculogenesis and steroidogenesis, early embryogenesis, endometrial receptivity, and pregnancy. We further discuss the recent advances in reproductive endocrinology and future research platforms. Establishing a better understanding of the effect of space travel on female reproductive health, as well as developing countermeasures to mitigate adverse effects, are decisive components of our species’ successful transition to an interplanetary one.

Luteinizing hormone (LH) is present throughout the natural follicular phase. However, the debate is still not settled on whether LH is needed during ovarian stimulation in IVF. This commentary looks at the evolution of this debate, mentioning three elephants in the room that were ignored by the Pharma industry, professional organizations, and clinicians alike: Individual genetics of the LH receptor gene may also serve to individualize LH needs during stimulation; however, the jury is still out regarding this approach. Individual endocrine and genetics parameters may shed meaningful light on the question of LH supplemental during ovarian stimulation.