Preserving fertility is essential when managing benign gynecologic disorders in reproductive-aged women. Surgical interventions can impact future fertility, therefore requiring an evidence-based, individualized approach. The FIGO Committee on Reproductive Endocrinology and Infertility reviewed current literature to develop recommendations for fertility-sparing surgical management. Effective treatment must balance disease control with fertility preservation. Evidence supports refined surgical techniques and alternative methods that minimize reproductive harm. In pregnancy loss management, medical treatment is preferred; however, if surgery is needed, hysteroscopic evacuation is safer than sharp curettage, reducing the risk of intrauterine adhesions. Similarly for other operative hysteroscopic procedures or abdominal procedures, including myomectomy, the use of an adhesion-reducing substance is recommended. During abdominal myomectomy, only symptomatic or fertility-impairing fibroids should be removed, as excessive resection may reduce pregnancy chances. In endometrioma surgery, preserving ovarian tissue is crucial by minimizing stripping of the pseudocapsule, or using sclerotherapy may help. Oocyte cryopreservation should be discussed when recurrence or reduced ovarian reserve is a concern. Hydrosalpinx often requires salpingectomy to enhance in vitro fertilization outcomes, but surgeons should protect ovarian blood flow by minimizing thermal injury. For adenomyosis, medical management is preferred due to the risks associated with surgical techniques like the triple-flap procedure. In polycystic ovary syndrome, laparoscopic ovarian drilling is discouraged; ovulation induction with letrozole or gonadotropins is safer and effective. In summary, fertility-sparing treatment demands personalized, evidence-based strategies that prioritize reproductive potential while managing disease. As reproductive goals evolve, continued refinement of these approaches remains vital to women's health care.

The presence of uterine fibroids impacts fertility through multiple mechanisms. While subserosal fibroids have minimal impact, especially when of reduced size, the presence of intramural fibroids impacts both the likelihood of pregnancy and its outcomes. Submucosal fibroids significantly reduce the chance of pregnancy and increase pregnancy complications. While noninvasive techniques can treat fibroids and appear safe, surgical management of FIGO Type 0, 1, 2, and 3 fibroids remains the gold standard in women desiring pregnancy. Uterine artery embolization is not recommended. Where the ovaries are not visible due to the presence of large fibroids, assisted reproduction and transvaginal oocyte pick-up become a challenge and consideration for myomectomy should be given. A cesarean section should be performed for women where the uterine cavity has been opened at the time of myomectomy.

Infertility is a condition with significant psychological, economic, and health implications. Investigations are generally conducted by a primary healthcare provider who then refers to a specialist; however, multidisciplinary care is often required. On occasion, patients move clinics, resulting in time delays and repeated investigations, further delaying treatment and adding to the patient's financial burden. To address this critical issue, FIGO's Committee on Reproductive Endocrinology and Infertility (REI) created the Fertility Passport. This passport should be provided to patients experiencing fertility issues so that it can be used during their infertility treatments. It documents basic investigations, diagnosis, treatments, and results. The REI Committee recommends the use of the passport to facilitate the diagnosis and treatment of fertility issues among patients accessing both domestic and cross-border care.

Gamete donation has become a crucial part of Assisted Reproductive Technologies (ARTs), providing hope to individuals, including those who may have no other option for parenthood. This process comes with a wide range of ethical, medical, and legal challenges that need to be carefully addressed to protect the well-being and rights of all parties involved: donors, recipients, and offspring. Navigating these complexities requires strict ethical standards, robust regulatory frameworks, and international collaboration. By standardizing these, the field of gamete donation can continue to develop while ensuring that all parties are well informed and safeguarded. This paper explores the ethical concerns and core principles surrounding gamete donation, offering recommendations to ensure safe, equitable, and ethically responsible practices that protect and support all parties involved.

All patients where the cancer treatment has gonadotoxic potential should be referred for oncofertility advice. The effect of chemotherapy and radiotherapy on the human ovary can vary from no impact to full-blown premature ovarian failure due to hormonal and follicular depletion. Total contraindications to fertility cryopreservation include acute malignancy that requires immediate lifesaving therapy. In prepubertal girls, the only option for urgent fertility preservation is ovarian tissue cryopreservation. Prepubertal testicular tissue cryopreservation is experimental.

Endometriosis affects 1 in 10 women globally. We aimed to determine health provider involvement and preferred methods of obtaining an endometriosis diagnosis across international jurisdictions. A global cross-sectional survey, distributed through formal and informal FIGO Reproductive Medicine, Endocrinology, and Infertility (REI) committee networks from September through October 2024. A total of 445 respondents from 76 countries began the survey, with 360 completions. Of the respondents, 63.9% were female, with most being gynecologists. Academics and/or researchers comprised 6.7%, with 39.2% involved in research in some capacity. Endometriosis was largely diagnosed by gynecologists (95.0%), with most respondents overall describing ultrasound as the most common method of diagnosis (77.8%). Of those surveyed, 93.6% stated clinicians in their country used non-invasive imaging (predominantly ultrasound) to diagnose endometriosis before surgery. One third of respondents did not feel confident distinguishing between routine gynecological scans and specialist endometriosis imaging. Significant barriers for uptake of imaging diagnostics included access to training, cost, and geographical accessibility. Regarding adoption of non-invasive imaging in clinical care, "game-changing" effects were described, including improvements in surgical preoperative mapping, and patient-centered care, with concerns that it could increase clinical workloads. Significantly, shifts in endometriosis diagnosis, from visualization of lesions at laparoscopy to non-invasive imaging diagnostics, were observed internationally. Policies should aim to overcome barriers to uptake of imaging-based diagnostics by supporting training initiatives, reducing associated costs, and improving geographical accessibility. Respondents predicted transformative changes in endometriosis care once non-invasive endometriosis diagnostics are effectively adopted.

Epigenetic regulation of molecular reproduction in human and animal models has a profound impact on phenotypic heterogeneity, response to extrinsic factors, and overall health and disease. Epigenetic processes influence all stages of the life cycle, from gametogenesis through organismal aging, and utilize multiple mechanisms of epigenetic inheritance. In this chapter, we discuss the major principles and processes of molecular epigenetics. These epigenetic changes may last through cell divisions for the duration of cell's life and may last for multiple generations without involving changes in the underlying DNA sequence. DNA methylation and histone modification will be discussed, presenting the mechanisms of covalent modification, RNA transcripts, and microRNAs. Epigenetic regulation of embryonic development and epigenetic reprogramming will be analyzed in detail with reference to sporadic or transgenerational inheritance. We will also discuss environmental and maternal factors during pregnancy that influence developmental origins of health and disease (DOHaD) of humans. These factors can affect development of the next generation even before conception and can continue throughout pregnancy, early childhood, or into adult life. Epigenetic changes in children born after ART are discussed with data concerning epigenetic syndromes and epigenetic conditions that are resolved by adulthood. Finally, psychological conditions during pregnancy can influence adverse birth outcomes, long-term defects of cognitive development, behavioral problems during childhood, and constant high baseline levels of stress-related hormones.

Fertility preservation is a growing field in reproductive medicine that may raise ethical questions. Preservation of fertility must be discussed with the patient if gonadotoxic treatment is required, whether in the case of benign or malignant pathology, or in the management of transgender identity. As a result, surgery or chemotherapy that has fewer adverse impacts on fertility should be proposed if this does not alter the prognosis of the disease. If the risk of infertility persists, then fertility cryopreservation should be proposed for children and adults of reproductive age. Sperm, oocytes, and gonadal tissue can be cryopreserved for many years. FIGO wishes to emphasize the importance of fertility preservation in the medical and surgical management of patients, and the importance of a specialized, multidisciplinary approach.

Epigenetic regulation of molecular reproduction in human and animal models has a profound impact on phenotypic heterogeneity, response to extrinsic factors, and overall health and disease. Epigenetic processes influence all stages of the life cycle, from gametogenesis through organismal aging and utilize multiple mechanisms of epigenetic inheritance. In this chapter, we discuss the major principles and processes of molecular epigenetics. These epigenetic changes may last through cell divisions for the duration of a cell's life and may last for multiple generations without involving changes in underlying DNA sequence. DNA methylation and histone modification will be discussed presenting the mechanisms of covalent modification, RNA transcripts, and micro RNAs. Epigenetic regulation of embryonic development and epigenetic reprogramming will be analyzed in detail with reference to sporadic or transgenerational inheritance. We will also discuss environmental and maternal factors during pregnancy that influence developmental origins of health and disease (DOHaD) of humans. These factors can affect development of next generation even before conception and can continue throughout pregnancy, early childhood, or into adult life. Epigenetic changes in children born after ART are discussed with data concerning epigenetic syndromes and epigenetic conditions that are resolved by adulthood. Finally, psychological conditions during pregnancy can influence adverse birth outcomes, long-term defects of cognitive development, behavioral problems during childhood, and constant high baseline levels of stress-related hormones.

The scientific and medical world, as well as society at large may need more time to accept and internalize the concept of transsexual reproduction. The goal of this chapter is to emphasize that trans men and women should be offered various options of assisted reproductive technology treatment, equal to the fertility preservation treatment that cancer patients receive. Specifically, transgender women (male-to-female transsexual patients), prior to hormonal therapy, should be offered sperm cryopreservation or, in adolescents, testicular biopsy with testicular tissue cryopreservation for future use: for transplantation, or the use of spermatogonial stem cells for in vitro maturation into spermatozoa. Trans men (female-to-male transsexual patients) should be offered cryopreservation of oocytes, or of ovarian tissue, before and during the androgenic therapy or oophorectomy. Data accumulated on gay and lesbian couples suggest that with the new technologies and treatment options, transgender people too can benefit from equal opportunities to produce children, as do other gender-nonconforming people.

The aim of the study was to evaluate the clinical pregnancy outcomes, fetal complications and malformation rate of intracytoplasmic injection of thawed cryopreseverd sperm extracted by testicular aspiration from men with non-obstructive azoospermia (NOA) compared with intracytoplasmic injection of fresh ejaculated sperm from men with severe oligoteratoasthenozoospermia (OTA) and standard in vitro fertilization using ejaculated sperm from normospermic men. The mean oocyte fertilization rate was significantly lowest for ICSI with testicular aspirated sperm (NOA group). However, there was no significant difference among the three groups in pregnancy outcomes, namely rates of spontaneous abortion, biochemical pregnancy, extrauterine pregnancy, singleton multifetal pregnancy, preterm delivery before 36 weeks’ gestation, maternal complications, transfer to the neonatal intensive care unit, intrauterine growth restriction or fetal malformations. These results suggest that despite some earlier findings that intracytoplasmic injection of aspirated sperm from men with NOA is associated with lower fertilization rates and embryo quality, the pregnancy and immediate neonatal outcomes may be unaffected.

BACKGROUND:To verify whether or not microinjection of sperm with a normal nuclear shape but large vacuoles affects IVF-ICSI pregnancy outcome.METHODS:A comparative study testing IVF outcome parameters of IVF-ICSI, based on morphological selection of spermatozoa with normal nuclei against those based on microinjection of sperm with a normal nuclear shape but large vacuoles. An experimental group, including 28 IVF-ICSI cycles, where only embryos obtained from microinjection of spermatozoa with a normal nuclear shape but large vacuoles were transferred, was matched with a control group, including 28 IVF-ICSI cycles, where only embryos obtained from microinjection of spermatozoa with a strictly defined morphologically normal nuclear shape and content were transferred. The main outcome was IVF-ICSI pregnancy rate.RESULTS:The experimental group exhibited a significantly lower pregnancy rate per cycle and significantly higher abortion rate per pregnancy compared to the control group (18 versus 50%, and 80 versus 7%, respectively, P=0.01).CONCLUSION:Microinjection of vacuolated sperm appears to reduce the pregnancy rate and appears to be associated with early abortion.