STUDY QUESTION:What updates of the International Glossary on Infertility and Fertility Care are required, to reflect contemporary scientific knowledge, social needs, and inclusive definitions, while harmonizing international communication across clinical, research, policy, and public domains? SUMMARY ANSWER:This 4th edition presents 348 consensus-based terms and definitions, including numerous revisions from the previous edition and 79 newly introduced definitions reflecting advances in reproductive science, technology, and evolving social contexts. WHAT IS KNOWN ALREADY:Previous glossary editions (2006, 2009, 2017) established internationally recognized definitions related to clinical practice, research, and policy. The 2017 edition comprised 283 terms and, among many others, expanded the concept of infertility to include not only its recognition as a disease, but also as an impairment of function generating disability. The glossary has been extensively used worldwide and has contributed to international standardization of data collection, appropriate comparison of outcome measures, and provided a reference for all stakeholders including policy makers. STUDY DESIGN, SIZE, DURATION:Under guidance of the organizing committee, 21 professionals from across the world, and representing expertise in different sub-specialties, formed five working groups: clinical definitions; outcome measures; embryology laboratory; clinical and laboratory andrology; and epidemiology, public health and gender related definitions. The definitions from the previous glossary were evaluated and new terms identified. All definitions were then reviewed by an international advisory panel of nine experts that evaluated the glossary from scientific, ethical, cultural, and policy perspectives. PARTICIPANTS/MATERIALS, SETTING, METHODS:Between November 2024 and October 2025, periodical virtual meetings were held within and between working groups and the organizing committee. Following circulation of the first consensually agreed draft, a one-day in-person meeting with representatives of all working groups and members of the international advisory panel was held at ESHRE, June 2025. Most terms and definitions were discussed and agreed. In the absence of agreement, further discussions were held between the organizing committee, working group chairs and members of the advisory panel. It had been determined at the outset that final disagreement would be resolved via a two-third majority vote. All terms and definitions were, however, reached by consensus and adopted following a final round of review and approval by all authors. MAIN RESULTS AND THE ROLE OF CHANCE:The glossary now includes 348 terms. Compared to the previous edition, 14 terms were deleted, numerous terms modified and 79 new terms were added. Modifications reflect current scientific knowledge, technological advancements, and inclusivity related to gender and family structures. Chance does not play a role, as all definitions are consensus-based. LIMITATIONS, REASONS FOR CAUTION:Some terms may require future refinement as scientific knowledge evolves and societal contexts change. The glossary reflects consensus rather than empirical testing of all definitions. WIDER IMPLICATIONS OF THE FINDINGS:This glossary provides a global reference for standardized terminology, supporting clinical care, research, international comparisons, policy making, patient communication, and reproductive health literacy. STUDY FUNDING/COMPETING INTEREST(S):Neither ICMART, responsible for conducting this project, nor any of the participants received specific financial support for their activities in this project. Ferring provided ICMART with a fixed amount to cover venue costs and a one-day hotel accommodation for participants attending the in-person meeting held prior to the ESHRE Congress in June 2025. Disclosures were provided by all authors, and none reported any conflict of interest related to this manuscript. TRIAL REGISTRATION NUMBER:N/A.

IntroductionOlder adults can face challenges when seeking care from emergency departments (EDs) due to presenting with multiple comorbidities and non-specific symptoms. Psychosocial care is a possible target to help improve ED care for this population. It is possible that digital health technologies can be implemented within emergency settings to improve the provision of psychosocial care. However, it is unclear what the barriers and facilitators are to implementing digital psychosocial interventions for older adults presenting to the ED. Therefore, the scoping review aims to determine what are these barriers and facilitators.Methods and analysisThe scoping review will be conducted in line with the Joanna Briggs Institute guidelines and will use the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) checklist. The databases Medline, Embase, PsycINFO and Scopus will be searched. The search strategy will be developed in consultation with a specialist research librarian and will cover three key concepts: EDs, digital health technologies and older adults. Additionally, the first 100 hits of a Google Scholar search will be screened for inclusion. We will include both qualitative and quantitative studies that investigate ED digital interventions for psychosocial care where the primary focus is the views, attitudes, experiences and perceptions of patients, families and staff. After extracting all data, analysis and synthesis will follow the ‘best-fit framework synthesis’ approach and the Theoretical Domains Framework will be used to identify barriers and facilitators.Ethics and disseminationEthics approval is not required for this scoping review since only publicly available data will be analysed and appraised. The findings of the scoping review will be disseminated through peer-reviewed publications and conference presentations.

Some Australian women who require donor oocytes to achieve parenthood travel to South Africa, where egg donors are more readily available and egg donation comparatively affordable. In South Africa, egg donation arranged through donor agencies or egg banks is anonymous, whereas Australian las does not permit donor anonymity. This study explored Australian recipients' views on the implications of donor anonymity for their children, including the potential for future donor identification through direct-to-consumer genetic testing and social media. It also examined whether South African infertility counsellors, inform donors about possible future identification. Semi-structured interviews were conducted with twelve Australian egg recipient parents, twelve South African egg donors, and nine South African counsellors between 2021 and 2023, and analysed thematically. Australian recipients commonly hoped their donor-conceived children might learn the donor's identity and some had already engaged in online sleuthing or anticipated future identification through genetic testing. In contrast, South African donors generally expected anonymity to be permanent and expressed mixed feelings about potential future contact. Counsellors reported that identification risks were not consistently discussed with donors. This mismatch in expectations may have psychological consequences for all parties, highlighting the need for more robust implications counselling in cross-border egg donation arrangements.

Abstract Study question What are the characteristics and treatment outcomes of women who undertook planned egg freezing (PEF) in Australia and New Zealand between 2009 and 2023? Summary answer There has been an average yearly increase in the uptake of PEF of 35%, with most women undergoing a single PEF procedure in their mid-thirties. Given ten years follow-up a little over one in four women return, with nearly half of those using donor sperm and one-third achieving a live birth. What is known already PEF, where women freeze their eggs as a strategy to preserve fertility, has increased dramatically in high income countries in the last decade. Despite the rapid uptake of PEF, there remains limited information to guide women, clinicians and policy makers regarding the characteristics of women undertaking this procedure and treatment outcomes. Study design, size, duration A retrospective population-based cohort study of all women who undertook PEF in Australia and New Zealand between 2009 and 2023, including their subsequent return to thaw their eggs and treatment outcomes. Where women returned to utilise their eggs, all subsequent embryo transfer procedures were linked enabling calculation of live birth rates per woman. Participants/materials, setting, methods 20,209 women who undertook PEF in Australia and New Zealand between 2009 and 2023 including 1,657 women who returned to thaw their eggs. Main results and the role of chance There has been a huge increase in uptake of PEF, from 55 women in 2009 to 4,919 in 2023. Women who freeze their eggs are typically aged 34-38 years (interquartile range) and nulliparous (98.6%). For women with at least 10 years follow-up (i.e. undertook PEF in 2009-13; N=514), 27.9% returned and thawed their frozen eggs (average time to return: 4.9 years). This reduced to 22.1% in those with at least 5 years follow-up (i.e. undertook PEF in 2009-2018; N=4,288). Of those who used their frozen eggs, 47% used donor sperm. After at least two years follow up, 33.9% had a live birth, rising over time to 37.8% for eggs thawed between 2019-2021. Limitations, reasons for caution In the timeframe 2009-2019 we did not have information on whether egg freezing occurred because of a cancer diagnosis, a cohort we wished to exclude from the study. As a result, for this timeframe we weighted observations by the probability that egg freezing occurred due to cancer, with the prediction model developed on the years 2020-2023. Wider implications of the findings This study provides recent and comprehensive data on PEF to guide prospective patients and clinicians and inform policy. The exponential growth in PEF in Australia and New Zealand mirrors trends in other high-income countries, suggesting a doubling time of 2-3 years. Study findings highlight the need for setting realistic expectations about the likelihood of returning to use frozen eggs and live birth rates. Study funding/competing interest(s) 2020-2025 MRFF Emerging Priorities and Consumer Driven Research initiative: EPCD000014

AIM:This study aimed to understand primary healthcare providers' beliefs about barriers and facilitators providing culturally competent midlife care to migrant women. BACKGROUND:Primary healthcare is the entry level to the health system. It is usually the first point of contact in accessing the healthcare system and provides a range of services including health promotion and prevention. Migrant women are less likely to access and engage in health screening and health promotion activities and consequently may miss out on optimal health in older age. METHODS:A cross-sectional study including two free-text questions, part of an online survey, was thematically analysed. 76 primary healthcare providers answered the free-text questions. FINDINGS:Competing priorities as a result of migration and settlement experiences, the healthcare systems' limited resources to respond to the needs of migrant population and culturally informed beliefs and behaviour about menopause were viewed as barriers to midlife care for migrant women. Flexible models of primary healthcare and coordinated engagement with community groups were proposed to address these barriers. Primary healthcare providers perceived the current primary healthcare model to be inadequate to address the additional needs of migrant women. A review of the model of care may include 'task shifting' where nurses provide advanced care to migrant women in midlife. Perceptions of midlife and menopause are informed by culture. Hence, a culturally informed health promotion programme led by migrant women may be one strategy to address the limited participation in preventative healthcare including health screening at the time around menopause.

Research question: What are the health outcomes of individuals aged 27-38 years conceived with and without assisted reproductive technology (ART)? Design: An online survey, hosted in REDCap, was used to collect information on self-reported physical, psychological and reproductive health from an established cohort of people conceived with and without ART who were now aged 27-38 years. Questions included lists of common conditions and required tick-box responses to determine prevalence. A validated scale was used to assess psychological well-being. Results: There were 313 ART-conceived (236 IVF and 77 gamete intrafallopian transfer [GIFT]) and 153 non-ART conceived respondents. No marked differences between the ART and non-ART groups were observed in physical or psychological health measures. Similar proportions in both groups had had children and reported using medically assisted reproduction to conceive. More women in the ART than the non-ART group reported at least one reproductive health disorder (P = 0.01). Male reproductive health disorders were rare in both groups. Conclusions: Subjective indicators of health were no different between ART-and non-ART-conceived individuals, except for a slight increase in adverse reproductive health disorders reported by ART-conceived female participants. This warrants closer clinical scrutiny. Overall, a larger sample and objective measures in individuals beyond 30 years of age would provide the ultimate reassurance that ART is not associated with long-term health problems. This study is the first of its kind and may provide some reassurance of safety for people conceived with ART and those who contemplate using it.

What are the psychosocial and behavioural consequences of anti-müllerian hormone (AMH) testing in women without a history of infertility? AMH testing influenced emotional well-being and reproductive decision-making, with those who perceived their AMH as ‘low’ experiencing greater distress, regret, and behavioural changes. AMH is widely used as a marker of ovarian reserve; however, it does not predict natural fertility or future reproductive potential. Despite this, many women undergo testing outside of clinical infertility contexts, often without adequate counselling regarding its limitations or implications. Prior studies suggest that misunderstanding AMH results may contribute to unwarranted anxiety and affect reproductive decision-making. A cross-sectional, anonymous online survey of 251 women with no history of infertility who had undergone AMH testing within the past five years. Participants aged 18–55 years with no prior history of infertility were recruited via social media advertising and women’s health organizations. The survey assessed their psychosocial responses to their AMH test result, reproductive decision-making, understanding of AMH, and interactions with healthcare providers. Among 251 participants (mean age: 36 years, SD: 4.7), mean age at first AMH test was 33 years (SD: 4.3). The most common reasons for testing were considering pregnancy soon (29%) and curiosity about fertility (19%). The vast majority (94%) correctly identified AMH as a measure of ovarian reserve, but 20% incorrectly believed it assessed fertility. Almost half (47%) perceived their AMH result as ‘low’, and this was associated with greater emotional distress (p < 0.001) and increased decisional regret about testing (p = 0.038). Those with a perceived ‘low’ AMH result were also more likely to bring forward conception plans (p < 0.001), pursue elective egg freezing (p < 0.001), or consider fertility treatment (p < 0.001). Findings rely on self-reported perceptions and are subject to recall bias. The sample may not be representative of all women undergoing AMH testing, as participation was voluntary, and recruitment was conducted online. Despite evidence refuting AMH’s ability to predict natural fertility, many women undergo testing without appropriate guidance, leading to distress and potentially medically unnecessary interventions. These findings highlight ethical concerns surrounding AMH testing in women without infertility and underscore the need for better-informed counselling and evidence-based guidance before testing. No

PURPOSE:To review information about planned oocyte cryopreservation (POC) provided by social media influencers (SMIs) on Instagram Reels. METHODS:This was a review of content on Instagram Reels. The two most popular hashtags on Instagram discussing POC, #eggfreezing and #fertilitypreservation, were used to search for Instagram Reels in September 2024. A deductive summative content analysis was conducted on the selected Reels where content was mapped onto seven pre-determined themes identified as important for informed decision-making about POC in previous research. RESULTS:Thirty-four Instagram Reels were included in the analysis. Most only discussed two or three of the seven themes. The 'benefits of POC' was the most frequently discussed theme (25/34) followed by 'factors that affect the likelihood of a live birth from cryopreserved oocytes' (17/34) and 'explanation of the POC process' (14/34). Less than one-third (11/34) mentioned the 'possibility of a failed cycle or needing multiple cycles' and even fewer the 'physical risks or side-effects' (5/34), 'time commitment' (5/34), and 'financial considerations' (4/34). No Reel discussed the risk of OHSS or engaged with the decisions women need to make after POC. CONCLUSION:SMIs' Instagram Reels excessively emphasise the benefits of POC, minimise or fail to discuss the potential risks and costs, and omit information crucial for informed decision-making. Given the increasing use of POC, in conjunction with the growing prominence of paid partnerships between influencers and fertility clinics, guidelines are needed for SMIs and the platforms that they use to market POC.

PROBLEM:Limited awareness about the importance of preconception health is a recognised barrier to preparing for pregnancy. BACKGROUND:Opportunities exist to improve the health of future parents through preconception care. One of the recognised barriers to pregnancy preparation is a lack of knowledge and a lack of presentation for information and care. AIM:To explore the understanding of "preconception health" amongst people of reproductive age in Australia to inform the delivery of preconception care. METHODS:A qualitative descriptive study using online interviews with people of reproductive age in Australia. Recruitment was via social media (Facebook). Interview transcripts were analysed thematically. FINDINGS:Of the 20 women and five men we interviewed, all acknowledged the importance of preparing for pregnancy. Despite broadly understanding the concept, most participants had limited understanding of the details of preconception health. To increase their knowledge, participants' preferred sources of information included education in schools, reputable online sources, primary and maternity healthcare providers, and community members with lived experience. DISCUSSION:People in Australia are keen to learn about preparing for pregnancy and appreciate this as important. Suggested avenues to improve awareness and understanding about optimal preconception health included through school education, primary and reproductive healthcare providers, and online resources. This can improve understanding and behaviours before first and subsequent pregnancies. CONCLUSION:Preconception care requires a life-course approach, beginning with universal education through schools, enhanced by readily accessible reputable online resources, and access to trusted primary and maternity care providers. Maternity care providers can be key drivers in this process.

BACKGROUND:Due to the shortage of oocyte donors in Australia, Australian women increasingly travel overseas for oocyte donation. South Africa is a recognised 'repro-hub' due to the accessibility of relatively affordable, high-quality assisted reproductive technology services and the availability of donors. In contrast to Australia, where only known and identity release altruistic gamete donation is permitted, in South Africa, oocyte donors are anonymous and receive fixed compensation. AIMS:To explore the consequences for Australian recipients of cross-border oocyte donation (CBOD) in South Africa. MATERIALS AND METHODS:Semi-structured interviews were conducted with 12 Australian recipients who had at least one live birth after oocyte donation in South Africa between 2012 and 2020. Interviews were transcribed and transcripts analysed thematically. RESULTS:Most participants had failed assisted reproductive treatment in Australia before travelling to South Africa. Inability to secure an Australian donor led to CBOD. Ten recipients had at least one double embryo transfer (DET). Of the 15 pregnancies, participants reported one third were twin pregnancies. Some had more than one double embryo transfer cycle. Donors were anonymous, creating disparity around access to genetic information between children conceived with an Australian donor and those conceived with a South African donor. Some Australian recipients used sleuthing methods to locate donor siblings whose recipient parents had used the same donor. CONCLUSIONS:Double embryo transfers increase the possibility of multiple pregnancy and its associated risks of poorer obstetric outcomes, and donor anonymity prevents donor conceived children's ability to officially access information about the donor through donor registers. Strategies to address the shortage of Australian oocyte donors could alleviate the need for CBOD. Education about the consequences of DET and donor anonymity is needed.

Reproductive health conditions present various challenges for women in all aspects of their lives, including in the workplace. This study explores the workplace experiences of employed women with reproductive healthcare needs arising predominantly from endometriosis, as well as adenomyosis and infertility. Semi-structured interviews were conducted with 12 women with one or more of these conditions who were employed while experiencing symptoms of their condition or seeking treatment (such as in-vitro fertilization or laparoscopic surgery). Interviewees reported significant physical and psychological hardship because of their reproductive health conditions, namely pain associated with endometriosis. The impact of reproductive health needs and treatment on women’s ability to work included: difficulty managing symptoms, additional pressure to perform, exhaustion of ‘sick leave’, and working less and negative impact on career progression. In terms of how workplaces can improve the wellbeing of women with endometriosis and other reproductive health needs, women would benefit from: flexibility and working from home, access to paid reproductive health leave, and improved workplace education, trust and understanding. Women’s own accounts of how endometriosis and their reproductive health impacts their working lives, and what employers can do to support them, provides a platform to better understand women’s needs. These findings can inform public-policy solutions and workplace policies to better meet the needs of women with endometriosis and improve their workforce participation.

OBJECTIVE:Little is known about the psychosocial care of older people presenting to the emergency department (ED), or whether their psychosocial well-being during and after an ED admission can be enhanced. People over the age of 65 years experiencing psychosocial distress and mental health concerns have higher rates of ED admission than those without. As part of a larger mixed-methods study investigating the relationships between older people's psychosocial well-being and emergency care, this study aimed to explore the experiences of older people in ED and their influence on patient psychosocial well-being. METHODS:Participants aged 65 years or older receiving care in a large Australian public hospital ED were invited to participate in a telephone interview soon after discharge. Interviews were audio recorded and transcribed. Transcripts were analysed thematically. RESULTS:Eleven people (five women) aged 68-87 years participated in semi-structured interviews. Analyses revealed three overarching themes: 'interpersonal interactions', 'quality of care' and 'physical environment'. The theme 'interpersonal interactions' had two subthemes: 'communication' and 'human contact'. The three subthemes of 'quality of care' were 'appropriate care', 'psychological care' and 'unmet needs'. Physical environment referred to participant impressions of the ED setting. CONCLUSIONS:We found that staff sensitivity in their interactions with patients and their efforts to promote patients' physical comfort and protect their privacy influenced the psychosocial well-being of older adults in the ED. Based on the findings, we present a set of recommendations for enhancing the psychosocial care of older adults during ED admission.