Media representations have long influenced public understandings of infertility and assisted reproductive technologies (ART), with traditional media frequently relying on moralized or sensational narratives that reinforce stigma and oversimplification. The rise of social media and artificial intelligence (AI) has reshaped reproductive health communication, allowing patients to share lived experiences, build community, and access information outside clinical settings, while also increasing exposure to misinformation. This review synthesizes peer-reviewed research, clinical commentary, and digital media analyses to examine infertility narratives, online patient engagement, and AI-driven information dissemination. Findings indicate that social media has expanded patient agency and reduced isolation, but AI-generated content and influencer marketing contribute to the rapid spread of inaccurate or misleading fertility information. Despite these risks, digital platforms offer significant opportunities for evidence-based education and empathetic engagement. Clinicians who thoughtfully engage with social media and AI can counter misinformation, direct patients to trustworthy resources, and strengthen patient-physician relationships. When used responsibly, these tools can enhance communication and promote more informed, compassionate infertility care.

Primary ovarian insufficiency (POI) is a heterogenous disease with numerous causes, affecting 1

The role of cytoplasmic fragmentation in human embryo development and reproductive potential is widely recognized, albeit without standard definition nor agreed upon implication. While fragmentation is best understood to be a natural process across species, the origin of fragmentation remains incompletely understood and likely multifactorial. Several factors including embryo culture condition, gamete quality, aneuploidy, and abnormal cytokinesis seem to have important role in the etiology of cytoplasmic fragmentation. Fragmentation reduces the volume of cytoplasm and depletes embryo of essential organelles and regulatory proteins, compromising the developmental potential of the embryo. While it has been shown that degree of fragmentation and embryo implantation potential are inversely proportional, the degree, pattern, and distribution of fragmentation as it relates to pregnancy outcome is debated in the literature. This review highlights some of the challenges in analysis of fragmentation, while revealing trends in our evolving knowledge of how fragmentation may relate to functional development of the human embryos, implantation, and pregnancy outcome.

Purpose of Review To summarize standards and recent advances in the understanding of immunology in recurrent implantation failure in IVF. Recent Findings Recent consensus groups have put forth recommendations regarding the criteria for RIF. The focus of recent studies in RIF has shifted to more nuanced relationships of immunologic dysfunction at the maternal/fetal interface rather than systemic peripheral sources. Recent areas of novel therapy investigation include intrauterine PMBCs, PRP, and GCSF. Accumulating data on chronic endometritis suggests it may be associated with recurrent implantation failure and treatment may improve reproductive outcomes. Summary RIF remains a frustrating and elusive diagnosis for patients and clinicians. In the era of improved IVF protocols and genetic screening, the true incidence of RIF is likely quite low. New recommendations for a consensus diagnosis for RIF may improve the generalizability of future studies. The contribution of immunologic factors in RIF has long been a focus of investigation, and prior therapies have focused on systemic immune suppression, without clear improvement in pregnancy rate and at high cost to patients. More recent studies have identified immune profiles at the maternal/fetal interface that may provide avenues for more targeted and effective therapies. Intrauterine PMBCs, PRP, and subcutaneous GCSF may offer some benefit in improving implantation rate, although data is preliminary and not yet proven for clinical practice. Chronic endometritis remains a potential contributor to RIF, although treatment and/or cure and its relationship to improved live birth rates remain debatable. Unproven therapies should continue to be avoided in this population.

The role of cytoplasmic fragmentation in human embryo development and reproductive potential is widely recognized, albeit without standard definition nor agreed upon implication. While fragmentation is best understood to be a natural process across species, the origin of fragmentation remains incompletely understood and likely multifactorial. Several factors including embryo culture condition, gamete quality, aneuploidy, and abnormal cytokinesis seem to have important role in the etiology of cytoplasmic fragmentation. Fragmentation reduces the volume of cytoplasm and depletes embryo of essential organelles and regulatory proteins, compromising the developmental potential of the embryo. While it has been shown that degree of fragmentation and embryo implantation potential are inversely proportional, the degree, pattern, and distribution of fragmentation as it relates to pregnancy outcome is debated in the literature. This review highlights some of the challenges in analysis of fragmentation, while revealing trends in our evolving knowledge of how fragmentation may relate to functional development of the human embryos, implantation, and pregnancy outcome.

Purpose of Review Advances in RNA sequencing have revealed diverse endometrial microbiota. As the field of reproductive endocrinology and infertility continues to optimize in vitro fertilization success, the role of endometrial microbiota in endometrial receptivity has gained attention. This review aims to provide a comprehensive summary of our current understanding of the endometrial microbiota and its relationship with fertility while also highlighting future directions. Recent Findings Researchers have been able to build profiles of endometrial microbiomes that are associated with both fertility and infertility. Emerging patterns demonstrate endometrial microbiomes associated with infertility have similarities to those found in chronic endometritis. Studies are beginning to describe the intricate interplay between the microbiota and the immune system. An altered immune response to a dysbiotic endometrium may negatively impact fertility. Summary Understanding an individual’s microbiome could allow clinicians to personalize treatments to enhance reproductive success in infertile patients. Currently, investigations have shown promise in interventions that include antibiotics and steroids, but there are many other opportunities for emerging areas of research.

Health care is a complex field with extremely high stakes for patients. This review examines the benefits of implementation of the daily huddle in a women’s health clinic. Huddles can increase patient safety in multiple ways such as improving communication, preventing errors and adverse events, and improving situational awareness of the care team. In our program, huddles were an effective tool on a daily basis and were especially crucial in system implementation and during the coronavirus disease 2019 pandemic. This review also examines factors that can negatively influence huddles and suggestions to improve implementation.

The intracytoplasmic sperm injection (ICSI) has significantly improved male factor infertility treatment; however, complete fertilization failure still occurs in 1-5% of ICSI treatment cycles mainly due to oocyte activation failure. It is estimated that around 40-70% of oocyte activation failure is associated with sperm factors after ICSI. Assisted oocyte activation (AOA) as an effective approach to avoid total fertilization failure (TFF) has been proposed following ICSI. In the literature, several procedures have been described to overcome failed oocyte activation. These include mechanical, electrical, or chemical stimuli initiating artificial Ca2+ rises in the cytoplasm of oocytes. AOA in couples with previous failed fertilization and those with globozoospermia has resulted in varying degrees of success. The aim of this review is to examine the available literature on AOA in teratozoospermic men undergoing ICSI-AOA and determine whether the ICSI-AOA should be considered as an adjunct fertility procedure for these patients.

The aim of this study was to investigate if variation in endometrial thickness affects clinical pregnancy and live birth rates among patients undergoing single euploid embryo transfer (SET). A retrospective review of IVF cycles performed at a single private fertility institution between 2015 and 2020 was performed. Patients with normal uterine anatomy undergoing their first SET of a euploid embryo undergoing their first cycle at the center were included, for a total of 796 cycles. Endometrial thickness was measured by transvaginal ultrasound following 10–14 days of estradiol exposure. Specific infertility diagnoses did not significantly impact endometrial lining thickness with means across diagnoses ranging from 9.3 to 11.0 mm. Endometrial thickness was grouped into five categories: < 8 mm, 8–10 mm, 10–13 mm, 13–15 mm, and ≥ 15 mm. Using 8–10 mm as the reference group, the odds ratio of live birth was 0.5, 1.22, 1.05, and 1.05 for < 8 mm, 10–13 mm, 13–15 mm, and ≥ 15 mm groups, respectively. Risk of first trimester miscarriage was equivalent across groups. There was a trend toward an increased rate of biochemical pregnancies in patients with a < 8 mm and ≥ 15 mm endometrium; however, this was not statistically significant. The clinical pregnancy and live birth rate were lowest in patients with < 8-mm endometrial thickness. For single euploid embryo transfers, an endometrial lining greater than or equal to 8 mm confers optimal live birth rates following a medicated FET cycle. These data confirm the findings of prior studies in fresh embryo transfers without the confounders of supraphysiologic ovarian hormone concentrations and genetically untested embryos.

The objective of this review is to define live birth rate (LBR) and clinical pregnancy rate (CPR) for women ≥ 40 undergoing ovulation induction (OI)/intrauterine insemination (IUI). A systematic review was performed in accordance with PRISMA guidelines using PubMed and Google Scholar. The primary and secondary outcomes of interest were LBR and CPR, respectively. There were 636 studies screened of which 42 were included. In 8 studies which provided LBR for partner sperm, LBR/cycle ranged from 0 to 8.5% with majority being ≤ 4%. Cumulative LBR was 3.6 to 7.1% over 6 cycles with the majority of pregnancies in the first 4. In the four studies providing LBR for donor sperm cycles, LBR/cycle ranged from 3 to 7% with cumulative LBR of 12 to 24% over 6 cycles. The majority of pregnancies occurred in the first 6 cycles. There were three studies with LBR or CPR/cycle ≥ 1% for women ≥ 43. No studies provided data above this range for women ≥ 45. In 4 studies which compared OI/IUI and IVF, the LBR from IVF was 9.2 to 22% per cycle. In 7 studies which compared outcomes by stimulation protocol, no significant differences were seen. For women ≥ 40 using homologous sperm, the highest probability of live birth is via IVF. However, if IVF is not an option, OI/IUI may be considered for up to 4 cycles in those using partner sperm or 6 cycles with donor sperm. For women > 45, OI/IUI is likely futile but a limited trial may be considered for psychological benefit while encouraging consideration of donor oocyte IVF or adoption. Use of gonadotropins does not appear to be more effective than oral agents in this age group.

Intrauterine insemination (IUI) of washed sperm with or without ovarian stimulation has been empirically applied as first line of treatment for unexplained or male-factor infertility given it is less costly and less invasive than in vitro fertilization (IVF). For some patients with severe male factor, treatment with IVF may not be an option for any number of reasons including high cost of IVF, lack of insurance coverage, and limited access to or long wait times for IVF at their local or regional center. For this reason, some infertility clinics continue to offer IUI to couples with severe male factor and ask the male partner to collect two sequential ejaculates to pool sperm for IUI. We sought to determine if pooling consecutive ejaculates in infertile men with severe male factor improve pregnancy outcome following IUI.

Objective Assisted reproductive technologies (ARTs) are complex processes with multiple and diverse opportunities for human error. Errors in ART are thought to be rare, but can have devastating consequences for patients and their offspring. The objectives of this article are to review known cases of human error in the ART laboratory and suggest preventative strategies. Methods We performed a systematic review of the literature in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines using PubMed and Google Scholar databases. Studies were eligible for inclusion if they involved known cases of unintentional human error in the ART laboratory. Only full-text articles in English were included. References of the resulted studies were considered for inclusion. Results A total of 420 articles were screened and 37 articles were selected for inclusion. These largely included case reports and reviews in the medical and legal literature. Twenty-two adverse events due to human error in the ART laboratory were identified. Eight of these adverse events were the result of the insemination with the wrong sperm, 6 errors lead to the transfer of the wrong embryo, 3 lead to an error in preimplantation genetic testing, and 5 adverse events lead to the failure of gamete and embryo cryostorage. Conclusions Since the advent of ART, there have been reports of catastrophic events occurring secondary to human error in the laboratory to include incidents of unintended parentage, and have resulted in the loss of embryos and gametes through cryostorage failure. Proposed solutions include the stringent implementation and adherence to safety protocols, adequate laboratory staffing and training, and novel methods for specimen labeling and tracking. Of utmost importance is having knowledge of these errors and the ability to determine cause so that future events can be prevented.

Infertility has a prevalence of up to 16% worldwide and is on the rise in developed nations, largely due to pursuing childbearing at advanced reproductive ages. Advances in assisted reproductive technology have benefitted socioeconomically advantaged patients disproportionately. High costs of fertility care are largely responsible for this disparity; however, patients in rural areas also face barriers in accessing both gynecology and reproductive endocrinology subspecialty care. Here, focusing on the USA, we discuss fertility care in geographically underserved areas and low-resource settings, and the impact on reproductive outcomes. Increased innovation to improve patient access to fertility care such as assisted reproductive technology is critical for ensuring equity. Remote monitoring is frequently performed by fertility centers, but partnership with local gynecologists has also been demonstrated to be an effective assisted reproductive technology monitoring method. Telehealth is now in mainstream use and the continued application to reduce geographic barriers to infertility patients is imperative. Partnership between local gynecologists and reproductive endocrinology and infertility specialists may improve patient access to fertility care and provide the unique benefits of continuity and ongoing local social support.

To determine if human sperm survival after overnight incubation with oocyte-cumulus complexes (OCCs) is predictive of oocyte fertilization rate, embryo quality, and blastocyst development rate. A retrospective cohort study of 124 infertile couples undergoing consecutive conventional IVF cycles from January 2017 to December 2020 in an academic fertility program. Fresh or frozen patient's sperm or frozen donor sperm were prepared using density gradient followed by swim-up procedure and the number of spermatozoa recovered after wash was recorded. 125,000 motile sperm were added to center-well culture dishes containing 4 cumulus-oocyte complexes and incubated in 37°C and 5.5% CO2 overnight. Percentage of the progressive sperm motility at fertilization check 18 hours post insemination was recorded. Data were analyzed using Spearman Correlations. The median total fertilization rate was 79% (Q1=61,Q3=100) and the median normal fertilization rate was 70% (Q1=50, Q3=80). The sperm motility in neat semen, washed sperm, and 18 hour post insemination did not correlate with the total or normal fertilization rate (p = .13 and .12, respectively) nor with embryo development as well as embryo quality (good, average, poor and slow) on days 3, 5 and 6. In addition, there was no correlation between the rate of motility decrease 18 hours post insemination and the male age, total motile sperm, sperm recovery rate, fertilization, or embryo development. No threshold level for the effect of motility on normal fertilization and day-3 embryo development was found. There was no relationship between the percentage of spermatozoa that maintain their motility 18 hours post insemination with normal fertilization, embryo quality, and blastocyst development rates. The 18 hours sperm motility screening is not predictive of fertilization rate and embryo development.

The mouse embryo assay (MEA) has been used in the field of human in vitro fertilization (IVF) for multiple purposes such as developing embryo culture media, quality control within the laboratory, and procedural training and proficiency testing for embryology staff. In addition, manufacturing companies use the MEA as a means of quality control for the development of embryo culture media and medical devices and to meet the standards of testing for FDA approval of new products. It has long been considered by embryologists and laboratory scientists whether the MEA is an accurate or sensitive test in the quality assessment of culture media and medical devices or if use of this testing is more an obligation. There is no uniformly accepted gold standard method for IVF lab quality control or FDA approval. This review aims to revisit the role of the use of mouse embryos in the formulation of IVF media for clinical use and the different methods of employing the mouse embryo assay for quality control. In addition, we will review the use of the MEA as an important adjunct in the training for embryology staff and fellows in training in reproductive endocrinology and infertility (REI), as well as alternatives to the use of the MEA for these purposes.

Objective Assisted reproductive technologies (ARTs) are complex processes with multiple and diverse opportunities for human error. Errors in ART are thought to be rare, but can have devastating consequences for patients and their offspring. The objectives of this article are to review known cases of human error in the ART laboratory and suggest preventative strategies. Methods We performed a systematic review of the literature in accordance with Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines using PubMed and Google Scholar databases. Studies were eligible for inclusion if they involved known cases of unintentional human error in the ART laboratory. Only full-text articles in English were included. References of the resulted studies were considered for inclusion. Results A total of 420 articles were screened and 37 articles were selected for inclusion. These largely included case reports and reviews in the medical and legal literature. Twenty-two adverse events due to human error in the ART laboratory were identified. Eight of these adverse events were the result of the insemination with the wrong sperm, 6 errors lead to the transfer of the wrong embryo, 3 lead to an error in preimplantation genetic testing, and 5 adverse events lead to the failure of gamete and embryo cryostorage. Conclusions Since the advent of ART, there have been reports of catastrophic events occurring secondary to human error in the laboratory to include incidents of unintended parentage, and have resulted in the loss of embryos and gametes through cryostorage failure. Proposed solutions include the stringent implementation and adherence to safety protocols, adequate laboratory staffing and training, and novel methods for specimen labeling and tracking. Of utmost importance is having knowledge of these errors and the ability to determine cause so that future events can be prevented.