ASRM supports the recommendations in the 2024 American College of Obstetricians and Gynecologists Clinical Practice Update regarding Rho(d) immune globulin administration in the first trimester.

Luteal phase deficiency (LPD) is a clinical diagnosis associated with abnormal luteal phase length of ≤10 days. Potential etiologies of LPD include inadequate progesterone duration, inadequate progesterone levels, or endometrial progesterone resistance. Luteal phase deficiency has been described in association with medical conditions, but also in fertile, normally menstruating women. Although progesterone is important for the process of implantation and early embryonic development, LPD has not been proven to be an independent entity causing infertility or recurrent pregnancy loss. Controversy exists regarding the multiple proposed measures for diagnosing LPD, and assuming it can be diagnosed accurately, whether treatment improves outcomes. This document replaces the document of the same name, last published in 2021 (Fertil Steril 2021;115(6):1416-23).

Uterus transplantation (UTx) has evolved from experimental procedure to an increasingly established infertility treatment for women with absolute uterine factor infertility. Despite procedural progress, UTx remains a very complex infertility treatment. Here, we examine key complexities and challenges that will shape the future of UTx. Donor-related considerations include selection criteria for both live and deceased donors to maximize the likelihood of transplantation success. The implications of exposing healthy live donors to risks of postoperative complications, organ availability and logistical challenges with deceased donation are also explored. Recipient-related challenges encompass the historically high risk of graft failure, immunosuppression risks, pregnancy complications, and reproductive planning to prepare for and optimize the chances of achieving the desired family size. The potential expansion of UTx to additional patient populations introduces ethical concerns. Access to UTx remains limited by the need for specialized multidisciplinary expertise and substantial financial resources, resulting in significant geographic and socioeconomic disparities. Comparisons with the alternative pathway, gestational surrogacy, provide important context for discussions of value and resource allocation. The ethical analysis highlights tensions surrounding acceptable risk in a non-life-saving transplant, protection of live donors, equitable access, and balance between reproductive autonomy and societal responsibility. By drawing on perspectives from multidisciplinary UTx-experts, this Views and Reviews article concludes that UTx is an effective and ethically acceptable infertility treatment. Continued accumulation of clinical experience, registry-based outcomes, technological advances, and broader healthcare engagement will be essential to improve safety and efficacy and support integration of UTx into clinical practice.

Therapeutic donor insemination (TDI) is a widely utilized and effective fertility treatment in which decisions around cycle management decisions aim to optimize pregnancy outcomes while balancing cost, access to care, and patient burden. Key aspects of care, including timing of insemination, monitoring strategies, use of ovulation induction and luteal phase support, are often guided by institutional preference rather than definitive evidence. Accurate synchronization of insemination with ovulation is central to TDI success. Available approaches include urinary luteinizing hormone (LH) detection, serum LH monitoring, and ultrasound-based follicular tracking with or without ovulation triggering. Although these methods differ in precision and patient burden, current evidence demonstrates comparable pregnancy outcomes in most ovulatory patients. In ovulatory individuals, natural-cycle TDI yields favorable cumulative pregnancy rates. The addition of oral ovulation induction confers only modest improvements in pregnancy outcomes while significantly increasing the risk of multiple gestation. Accordingly, escalation to ovulation induction should be individualized. The role of luteal phase support remains incompletely defined, with current evidence not supporting its routine use in natural TDI cycles or those with oral ovulation induction agents. Overall, a pragmatic, patient-centered approach that prioritizes effective yet minimally burdensome strategies is supported by available evidence.